Evaluating atrial fibrillation management through digital monitoring: a systematic qualitative review of patient perspectives on mHealth and wearables

Background

Atrial fibrillation (AF) contributes substantially to global cardiovascular morbidity and requires sustained long-term management to mitigate long term risk. mHealth apps and wearables enable remote rhythm monitoring, but their effectiveness depends on sustained patient engagement; understanding patient perspectives is key to implementing patient-centred digital AF care.

Purpose

To synthesise qualitative evidence on patient experiences and perceptions of mHealth and wearable technologies in AF management.

Methods

MEDLINE, Embase, Scopus, and PsycINFO were systematically searched from inception to November 2025. Studies were eligible if they reported primary qualitative data examining patient experiences of mHealth applications or wearable monitoring technologies in AF care. 2186 records were screened. Data were synthesised using the Thomas and Harden thematic synthesis approach. Preliminary descriptive themes are presented here, with a full analytical synthesis currently ongoing in accordance with this framework. Methodological quality was appraised using the CASP qualitative checklist.

Results

Nine studies were included, yielding four overarching themes.

(1) Digital “safety net”: monitoring provided reassurance, validated symptoms, and fostered a sense of continuous clinical oversight. Real-time rhythm data reduced uncertainty and supported earlier help-seeking.

(2) Empowerment and “value gap”: tools enhanced autonomy and AF-specific health literacy, improving confidence in self-management and consultation discussions. However, perceived utility often declined over time when data offered limited new insights, reducing sustained engagement.

(3) Socio-technical barriers: usability challenges, manual data entry burden, technical friction, and limited digital literacy, particularly among older patients, impeded adoption. Concerns around data interpretation and privacy further influenced engagement, with risk of widening inequities.

(4) Hospital-centric preferences: while convenient, digital tools were viewed as complementary rather than replacing face-to-face specialist care, which remained central for trust, interpretation, and emotional reassurance.

Overall reporting quality was moderate to high, though reflexivity was inconsistently addressed.

Conclusion

Patients perceive mHealth and wearable technologies in AF as valuable emotional and clinical “safety nets,” supporting reassurance and self-management. However, sustained engagement is influenced by perceived ongoing value, usability, and relational trust. To realise the preventive potential of digital AF care, implementation strategies should prioritise blended models that integrate remote monitoring with structured clinician interaction, minimise manual user burden, and tailor digital content to patient experience level. Such approaches are essential to ensure equitable, meaningful, and durable adoption.PRIMSA chartFigure