Wearable Devices Show Promise for Heart Rate, Sleep of Hospitalized Patients

Wearable devices show promise for monitoring the heart rate and sleep of patients in hospitals, according to the findings of a recent systematic review.

Older patients are frailer after hospitalization and have a high chance of readmission. Low activity and poor sleep during hospital stays could lead to such instances of readmission. Continuously monitoring those items by using wearables could reduce the prevalence.

Vikas Patel, B.M.Sc., M.D., and a team of Toronto-based investigators conducted a systematic review to evaluate the validity and utility of wearable devices for monitoring hospitalized patients. They identified articles on three main concepts: wearables, monitoring, and inpatients.

Databases were searched and articles were screened by two reviewers. Eligible studies included medical or surgical patients at least 18 years old, wearable devices (watch, vest, pendant, jewelry, headset, and wristband), described an element of continuous monitoring for at least 24 hours, and described the measurement of at least one digital biomarker other than just physical activity or standard hospital telemetry for heart rate recording.

The two reviewers extracted data such as year of publication, study setting and design, number of participants, gender ratio, mean age of participants, digital biomarkers measured, average and maximum duration the wearable was worn, and patient completion rate. Additional information included the types of wearables worn — medical grade (approved or cleared by the FDA), research grade (used typically in research settings), and consumer grade (used generally by consumers), and the placement sites on the body.

Overall, 14 studies were included in the systematic review. Of them, nine different types of commercial wearables were described, and seven different health variables were assessed. The mean patient completion rate was more than 90%.

There were five studies that assessed heart rate accuracy. A wearable sensor accurately detected tachycardia with a sensitivity of 90% and specificity of 97%. In another study, Fitbit-derived heart rate values were slightly lower than those from continuous electrocardiography monitoring, but a majority were within five beats per minute.

Six studies used wearables to assess sleep. Two assessed whether wearable readings were reliable. Findings of one study demonstrated self-reported sleep correlated with the actigraphy-recorded number of awakenings. Another study’s findings revealed a moderate correlation between wearable-derived sleep duration and questionnaire-derived sleep quality.

Three articles gave insight into wearables’ accuracy at measuring the respiratory rate of patients. In one, it was reported there was a strong correlation between wearable and manual respiratory rate readings.

Investigators found evidence to support the use of Fitbit, ViSi Mobile, and the HealthPatch to measure heart rate because both were validated against intermittent and continuous reference standards. Many devices were not validated in inpatient settings, and readings from most that were validated in such settings had wide limits of agreement.

The team suggested future research to determine the accuracy of the digital biomarkers of hospitalized patients and to learn if wearables improve the health outcomes of hospitalized patients.

The study, “Evaluating the Validity and Utility of Wearable Technology for Continuously Monitoring Patients in a Hospital Setting: Systematic Review,” was published online in JMIR mHealth and uHealth.