Wearable cardiac monitoring: where are we now and where are we going?


Take Home Messages
  • Advances in non-invasive heart rate & rhythm monitoring are progressing faster than we can validate new technologies.
  • Devices differ in duration of monitoring and type of data provided: from continuous heart rate data to 30-second ‘event’ six-lead ECG traces.
  • Leadless alternatives to traditional Holter monitors are preferred by patients but most are not currently available on the NHS due to lack of validity and cost-effectiveness data.
  • Interpreting data from patients’ self-initiated cardiac monitoring is a challenge and is likely to constitute an increasing proportion of our cardiology workload over the coming decades.
  • Other challenges for the future include: liability and data protection, exacerbation of health anxiety and health inequality.

Non-invasive ambulant cardiac monitoring is on the rise (1). There is now a dizzying (pardon the metaphor!) array of products that allow patients to monitor their heart rate and electrocardiogram (ECG), often without needing to consult a clinician. Many patients (or should we call them ‘consumers’?), opt to do so, even in the absence of symptoms or cardiovascular abnormality. Few of the newer wearable technologies are currently funded on the NHS, but patients bring their self- funded gadgets’ data to our clinics. As cardiologists we need to know: what are the different products capable of? How can we use these newer devices and their data in our practice? And what are the future challenges we face in this new world of patient-initiated cardiac monitoring?