Non-invasive monitoring strategies for atrial fibrillation detection in adult cardiac surgery patients after hospital discharge: A scoping review

Abstract

Background

Atrial fibrillation (AF) is a common complication after cardiothoracic surgery, affecting up to 50 % of patients. It can develop after discharge, leading to frequent hospital readmissions. There is a growing need for effective monitoring strategies to detect AF in the post-discharge period.

Objectives

To synthesis the available literature on various mobile monitoring devices used to detect AF in adult cardiac surgery patients post-discharge from the hospital.

Methods

Following Arksey and O’Malley’s framework and the PRISMA-ScR guidelines. A comprehensive search of six databases (PubMed; MEDLINE; CINAHL; Scopus; ProQuest; and Web of Science) was performed, including studies published between 2009 and 2024. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS).

Results

A total of 1256 de-duplicated studies were screened, and 102 studies underwent full-text review. Five studies were included: four prospective cohort studies, and one randomised clinical trial. Samples sizes ranged from 23 to 730 adults undergoing cardiac surgery, with follow-up between four weeks to three months post-discharge. Handheld and wearable ECG-based devices were the most used tools for AF detection, demonstrating high sensitivity and specificity. Their use effectively reduced unplanned hospital visits and improved clinical outcomes. Patient adherence to monitoring protocols was generally high, though variability in engagement was noted.

Conclusions

Handheld and wearable ECG- based devices, are effective for post-discharge AF detection in cardiac surgery patients. Integrating these tools into routine post-discharge care can improve patient outcomes. Future research should focus on long-term effectiveness and strategies to optimise patient engagement and implementation in clinical practice.