Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers: the RATE-AF randomized trial

BigData@Heart Consortium

doi:10.1038/s41591-024-03094-4

Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers: the RATE-AF randomized trial

BigData@Heart Consortium

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

Consumer-grade wearable technology has the potential to support clinical research and patient management. Here, we report results from the RATE-AF trial wearables study, which was designed to compare heart rate in older, multimorbid patients with permanent atrial fibrillation and heart failure who were randomized to treatment with either digoxin or beta-blockers. Heart rate (n = 143,379,796) and physical activity (n = 23,704,307) intervals were obtained from 53 participants (mean age 75.6 years (s.d. 8.4), 40% women) using a wrist-worn wearable linked to a smartphone for 20 weeks. Heart rates in participants treated with digoxin versus beta-blockers were not significantly different (regression coefficient 1.22 (95% confidence interval (CI) -2.82 to 5.27; P = 0.55); adjusted 0.66 (95% CI -3.45 to 4.77; P = 0.75)). No difference in heart rate was observed between the two groups of patients after accounting for physical activity (P = 0.74) or patients with high activity levels (≥30,000 steps per week; P = 0.97). Using a convolutional neural network designed to account for missing data, we found that wearable device data could predict New York Heart Association functional class 5 months after baseline assessment similarly to standard clinical measures of electrocardiographic heart rate and 6-minute walk test (F1 score 0.56 (95% CI 0.41 to 0.70) versus 0.55 (95% CI 0.41 to 0.68); P = 0.88 for comparison). The results of this study indicate that digoxin and beta-blockers have equivalent effects on heart rate in atrial fibrillation at rest and on exertion, and suggest that dynamic monitoring of individuals with arrhythmia using wearable technology could be an alternative to in-person assessment. ClinicalTrials.gov identifier: NCT02391337 .

Original language	English
Pages (from-to)	2030-2036
Number of pages	7
Journal	Nature Medicine
Volume	30
Issue number	7
DOIs	https://doi.org/10.1038/s41591-024-03094-4
Publication status	Published - Jul 2024

Keywords

Humans
Digoxin/therapeutic use
Heart Rate/drug effects
Female
Male
Aged
Wearable Electronic Devices
Atrial Fibrillation/drug therapy
Adrenergic beta-Antagonists/therapeutic use
Aged, 80 and over
Heart Failure/drug therapy
Exercise
Smartphone

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10.1038/s41591-024-03094-4

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title = "Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers: the RATE-AF randomized trial",

abstract = "Consumer-grade wearable technology has the potential to support clinical research and patient management. Here, we report results from the RATE-AF trial wearables study, which was designed to compare heart rate in older, multimorbid patients with permanent atrial fibrillation and heart failure who were randomized to treatment with either digoxin or beta-blockers. Heart rate (n = 143,379,796) and physical activity (n = 23,704,307) intervals were obtained from 53 participants (mean age 75.6 years (s.d. 8.4), 40% women) using a wrist-worn wearable linked to a smartphone for 20 weeks. Heart rates in participants treated with digoxin versus beta-blockers were not significantly different (regression coefficient 1.22 (95% confidence interval (CI) -2.82 to 5.27; P = 0.55); adjusted 0.66 (95% CI -3.45 to 4.77; P = 0.75)). No difference in heart rate was observed between the two groups of patients after accounting for physical activity (P = 0.74) or patients with high activity levels (≥30,000 steps per week; P = 0.97). Using a convolutional neural network designed to account for missing data, we found that wearable device data could predict New York Heart Association functional class 5 months after baseline assessment similarly to standard clinical measures of electrocardiographic heart rate and 6-minute walk test (F1 score 0.56 (95% CI 0.41 to 0.70) versus 0.55 (95% CI 0.41 to 0.68); P = 0.88 for comparison). The results of this study indicate that digoxin and beta-blockers have equivalent effects on heart rate in atrial fibrillation at rest and on exertion, and suggest that dynamic monitoring of individuals with arrhythmia using wearable technology could be an alternative to in-person assessment. ClinicalTrials.gov identifier: NCT02391337 .",

keywords = "Humans, Digoxin/therapeutic use, Heart Rate/drug effects, Female, Male, Aged, Wearable Electronic Devices, Atrial Fibrillation/drug therapy, Adrenergic beta-Antagonists/therapeutic use, Aged, 80 and over, Heart Failure/drug therapy, Exercise, Smartphone",

author = "{BigData@Heart Consortium} and Gill, {Simrat K} and Andrey Barsky and Xin Guan and Bunting, {Karina V} and Andreas Karwath and Otilia Tica and Mary Stanbury and Sandra Haynes and Amos Folarin and Richard Dobson and Julia Kurps and Asselbergs, {Folkert W} and Grobbee, {Diederick E} and Camm, {A John} and Eijkemans, {Marinus J C} and Gkoutos, {Georgios V} and Dipak Kotecha",

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doi = "10.1038/s41591-024-03094-4",

language = "English",

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T1 - Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers

T2 - the RATE-AF randomized trial

AU - BigData@Heart Consortium

AU - Gill, Simrat K

AU - Barsky, Andrey

AU - Guan, Xin

AU - Bunting, Karina V

AU - Karwath, Andreas

AU - Tica, Otilia

AU - Stanbury, Mary

AU - Haynes, Sandra

AU - Folarin, Amos

AU - Dobson, Richard

AU - Kurps, Julia

AU - Asselbergs, Folkert W

AU - Grobbee, Diederick E

AU - Camm, A John

AU - Eijkemans, Marinus J C

AU - Gkoutos, Georgios V

AU - Kotecha, Dipak

N1 - Publisher Copyright: © The Author(s) 2024.

PY - 2024/7

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N2 - Consumer-grade wearable technology has the potential to support clinical research and patient management. Here, we report results from the RATE-AF trial wearables study, which was designed to compare heart rate in older, multimorbid patients with permanent atrial fibrillation and heart failure who were randomized to treatment with either digoxin or beta-blockers. Heart rate (n = 143,379,796) and physical activity (n = 23,704,307) intervals were obtained from 53 participants (mean age 75.6 years (s.d. 8.4), 40% women) using a wrist-worn wearable linked to a smartphone for 20 weeks. Heart rates in participants treated with digoxin versus beta-blockers were not significantly different (regression coefficient 1.22 (95% confidence interval (CI) -2.82 to 5.27; P = 0.55); adjusted 0.66 (95% CI -3.45 to 4.77; P = 0.75)). No difference in heart rate was observed between the two groups of patients after accounting for physical activity (P = 0.74) or patients with high activity levels (≥30,000 steps per week; P = 0.97). Using a convolutional neural network designed to account for missing data, we found that wearable device data could predict New York Heart Association functional class 5 months after baseline assessment similarly to standard clinical measures of electrocardiographic heart rate and 6-minute walk test (F1 score 0.56 (95% CI 0.41 to 0.70) versus 0.55 (95% CI 0.41 to 0.68); P = 0.88 for comparison). The results of this study indicate that digoxin and beta-blockers have equivalent effects on heart rate in atrial fibrillation at rest and on exertion, and suggest that dynamic monitoring of individuals with arrhythmia using wearable technology could be an alternative to in-person assessment. ClinicalTrials.gov identifier: NCT02391337 .

AB - Consumer-grade wearable technology has the potential to support clinical research and patient management. Here, we report results from the RATE-AF trial wearables study, which was designed to compare heart rate in older, multimorbid patients with permanent atrial fibrillation and heart failure who were randomized to treatment with either digoxin or beta-blockers. Heart rate (n = 143,379,796) and physical activity (n = 23,704,307) intervals were obtained from 53 participants (mean age 75.6 years (s.d. 8.4), 40% women) using a wrist-worn wearable linked to a smartphone for 20 weeks. Heart rates in participants treated with digoxin versus beta-blockers were not significantly different (regression coefficient 1.22 (95% confidence interval (CI) -2.82 to 5.27; P = 0.55); adjusted 0.66 (95% CI -3.45 to 4.77; P = 0.75)). No difference in heart rate was observed between the two groups of patients after accounting for physical activity (P = 0.74) or patients with high activity levels (≥30,000 steps per week; P = 0.97). Using a convolutional neural network designed to account for missing data, we found that wearable device data could predict New York Heart Association functional class 5 months after baseline assessment similarly to standard clinical measures of electrocardiographic heart rate and 6-minute walk test (F1 score 0.56 (95% CI 0.41 to 0.70) versus 0.55 (95% CI 0.41 to 0.68); P = 0.88 for comparison). The results of this study indicate that digoxin and beta-blockers have equivalent effects on heart rate in atrial fibrillation at rest and on exertion, and suggest that dynamic monitoring of individuals with arrhythmia using wearable technology could be an alternative to in-person assessment. ClinicalTrials.gov identifier: NCT02391337 .

KW - Humans

KW - Digoxin/therapeutic use

KW - Heart Rate/drug effects

KW - Female

KW - Male

KW - Aged

KW - Wearable Electronic Devices

KW - Atrial Fibrillation/drug therapy

KW - Adrenergic beta-Antagonists/therapeutic use

KW - Aged, 80 and over

KW - Heart Failure/drug therapy

KW - Exercise

KW - Smartphone

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DO - 10.1038/s41591-024-03094-4

M3 - Article

C2 - 39009776

SN - 1078-8956

VL - 30

SP - 2030

EP - 2036

JO - Nature Medicine

JF - Nature Medicine

IS - 7

ER -

Consumer wearable devices for evaluation of heart rate control using digoxin versus beta-blockers: the RATE-AF randomized trial

Abstract

Keywords

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