Talking about wearable devices permeating routine clinical care

Over the past decade, there has been a rapid development and rapid adoption of consumer technology that can capture physiological data relevant to heart health, including physical activity, heart rate, electrocardiograms, and episodes of heart failure. atrial fibrillation (AF).

And health care providers are taking notice, according to a new analysis of 21,013,729 health care provider notes from 492,192 adult primary care patients (60.7% female; mean age, 48 years).

The analysis found that the annual mention of wearable devices with heart sensors increased from 0.0002% of supplier notes in 0.0006% of patients in 2005 to 0.14% of notes in 0.89% of patients in 2019.

“By 2019, consumer wearables were mentioned in medical notes for nearly 1% of adult primary care patients. This is a dramatic increase from just a few years earlier,” said Steven Lubitz, MD, MPH, Massachusetts General Hospital, Boston, theheart.org | Medscape Cardiology.

Among wearables, Fitbit was the most referenced device, accounting for 74% of patients with devices and responsible for the rapid rise in device listings between 2012 and 2016, before declining in 2017. As of 2015, Apple Watch fueled a growth in device listings.

Patient-level factors associated with talking about wearable devices in clinical encounters included younger age, female gender, higher income, obesityhyperlipidemia, hypertensionAF/atrial flutterother arrhythmias and white races.

Device entries were most likely in cardiology encounters (odds ratio, 4.74). Other note-level factors associated with device listing were calendar year, obesity, AF/flutter, other arrhythmias, hypertension, and hyperlipidemia.

“We expect the mention of consumer devices in patient-caregiver meetings to increase significantly in the coming years as manufacturers increasingly use validated technology and algorithms capable of measuring signals of clinical relevance,” Lubitz said.

“We anticipate that the increase in consumer device mentions during patient provider outcomes will be driven by patients seeking advice on device measurements and notifications as well as clinicians seeking to leverage the capabilities of consumer devices for clinical management,” he added. he to it.

The study was published online June 27 in Circulation: Cardiovascular Quality and Outcomes.

Big challenges ahead

Lubitz said “major” challenges and unanswered questions for the field include how consumer wearable devices relate to clinical outcomes and how clinicians can best integrate data from consumer devices into practice.

Other questions include how physicians should discuss, advise, and perhaps recommend consumer devices to patients; whether portable devices encourage appropriate or inappropriate use in healthcare; and whether consumer health technology contributes to disparities in care or can be used to reduce existing disparities.

Gregory M. Marcus, MD, University of California, San Francisco, approached for comment, noting that while 1% of visits involved a wearable device, it’s important to keep this “seemingly small number” with different contexts in mind.

“First, the trajectory of the increase in frequency of wearable device mentions was quite staggering, including more than a 100-fold change over the study period,” Marcus said. theheart.org | Medscape Cardiology

He also noted that this analysis was limited to just healthcare documentation of a discussion about a wearable, “which is certainly a substantial underestimation of the true frequency of conversations about wearables between healthcare professionals and their patients.”

Marcus said it’s also important to note that the study was not designed to determine whether the mention of a wearable device was associated with overall increased or decreased health care use.

The study provides “an interesting insight into how the use of these devices permeates clinical practice, but original research will be needed to determine optimal workflows that best support, rather than hinder, the efforts of the healthcare provider and the well-being of our patients.” “, he said. †

Funding for the study was provided in part by the National Institutes of Health and the American Heart Association ciatio n. Lubitz receives sponsored research support from Bristol Myers Squibb/Pfizer, Bayer AG, Boehringer Ingelheim, Fitbit, IBM Health, Medtronic and Premier, Inc, and has consulted for Bristol Myers Squibb/Pfizer, Bayer AG, Blackstone Life Sciences and Invitae. Marcus has no relevant disclosures.

Circ Cardiovasc Qual Results† Published online June 27, 2022. Abstract

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