Recently, there has been significant momentum in the widespread adoption of digital health technologies for detecting and managing atrial fibrillation (AF). The diagnostic accuracy of various commercially available devices is well described and influenced by factors such as device type (handheld vs wearables), technology used (photoplethysmography vs ECG) and duration of monitoring (continuous vs intermittent). Several studies have reported the sensitivity and specificity for different mobile health solutions in AF detection, with values ranging from 68% to 100%.1 These technologies will no doubt continue to advance with improved algorithms and the integration of artificial intelligence. Several crucial questions emerge: who should we offer these technologies to, what will the uptake be and will the intended end-users truly benefit from the integration of these technologies into their daily lives?

In this issue of Heart, van der Velden et al conducted a comprehensive analysis, merging data from the randomised clinical trials of STROKESTOP (2012) and STROKESTOP II (2016) to assess participant adherence to the handheld ECG screening protocol and discern its correlation with clinical outcomes.2 This post-hoc analysis focused on 6436 participants aged 75 years old in STROKESTOP and 3712 participants aged 75–76 years old in STROKESTOP II. The study revealed that adherence was higher in the earlier systematic screening study, where participants were instructed to perform twice-daily 30-second measurements using a handheld ECG device, compared with the latter study with a four-times-daily protocol over 2 weeks (median adherence for STROKESTOP: 100% (92–100%) vs STROKESTOP II: 90% (75–98%)). Interestingly, a demographic pattern emerged from their analysis: females and lower socioeconomic participants demonstrated better compliance with screening protocols across both studies. Further evaluation of the STROKESTOP cohort also found a significant …