Researchers examined data from health claims and clinical notes for 16,320 patients with atrial fibrillation to identify 125 individuals whose records indicated they used wearables. The patients who used wearables were matched 1:4 with 500 individuals whose records made no mention of wearables.
For the analysis, researchers followed patients for 90 days from an index date to determine if there were differences between the two groups in mean pulse rate or health care utilization. The index dates were set by the first mention of wearables in the health records for people included in that group; controls had an index date set by a health care visit for atrial fibrillation within 60 days of their matched individual in the wearables group.
Over the 90-day follow-up period, there was no significant difference in mean pulse rate between the wearables group (75.01 beats per minute) and the matched controls (75.79 beats per minute), researchers report in JAMA Network Open.
Health care utilization related to atrial fibrillation was higher, however, for the wearables group based on a composite score of clinical encounters for treatments the study team identified as being potentially triggered by a wearable, such as cardioversions and prescription orders.
Mean health care utilization scores were significantly higher among patients who used wearables (3.55; range 0-8, with higher scores indicating higher utilization) than among those who didn't (3.27). In particular, the proportion of patients who underwent ablation was significantly larger in the wearables group (17.6%) than the control group (7.4%).
"Patients who use wearables may have more severe or symptomatic disease at baseline, which could explain more interactions with the healthcare system," said senior study author Dr. Rashmee Shah, of the division of cardiovascular medicine at the University of Utah School of Medicine in Salt Lake City.
"But one must also consider the hypothesis that the wearables alert users to heart rates and rhythms that would have otherwise been unknown," Dr. Shah said by email. "This pattern could lead to more interactions with the healthcare system, as well."
One key unanswered question is whether more atrial fibrillation treatments, triggered by wearables or not, might help patients feel better or live longer, Dr. Shah said. This makes it hard to say at this time whether wearables might be a cost-effective tool for managing atrial fibrillation.
The study was done at a single center, and results may not be generalizable to other populations, the authors note. The researchers also lacked data on how the wearables were configured, and whether these devices gathered only pulse measurements or also included rhythm classification software.
"At least in this single-center study, patients using wearables were younger with fewer comorbidities, less likely to be socioeconomically deprived, and more likely to seek care than patients with atrial fibrillation who did not use wearables," said Dr. Paul Varosy, director of cardiac electrophysiology at the VA Eastern Colorado Health Care System and a professor of medicine at the University of Colorado Anschutz Medical Campus, in Aurora.
More studies like this one are still needed, however, to help provide context to clinicians on how wearables might be used effectively in the future to help manage patients with atrial fibrillation, Dr. Varosy, who wasn't involved in the study, said by email.
"This context is important, since wearables are mostly chosen by patients with or without the involvement of their providers, unlike most other medical diagnostic tools, which are largely prescribed by the health care team," Dr. Varosy said.
SOURCE: https://bit.ly/3yTWyg3 JAMA Network Open, online May 27, 2021.
By Lisa Rapaport
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