A smartwatch can tell you when it’s time to see a cardiologist

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A cardiologist sometimes has to be a detective.

Take the case of the 75-year-old woman who wasn’t an athlete, yet one measure of her heart health seemed to say otherwise.

“It didn’t make sense,” said Dr. Sarah Taylor, a cardiologist who specializes in heart rhythm disorders.

The woman was wearing a watch that, among other things, recorded her heart rhythm.

“So I looked a little deeper,” said Taylor, who is with Rochester Regional Health. “Her rhythm actually was atrial fibrillation that had not been detected otherwise. There would have been no other way to detect she had atrial fibrillation other than the watch. So there’s a lot of hidden information in there that, with a little insight, can really lead to positive changes.”

Smartwatches, probably the most common type of wearable monitoring device aimed at consumers, have evolved from simply tracking steps to being able to detect atrial fibrillation. The arrhythmia can be a risk factor for stroke, particularly when a person has underlying health conditions.

Some of the devices and associated smartphone apps can record oxygen levels which, combined with other measures, can indicate sleep apnea, a condition where a person stops breathing for periods of time while they are asleep.

Software also can track heart rate variability, which can be a marker of stress.

“It’s very interesting how you can use that to implement wellness techniques in your day,” Taylor said. “These devices that give you feedback on a minute-by-minute basis or even a day-to-day basis help you figure out what in your life is working well, what is giving you stress and what can you modify.”

Many cardiologists share experiences similar to Taylor’s.

Dr. Mehmet Aktas is on the advisory board of the American Heart Association and is an electrophysiologist with UR Medicine Cardiac Care. One reason he said he bought a smartwatch with monitoring capabilities was to keep up with his patients.

“When a patient said to me, ‘Doc, my watch alerted me to the presence of atrial fibrillation,’ it was hard for me to understand how that alert occurred. But then reading about the information, learning the algorithm that’s involved in setting this alert, I had a stronger understanding of what that information meant. It has allowed me to relate to some of the data that my patients were presenting to me in clinic.”

He also uses the data to monitor his own health. But he’s in the business of interpreting heart data, so he knows what he’s looking at.

Aktas said that, for the layperson, information overload is a concern and there is the possibility of false alarms that can lead to anxiety and unnecessary procedures.

“I think this is one of the areas that really requires additional research to try to figure out which populations would benefit from devices like this, where having a wearable might improve their outcome,” he said.

His conclusion is similar to what some research has shown.

A study from 2019 by the National Library of Medicine https://pubmed.ncbi.nlm.nih.gov/30784691/ concluded that detecting atrial fibrillation is feasible, but their use needed to evaluated in large population samples.

Over the past year, research reported by the American College of Cardiology https://www.acc.org/About-ACC/Press-Releases/2022/04/04/15/45/Smartwatch-App-Found-to-Accurately-Detect-Atrial-Fibrillation and a study in the Journal of the American Heart Association concluded that wearables can be screening tools and help in long-term management of atrial fibrillation.

The devices have not been studied as extensively for other heart conditions. Dr. Jonathan Rodriguez, attending cardiologist at Finger Lakes Health, said the devices are not appropriate for evaluating chest pain that may be associated with a heart attack.

“I do have some older patients who have smartwatches, and the majority of those don’t have the kind of problem that a smartwatch would be able to help them with. But at the end of the day, it’s still just a screening tool. Anything that would require a change in medication or anything like that would need more.”

As for their ability of the devices to detect atrial fibrillation, “I think it’s becoming more and more useful,” he said. “AFib is probably under-diagnosed in the population because a lot of patients can have subclinical atrial fibrillation, meaning they don’t have any symptoms.”

But access to the devices is not being enjoyed equally. He said that cost and lack of an internet connection can be barriers, something he compared to the inequity with telemedicine that happened during the pandemic. An individual’s comfort with technology also can prevent them from experiencing potential benefits of the devices.

Rodriguez said most of the marketing is toward younger people, when it’s older adults who may have a greater need.

“I think younger people are using them for step-counting rather than biometric information,” he said. But the devices can help track activity and body composition, important if a person is trying to lose weight.

“Obesity is an issue,” he said. “Along with obesity comes sleep apnea, so it can give them hard information, like your blood oxygen is dipping into the seventies when you’re asleep. This is not a good thing and, there are long-term consequences with that and you should do something about it.”

For people looking for motivation, the devices can be better than a lecture.

Craig Dennison, exercise physiologist/program coordinator for UR Medicine’s Cardiac Rehabilitation program, gets questions from patients about which type of device to get.

“I’m like, what is your main criteria,” he said.

He said he’s skeptical of a watch that claims to take blood pressure. “Without compressing the blood vessels in the arm and then releasing them, I have no idea how you accurately get a blood pressure.”

For patients who want to track their heart rate, he has suggested a heart-rate monitor with a chest strap, which is picking up the electrical signal from your heart and sending it to your watch or phone app. “Those are highly, highly accurate.”

For someone who wants to increase their activity, he said a simple fitness tracker can do the job.

“Looking at the number of steps you take per day is a great baseline way to increase your physical activity. We’ll say, if you want to get one, get one and over a week don’t even think about what you’re doing. Just wear it for a week and see how many steps per day you’re averaging.

“If you’re doing 3,500 steps per day. Let’s see if you can get up to 4,000 steps per day and then just slowly increase that over time. That does work. That is a motivational tool because it’s simple feedback.”

Patti Singer is a freelance writer in Rochester. Contact her at [email protected].