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Understanding the potential downsides of cardiac wearables
While cardiac wearable devices can improve care, an Inova cardiologist is warning of their downsides, including patient anxiety from false readings and a fixation on the data.
Healthcare wearable devices have the potential to boost cardiac care outcomes significantly. However, one Inova Health System cardiologist is warning about the potential downsides of cardiac wearables.
In recent years, healthcare wearable device use has exploded, with data showing that of the half a billion smartwatch users worldwide, 92% use them to maintain their health and fitness. In the U.S., wearables use increased by 8 percentage points from 27% in 2018 to 35% in 2023.
According to Brett Atwater, MD, Inova's Electrophysiology section chief and Inova Schar Heart and Vascular's Atrial Fibrillation D'Aniello Chair, this rise in utilization, particularly in the cardiac care arena, can be attributed to the advanced capabilities of the devices and rising consumer demand.
"The devices have very high sensitivity and specificity, and then they achieve FDA clearance for use in monitoring for atrial fibrillation," he said. "I think that does drive many healthcare providers to encourage their patients to get a wearable device if they may be at high risk for atrial fibrillation. I think some of it is the consumers themselves, they perceive that there may be some health benefits to purchasing the device."
And there are many health benefits, Atwater acknowledged. However, the technology also comes with its fair share of challenges, including patient anxiety and self-treatment risks.
RISE IN PATIENT ANXIETY
Healthcare wearable devices can inadvertently drive patient anxiety and stress. One study from 2024 revealed that wearable devices are associated with pathologic symptom monitoring, excessive preoccupation with symptoms and higher healthcare use among patients with atrial fibrillation (AFib), which is the most common type of irregular heartbeat.
Atwater has seen this play out firsthand. Inconclusive or false readings can cause patients to become anxious, as they are looking for reassurance from the device. In some cases, an irregular reading may result from conditions other than AFib, like frequent premature atrial contractions or frequent premature ventricular contractions. However, patients could misunderstand the readings and become concerned that they have AFib, causing stress levels to rise.
"I've had a few patients who say, 'Look, I can't wear this anymore because it's just driving me nuts with all these alerts and all these problems. I just need to be able to live my life and not be worried about this all the time,'" Atwater shared. "So yeah, there are certainly times where, for mental health reasons, we decide this is too much information for the patient."
PATIENTS FIXATING ON LOWER-PRIORTY ISSUES
One of the significant benefits of healthcare wearables is engaging patients in their care. When patients are engaged, they are more likely to seek and take advice, Atwater explained.
However, this increased engagement could also lead to scenarios in which patients become so fixated on the readings from their devices that they want to spend the majority of their consultation talking about just that. This means the physician has less time to discuss other, more pressing issues that could cause health challenges.
"Maybe there's another problem like blood pressure or coronary disease, something that's not really assessed by the watch," he said. "And so, [talking about the device's findings] can utilize a disproportionate amount of time during the clinic visit."
PATIENTS MAKING TREATMENT CHANGES ON THEIR OWN
Inconclusive or false readings don't just drive patient anxiety -- they may also lead patients to take their care into their own hands without clinician guidance.
Atwater shared an alarming example: an AFib patient with a high risk of stroke could decide to stop taking their anticoagulation medication based on a false heart rhythm reading on their Apple Watch, inadvertently increasing their stroke risk.
"Right now, we don't know whether the device is good enough at predicting stroke to know whether we can use it to make decisions about anticoagulation," he said. "So that's one of the risks -- patients may believe in the technology so much that they make their own decisions about how to treat their atrial fibrillation, especially with anticoagulants."
On the flip side, patients who receive false positive readings may misdiagnose themselves as having AFib and take steps to seek treatment. This could result in unnecessary appointments and inefficient clinical workflows.
RISK OF WIDENING CARE GAPS
While healthcare wearables could help reduce cardiac care gaps by expanding access to vulnerable groups, Atwater noted that using them often involves buying new tools, which could prevent those groups from accessing the benefits of wearables.
These vulnerable groups, which include older, economically disadvantaged and rural patients, also have lower digital health literacy levels, making it harder for them to use wearables, even if they can access the technology itself.
This could ultimately create two healthcare systems: one for the haves and another for the have-nots. Health systems must implement strategies to ensure that social determinants of health barriers do not prevent high-risk patients from accessing cardiac wearable technology.
OVERCOMING CARDIC WEARABLE CHALLENGES
While some of the less-than-ideal effects of wearables use are outside the hands of cardiac care physicians, they can take steps to mitigate certain challenges.
For instance, they can help patients better understand the readings on their wearable devices.
"I'll teach them what I am doing when I'm looking at [the reading] to determine if this is atrial fibrillation or not," Atwater said. "And once they're empowered with the knowledge of what I'm looking at and how I'm making that determination, then they have some relief from the anxiety."
Another way to mitigate some of the negative effects of wearables is to encourage patients to turn off the AFib alerts, especially if they are already being treated for the condition and its potential adverse effects, like stroke.
Cardiac care requires a comprehensive treatment strategy that considers each patient's varied needs. While wearables can play a critical role in enhancing and personalizing that care, clinicians must ensure that they don't ultimately cause more harm than good.
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
