Future of Wearables in Heart Failure Patients

DeVore AD, Wosik J, Hernandez AF.
The Future of Wearables in Heart Failure Patients. JACC Heart Fail 2019;7:922-932.

The following are key points to remember from this state-of-the-art review on the future of wearables in patients with heart failure (HF):

  1. The key value proposition of wearables is to extend patient data collection outside of conventional clinical encounters.
  2. Wearables can be connected through a smartphone with internet connection to a patient’s environment in order to potentially improve the health of HF patients. Despite numerous potential applications, there are very limited data demonstrating significant changes in care or improvement in patient-centered outcomes resulting from the use of wearables in HF.
  3. Accelerometer technology is now part of a US Food and Drug Administration (FDA)-approved accessory for the Apple watch, the Kardia Band (Apple, Cupertino, CA), and was incorporated into the Apple Watch Series 4. The accuracy of these devices is under investigation, and there are limited data in patients with HF.
  4. Smartwatches currently use photoplethysmography to detect irregular rhythms, a noninvasive technology that uses a light source and a photodetector at the skin surface to measure the variations in blood circulation. That technology is routinely used for monitoring heart rate, and the accuracy may be impacted by patient (e.g., movement or ectopic beats) and environmental factors (e.g., ambient temperature or light).
  5. The challenges of identifying appropriate patients for wearables should not be minimized and should underscore the need for robust data on effectiveness in the population of interest.
  6. Emerging technologies in wearables in patients with HF include: a) Remote dielectric sensing technology where low-power electromagnetic signals transmitted across the chest measure dielectric properties of tissue (e.g., lung’s fluid content), b) measurement of whole-body movements (ballistocardiogram) and chest wall vibrations (seismocardiogram), and c) textile piezo resistive sensors (weight measurements from shoe integrated pressure sensors).
  7. Successful integration of wearable devices into routine HF care presents many challenges. First, technology innovation has outpaced the ability of clinicians and health systems to incorporate the infrastructure for optimal use of data.
  8. To efficiently use mHealth data, all tools (e.g., wearables, other medical devices, and software) must be interconnected and interoperable. However, this interconnectedness must be approached with caution because these connections increase the vulnerability to cyber attacks.
  9. The initial capabilities of wearable devices for patients with HF have been limited to monitoring and reporting of functional or physiological data, but the potential of wearable devices can extend far beyond this basic reporting. For one thing, wearable devices can become an important component of clinical trials.
  10. The authors of this article believe there is great potential for wearables to improve HF care, but the following significant steps are necessary by the HF community: a) to generate sufficient efficacy data in real-world HF populations; b) to adopt payment models that incentivize high quality, longitudinal HF care and allow for investing in infrastructure to optimally use mHealth data; and c) along with health systems, professional societies and patient organizations, to develop systems and social change to appropriately use new technologies and enhance HF care.

Perspective: This is an important article, which highlights the promise and the potential to pursue research opportunities across the spectrum of HF from Stages A to D.

Keywords: Accelerometry, Ambroxol, Arrhythmias, Cardiac, Ballistocardiography, Electromagnetic Phenomena, Heart Failure, Heart Rate, Internet, Photoplethysmography, Remote Sensing Technology, Telemedicine

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