From sophisticated smartwatches to simple fitness monitors, digital devices are strapped to millions of people’s wrists, often with the goal of self-improvement. For many, these devices provide a window into their health, tracking everything from steps taken to hours of sleep. But for patients with atrial fibrillation (AF), a common heart rhythm disorder, these wearable devices may do much more than count steps. They could stoke anxiety and encourage unnecessary medical procedures.
A surprising study has been published. Journal of the American Heart Association The study, conducted by a team led by Dr. Lindsay Rothman of the University of North Carolina School of Medicine, reveals a complex relationship between wearable devices and patients with atrial fibrillation. While these gadgets provide relief to some, for others they may unintentionally lead to increased anxiety, over-monitoring of symptoms, and increased healthcare utilization.
Affecting millions of people worldwide, atrial fibrillation is characterized by an irregular, often rapid heartbeat. Symptoms are unpredictable and can sometimes be severe, ranging from palpitations and shortness of breath to fatigue and chest pain. Given the nature of atrial fibrillation, it’s no wonder patients turn to wearable devices for constant monitoring and peace of mind.
But the findings paint a nuanced picture of this technology-driven approach to cardiac health management. The researchers found that atrial fibrillation patients who used wearables were more likely to be preoccupied with their symptoms and had greater concerns about their atrial fibrillation treatment than non-wearers. Perhaps most strikingly, one in five wearable users reported experiencing strong fear and anxiety in response to arrhythmia notifications from their devices.
Dr. Rothman’s team found that this anxiety is not a passing concern. The study found that a similar percentage of wearable users regularly contacted their physicians if their devices showed signs of atrial fibrillation or if their electrocardiogram results were abnormal. This behavior has real-world medical implications, with wearable users showing significantly higher rates of atrial fibrillation-specific clinic visits, diagnostic tests, and even surgery.
The impact extends beyond individual patient experiences to healthcare providers and clinics. The study found that wearable users were significantly more likely to use informal healthcare resources, such as calling a clinic or sending a message to a healthcare provider through a patient portal. While this increased communication could be beneficial for patient engagement, it could also have a negative impact on an already overburdened healthcare system.
While these findings may seem disturbing, it is important to note that the relationship between wearables and healthcare utilization is not entirely negative. Many AF patients who use wearables report feeling safer using their devices. This sense of security, along with the potential for earlier detection of serious heart rhythm problems, should not be discounted.
But the study raises important questions about the unintended consequences of continuous health monitoring: For some patients, the constant data coming from wearable devices may make normal variations in their heart rhythm a constant source of concern. While well-intentioned, this heightened awareness could lead to unnecessary anxiety and medical interventions.
“Given the significant increase in use of wearable devices in this patient group (and the general population), we believe prospective studies and randomized trials are needed to understand the net impact of wearable devices (including alerts) on patients’ healthcare utilization and mental health, as well as the downstream impact on healthcare providers, hospitals, and health systems,” Rothman said in a statement.
As wearable technology advances and becomes increasingly integrated into healthcare settings, it will be important to balance the benefits of continuous monitoring with the potential for anxiety-inducing hypervigilance. This study reminds us that while technology can be a powerful tool in managing chronic conditions such as AF, it is not a silver bullet.
Going forward, healthcare providers may need to consider customizing their approach to the use of wearables based on individual patient characteristics. For some, these devices may provide valuable reassurance and early warning of potential problems. For others, a more cautious approach to self-monitoring may be necessary to prevent undue stress and healthcare overuse.
Paper Summary
methodology
Researchers conducted a retrospective study of 172 AF patients at UNC Health. Participants completed detailed questionnaires about their wearable device use, mental health, and quality of life. This self-reported data was then combined with information from electronic health records to examine health care utilization patterns. The study used statistical methods to account for potential confounding factors and compared a range of outcomes between wearable device users and non-users over a nine-month period.
result
The study found that AF patients who used wearable devices had higher rates of symptom monitoring and difficulty concentrating, and concerns about AF treatment compared to non-users. Approximately 20% of wearable device users experienced strong fear and anxiety in response to arrhythmia notifications and contacted their physician more frequently due to device alerts. Wearable device users had significantly higher AF-specific healthcare utilization, including increased outpatient visits, diagnostic tests, and procedures. They also used informal healthcare resources more frequently, particularly by messaging healthcare providers through patient portals and calling clinics more frequently.
Limitations
This study has several limitations: As it is an observational study from a single health system, causal relationships cannot be established; the sample may not be representative of all patients with AF; and the reliance on self-reported data for some measures may introduce recall bias. Additionally, this study could not determine whether wearable data directly triggered healthcare contact or whether the observed increase in healthcare utilization among wearable users was relevant. It is also unclear whether reported anxiety contributed to worsening AF symptoms, although it is well documented that anxiety contributes to a variety of conditions, including AF.
Discussion and Summary
This study highlights the complex impacts that wearable devices have on patients with AF. Although many users reported feeling reassured by the use of the device, a significant proportion of users experienced anxiety and increased healthcare utilization. The findings suggest that a more personalized approach to the use of wearable devices in AF management is needed. Future research should focus on identifying patients who would most benefit from wearable devices and developing strategies to mitigate potential adverse effects. This study also highlights the need for healthcare systems to prepare for the influx of patient-generated health data and its impact on clinical workflow.
Funding and Disclosure
The study was supported by a grant from the National Heart, Lung, and Blood Institute of the National Institutes of Health. Some of the researchers reported relationships with various medical device and pharmaceutical companies, but these were determined not to have significantly influenced the study’s findings.