Wearable devices ‘substantially underused’ among people with heart disease

Dhingra LS, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.16634.

Dhingra LS, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.16634.

Fewer than one in four people with or at risk for heart disease use wearable devices, with only half of those reporting consistent daily use, researchers reported.

In a nationally representative study of contemporary patterns of wearable device use among U.S. adults, researchers estimated that 72 million U.S. adults, or about one-third of the U.S. adult population, used wearable devices, and the use was significantly lower among those with CVD, with only 18% reporting wearable use. Additionally, one-quarter of adults with CVD who used wearable devices reported not using their device in the preceding month, which was nearly twice the respective rate for the at-risk and the overall populations.

"While we increasingly recognize the potential role of smartwatches and other wearables in cardiovascular monitoring, the use among those most likely to derive benefits is low," Rohan Khera, MD, MS, assistant professor in the section of cardiovascular medicine at Yale School of Medicine and cardiologist at Yale New Haven Hospital, told Healio. "Devices like the Apple Watch, Fitbit and other similar devices have several sensors and monitors that track health and lifestyle, including step count, exercise, heart rate variability and sleep. They can also detect heart arrhythmias such as atrial fibrillation. Novel sensors on some devices allow getting ECGs and oxygen levels. This wealth of information will progressively be used in clinical care. However, patients with CVD had lower use than the general population, defeating the purpose."

In a cross-sectional study, Khera and colleagues analyzed data from 9,303 U.S. adults who participated in the Health Information National Trends Survey (HINTS), the largest survey of technology utilization in the U.S., in 2019 and 2020. The mean age of participants was 49 years; 51% were women. Participants self-reported CVD history and CVD risk factors, including hypertension, diabetes, obesity or cigarette smoking, as well as their access to wearable devices, frequency of device use and willingness to share data with clinicians.

The primary outcome of the study was the proportion of participants who reported using wearable devices to monitor their activity and health during the preceding 12 months. Researchers evaluated national estimates of these proportions across CVD risk groups and across key demographic and socioeconomic subgroups. For participants who reported using wearable devices, researchers also assessed the frequency of wearable device use and the willingness to share health data with clinicians.

The findings were published in JAMA Network Open.

Within the cohort, 10% had CVD and 55.7% were at risk for CVD.

In nationally weighted assessments, an estimated 18% (95% CI, 14-23) of U.S. adults with CVD and an estimated 26% (95% CI, 24-28) of adults at risk for CVD used wearable devices compared with an estimated 29% (95% CI, 27-30) of the overall U.S. adult population. Compared with those without CVD or CVD risk factors, those with CVD were less likely to use a wearable device (OR = 0.52; 95% CI, 0.38-0.71), as were those who were at risk for CVD (OR = 0.73; 95% CI, 0.62-0.87; P < .01 for both). However, these differences became insignificant after adjusting for demographic and socioeconomic differences between the groups.

The researchers found that older age (OR = 0.35; 95% CI, 0.26-0.48), lower educational attainment (OR = 0.35; 95% CI, 0.24-0.52) and lower household income (OR = 0.42; 95% CI, 0.29-0.6) were independently associated with lower use of wearable devices among adults at risk for CVD.

Use of wearable devices did not vary by sex. In patients with CVD, use of wearable devices did not vary by race, but in patients at risk for CVD, Black adults were less likely to use wearable devices than white adults, according to the researchers.

Among participants who reported using wearable devices, a smaller proportion of adults with CVD reported using wearable devices every day (38%; 95% CI, 26-50) compared with overall adults (49%; 95% CI, 45-53) and at-risk adults (48%; 95% CI, 43-53).

"The present study finds that, in an era with expanding use of wearable devices, these devices are substantially underused among those with CVD compared with the general U.S. adult population," the researchers wrote. "These differences suggest that populations who stand to gain the most from the use of innovative technologies for CVD management are the least likely to use them."

Among device wearers, an estimated 83% of those with CVD (95% CI, 70-92) and 81% of those at risk for CVD (95% CI, 76-85) reported that they are comfortable sharing wearable device data with their clinicians to improve care.

"Key barriers to the broader use of these devices are likely their cost and their technological accessibility for older individuals," the researchers wrote. "Our study supports both as potential mechanisms through demonstrated lower use in individuals from low-income households and older adults. Moreover, most of these devices are individually purchased, despite the availability of technology relevant for disease monitoring."

Khera said the study was designed to identify access to devices as an implementation barrier.

"We are also pursuing large prospective studies to validate these tools and their impact on patient outcomes explicitly," Khera told Healio. "As more technology is built for these devices, and they play central roles in health management, there may be a role in pursuing insurance coverage for the health devices. We will also need to understand better how we inform clinicians about their approach to this wearable-derived information. For example, we recently conducted a two-center survey asking clinicians how they would respond to hypothetical scenarios of patients reporting AF data from their Apple Watch. We found no standard management strategy, with a large variation on how clinicians would approach an increasingly common situation in clinical practice."

Rohan Khera, MD, MS, can be reached at [email protected].