Electrocardiography (ECG) is the gold standard for the diagnosis of atrial fibrillation (AF). Recently, smartwatches like the Apple Watch have emerged as a promising, user-friendly device for rapid detection and diagnosis of AF, but the reliability and diagnostic accuracy still remain controversial. The purpose of this study was to perform a systematic review and diagnostic test accuracy meta-analysis evaluating the diagnostic performance of the Apple Watch ECG in detecting AF. The literature search was conducted on PubMed, Embase, and Cochrane Library through April 2024 for studies comparing the diagnostic accuracy of Apple Watch to standard 12-lead ECG. Statistical analysis was performed using R Software version 4.4.0 and OpenMeta[Analyst]. Pooled analyses of sensitivity, specificity, and area under the receiver operating characteristic curve were determined along with their 95% CIs. The quality of studies was analyzed using the QUADAS-2 tool. The meta-analysis included 11 studies comprising 4,241 participants. Their mean age was 62.56 ± 3.92 years, and 28% of the patients were females. The pooled sensitivity and specificity of the Apple Watch for detecting AF were 94.8% (95% CI: 91.7% to 96.8%; I² = 67%) and 95% (95% CI: 88.6% to 97.8%; I² = 88%), respectively. The area under the receiver operating characteristic curve was 0.96 (95% CI: 0.92-0.97). The Apple Watch ECG carries high accuracy in detecting atrial fibrillation, providing a convenient diagnostic option for patients.

Intravenous alteplase (ALT) is the standard treatment for acute ischemic stroke (AIS). However, recent trials comparing other tissue plasminogen activators (tPAs) like tenecteplase (TNK) and reteplase with ALT have yielded conflicting results. This necessitated a network meta-analysis to compare the efficacy and safety of various tPAs in AIS patients. We searched MEDLINE, Embase, and CENTRAL (until September 15, 2024) for randomized controlled trials (RCTs) comparing TNK or reteplase (any dose) with ALT (0.9 mg/kg) in AIS patients. A frequentist network meta-analysis was performed using risk ratio (RR) and 95 % CI for each comparison, and P-scores ranked treatments. Analyses were done using R Software 4.4.1. Sixteen RCTs (9259 patients, 62.1 % males) were included. Reteplase 18+18 mg significantly improved excellent functional recovery (mRS 0-1) (RR: 1.13; p < 0.01) and independent ambulation (mRS 0-2) at 3 months (RR: 1.07; p < 0.01) compared to ALT. The 0.25 mg/kg TNK group also showed improved functional recovery (mRS 0-1) (RR: 1.06; p < 0.01). For safety, 0.1 mg/kg TNK was associated with a higher incidence of symptomatic intracranial hemorrhage (s-ICH) (RR: 7.27; p < 0.01). No significant differences in ICH or all-cause mortality were found between ALT and other treatments. Reteplase 18+18 mg ranked highest for functional recovery (P-score=0.9638) and ambulation (P-score=0.9749), while ALT ranked highest for s-ICH (P-score=0.8060). No significant differences were observed between reteplase and TNK. Reteplase 18+18 mg and TNK 0.25 mg/kg demonstrated higher efficacy and comparable safety to ALT. Larger trials are needed to further explore these agents as alternatives to ALT.

Cancer patients are at an increased risk for the incidence and complications of acute myocardial infarction (AMI) due to shared risk factors and treatment-related adverse effects. Mortality trends for AMI-related deaths in adult cancer patients in the U.S. remain unexplored. This study used CDC WONDER data for death certificates from 1999 to 2020, identifying U.S. adults (≥25 years) with cancer (ICD-10: C00-D49) who died of AMI (ICD-10: I21) as the underlying cause. Age-adjusted mortality rates (AAMRs) and annual percent changes (APCs) were calculated and stratified by gender, age, race, and geographic location. Between 1999 and 2020, there were 109,462 AMI-related deaths in adult cancer patients. The AAMR decreased from 4.3 per 100,000 in 1999 to 1.4 in 2020. A significant decline occurred from 1999 to 2015 (APC: 6.65; 95 % CI: 6.95 to −6.40; p < 0.001), followed by a stable trend from 2015 to 2020 (APC: 1.36; 95 % CI: 2.69 to 0.91; p = 0.152). Men had higher AAMRs than women (3.5 vs. 1.5). AAMRs were highest in older adults (10.5) compared to middle-aged (0.7) and young adults (0.1). Racial disparities showed the highest AAMRs in non-Hispanic (NH) Black patients (2.7), followed by NH Whites (2.4), NH American Indian/Alaska Native (1.6), Hispanic/Latino (1.3), and NH Asian/Pacific Islander (1.1). Non-metropolitan areas had higher AAMRs than metropolitan areas (2.8 vs. 2.2). This analysis highlights a significant decline in AMI-related mortality among cancer patients in the U.S., with persistent disparities by gender, age, race and geographical location.

Minahil Iqbal, Sara Hira, Humza Saeed, Sufyan Shahid, Suha T Butt, Kamran Rashid, Mohammad Ahmad, Hammad Hussain, Anzalna Mughal, Gabriel P A Costa, Fernanda Gushken, Neil Nero, Shreya Sengupta, and Akhil Anand. J Neurogastroenterol Motil 2025;31:28-37. https://doi.org/10.5056/jnm24084