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Wearable devices, ischemic heart disease and cardiovascular outcomes: A systematic review and meta-analysis
Julia M A Ballavenuto1, Nisachon Tongtip1, Nina L S Fischer1
1Applied Health Sciences, School of Health Sciences, College of Medicine and Health, University of Birmingham, Birmingham, United Kingdom.
Insights
Wearable devices show potential benefits for patients with ischemic heart disease, reducing major adverse cardiovascular events and all-cause mortality. However, more high-quality research is needed to support their routine use alongside standard care.
Area of Science:
- Cardiology
- Digital Health
- Clinical Trials
Background:
- Ischemic heart disease (IHD) poses a significant global health burden.
- Wearable devices offer continuous physiological monitoring, potentially aiding in cardiovascular disease management.
- The integration of wearable technology into standard care for IHD patients requires robust evidence.
Purpose of the Study:
- To assess the impact of wearable devices, when used with usual care, on major adverse cardiovascular events (MACE) in IHD patients.
- To compare outcomes between IHD patients using wearables plus usual care versus usual care alone.
Main Methods:
- Systematic review and meta-analysis of randomized clinical trials (RCTs).
- Included studies involved adult patients with IHD using wearable devices and reporting cardiovascular outcomes.
- Searches conducted across multiple databases (MEDLINE, EMBASE, Cochrane Library, etc.) in April 2024; risk of bias assessed using Cochrane Risk of Bias tool.
Main Results:
- Six moderate-quality studies were included.
- Wearables demonstrated a significant reduction in major adverse cardiovascular events (MACE) (RR 0.75) and all-cause mortality (RR 0.64).
- No significant effects were observed for myocardial infarction, cardiovascular mortality, hospitalizations, arrhythmias, or heart failure; evidence quality was low to very low.
Conclusions:
- Wearable devices show promising effects in improving certain cardiovascular outcomes for IHD patients.
- Current evidence is limited by low to very low certainty, precluding strong recommendations for routine use.
- Large-scale, high-quality RCTs are necessary to establish the efficacy and guide the integration of wearables in IHD management.
Objectives:
To evaluate the impact of wearable devices when associated with usual care on the incidence of major adverse cardiovascular events (MACE) in patients with ischemic heart disease compared with usual care alone.
Methods:
Randomised clinical trials with patients aged 18 years and above with ischemic heart disease, using wearable devices and assessing at least one of the primary outcomes (myocardial infarction, stroke, cardiovascular mortality, or major adverse cardiovascular events) or secondary outcomes (all-cause mortality, hospitalisation, all arrhythmias, heart failure, unstable angina or revascularisation procedures) were included. MEDLINE, EMBASE, Cochrane Library, CINHAL, INAHTA and the Web of Science Core Collection were searched in April 2024. Studies were also identified via citation searching. Cochrane Risk of Bias version 1 was applied as provided in Covidence. Meta-analyses were performed when possible.
Results:
Six studies of moderate quality were included. Wearables showed positive effects in reducing major adverse cardiovascular events (RR 0.75, 95 % CI 0.57-0.98, two studies) and all-cause mortality (RR 0.64, 95 % CI 0.43-0.96, three studies); no significant effects were found on myocardial infarction (RR 0.89, 95 % CI 0.59-1.34, four studies), cardiovascular mortality (RR 0.35, 95 % CI 0.07-1.73, three studies), hospitalisations (RR 0.77, 95 % CI 0.56-1.07, five studies), all arrhythmias (RR 1.10, 95 % CI 0.49-2.48, two studies), and heart failure (RR 0.85, 95 % CI 0.61-1.18, two studies). Meta-analysis could not be performed for stroke, unstable angina, and revascularisation procedures. Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence was deemed low or very low.
Discussion:
While wearables seem to have some positive effects for patients with ischemic heart disease, only weak recommendations for use are possible. More large-scale, high-quality randomised clinical trials are needed to recommend the routine use of wearables in combination with usual care.
Protocol Registration On Prospero:
CRD42024586137.
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