Could a smart watch help monitor heart failure symptoms and show when intervention is needed?

Results from a Canadian study using Apple watches suggests that the widely available wearable technology can help physicians monitor their patients with heart failure, possibly alerting them to when the patients need healthcare intervention before there’s an emergency.The Apple watches measured heart rate, physical activity and oxygen saturation levels (peak oxygen uptake, pVO2). The findings suggest that the data collected by the watches showed strong concordance with clinical measurements of cardiopulmonary fitness, namely cardiopulmonary exercise testing (CPET) and the six-minute walk test. The watch data may alert physicians to a risk of emergency treatment. The researchers found that a 10% reduction in Apple watch-measured pVO2 was associated with a 3.62-fold increased hazard ratio of unplanned healthcare events, including hospitalization or emergency treatment. Those events occurred a median of 7.4 days after the drop in pVO2.“Thinking of ways to treat, manage and monitor patients where they’re at has been a crucial focus for us,” said Dr. Heather Ross, a cardiologist and clinician-scientist at the University Health Network’s Peter Munk Cardiac Centre in Toronto and co-senior author of the study.“The findings of this study are a potential game-changer because they allow us to identify signals that would tell us a patient was in trouble before they ended up coming to the emergency room,” Dr. Ross said in a University Health Network press release.Apple watch technology provided a sensitivity of 88% and specificity of 62% of predicting unplanned healthcare use after a 10% drop of pVO2.“Prioritizing sensitivity is crucial, because the early identification of at-risk patients enables proactive measures, such as expedited clinical visits, which can reduce the risk of unplanned healthcare utilization,” the researchers note in the paper.The trial was called the Ted Rogers Understanding Exacerbations of Heart Failure study (TRUE-HF). It involved 217 patients with heart failure who carried out regular activities for three months while wearing Apple Watch devices. They had a clinic visit and CPET at the beginning of the trial and after three months. The majority of participants (52.5%) were in New York Heart Association (NYHA) functional class II, with 25.3% NYHA Class III and 20.7% NYHA Class I and 1.4% for NYHA Class IV. The researchers used a deep learning model to analyze patterns in data to estimate cardiopulmonary fitness. Apple supplied the iPhones and Apple Watch devices for the study. Apple also worked with researchers to develop the app used in the study.The researchers validated their findings with those from the U.S. National Institutes of Health's All of Us research program, which used FitBit wearable technology. Both studies showed that wearable technology was able to predict unplanned healthcare visits in patients with heart failure.“The future goal is to have an unobtrusive, free-living, near continuously monitoring equitable device that allows us to track a patient’s status and intervene when it changes,” said Dr. Ross.Whether Apple watch data would work for sicker patients with heart failure remains unclear. The algorithm required patients to reach at least 60% of their maximin heart rate before it started reporting observations, so there were fewer observations for sicker patients. How to manage the massive amount of data generated by patients is another area that requires for further study. The study was published in Nature Medicine.

Could a smart watch help monitor heart failure symptoms and show when intervention is needed?

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