Authors' objectives: Atrial fibrillation (AF) is the most common form of arrhythmia, and if left uncontrolled, can lead to hospitalisation, and is associated with a range of serious health issues such as strokes and heart failure. More than 1.6 million people in the UK, and more than 80,000 people in Wales have been diagnosed with atrial fibrillation. In Wales, atrial fibrillation is a contributing factor to one in five strokes and there are approximately 15,000 people aged 65 years or older with undiagnosed atrial fibrillation in Wales. AF has a broad impact on health services across both primary and secondary care. The development of smartphone-based screening and monitoring devices has the potential to increase screening coverage, improve clinical detection, and facilitate the monitoring of AF without the need for external and additional hardware. This report aims to identify and summarise evidence that addresses the following question: What is the clinical and cost effectiveness of smartphone based photoplethysmography for the detection and monitoring of atrial fibrillation among people with suspected or confirmed atrial fibrillation?

Authors' results and conclusions: HTW researchers identified 11 observational studies. The evidence included in this review suggests there are outcomes to support the effectiveness of photoplethysmography applications to detect AF in those suspected of having AF and/or under monitoring for AF, although the statistical significance of some outcomes were not reported and there are several limitations of the studies that are noted in this review. Outcomes reported in the evidence base included diagnostic accuracy outcomes which were reported across nine studies: sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), correctly classified rate, rate of no diagnosis, overall accuracy and atrial arrhythmia recurrence rate. Other outcomes included resource use (reported in two studies), environmental outcomes (reported in one study), patient compliance (reported in three studies), signal quality and technical failure (reported in five studies) changes to patient management (reported in one study), and adverse events (reported in one study). HTW researchers did not identify any quality-of-life outcomes. Evidence to support longer-term effectiveness and long-term resource use savings is limited. One directly applicable economic analysis was identified which considered a retrospective analysis of UK patients using the FibriCheck smartphone app in comparison to 12-lead ECG monitoring. We did not develop an economic model to estimate the cost effectiveness of PPG as, after consultation with experts, it was determined that the evidence base was insufficient to be used as the basis for an economic evaluation.

Authors' recommendations: Smartphone photoplethysmography (PPG) shows promise for the detection and monitoring of atrial fibrillation in adults with known or suspected atrial fibrillation, but the evidence is insufficient to support routine adoption. The available evidence indicates that PPG applications have good diagnostic accuracy, and their use could potentially lead to a reduction in resource use and a faster diagnosis for some patients. The evidence to support longer-term effectiveness and long-term resource use savings is limited and there is not enough evidence to support the cost effectiveness of smartphone PPG.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: The Appraisal Panel strongly encourages further research generation in this area.

Project Status: Completed

Year Published: 2025

URL for published report: https://healthtechnology.wales/reports-guidance/photo-plethysmography-for-the-management-of-atrial-fibrillation/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk