Wrist Wearable Devices & Heart Disease

Introduction

Health is an inseparable part of human lives, for without which we as an active functioning organism cease to exist. As such it has been a topic of close scrutiny, beginning with the concept of causation and outcome resulting from magical elements all the way to inception of scientific medicine by Greeks around 300 B.C and the period of scientific subdivision from the 1800’s. There has always been a central concept of “healer” or a healthcare provider like a doctor throughout human history. Introduction of preprocessor enabled personal computers in 1970 and with the advent of worldwide web, technologies like telemedicine have emerged which do not require a certain healthcare provider to be present in person. There has been a rapid expansion in Healthcare Information Technology(HIT).

In 2009, the United States passed a new law called the Health Information Technology for Economic and Clinical Health Act (HITECH act) and provided incentives to encourage healthcare organizations and providers to adopt the usage of Electronic Health Records(EHRs). Once EHRs are used medical devices can be integrated to the admission, discharge and transfer(ADT) system where the data is being updated continuously. Medical Device Integration Model Based on the Internet of Things [1] and Web Services [2] have been proposed. For managing, analysis and visualizing the resultant large size of electronic information, cloud computing is poised to become the fifth utility delivering economies of scale and cost benefits that are difficult for institutions to ignore. [3] This state of advance computing has led to creation of new fields in medicine such as systems medicine where patient’s molecular data can be inexpensively integrated with clinical measurements with the possibility for healthcare strategies that are specifically tailored to an individual.

Wearable technology or simply known as wearables are electronic devices consisting of microcontrollers that can be implanted on the body or used as accessories. They can be used to measure heart rate, distance travelled during exercise, blood pressure, and heart rhythms [4]. They play a crucial role in decreasing the mortality as well as the reducing the economic burden of diseases especially chronic heart diseases such as coronary artery diseases(CAD) in which the balance between oxygen supply and demand of myocardial muscles is affected mainly due to atherosclerotic blood vessels (blood vessels clogged by fat cells). Heart diseases also encompasses stroke, heart failure, arrthymias and other peripheral vascular diseases such as thromboembolism and Berger’s Disease. According to the CDC, about 610,000 people die of heart disease in the United States every year (1 in every 4 deaths).

Heart disease is the leading cause of death for both men and women [4]. In the United States, someone has a heart attack every 34 seconds & 60 seconds, someone in the USA dies from a heart disease-related event. Every year about 735,000 Americans have a heart attack: 525,000-first heart attack & 210,000 repeat heart attack. Wearables are revolutionizing novel real time monitoring techniques that lead to timely intervention of heart emergencies such as cardiac arrest, myocardial infarction (Heart attack) and also help in self-monitoring by promoting long term weight loss as evidenced in The IDEA Randomized Clinical Trial [5], assessment of daily activities and calories expended. They even allow to share the progress with family members or friends and may provide greater motivation to a more active lifestyle. Furthermore, electronic devices help with patient engagement with their electronic health records made accessible by the provider as highlighted in MACRA Stage 3 Objective 6[7]. It has been estimated that Seven in ten U.S. adults track a health indicator for themselves or for a loved one [6].

While the accuracy of wrist wearables does not come close to the accurate measurement compared to that of electrode-containing chest monitors [8], they are often used recreationally used to track fitness with variable degrees of accuracy. Appropriate validation of devices may be necessary in patient groups that rely on these devices to stay on physician recommended thresholds. There is further evidence that wearables are not as accurate as Spo2.R-derived heart rates [9]. On another study that assessed the accuracy of seven commercially available wrist-worn devices in estimating heart rate (HR) and energy expenditure (EE) on Apple Watch, Basis Peak, Fitbit Surge, Microsoft Band, Mio Alpha 2, PulseOn, and Samsung Gear S2, an acceptable error rate was found [10]. However, wrist wearables maybe preferred over other fabric based wearables for ease of use, and as a vital tool for monitoring overall health and activity.

References:

1. Hao A., Wang L. Medical Device Integration Model Based on the Internet of Things, Open Biomed Eng J. 2015; 9: 256–261.
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3. M. Delgado, "The Evolution of Health Care IT: Are Current U.S. Privacy Policies Ready for the Clouds?" 2011 IEEE World Congress on Services, Washington, DC, 2011, pp. 37 Hu S, Wei H, Chen Y, Tan J. A Real-Time Cardiac Arrhythmia Classification System with Wearable Sensor Networks. Sensors (Basel, Switzerland). 2012;12(9):12844-12869. doi:10.3390/s120912844.1-378.
4. Heart Disease Facts, Retrieved from www.cdc.gov/heartdisease/facts.htm
5. Jakicic JM, Davis KK, Rogers RJ, et al. Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss. The IDEA Randomized Clinical Trial. JAMA. 2016;316(11):1161–1171.
6. Fox S, Duggan M. Tracking for Health. Pew Research Center, Pew Internet and American Life Project. 2013. http://pewinternet.org/Reports/2013/Tracking-for-Health.aspx. Accessed July 20, 2018
7. Golder D, The Good, the Bad and the Ugly of Meaningful Use Stage 3: Objective 6 – Coordination of Care through Patient Engagement, Retrieved from www.impact-advisors.com/meaningful-use/the-good-the-bad-and-the-ugly-of-meaningful-use-stage-3-objective-6-coordination-of-care-through-patient-engagement. Accessed July 20, 2018
8. Wang R, Blackburn G, Desai M, et al. Accuracy of Wrist-Worn Heart Rate Monitors. JAMA Cardiol. 2017;2(1):104–106.
9. Kroll RR, Boyd JG, Maslove DM. Accuracy of a Wrist-Worn Wearable Device for Monitoring Heart Rates in Hospital Inpatients: A Prospective Observational Study. Eysenbach G, ed. Journal of Medical Internet Research. 2016;18(9):e253.
10. Shcherbina A, Mattsson CM, Waggott D, et al. Accuracy in Wrist-Worn, Sensor-Based Measurements of Heart Rate and Energy Expenditure in a Diverse Cohort. Liggett SB, ed. Journal of Personalized Medicine. 2017;7(2):3.