It’s no secret that Apple sells theApple Watchbased in part on its life-saving abilities. In at least two different ads, the company has suggested, not at all discreetly, that if people weren’t wearing an Apple Watch they would have died.
Features like automatically calling emergency services after a car crash or a fall go a long way towards keeping people safe, but thepreventative health featuresfor identifying chronic cardiovascular health problems can be just as much, if not more impactful, and they’ve proliferated across the smartwatch landscape since Apple started pushing them.
“Wearable Devices, Health Care Use, and Psychological Well‐Being in Patients With Atrial Fibrillation,” a new study published in theJournal of the American Heart Associationfound that widespread wearable use might not only be a positive thing, however. In particular, for patients with atrial fibrillation (AFib), an irregular heartbeat in the upper chambers of the heart, wearing a smartwatch may even increase the stress and anxiety caused by their condition, and put even greater demands on the healthcare system.
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Sorting through the data
What do you do with all the things your watch tells you?
The amount of raw data smartwatches collect naturally leads to questions, according to Lindsey Rosman, Ph.D, one of the researchers behind the study and an Assistant Professor of Medicine in the Division of Cardiology at the University of North Carolina School of Medicine.
“I have a clinic one day per week where I see patients who are referred to me from our cardiology providers. And over the course of several years, we just kept noticing that folks were coming in with lots of questions and lots of concerns about information they were getting from their wearable devices,” Dr. Rosman says.
Those concerned patients led Dr. Rosman and her colleagues to conduct a case study investigating the issue, which revealed a similar trend. “So we wanted to get a bigger sample and better understand whether folks who use wearables may have more anxiety about their heart and their device than folks who aren’t using wearables,” she says.
Smartwatches provide a lot of information with little context, something that itself can be stressful, and according to Dr. Rosman, “patients with cardiovascular conditions have a higher rate of anxiety than people who don’t have a cardiovascular condition.” Explaining what could be causing that stress and anxiety makes it easier to avoid, and could prevent putting even more demands on the healthcare system helping these patients.
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Connecting smartwatch ownership to healthcare use
The study Dr. Rosman and her colleagues constructed ultimately connected information from electronic health records (EHR) and multiple surveys and questionnaires to analyze 172 different AFib patients, 83 of which owned and or used a smartwatch.
How these patients were accessing and using the healthcare system both formally (appointments, procedures, etc.) and informally (patient portal messages, doctor calls, etc.), along with a psychological profile were established, and statistical analysis was applied to the results.
Patients who had wearables were also found to be more concerned about the treatment they were receiving for AFib in general.
Using the survey data, Dr. Rosman’s team was able to identify when a smartwatch was purchased and how a patient’s healthcare usage changed after they started using a watch. There are some limitations, of course: The reason why these patients purchased a wearable in the first place is unknown and there could be selection bias in the sense that the study included wearable users who might have already been overly concerned with their heart. But the findings published in the study are still illuminating.
Smartwatches impact anxiety and healthcare use
Wearables affect patients' relationship with their symptoms
According to the study, “individuals who used wearables reported higher mean scores on measures of cardiovascular symptom monitoring and preoccupation” than the patients participating who didn’t have a wearable. Patients who had wearables were also found to be more concerned about the treatment they were receiving for AFib in general.
And all of these findings were without any obvious differences between the patients. “When we looked at patients' psychological characteristics, folks who had generalized anxiety, depression, they didn’t differ between wearable users and non-users,” Dr. Rosman says. “The only psychological difference was that intense preoccupation with their symptoms and the dissatisfaction with their current cardiovascular care.”
Wearables affect healthcare use
Those effects on how patients' feel about their condition trickle down to how they interface with the healthcare system. “Patients with wearables were significantly more likely to receive ECGs, echocardiograms / transesophageal echocardiograms and ablation procedures than those without a wearable,” the study says.
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Wearable users were also far more likely to use informal healthcare resources, including sending significantly more messages to their healthcare providers than patients without wearables. According to Dr. Rosman, those kinds of messages and calls “can be very time-consuming for providers and are typically not reimbursable hours.” That kind of extra work can have a significant impact on doctors and contribute to higher levels of burnout over time.
Not everyone benefits from a smartwatch
We need better education on what smartwatches can do
“If you think about it, if you’re constantly reminded that you have this cardiological condition, that could have a significantly negative impact on your quality of life,” Dr. Rosman says. That’s really the heart of the whole study. These patients already knew they had AFib, but their smartwatches and fitness trackers would remind them of their irregular heartbeats all the same. That appeared to lead to more stress, more worry about a condition they were already receiving treatment for, and more time demanded from healthcare providers already struggling to meet demand.
These patients already knew they had AFib, but their smartwatches and fitness trackers would remind them of their irregular heartbeats all the same.
Because of the limitations of the study, Dr. Rosman says that what’s been established is an association between AFib patients with wearables and anxiety, as opposed to definitive proof wearables are putting patients on edge. The hope, though, is that it sparks interest in a “robust randomized trial” that can iron out the limitations, and “make it more clear whether these devices are causing anxiety.”
And if there’s any urgency to that goal, it’s because the number of wearable users is only going to increase. “We’re going to need a system in place to manage the data deluge,” Dr, Rosman says. That could look like the device clinics that were set up to manage the new information produced when pacemakers became commonplace, or just encouraging patients to not use a smartwatch unless it’s actually beneficial.
Providers and patients alike need education about what these devices can and cannot do.
“I think there’s been a push over the last couple of years of ‘wearables are great for everyone’ and I don’t necessarily think that’s the case,” Dr. Rosman says. For as many people who feel safer and more informed with their watch on (64% of the wearable wearing participants in Dr. Rosman’s study), there may be just as many people who really don’t benefit from all the stimuli a smartwatch can provide.
Identifying if smartwatches cause anxiety will help, but a better understanding of what these devices do is needed too. “Providers and patients alike need education about what these devices can and cannot do,” Dr. Rosman says. That falls on a company like Apple to be more clear about what the Apple Watch tracks and health conditions it can actually identify, and providers to know the best practices around these tools and how to keep their patients from being overwhelmed by them.
Until then, as wearables get more popular, and pick up more and more elaborate skills, they’ll only get noisier. And that’s noise that, on the wrong wrist, might just end up making everyone more uncomfortable.
