Critical care
our smartphones and watches. These technologies have not only led to significant improvements in early diagnosis and prevention of cardiac disease, but also revolutionised the way patients receive cardiac care, explains Dr Alexandra Kharazi, a board-certified cardiothoracic surgeon, and member of the American College of Surgeons. “The most significant advances that I have seen in cardiac monitoring technology in recent years are devices which link vital signs to our electronic devices,” she says.
While we were once only able to monitor our heart rate during routine check ups at our local general practices, this is far from the case now. Almost everyone is easily able to track their own health data, whether it be their daily step count, or in the case of those with cardiac issues, monitor their heart rate. “An example of this type of device is the Fitbit,” shares Kharazi. “Other devices include ECG monitors for at-home use and continuous glucose monitoring.” For those patients who don’t have to worry about their cardiac health, these technological advances may seem miniscule, but for those who live in constant fear of cardiac issues, access to such precise information can be potentially lifesaving. In particular, these devices can be especially convenient in the aftercare of patients who have had heart surgery, Dr Kharazi explains. “For example, if they feel palpitations, and monitoring confirms a high heart rate, this information can be used to adjust existing medications between clinic visits,” she says. In a time when most medical specialities are overworked and struggling, these innovations have the potential to not only save the time of healthcare professionals, but also the lives of their patients. “I only do this when I have recently examined the patient and the information makes sense in their clinical scenario,” Kharazi clarifies. “If there are any concerns or discrepancies however, I schedule them for a clinic visit or send them to the ER.” The advantages of wearable devices have also begun to be more widely noticed by the medical community, with a 2021 article published in the Journal of Clinical Medicine stating there is a growing body of evidence that supports the clinical benefits of this technology in the management of patients who have previously experienced heart failure. A more recent 2023 paper authored by 16 physicians active in medical research concluded that cardiovascular data collected by wearables has the potential to improve individual patient care and lead to healthier populations.
The challenges of remote monitoring While the advances being made in this field hold great promise, challenges do persist. Data security and privacy concerns being the major one, as personal
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health data is transmitted and stored electronically. But according to popular studies, these risks are minimal, explains Dr Subasit Acharji, an interventional cardiologist and vascular specialist. “There appears to be little regulatory or privacy concerns with using arrhythmia detection monitoring in clinical practice,” he says. “In both the 2019 Apple Heart Study and the 2022 Fitbit Heart Study, participants’ arrhythmia detection were de-identified and individual-level data were unavailable.” However, since these studies were published, the wearable devices industry has seen a huge boom, and not all suppliers are as careful with their data as Apple or Fitbit.
There’s a growing body of evidence to support the clinical use of cardiac data from wearable technologies.
“The most significant advances that I have seen in cardiac monitoring technology in recent years are devices which link vital signs to our electronic devices.” Dr Alexandra Kharazi
In 2021, news was released surrounding a huge breach in data that had been collected from major wearable device providers. It was suggested that nearly 61 million records had been exposed, which included basic personal information such as display names, dates of birth and GPS logs. While in the US, where the FDA regulates medical devices, there is still little regulation on the personal data these devices store and disperse.
A fundamental ethical consideration is the issue of informed patient consent when it comes to wearable devices. Whilst many users of this technology may not be paying particular attention to how their data will be used and who will have access to it, they need to consider the potential risks of this and maybe involuntarily participating in remote monitoring programmes.
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