Association of Wearable Device Use With Pulse Rate and Health Care Use in Adults With Atrial Fibrillation
Authors: Libo Wang, Kyron Nielsen, Joshua Goldberg, Jeremiah R. Brown, John S. Rumsfeld, Benjamin A. Steinberg, Yue Zhang, Michael E. Matheny, Rashmee U. Shah
Journal: JAMA Network Open (2021)

<h3>Importance</h3> Increasingly, individuals with atrial fibrillation (AF) use wearable devices (hereafter<i>wearables</i>) that measure pulse rate and detect arrhythmia. The associations of wearables with health outcomes and health care use are unknown. <h3>Objective</h3> To characterize patients with AF who use wearables and compare pulse rate and health care use between individuals who use wearables and those who do not. <h3>Design, Setting, and Participants</h3> This retrospective, propensity-matched cohort study included 90 days of follow-up of patients in a tertiary care, academic health system. Included patients were adults with at least 1 AF-specific<i>International Statistical Classification of Diseases and Related Health Problems, Tenth Revision </i>(<i>ICD-10</i>) code from 2017 through 2019. Electronic medical records were reviewed to identify 125 individuals who used wearables and had adequate pulse-rate follow-up who were then matched using propensity scores 4 to 1 with 500 individuals who did not use wearables. Data were analyzed from June 2020 through February 2021. <h3>Exposure</h3> Using commercially available wearables with pulse rate or rhythm evaluation capabilities. <h3>Main Outcomes and Measures</h3> Mean pulse rates from measures taken in the clinic or hospital and a composite health care use score were recorded. The composite outcome included evaluation and management, ablation, cardioversion, telephone encounters, and number of rate or rhythm control medication orders. <h3>Results</h3> Among 16 320 patients with AF included in the analysis, 348 patients used wearables and 15 972 individuals did not use wearables. Prior to matching, patients using wearables were younger (mean [SD] age, 64.0 [13.0] years vs 70.0 [13.8] years;<i>P</i> &lt; .001) and healthier (mean [SD] CHA<sub>2</sub>DS<sub>2</sub>-VASc [congestive heart failure, hypertension, age ≥ 65 years or 65-74 years, diabetes, prior stroke/transient ischemic attack, vascular disease, sex] score, 3.6 [2.0] vs 4.4 [2.0];<i>P</i> &lt; .001) compared with individuals not using wearables, with similar gender distribution (148 [42.5%] women vs 6722 women [42.1%];<i>P</i> = .91). After matching, mean pulse rate was similar between 125 patients using wearables and 500 patients not using wearables (75.01 [95% CI, 72.74-77.27] vs 75.79 [95% CI, 74.68-76.90] beats per minute [bpm];<i>P</i> = .54), whereas mean composite use score was higher among individuals using wearables (3.55 [95% CI, 3.31-3.80] vs 3.27 [95% CI, 3.14-3.40];<i>P</i> = .04). Among measures in the composite outcome, there was a significant difference in use of ablation, occurring in 22 individuals who used wearables (17.6%) vs 37 individuals who did not use wearables (7.4%) (<i>P</i> = .001). In the regression analyses, mean composite use score was 0.28 points (95% CI, 0.01 to 0.56 points) higher among individuals using wearables compared with those not using wearables and mean pulse was similar, with a −0.79 bpm (95% CI −3.28 to 1.71 bpm) difference between the groups. <h3>Conclusions and Relevance</h3> This study found that follow-up health care use among individuals with AF was increased among those who used wearables compared with those with similar pulse rates who did not use wearables. Given the increasing use of wearables by patients with AF, prospective, randomized, long-term evaluation of the associations of wearable technology with health outcomes and health care use is needed.