Wearable Heart Rate Tracking Linked to Increased Anxiety in AFib Patients

Lindsey Rosman, PhD

Credit: UNC School of Medicine, Department of Medicine, Division of Cardiology

A new study found patients with atrial fibrillation (AFib) who used wearables to track their heart rate were associated with being more likely to monitor their symptoms and be preoccupied.¹

“The current study begins to answer important questions that move beyond whether wearables can safely and reliably detect arrhythmias, to understanding how these devices are being used by diverse segments of the population, and their impact on health care use and overall well‐being,” investigators wrote. “Our findings suggest that while many individuals with AF may benefit from using wearable devices, a considerable proportion may experience unintended, adverse effects.”

More and more people with AFib are using wearables for symptom monitoring. The wearable alerts heart rates and irregular rhythm notifications, using an electrocardiogram. However, it is not known how checking heart rhythm fluctuates through the day could impact their psychological well-being or their desire to seek a doctor.

Investigators, led by Lindsey Rosman, PhD, from the department of medicine at the Division of Cardiology University of North Carolina at Chapel Hill, conducted a retrospective, propensity-matched study of patients with AFib. Roseman and colleagues used survey and electronic health record data to examine how specific (outpatient or inpatient visits, rhythm-related testing, and procedures) and informal health care use (telephone calls and patient messages) for AFib over a 9-year month period compared between wearable users and nonusers. They also evaluated the effects of wearable cardiac monitoring features on patient behavior and well-being.

The study included 172 patients with AFib with a mean age of 72.6 ± 9.0 years and 42% women. Most participants were White men with paroxysmal AFib fibrillation, had underlying cardiovascular disease, such as hypertension and coronary artery disease, and had prescriptions for β blockers, statins, and anticoagulation medications. In total, 83 patients used a wearable.

Most of the participants wore wearable devices nearly every day (93%), with the most popular devices being the Apple Watch (56%) and Fitbit (31%). Wearable users were slightly younger in age (71 vs 74 years) and more likely to have an implanted cardiac device at baseline than nonusers.

Compared with nonusers, wearable users reported greater rates of symptom monitoring, preoccupation (P = .03), and AFib fibrillation treatment concerns (P = .02). Monitoring symptoms has led 20% of wearable users to experience anxiety and to always contact their doctor after receiving an irregular rhythm notification. Wearable users sent significantly more messages to healthcare providers than nonusers (3.59 [95% CI, 2.57–4.61] versus 2.41; 95% CI, 1.82 – 3.0; P = .04).

“While our data cannot determine directionality between wearable devices and adverse psychological outcomes, it is possible that fear and uncertainty may drive some patients with [AFib] to engage in hypervigilant self‐monitoring behaviors with a wearable in an attempt to ‘control’ or mitigate distress associated with an unpredictable heart rhythm disorder,” investigators wrote.

Investigators saw after matching, specific healthcare use for AFib was significantly greater among wearable users compared with nonusers (4.05; 95% confidence interval [CI], 2.91 – 5.18; vs 2.70; 95% CI, 1.99 – 3.41; P = .04), with significantly greater rates of electrocardiogram, echocardiograms/transesophageal echocardiogram, and ablation. Additionally, wearable users were significantly more likely to use informal healthcare resources compared to nonusers (P = .05).

“Given the significant increase in use of wearable devices in this patient group (and the population in general),” Rosman said in a press release.² “We believe prospective studies and randomized trials are needed to understand the net effects of wearables—including their alerts—on patients’ healthcare use and psychological well‐being, as well as the downstream effects on providers, hospitals, and health systems.”

References

1. ^{Rosman L, Lampert R, Zhuo S, et al. Wearable Devices, Health Care Use, and Psychological Well-Being in Patients With Atrial Fibrillation. J Am Heart Assoc. Published online July 16, 2024. doi:10.1161/JAHA.123.033750}
2. ^{Wearable Devices Can Increase Health Anxiety. Could They Adversely Affect Health? EurekAlert! July 24, 2024. https://www.eurekalert.org/news-releases/1052495. Accessed July 26, 2024.}