Wearables linked to ‘pathologic’ heart disease symptom monitoring

Using wearable devices is associated with pathologic symptom monitoring, excessive preoccupation with symptoms, and higher healthcare use among patients with atrial fibrillation (AFib), according to new research published in the Journal of the American Heart Association.

According to the Centers for Disease Control and Prevention (CDC), AFib is the most common type of treated heart arrhythmia. In this condition, irregular beating occurs in the upper chambers of the heart, and blood doesn't flow as well as it should from the upper to the lower chambers of the heart. AFib is deadly, with the condition mentioned on 232,030 death certificates in 2021. A 2013 study published in the American Journal of Cardiology estimates that AF prevalence will increase to 12.1 million cases in 2030.

Wearable devices are increasingly used to manage AFib as they provide a noninvasive method for continuously monitoring various metrics, like physical activity, stress, heart rate, and sleep patterns. For instance, a 2022 survey of 2,005 US consumers reveals that pulse rate (59 percent), calories and nutrition (42 percent), and heart health (40 percent) are the top health metrics Americans track using wearables.

However, the effects of wearable devices on AFib patients’ healthcare use and psychological well-being are not well understood.

Thus, researchers from the University of North Carolina at Chapel Hill, Yale University School of Medicine, and Cleveland Clinic conducted a study using survey and EHR data for AFib patients to assess formal healthcare use, such as outpatient and inpatient visits, rhythm-related testing, and procedures, and informal healthcare use, like telephone calls and patient portal messages. They also examined the effects of wearable device features and alerts on patient behavior and well-being.

The researchers recruited AFib patients receiving treatment at an outpatient electrophysiology clinic in North Carolina between December 1, 2022, and February 27, 2023. The patients completed survey questionnaires regarding sociodemographic characteristics, wearable device use, psychological well-being, and quality of life.

Of 172 AFib patients included in the analysis, 83 used a wearable device. Apple Watches (56 percent) and Fitbits (31 percent) were the most commonly used devices.

The study shows that wearable device users reported higher rates of symptom monitoring and preoccupation with their symptoms compared with non-users. The former also had more AF AFib treatment concerns.

Approximately 15 percent of wearable device users felt anxious, scared, or concerned in response to wearable alerts for high and low heart rates, and 20 percent said they always contacted their doctors in response to irregular rhythm notifications. About 45 percent of users reported checking their heart rate or performing an electrocardiogram (ECG) daily, and 19 percent reported using heart rate and rhythm monitoring features in response to cardiac symptoms.

Researchers also observed that AFib-specific healthcare use was significantly greater among wearable users than non-users, with wearable device use linked to significantly higher rates of ECGs, echocardiograms/transesophageal echocardiograms, and ablation.

Further, wearable device users were significantly more likely to use informal healthcare resources compared with non-users. Wearable device users sent more messages to healthcare providers than non-users, and providers sent nearly twice as many response messages to wearable device users compared with non-users.

Thus, researchers concluded that wearable users were more likely to undertake “pathologic” symptom monitoring, experience anxiety, report treatment concerns, and use formal and informal healthcare resources than non-users.

“The current study begins to answer important questions that move beyond whether wearables can safely and reliably detect arrhythmias, to understanding how these devices are being used by diverse segments of the population, and their impact on health care use and overall well-being,” they wrote. “Our findings suggest that while many individuals with AF may benefit from using wearable devices, a considerable proportion may experience unintended, adverse effects.”