Tech in Medicine: Are Smartwatches Changing the Way We Practice?

Smartwatches and other wearable fitness trackers are everywhere—and they’re doing way more than counting steps. These devices now track heart rate variability (HRV), flag irregular heart rhythms, and even record single-lead ECGs. Cool, right? But what happens when a patient walks in with their wrist buzzing and a bunch of data they want us to interpret? Let’s dive into the world of wearables and what they mean for us as healthcare providers!

HRV: The Buzzword Patients Keep Asking About

So, what is HRV? It’s basically the variation in time between heartbeats—specifically, the R-R intervals on an ECG. It’s all about the battle between your sympathetic (fight-or-flight) and parasympathetic (rest-and-digest) nervous systems.

Here’s the gist:

• High HRV = Good. Higher HRV at rest indicates a healthy balance between sympathetic and parasympathetic activity—it’s associated with being young, physically fit, and in good overall health.
• Low HRV = Uh-oh. It can point to stress, autonomic dysfunction, or underlying issues like diabetes, heart disease, or poor fitness. Low HRV can predict problems in the future like hypertension.

The Catch: HRV is context-dependent. It’s only meaningful in certain situations (like at rest). If someone’s got a cold, just ran a 5K, or is mid-panic about their smartwatch reading, their HRV is naturally going to dip. Context matters!

What About Arrhythmias? Can Smartwatches Catch Those?

Here’s where things get interesting (and occasionally annoying). Most smartwatches use optical sensors to detect heart rate and can flag irregular rhythms that might be atrial fibrillation (AF). Some can even do a single-lead ECG if you put your finger on the watch.

How good are they?

• Studies like the Apple Heart Study show pretty solid accuracy, with most irregular rhythm notifications matching up with AF on further testing.
• BUT (there’s always a but), they’re not perfect. False positives happen, especially in younger folks, and some readings end up inconclusive.

If a patient shows up with smartwatch data suggesting AF, it’s worth following up with a proper 12-lead ECG in the office, and considering event monitor placement. There is technology available to export and ECG and print it for your EHR, but at the current time, this doesn’t count as a vetted diagnosis for arrhythmia. 

The Pros and Cons of Smartwatches in Medicine

The Good Stuff:

• Patients Are Engaged: People are paying attention to their health, and that’s a win.
• Early Detection: Devices can catch arrhythmias like AF that might otherwise go unnoticed.
• Convenience: Patients can gather data in real time—no bulky Holter monitors required.

The Not-So-Good Stuff:

• Accuracy Gaps: They can be off, especially during exercise or for people with darker skin tones or obesity.
• No FDA Oversight: Most wearables aren’t regulated, so quality can vary.
• Equity Issues: These gadgets aren’t cheap, and not everyone can afford them.

So, What Should You Do When Patients Bring You Data?

• Set Expectations: Explain that wearable data is cool but not perfect. Context is everything!
• Acknowledge Their Effort: They’re taking control of their health, and that’s awesome.
• Decide on Next Steps: If the data raises red flags (like AF), follow up with proper testing.

For HRV, steer the conversation toward overall health. Rather than fixating on boosting HRV, encourage patients to focus on fitness, managing stress, and addressing any underlying conditions.

The Future of Smartwatches in Healthcare

Smartwatches are here to stay, and the technology is only going to improve. Imagine athletic gear that monitors your heart rate or wearables that integrate seamlessly into electronic health records. That said, we’ve got some hurdles to clear first:

• Regulation: No FDA oversight means variable quality.
• Integration: How do we get this data into our workflow?
• Equity: We need to make sure everyone can benefit, not just the tech-savvy or well-off.

The best part? Patients are more involved in their health than ever before. This isn’t just about gadgets—it’s about empowerment. And that’s something we should embrace, even if it means deciphering a few messy ECG strips along the way.

What This Means for Your Practice 

Smartwatches are a fun, promising addition to healthcare, but they’re not perfect. They’re like the overenthusiastic intern—super helpful sometimes, but also prone to getting things wrong. With a little patience (and maybe a grain of salt), they can be a great tool to engage patients and guide care.

This content includes material generated by ChatGPT to aid in the editing process. All material has been human-reviewed and approved by our content team.