Smart Watch, Heart Watch

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Show your heart some love. In addition to hosting Valentine’s Day, February is also American Heart Month. With developments in technology, monitoring heart health is something people can do not only during February, but also throughout the year. Two area cardiologists assess the use of smart devices for detection and management of cardiac conditions.

The Evolution of Smart Technology

Dr. Tomas Ayala, Heart Center at Mercy Medical Center

Dr. Tomas Ayala of the Heart Center at Mercy Medical Center has long suggested patients use tools to monitor cardiac health, “even going back to digital pedometers and fitness trackers,” he says. These devices encourage wearers and keep them accountable. “The American College of Cardiology recommends 150 minutes a week of moderate intensity aerobic exercise. Fitbit and smartwatches help us track progress and remain motivated; they also make it more difficult to ‘lie’ to ourselves.”

Technology has gotten much more sophisticated since early pedometers, notes Ayala. “We now have wrist-based devices that can give us not just heart rate and steps, but heart rhythm information, oxygen saturation, sleep quality information and even blood pressure.”

Dr. Vincent See is a cardiologist and cardiac electrophysiologist at the University of Maryland Medical Center and assistant professor of medicine at University of Maryland School of Medicine. In his work, See often encounters patients who use smart devices.

“Some may be used to monitor heart rate and even detect abnormal heart rhythms. A few of them are FDA approved to do electrocardiogram screening for arrhythmias, especially atrial fibrillation (AFib),” he reports.

Beyond reading rhythms, these smart devices can monitor daily routines, track activity and diet, send reminders to modify activity or take medications and serve as a portal for patient education and messaging. “Their use by patients young and old seems to be growing with time and has likely increased since COVID-19 hit us.”

Enhancing User Experience and Data Reporting

Dr. Vincent See, Cardiologist and Cardiac Electrophysiologist at the University of Maryland Medical Center

Increasing use of smart technology seems a natural progression in today’s society. Is age a factor in the inclination to use it? Some people assume that smart device user demographics skew heavily toward younger patients.

“I think there has been a bias that older people don’t adopt new technology,” says See. “We’ve gotten some pushback that ‘patients with atrial fibrillation are older and may not use smartphones as much.’ While that is true for some, there is wider use than a few years ago and more than many people think. In 2017, the Pew Research Center reported that four in 10 adults older than 65 owned smartphones, which was double from 2013. Our own recent data found that 95% of our patients with atrial fibrillation own smartphones, 15% use lifestyle-related apps, and 71% are open to using smart devices for health purposes.”

The Apple Watch has been a significant player in the increased use of smart devices, according to Ayala, although he notices that some people are intimidated by the more advanced functionality of these devices. “As with any new technology, I am confident that user experience and comfort will continue to improve.”

Ayala recalled an example when smart technology made a meaningful difference for a patient. “Last year, a young woman was having episodes of rapid heart rate that caused her to feel lightheaded. She had worn a heart monitor for a few weeks, but the episodes were infrequent enough that nothing showed up.” It was her Apple Watch that captured her heart rhythm during an episode. “I was able to use that information to make a diagnosis and provide treatment options.”

In another case, Ayala says, “I saw a young man who kept having uncomfortable palpitations. I had him wear a heart monitor, and while we saw a few extra beats, there was nothing to explain his symptoms. I suggested that he look into a portable EKG monitor manufactured by Kardia. He purchased it and showed up at my office a few weeks later with printouts from his monitor showing the heart rhythm abnormality that was troubling him.”

Ayala has many patients with AFib, an arrhythmia that causes irregular heartbeat. “Smart devices can be used to monitor rhythm to determine if a ‘funny’ sensation is AFib or something more benign. Over time, this can be used as feedback so the person can learn exactly how their AFib feels. I’ve had patients that would go to the ER as soon as they felt anything unusual, thinking it might be their AFib. Most of the time, it wasn’t. With the monitor, they feel more confident in saying, ‘This is not AFib. It is not an emergency.’ Similarly, they may feel strange and find that their AFib is active and can call their doctor with concrete information.”

Where Is Heart Monitoring Technology Headed?

The types of devices used may vary, but the goals are enhancing mobility, accessibility and communication. “Smartphones are really mini computers,” notes See. “There has been an explosion of apps and devices. There are text reminders. Smart devices are allowing for more secure and HIPAA-compliant communication between patients and clinicians. On a clinical front, there are cardiac implantable devices that used to require more in-person interaction but now have more remote check or app interface options. The lines between consumer and clinical use of devices may blur over time, too.”

At present, personal devices are still more for general screening. Dedicated, office-based cardiac monitors remain the gold standard for definitive diagnosis, but the future of this technology is promising, Ayala predicts. “Within the next few decades, we may even see smart wearable devices that can determine if a person with heart failure has too much fluid and needs medication adjustment. That can determine near-real-time cholesterol and inflammation levels to provide feedback on diet and exercise. It might even be possible to use smart devices with artificial intelligence to predict if an individual is at short-term risk of heart attack or stroke.”

As with anything, using smart devices can present potential concerns.

“The first has to do with privacy,” says Ayala. “There are questions as to who owns the data, even if not individually identifiable. Most apps require, as part of the end user agreement, to allow aggregation of information. Another concern is accuracy. Heart rate monitors are generally very good as long as there is not significant motion. Cardiac rhythm monitors are reasonably good but still require an expert to interpret the findings. Smartwatch-based blood pressure monitors are not yet accurate enough to replace blood pressure cuffs. Technologies will continue to be refined, and they will eventually be significantly more reliable.”

During the pandemic, remote health care has become a necessity, but patients still value personal connection with their trusted providers—something that no smart device can replace.

“It is important to recognize that there will be trade-offs in how technology impacts our interactions as individuals, groups and society,” says See. “We don’t want people to withdraw from interpersonal interactions. We don’t want to sacrifice security, and we don’t want app and alert fatigue to diminish the usefulness of these tools. In the end, we want to help people do better, rather than creating more issues or costs. How to navigate this will require a lot of study and thought by many stakeholders. Technology isn’t going away, but it will continue to evolve.”

“There is no doubt that smart technology, in the form of watches, clothing, bandage-type applications and other wearables will be integral to health-care delivery in the future,” says Ayala. “These (devices) will be used for diagnostic support and therapeutic monitoring. We may even reach a point where a person’s medical history, medication, test results, EKGs, radiographs and stress tests will all be accessible through smart devices. They will assist in monitoring response to therapy and provide seamless communication between patients and providers.”

Now you can wear your heart on your sleeve and a heart monitor on your wrist. Protecting your cardiac health has never been smarter.

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