The randomized-controlled EQUAL trial demonstrates how smartwatch-based screening for atrial fibrillation (AF) detects more occurrences of new-onset AF compared with standard care. These data were reported by Nicole J van Steijn, MD, of the University of Amsterdam, the Netherlands, and colleagues from the Netherlands and US, in a mansucript published Thursday online in the Journal of the American College of Cardiology. AF can cause stroke and lead to other cardiovascular diseases, but it is often asymptomatic and underdiagnosed. Smartwatches are easy to navigate, non-invasive screening tools for potential AF. Remote smartwatch screening for AF and the potential risk for stroke were evaluated in this prospective study. The EQUAL (Enhanced detection and Quickened diagnosis of Atrial fibrillation using AppLe Watch) trial was a multicenter, two-arm, open-label, randomized-controlled trial (RCT) that took place between November 2022 and December 2023. No other trial to date has evaluated the effectiveness of smartwatch-based AF screening. Patients aged 65 years and older who had elevated stroke risk, from secondary care centers in the Netherlands, were included and monitored for six months. Comorbidities in the patient population included diabetes, history of hypertension and history of heart failure along with other vascular disorders Patients received either standard care or monitoring with a smartwatch with photoplethysmography (PPG) and single-lead electrocardiogram (ECG) functions. An independent team evaluated the ECG findings remotely. New-onset AF was the primary outcome in this study (episode of AF lasting ≥30 seconds on single-lead ECG or standard ECG). A total of 437 patients (n=219 smartwatch, median age=75 years, 41.1% female; n=218 standard care, median age=75 years, 52.3% female) were randomized. In the smartwatch group, 9.6% of patients had new-onset AF, while in the control group, 2.3% of patients developed AF (risk difference=7.3 percentage points, 95% confidence interval [CI]=2.9-11.7, p=0.001; hazard ratio [HR]=4.40, 95% CI=1.66-11.66). Only patients in the smartwatch group had several asymptomatic AF episodes recorded. Paroxysmal, or symptomatic, AF was observed in both the smartwatch and control groups. Investigators in this RCT demonstrated the use of smartwatches for better detection and screening for AF. Compared with standard care procedures, smartwatches recorded more episodes of AF, potentially improving risk stratification measures for stroke. "Using smartwatches with PPG and ECG functions aids doctors in diagnosing individuals unaware of their arrhythmia, thereby expediting the diagnostic process. Our findings suggest a potential reduction in the risk of stroke, benefiting both patients and the healthcare system by reducing costs. This reduction would offset the initial cost of the device,” concluded corresponding author Michiel M. Winter, MD, PhD, also of the University of Amsterdam in addition to the Cardiology Centers of the Netherlands, Utrecht, in a corresponding press release. Source: Van Steijn NJ, Blommestijn IS, Blok S, et al. Enhanced detection and prompt diagnosis of atrial fibrillation using Apple Watch: A randomized controlled trial. J Am Coll Cardiol. 2026 January 22 (Article in Press). Image Credit: peopleimages.com – stock.adobe.com