How great is the benefit of wearables for health and patients? – Health

The classic wristwatch is now being replaced by a smartwatch on many wrists. This is also because the smart watches have certain capabilities that their mechanical predecessors cannot: for example, counting steps and monitoring the heart. But how useful is that actually? The heart specialist Konstantinos Rizas from the University of Munich Hospital is researching this question.

SZ: How many of your patients already use a smartwatch or fitness tracker?

Konstantinos Rizas: Outside of our studies, it is probably around five to ten percent. We treat mainly older patients in cardiology, and they are not as enthusiastic about using such devices as younger patients. But when they do use them, they generally take the application much more seriously.

Would it make sense for more people to wear such devices?

During the Covid-19 pandemic, we conducted a study with around 5,500 people aged between 50 and 90 together with the Bavarian Insurance Chamber. None of the test subjects had a known cardiac arrhythmia. We divided the test subjects into two groups per batch. One group measured their pulse twice a day for six months using a smartphone; they also went to their family doctor for check-ups as usual. In the group with the smartphones, atrial fibrillation was discovered twice as often as in the other group. Among the older participants between 65 and 70 years of age, it was even three times as common. Such arrhythmias increase the risk of stroke. Another advantage is that if they are discovered, the patient can be prescribed blood thinners to prevent a stroke.

You have to actively measure your pulse with your smartphone, whereas the new smartwatches monitor your pulse passively on your wrist. However, this can sometimes result in false alarms.

Yes, that can happen. But it usually goes away quickly. With some smartwatch models, you can check an irregular pulse measurement directly with an ECG. All you have to do is put your finger on the watch, then you can take a proper ECG and find out whether you should see a doctor.

The devices can only record ECGs very simply. Are they reliable enough?

The so-called watches record single-lead ECGs. In the clinic we have twelve-lead ECGs. But the simple ECGs are sufficient for atrial fibrillation. To detect a heart attack, you have to look at the heart from different sides instead. That’s where you need better equipment.

If people are diagnosed with atrial fibrillation without having any symptoms, does that even make sense?

This is currently the subject of intense debate. So far, in hospitals we have tended to treat so-called subclinical atrial fibrillation in the same way as atrial fibrillation that is discovered because patients feel that their heart is not beating in rhythm or because they experience palpitations. However, there were two large studies last year that showed that blood thinning is not necessarily beneficial for subclinical atrial fibrillation. It can indeed reduce the rate of stroke. But because stroke is very rare in patients who do not feel their arrhythmia at all, the risks from the higher bleeding rate as a result of blood thinning are greater than the benefits of reducing the risk of stroke. So we currently do not know for sure how best to treat patients whose atrial fibrillation is still subclinical.

Are there other applications for wearables in cardiology?

Trackers and smartwatches can help in many areas of cardiology. For example, they can monitor activity in patients with heart failure. If patients move less than recommended, it indicates that they are not yet receiving enough medication. Sick patients are usually motivated to move. If they do not manage to do so, it shows that their heart is too weak despite the treatment. In another study, we also monitored patients after they had been discharged from hospital who had undergone surgery for heart valve defects. If they were active after the operation, this indicated that things were going well.

Are there any dangers associated with the devices? Perhaps because people are unnecessarily worried by false alarms?

This is a very important topic. In fact, a recent study shows that younger people who wear wearables mostly have anxiety disorders and go to the doctor more often than people who don’t wear them. Whatever the cause and effect here, it is something that needs to be considered – also with regard to the medical system. If more people wear smartwatches in the future, this could also lead to emergency rooms becoming overcrowded.

Would you also advise young, healthy people against using the devices?

I have personally bought every generation of these smartwatches so far. For that reason alone, I cannot tell anyone to stay away from them. You can get very important information from these devices, but you also have to be able to interpret it correctly. In the future, it would be important for doctors to be able to assess findings online and be paid for.

Editor’s note: In SZ Health Forum Experts will speak at Wednesday, September 18th from 7.30pm online about the benefits and potential risks of smartphones and fitness trackers and where they are already in the medicine Questions from viewers will also be answered. Participation is free, but registration for the live stream is required sz.de/experience .