Fewer Americans with or at risk for cardiovascular disease (CVD) used a wearable health monitoring device than the general population, according to a nationally representative sample using 2019-2020 Health Information National Trends Survey (HINTS) data.

Only 18% of adults with CVD and 26% of those at risk for CVD reported using a wearable device to monitor their health and overall activity, compared with 29% of the general population, found Rohan Khera, MD, MS, of the Yale School of Medicine in New Haven, Connecticut, and colleagues.

Of those with CVD who owned one of these devices, only 38% used it every day. Meanwhile, nearly half of those at-risk or in the general population sported their device daily, the group reported in JAMA Network Open.

An estimated 83% and 81% of those with and at-risk for CVD shared their device data with their clinicians, respectively.

“While we increasingly recognize the potential role of smartwatches and other wearables in cardiovascular monitoring, the use of those most likely to derive benefits is low,” Khera told MedPage Today.

“These devices have several sensors and monitors that track health and lifestyle, including step count, exercise, heart rate variability, and sleep. They can also detect heart arrhythmias, such as atrial fibrillation,” he explained. “Novel sensors on some devices allow getting ECGs and oxygen levels.”

“This wealth of information will progressively be used in clinical care,” Khera added. “However, patients with cardiovascular disease had lower use than the general population. We also found a concerning but not unexpected gradient across income, education, and age, with underuse in our higher-risk populations.”

Older age (over 65 vs 18-49 years), lower education (high school vs higher education), and lower household income (under $20,000 vs over $50,000) were each independently tied with a significantly lower likelihood of device use in individuals with CVD and at-risk for CVD:

• Older age: OR 0.22 (95% CI 0.09-0.56) and OR 0.35 (95% CI 0.26-0.48), respectively
• Lower education: OR 0.27 (95% CI 0.11-0.63) and OR 0.35 (95% CI 0.24-0.52)
• Lower household income: OR 0.29 (95% CI 0.11-0.76) and OR 0.42 (95% CI 0.29-0.60)

Adults 65 and over had the lowest likelihood of device use, despite this age group representing half of all adults with CVD. When it came to risk factors for participants with CVD, cigarette smokers were 91% less likely to wear one of these devices. Those with CVD and diabetes were also significantly less likely to wear one.

The steep contrast in device use between groups stood out to Raj Khandwalla, MD, of the Smidt Heart Institute at Cedars-Sinai in Beverly Hills, who wasn’t involved with the study.

“I think we would all expect, in this field, that folks who are older are going to use their devices less than younger folks,” Khandwalla told MedPage Today. “That wasn’t as surprising. But the disparity between income and educational attainment was stark.”

Khera added that, “As new remote monitoring strategies increasingly rely on digital tracking of patients, these disparities in the utilization of these devices will be important to address. We cannot afford to deepen the outcome disparities in our most vulnerable patients by relying on technology unless we can ensure equitable access.”

The researchers pointed out that device cost and technological accessibility for older individuals prove to be barriers to greater widespread access.

While these differences could potentially exacerbate health disparities, Khandwalla said that there is no conclusive research showing that wearable device use leads to improved outcomes, and its an “area of investigation.”

While wearable health monitoring devices have become increasingly common, Isaac George, MD, of NewYork-Presbyterian/Columbia University Irving Medical Center in New York City, told MedPage Today that more data on the reliability and accuracy of their data output are necessary.

“Currently, we have access to data on implantable devices such as pacemakers or the implanted monitors for heart pressures, that can help physicians treat patients and ultimately assist in preventing heart failure. It is important to note that those devices provide much more specific data points,” said George, who also was not involved with the study. “Ultimately, we will have to figure out if the data that is captured by wearables is able to be utilized in clinical settings, and I’m hopeful that this is where AI can come in to help automate the data gathering and interpretation.”

“While the study is observational, it does give us insight into how important wearables can be and leaves us with some important questions,” said George — How will the data be used? Who is responsible for checking and understanding the data? How can the field become more user friendly?

A 2022 review of wearable health devices for CVD monitoring found that smartwatches and wristbands accounted for the largest share of commercially available devices. It noted that consumers lean on these types of devices more than CVD biomedical variable monitoring patches due to their comfort and ease of use in daily life. Only 58% of the commercial devices reviewed by the NIH had “some FDA approval.”

The population-based cross-sectional study included participant data from 9,303 adults in HINTS, representing 247 million U.S. adults (mean age 49 years, 51% women).

Of these, 10% had a history of CVD (heart attack, angina, heart failure), representing approximately 20 million adults with CVD (mean age 62 years, 43% women); and 55.7% had CVD risk factors (hypertension, diabetes, obesity, smokers), a group that represented 135 million adults (mean age 51 years, 43% women).

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