Multi-sensor wearables re-shaping care of chronic heart-failure: A narrative review

Heart-failure decompensation often evolves between visits, driving recurrent admissions and cost. Multi-sensor wearables, adhesive patches, smart watches, and garments capture electrocardiography, thoracic impedance, photoplethysmography, respiration, activity, and speech for near-real-time review. Evidence synthesis indicates two signals. First, integrated telemonitoring, combined with structured clinical intervention during the post-discharge vulnerable phase, reduces cardiovascular events and heart failure hospitalisations in randomised programmes. Second, device-level performance metrics (lead time, alert burden, detection accuracy) demonstrate early warning capability but do not alone establish outcome benefit. Implantable multi-sensor algorithms offer a median lead time of approximately one month, accompanied by manageable alert rates. External systems that estimate lung fluid or fuse wearable signals demonstrate promising feasibility, although large pragmatic trials remain limited. Consumer smartwatches achieve high accuracy for detection of atrial fibrillation in general population; however, evidence is lacking for detection of heart failure decompensation, or for improving the outcome. Key implementation issues include AI-validation, workflow-linked triage, cost-effectiveness, cybersecurity, and equitable access for low- and middle-income settings. Multi-sensor monitoring warrants targeted deployment within intervention pathways and rigorous evaluation focused on patient-important outcomes.