Growing Use of Wearables and Their Role in Remote Patient Monitoring

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Growing Use of Wearables and Their Role in Remote Patient Monitoring
by Arun Chandra, MD

Over the past decade, there has been a huge surge in the availability and popularity of wearable technology. This has largely been driven by the Apple Watch, with credit to the Fitbit, and we are seeing newer technologies over the past few years empowering patients to take more control over their health.

That's the significant driver behind the increased adoption of wearables: emphasis on proactive healthcare where patients can personally monitor vital signs. If users see aberrations before health issues progress to a more serious stage, they may be able to help get those issues under control and seek medical advice in a more proactive manner. The alternative could be a scenario where disease progresses to a point where a patient is feeling so sick that they need to see a doctor immediately or be admitted for inpatient telemetry monitoring.

With the Apple Watch, and similar technologies, health information is a glance away. You can see your pulse, EKG, oxygen reading, and other vitals. If any are aberrant, now you can preliminarily diagnose everything from heart conditions to lung conditions to even psychiatric conditions like anxiety disorder that presents with a rising heart rate.

To say the technological improvement in the wearables space has been significant would be an understatement. Wearables nowadays, compared to those in the past, have highly intricate, sophisticated sensors that can track everything from heart rate to sleep patterns to physical activity levels. More patients are welcoming the opportunity to view all their health data displayed out — visuals once associated largely with scientists and researchers. This access to data grants patients with more control over their own health rather than feeling like the only person who controls their health is the physician/provider.

Top Benefits of Wearables

There are numerous benefits associated with wearables — benefits increasingly supported by research. Here are four examples.

1. Early detection of heart conditions

Wearable devices equipped with heart rate monitoring capabilities, like the Apple Watch, can help in the early detection of irregularities in heart rate. This early detection may facilitate timely medical intervention and diagnosis.

A study published in the Journal of Cardiovascular Electrophysiology titled "Accuracy of the Apple Watch for detection of AF: A multi center experience," investigated the accuracy of atrial fibrillation detection using the Apple Watch. The findings suggested that the device has the potential to accurately identify atrial fibrillation with high specificity.

2. Remote patient monitoring

Wearable monitors enable remote monitoring of patients, providing healthcare professionals with real-time data on a patient's heart health. Specifically in the heart failure population, a recent Heart Failure Clinics review titled "Remote Monitoring Devices and Heart Failure" highlighted the benefits of remote patient monitoring (RPM) in engaging patients in their cardiovascular care and reducing the burden of heart failure in society.

3. Improved patient engagement

Wearable devices often promote active patient engagement in managing their health. Patients can track their heart rate, physical activity, and other relevant metrics, fostering a sense of control over their well-being. A review article titled "Wearable Devices in Cardiovascular Disease" published in Circulation Research, discussed how wearable devices contribute to patient engagement and empowerment in cardiovascular health.

4. Data collection for research

Large-scale data collected from wearable devices can contribute valuable insights into population health and aid in research efforts. The "Apple Heart Study," published in the New England Journal of Medicine, demonstrated how Apple Watch data could be used for large-scale screening of atrial fibrillation, providing insights into the prevalence of this condition in the general population.

Wearables Empowering Patients and Providers

The four studies cited are part of the rapidly growing research demonstrating the substantial benefits wearables are delivering to patients and providers. There are countless more, such as the 2022 Lancet study, "Effectiveness of wearable activity trackers to increase physical activity and improve health." It shows patients with wearables have more of a predilection to engage in physical activity. Why is this the case? When patients gain greater control over accessing their data, they naturally gravitate toward healthier habits, whether from a physical activity standpoint or healthy lifestyle habits. Users see that they're exercising and how this is positively reflected in their vitals. They see how eating healthier, like consuming less salt, affects their vitals in a positive manner. The constant, real-time feedback and real-time changes, which introduces a gamification element to health, enhances the experience of using a wearable.

For providers, wearables open up a gamut of opportunities to further help our patients. Consider the remote patient monitoring space. A patient with multiple high-risk chronic conditions is discharged from the hospital. If that patient is provided a wearable set up to transmit vitals data back to their physician/care team, we can now provide the constant monitoring that will enable us to act in a timelier manner on any alarming aberrations, possibly preventing the patient from becoming so sick that they require readmission and rehospitalization.

With wearables, patients can gain more autonomy and control over their health, making lifestyle changes that deliver measurable improvements, while physicians can gain access to more real-time data they can use to provide patients with guidance or treatments that keep diseases from progressing.

The Risks of Wearables

Patients considering wearables and providers considering whether to advise patients to use wearables should understand a few risks associated with the technologies. Patients can become overly sensitive and reactive to changes in their vital signs, which can lead to negative outcomes. Consider a fluctuation in heart rate that makes a patient more anxious, which leads to a downward spiral. Too much data consumption can cause anxiety.

Despite the noteworthy progress we've witnessed in recent years, the accuracy and reliability of wearables has room for improvement. While the Apple Watch can provide an EKG tracing, when a user's heart rate goes up, the accuracy of the reading goes down. When a person's heart rate goes very fast, the device may say it's an undetermined rhythm or atrial fibrillation, but sometimes the user can receive an inaccurate reading. This can precipitate anxiety or an improper diagnosis, if the user tries to self-diagnose the readings. As time goes on, accuracy and the reliability of the wearables will continue to improve, but it's important to recognize the current shortcomings.

Finally, the use of devices that capture personal information, including health information, always bring with them data security and privacy concerns. The heart studies being conducted using personal information from Apple Watches are pulling large datasets with the intention of furthering healthcare. Any data being uploaded to the internet and stored in the cloud may be accessed if a data breach occurs. For patients who have strong concerns about the potential for their data to be leaked, they should understand what data is captured by their wearable, where it's being stored, and how it's being accessed.

Wearables: Where We Are Today, Where We're Going Tomorrow

I'd like to conclude with some final summarizing thoughts on wearables. Patients having more control over their health and being more proactive about their health are largely a positive development, especially when wearables are part of a remote patient monitoring program. This allows for what is an essentially multifaceted approach to healthcare where providers are seeing patients in the clinic setting while monitoring patients outside the clinic and accessing real-time data that enables a more holistic picture of overall health. Continuous monitoring through wearables can lead to early interventions, thus contributing to better patient outcomes. When we can intervene at an earlier stage, we can reduce the likelihood of a disease manifesting and needing to treat the disease.

The future of wearables is as bright as it is exciting. Advancements in sensor technologies and EKG processing along with more sophisticated data analytics will continue to enhance the interpretation of data and allow for more precise interventions. The small investment of a wearable can be a big win-win for patients and providers.

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Growing Use of Wearables and Their Role in Remote Patient Monitoring

Over the past decade, there has been a huge surge in the availability and popularity of wearable technology. This has largely been driven by the Apple Watch, with credit to the Fitbit, and we are seeing newer technologies over the past few years empowering patients to take more control over their health.