Wearable Devices Can Improve Quality of Life in Chronic Heart Failure

Abstract

Introduction: Chronic heart failure (HF) requires ongoing management of diet and medications in order to avoid HF exacerbation that may cause troublesome symptoms and require acute intervention or hospitalization. In many cases, implanted device data (i.e. from cardiac resynchronization therapy (CRT) device or pulmonary artery pressure monitor show physiological changes in resting heart rate (HR) and intrathoracic fluid prior to clinical symptoms (i.e. weight gain, dyspnea, edema). However, implanted device data are not generally available to patients to enable anticipatory therapeutic changes. Hypothesis: Consumer wearable devices may offer an opportunity to enhance patient self-management, avoid HF exacerbation, and improve quality of life (QoL). Methods: In a 4-month pilot observational study, subjects with HF and an implanted CRT device wore a Jawbone Up3 device continuously. After 1 month, Jawbone resting HR data were compared to CRT device data to determine Jawbone HR signals that correlate to increased intrathoracic fluid measurements. Subjects were instructed to contact their HF care team in the event of individualized elevated resting HR signals. Subjects assessed QoL using valid and reliable psychometric instruments (Minnesota Living with Heart Failure [MLHF], SF-36) at the beginning and end of the study. Results: Eight of 11 subjects completed the 4-month study. Two subjects had poor correlation of HR data between Jawbone and CRT device without actionable signals to indicate impending HF worsening. No adverse events were reported. 6 of 8 subjects had improvement in MLHF score, with 5 subjects reaching clinical significance (>5 point change). There was statistically significant improvement in physical subscore (P = .03), non-significant improvement in total score (P = .07), and nonsignificant change in emotional subscore. SF-36 demonstrated significant improvement in emotional wellbeing (P = .03) with nonsignificant changes in other scales. Conclusions: In this pilot study, patients experienced no adverse outcomes and some evidence of clinically relevant improvement in quality of life after wearing a consumer-grade health monitor to track resting heart rate. Limitations included small sample size, as well as imprecision of the wearable monitor for resting HR data. In addition, permanent pacing limited the utility of resting HR data for several subjects. These pilot findings suggest that self-monitoring with a wearable device may improve quality of life for patients with HF, including perceived physical function and emotional wellbeing. Further study is needed to better characterize the utility of wearable devices to enable self-monitoring and improved HF outcomes.