Wearable device monitoring reduces the MACEs in patients with atrial fibrillation: A systematic review and meta-analysis.

Objective: Atrial fibrillation (AF), the most common type of arrhythmia, significantly impacts patients’ prognosis. While wearable devices are increasingly integrated into cardiovascular monitoring, their effect on clinical outcomes in AF remains unclear. This review demonstrates the impact of wearable technology on major adverse cardiovascular events (MACEs) and assesses its role in AF management and prognosis. Methods: A systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines across PubMed, Embase, Web of Science, and the Cochrane Library databases. Included studies investigated AF patients using wearable devices and reported clinical outcomes. Evidence quality was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. Statistical analyses were performed using R 4.4.2 and Review Manager 5.4. Results: Eleven articles were included in this meta-analysis, comprising 10 studies (seven randomized controlled trials and three observational studies). Compared with usual care, wearable devices uses significantly reduced risks of MACEs (risk ratio [RR], 0.66; 95% confidence interval [CI], 0.47–0.93), all-cause mortality (RR, 0.49; 95% CI, 0.29–0.85), ischemic stroke (RR, 0.13; 95% CI, 0.07–0.26), bleeding events (RR, 0.48; 95% CI, 0.33–0.70), and hospitalization (RR, 0.85; 95% CI, 0.74–0.97). Subgroup analyses suggested that the composite endpoint definitions and follow-up duration primarily explained heterogeneity. Evidence certainty ranged from high to low across outcomes. Sensitivity analysis confirmed the robustness of the findings for MACEs and hospitalization outcomes. Conclusion: Wearable devices for cardiac monitoring significantly reduce the MACEs risk and improve prognosis in AF patients. This review supports the effectiveness of wearable technology in AF management. © The Author(s) 2026