R ealtime Diagnosis from E lectrocardiogram Artificial Intelligence- G uided Screening for A trial Fibrillation with L ong Follow-Up (REGAL): Rationale and design of a pragmatic, decentralized, randomized controlled trial

• Published in: The American heart journal Vol. 267; p. 62
• Main Authors: Yao, Xiaoxi, Attia, Zachi I, Behnken, Emma M, Hart, Melissa S, Inselman, Shealeigh A, Weber, Kayla C, Li, Fan, Stricker, Nikki H, Stricker, John L, Friedman, Paul A, Noseworthy, Peter A
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Limited 01.01.2024
• Subjects: Adults; Algorithms; Alzheimer's disease; Artificial intelligence; Cardiac arrhythmia; Clinical trials; Cognitive ability; Dementia; Dementia disorders; Design; Diagnosis; EKG; Electrocardiography; Electronic health records; Fibrillation; Health risks; Heart rate; Informed consent; Intervention; Medical diagnosis; Medical equipment; Monitoring; Older people; Patients; Risk groups; Smartphones; Smartwatches; Software; Stroke; Telemedicine; Wearable computers; Wearable technology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2023.10.005

BackgroundAtrial fibrillation (AF) is associated with increased risks of stroke and dementia. Early diagnosis and treatment could reduce the disease burden, but AF is often undiagnosed. An artificial intelligence (AI) algorithm has been shown to identify patients with previously unrecognized AF; however, monitoring these high-risk patients has been challenging. Consumer wearable devices could be an alternative to enable long-term follow-up.ObjectivesTo test whether Apple Watch, used as a long-term monitoring device, can enable early diagnosis of AF in patients who were identified as having high risk based on AI-ECG.DesignThe Realtime diagnosis from Electrocardiogram (ECG) Artificial Intelligence (AI)-Guided Screening for Atrial Fibrillation (AF) with Long Follow-up (REGAL) study is a pragmatic trial that will accrue up to 2,000 older adults with a high likelihood of unrecognized AF determined by AI-ECG to reach our target of 1,420 completed participants. Participants will be 1:1 randomized to intervention or control and will be followed up for 2 years. Patients in the intervention arm will receive or use their existing Apple Watch and iPhone and record a 30-second ECG using the watch routinely or if an abnormal heart rate notification is prompted. The primary outcome is newly diagnosed AF. Secondary outcomes include changes in cognitive function, stroke, major bleeding, and all-cause mortality. The trial will utilize a pragmatic, digitally-enabled, decentralized design to allow patients to consent and receive follow-up remotely without traveling to the study sites.SummaryThe REGAL trial will examine whether a consumer wearable device can serve as a long-term monitoring approach in older adults to detect AF and prevent cognitive function decline. If successful, the approach could have significant implications on how future clinical practice can leverage consumer devices for early diagnosis and disease prevention.Clinicaltrials.gov: NCT05923359