Telehealth solutions and a shift toward remote, decentralized patient care sparked by the COVID-19 pandemic have resulted in what the medical community deems “the advent of remote monitoring.” It is now easier than ever before to retrieve vital data on patient physiology, including cardiovascular measures such as heart rate, rhythm, and blood pressure, using various innovative remote monitoring tools. Increasingly, health technologies and devices are marketed toward the consumer, emphasizing the growing capabilities of these products to measure and ultimately help improve overall health.
Electrocardiography (ECG) monitors are now a staple component of most smartwatches and activity trackers. According to estimates from CNBC, nearly 30% of Americans already use a wearable healthcare device, most of which can track, monitor, and transmit important cardiometabolic metrics. Furthermore, the use of external sensors in cardiovascular healthcare continues to grow. The global market for wearable health devices has reached a valuation of over $36 billion in 2020 and is forecasted to surpass $100 billion by 2028.
As a result of this continuous trend, the cardiovascular community must familiarize itself with the wearable technologies available and their clinical applications and potential challenges.
Wearable Heart Rate and Rhythm Sensors
Whether cardiovascular metrics transmitted by wearable health devices can be used to predict the risk of cardiovascular disease (CVD) or adverse CVD events remains to be clarified. However, current evidence suggests that measurements collected by these products can help determine the risk for and presence of certain conditions, including arrhythmias, heart failure, and coronary artery disease (CAD). For example, single-lead ECGs can be useful to diagnose simple arrhythmias, yet they are insufficient for accurate diagnosis of complex arrhythmias and other conditions such as myocardial infarction.
A high resting heart rate in healthy patients has been associated with an increased risk for CAD and all-cause mortality and is well recognized as a predictor of adverse outcomes in patients with heart failure. Impaired heart rate recovery following exercise has also been linked to an increased risk for cardiovascular events. These data can be easily collected using tech wearables through ECG or photoplethysmography (PPG) by calculating beat-to-beat time intervals and using algorithms to classify heart rhythm.
Innovations in Health Wearables
Wearable health devices marketed to consumers are becoming increasingly sophisticated and accurate in their data collection. However, their clinical validity remains under investigation.
As a result of the growing digital health ecosystem and expanded medical health records, a more comprehensive range of medical information is now accessible to clinicians and hospitals. At the same time, innovations in health tech wearables aim to allow even more detailed and robust tracking and data collection. Emerging products include clothing items equipped with sensors, such as smart shirts that collect and transmit cardiac, respiratory, and activity data.
Data Privacy, Clinical Validity, and Other Challenges
Despite developments in technological capabilities, critical challenges in efficacy and privacy prevent widespread adoption of wearable health tech in clinical practice. Concerns regarding the efficacy of devices, applications linked to them, and the data generated are key factors alongside data accuracy, clinical validity, and patient privacy.
Most importantly, conclusive evidence regarding device accuracy is lacking. One of the more recent pieces of research was a 2019 Apple-sponsored study published in The New England Journal of Medicine. Its results suggested that ECG-equipped smartwatches could detect certain kinds of abnormal heart rhythms, particularly in the elderly. Additional studies are underway to determine whether these tools can be reliable methods of remote patient monitoring, data gathering, and cardiovascular care.
Clinician Enthusiasm for Health Tech Products
In addition to the need for further investigation, the adoption of health tech wearables in clinical practice is dependent on clinician support. According to a survey conducted by the American Medical Association of physicians and their opinions on a variety of digital health tools, the majority favors the use of such devices. Over 87% of respondents reported at least some advantage in their usage overall, indicating wearables and telehealth devices as the primary category of interest. Nonetheless, there was a resounding call for improved efficiency and increased patient data privacy and security protection.
“Physician enthusiasm for technology is directly tied to a solution’s ability to help them take better care of patients,” Meg Barron, AMA digital health strategy vice president, concluded in a CNBC interview.
Current evidence supports the use of wearable tech devices for cardiovascular risk assessment and cardiovascular disease prevention, diagnosis, and management. However, expansive, well-designed trials are needed to conclusively establish the advantages of such technologies; their accuracy and clinical validity; and the potential risks involved.