{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T18:03:28Z","timestamp":1784311408597,"version":"3.55.0"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T00:00:00Z","timestamp":1784246400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Home ECG can detect atrial fibrillation (AF), but patients\u2019 hospital visit behavior after \u201cpossible AF\u201d alerts remains uncertain. We assessed the rates, timing, and correlates of hospital visits following \u201cpossible AF\u201d alerts in older adults with hypertension.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods and findings<\/jats:title>\n                    <jats:p>In a nationwide, decentralized cohort in Japan, 4,078 individuals aged \u226560 years enrolled; 3,820 were analyzed after exclusions. Participants used a home BP monitor equipped with a 30-s single-lead ECG capable of detecting \u201cpossible AF\u201d, twice daily for 3 months. Of 1,700 participants who received \u22651 \u201cpossible AF\u201d alert, 399 (23.5%) reported an alert-prompted healthcare facility visit within 3 months, and 289 (17.0%) underwent additional testing. Among 175 participants with valid visit dates, the median time to visit was 28 days (mean 36.4). In multivariable models, factors associated with lower odds of a hospital visit included age\u2009&lt;\u200965 years (OR 0.75, 95% CI 0.59\u20130.95, p\u2009=\u20090.016), current drinking (OR 0.73, 0.57\u20130.95, p\u2009=\u20090.018), no daily palpitations (OR 0.69, 0.50\u20130.95, p\u2009=\u20090.022), and no palpitations on the alert day (OR 0.51, 0.30\u20130.85, p\u2009=\u20090.010). Notably, 105 of 220 (47.7%) participants with physician-adjudicated AF remained without a clinical diagnosis at 12 months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this cohort of older, hypertensive individuals, follow-up rates after a \u201cpossible AF\u201d alert were low; fewer than one in four individuals visited a healthcare facility, and fewer than one in five underwent additional testing within 3 months. Hospital visits were less common among younger participants, those who consume alcohol, and those without palpitations. These findings highlight significant gaps between mHealth alerts and subsequent clinical action.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0353867","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:23:51Z","timestamp":1784309031000},"page":"e0353867","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rates and predictors of hospital visits after \u201cPossible AF\u201d alerts from a home ECG monitor in older adults with hypertension: A sub-analysis of the Omron Heart Study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5686-2425","authenticated-orcid":true,"given":"Yusuke","family":"Kakei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8597-7165","authenticated-orcid":true,"given":"Keitaro","family":"Senoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arito","family":"Yukawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kohei","family":"Kawai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masahiro","family":"Makino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Munakata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobunari","family":"Tomura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Shimoo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hirokazu","family":"Shiraishi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9373-4331","authenticated-orcid":true,"given":"Satoaki","family":"Matoba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,7,17]]},"reference":[{"issue":"14","key":"pone.0353867.ref001","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1056\/NEJMoa2019422","article-title":"Early rhythm-control therapy in patients with atrial fibrillation","volume":"383","author":"P Kirchhof","year":"2020","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0353867.ref002","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1056\/NEJMoa2029554","article-title":"Cryoballoon ablation as initial therapy for atrial fibrillation","volume":"384","author":"OM Wazni","year":"2021","journal-title":"N Engl J Med"},{"issue":"4","key":"pone.0353867.ref003","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1056\/NEJMoa2029980","article-title":"Cryoablation or drug therapy for initial treatment of atrial fibrillation","volume":"384","author":"JG Andrade","year":"2021","journal-title":"N Engl J Med"},{"issue":"7","key":"pone.0353867.ref004","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1253\/circrep.CR-20-0032","article-title":"Diagnostic value of atrial fibrillation by built-in electrocardiogram technology in a blood pressure monitor","volume":"2","author":"K Senoo","year":"2020","journal-title":"Circ Rep"},{"issue":"6","key":"pone.0353867.ref005","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0269506","article-title":"Screening for untreated atrial fibrillation in the elderly population: a community-based study","volume":"17","author":"K Senoo","year":"2022","journal-title":"PLoS One"},{"key":"pone.0353867.ref006","first-page":"101177","article-title":"The impact of home electrocardiograph measurement rate on the detection of atrial fibrillation recurrence after ablation: A prospective multicenter observational study","volume":"44","author":"K Senoo","year":"2023","journal-title":"Int J Cardiol Heart Vasc"},{"issue":"7","key":"pone.0353867.ref007","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003146","article-title":"Detection rate and treatment gap for atrial fibrillation identified through screening in community health centers in China (AF-CATCH): a prospective multicenter study","volume":"17","author":"Y Chen","year":"2020","journal-title":"PLoS Med"},{"issue":"20","key":"pone.0353867.ref008","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1056\/NEJMoa1901183","article-title":"Large-scale assessment of a smartwatch to identify atrial fibrillation","volume":"381","author":"MV Perez","year":"2019","journal-title":"N Engl J Med"},{"issue":"19","key":"pone.0353867.ref009","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1161\/CIRCULATIONAHA.122.060291","article-title":"Detection of atrial fibrillation in a large population using wearable devices: the fitbit heart study","volume":"146","author":"SA Lubitz","year":"2022","journal-title":"Circulation"},{"issue":"19","key":"pone.0353867.ref010","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1016\/j.jacc.2019.08.019","article-title":"Mobile photoplethysmographic technology to detect atrial fibrillation","volume":"74","author":"Y Guo","year":"2019","journal-title":"J Am Coll Cardiol"},{"issue":"13","key":"pone.0353867.ref011","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1161\/CIRCULATIONAHA.121.057014","article-title":"Screening for atrial fibrillation in older adults at primary care visits: VITAL-AF randomized controlled trial","volume":"145","author":"SA Lubitz","year":"2022","journal-title":"Circulation"},{"issue":"21","key":"pone.0353867.ref012","doi-asserted-by":"crossref","first-page":"2073","DOI":"10.1016\/j.jacc.2024.08.019","article-title":"Effect of screening for undiagnosed atrial fibrillation on stroke prevention","volume":"84","author":"RD Lopes","year":"2024","journal-title":"J Am Coll Cardiol"},{"issue":"5","key":"pone.0353867.ref013","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1001\/jamacardio.2021.0038","article-title":"Screening for atrial fibrillation in the older population: a randomized clinical trial","volume":"6","author":"DJ Gladstone","year":"2021","journal-title":"JAMA Cardiol"},{"issue":"1","key":"pone.0353867.ref014","article-title":"General health checks in adults for reducing morbidity and mortality from disease","volume":"1","author":"LT Krogsb\u00f8ll","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"issue":"5","key":"pone.0353867.ref015","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0286317","article-title":"Patterns and predictors of adherence to follow-up health guidance invitations in a general health check-up program in Japan: a cohort study with an employer-sponsored insurer database","volume":"18","author":"Y Mori","year":"2023","journal-title":"PLoS One"},{"issue":"2","key":"pone.0353867.ref016","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2016-000515","article-title":"High prevalence of modifiable stroke risk factors identified in a pharmacy-based screening programme","volume":"3","author":"RK Sandhu","year":"2016","journal-title":"Open Heart"},{"issue":"6","key":"pone.0353867.ref017","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1055\/a-2484-0641","article-title":"Relationship between screening-detected atrial fibrillation and blood pressure levels in elderly hypertensive patients: the OMRON Heart Study","volume":"125","author":"K Senoo","year":"2025","journal-title":"Thromb Haemost"},{"issue":"2","key":"pone.0353867.ref018","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1177\/0193945915570368","article-title":"Symptom representation and treatment-seeking prior to diagnosis of atrial fibrillation","volume":"38","author":"PJ McCabe","year":"2016","journal-title":"West J Nurs Res"},{"issue":"7","key":"pone.0353867.ref019","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1016\/j.hrthm.2016.03.003","article-title":"Typical, atypical, and asymptomatic presentations of new-onset atrial fibrillation in the community: characteristics and prognostic implications","volume":"13","author":"KC Siontis","year":"2016","journal-title":"Heart Rhythm"},{"issue":"1","key":"pone.0353867.ref020","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1111\/j.1360-0443.2004.00874.x","article-title":"Impact of alcohol consumption upon medical care utilization and costs in men: 4-year observation of National Health Insurance beneficiaries in Japan","volume":"100","author":"Y Anzai","year":"2005","journal-title":"Addiction"},{"issue":"8","key":"pone.0353867.ref021","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1177\/0898264310376539","article-title":"The prospective relationship between binge drinking and physician visits among older adults","volume":"22","author":"KR Jenkins","year":"2010","journal-title":"J Aging Health"},{"issue":"3","key":"pone.0353867.ref022","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1111\/j.1475-6773.2004.00244.x","article-title":"Alcohol drinking patterns and health care utilization in a managed care organization","volume":"39","author":"GA Zarkin","year":"2004","journal-title":"Health Serv Res"},{"issue":"1","key":"pone.0353867.ref023","doi-asserted-by":"crossref","DOI":"10.2196\/30807","article-title":"A smartphone app to improve oral anticoagulation adherence in patients with atrial fibrillation: prospective observational study","volume":"10","author":"K Senoo","year":"2022","journal-title":"JMIR Mhealth Uhealth"},{"issue":"1","key":"pone.0353867.ref024","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1038\/s41746-025-01568-4","article-title":"Attitudes of healthcare professionals and researchers toward wearable and app derived patient generated health data","volume":"8","author":"S Br\u00fcckner","year":"2025","journal-title":"NPJ Digit Med"},{"issue":"2","key":"pone.0353867.ref025","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1093\/europace\/euaa358","article-title":"The interpretation of CHA2DS2-VASc score components in clinical practice: a joint survey by the European Heart Rhythm Association (EHRA) Scientific Initiatives Committee, the EHRA Young Electrophysiologists, the Association of Cardiovascular Nursing and Allied Professionals, and the European Society of Cardiology Council on Stroke","volume":"23","author":"J Zhang","year":"2021","journal-title":"Europace"},{"issue":"5","key":"pone.0353867.ref026","doi-asserted-by":"crossref","first-page":"825","DOI":"10.1111\/nuf.12770","article-title":"Nurses\u2019 knowledge of anticoagulation therapy for atrial fibrillation patients: effectiveness of an educational course","volume":"57","author":"A Omoush","year":"2022","journal-title":"Nurs Forum"},{"issue":"12","key":"pone.0353867.ref027","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1093\/europace\/euy039","article-title":"Major knowledge gaps and system barriers to guideline implementation among European physicians treating patients with atrial fibrillation: a European Society of Cardiology international educational needs assessment","volume":"20","author":"H Heidbuchel","year":"2018","journal-title":"Europace"},{"issue":"36","key":"pone.0353867.ref028","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"45","author":"IC Van Gelder","year":"2024","journal-title":"Eur Heart J"},{"issue":"21","key":"pone.0353867.ref029","doi-asserted-by":"crossref","first-page":"1952","DOI":"10.1093\/eurheartj\/ehaa421","article-title":"STEEER-AF: a cluster-randomized education trial from the ESC","volume":"41","author":"KV Bunting","year":"2020","journal-title":"Eur Heart J"},{"issue":"7","key":"pone.0353867.ref030","doi-asserted-by":"crossref","DOI":"10.1016\/j.hrthm.2017.03.038","article-title":"2017 ISHNE-HRS expert consensus statement on ambulatory ECG and external cardiac monitoring\/telemetry","volume":"14","author":"JS Steinberg","year":"2017","journal-title":"Heart Rhythm"},{"issue":"2","key":"pone.0353867.ref031","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCEP.120.009204","article-title":"2021 ISHNE\/HRS\/EHRA\/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology\/Heart Rhythm Society\/European Heart Rhythm Association\/Asia-Pacific Heart Rhythm Society","volume":"14","author":"N Varma","year":"2021","journal-title":"Circ Arrhythm Electrophysiol"},{"issue":"6","key":"pone.0353867.ref032","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1093\/europace\/euac038","article-title":"How to use digital devices to detect and manage arrhythmias: an EHRA practical guide","volume":"24","author":"E Svennberg","year":"2022","journal-title":"Europace"},{"issue":"6","key":"pone.0353867.ref033","doi-asserted-by":"crossref","first-page":"850","DOI":"10.1253\/circj.CJ-24-0960","article-title":"2025 Japanese Heart Rhythm Society\/ Japanese Circulation Society Consensus Statement on the appropriate use of ambulatory and wearable electrocardiographs","volume":"89","author":"T Ikeda","year":"2025","journal-title":"Circ J"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353867","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T17:23:58Z","timestamp":1784309038000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0353867"}},"subtitle":[],"editor":[{"given":"Daniel","family":"Antwi-Amoabeng","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,7,17]]},"references-count":33,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0353867","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,17]]}}}