Perceptions of using smartwatches for the early detection of cardiac arrhythmias

doi:10.21203/rs.3.rs-4677442/v1

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Perceptions of using smartwatches for the early detection of cardiac arrhythmias

https://doi.org/10.21203/rs.3.rs-4677442/v1

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Background: As there is a growing trend toward a healthy lifestyle, wearable fitness trackers, such as smartwatches, are gaining interest in mentoring and detecting health issues earlier, particularly cardiac arrhythmia. Subsequently, there have been concerns about the accuracy of smartwatches and the results they generate. Therefore, this study was conducted to explore the public perception of using smartwatches for the early detection of cardiac arrhythmia, along with the current use of smartwatches among adults in five major regions of Saudi Arabia.

Methods: A cross-sectional study was conducted from May to October 2023. The study involved participants who were Saudi or non-Saudi, aged 22 or older, and who were willing to participate and share their perceptions of using smartwatches for the early detection of cardiac arrhythmia. The data were collected and recorded via a questionnaire that measures the current usage and public perceptions of wearable technology. The questionnaire was completed through face-to-face interviews with participants who met the inclusion and exclusion criteria.

Results: Our study revealed that the use of wearable fitness trackers is remarkably high. Nearly half of the participants (46.4%) reported actively using wearable technologies for health monitoring, with smartwatches being the most popular choice (42.0%). The factors affecting the use of these devices seem to be centered on age, education level, and income. Among 46.4% of users, 14.8% experienced the benefits of detecting irregular heartbeats. However, 49.5% of smartwatch users do not use an electrocardiogram (ECG) for monitoring.

Conclusion: There is growing interest in the use of wearable fitness trackers, especially smartwatches, for monitoring health issues such as cardiac arrhythmia. The positive perception of using this technology for the early detection of cardiac arrhythmia was significantly related to age and previous usage of these devices.

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Wearable fitness trackers have gained significant interest in the field of medicine and have revolutionized healthcare methods provided to patients. These devices not only track steps and mileage but also monitor ECG, heart rate, stress levels, oxygen levels, and sleep patterns. As a result, they have become essential for enhancing the early detection of any changes in a patient's health.^1–4 The integration of wearable fitness trackers in healthcare has opened up new possibilities for remote patient monitoring and personalized care.¹ These devices provide real-time data that can be used to identify potential health issues before they become serious. This has subsequently led to improved patient outcomes and reduced healthcare costs. One example of wearable fitness trackers is smartwatches, which have emerged as a popular alternative to traditional ECGs in the field of medicine.^4,6 In particular, there is a growing interest in using smartwatches to detect cardiac arrhythmia through ECG monitoring applications.⁵ ECG applications utilize a photoplethysmography (PPG) sensor that can calculate the pulse rate from the wrist, allowing patients to identify any abnormalities in the conductance pathway that may cause arrhythmia.^6,7

Cardiac arrhythmia is a condition characterized by unbalanced electrical activity leading to an accelerated, decelerated, or irregular heartbeat.⁵ This global issue significantly contributes to morbidity, mortality, and financial burden in both developed and developing nations,^8,9 with a prevalence rate ranging from 1.5–5% worldwide.¹⁰ Atrial fibrillation affects an estimated 34 million individuals globally.⁹ However, approximately one-third of patients with paroxysmal atrial fibrillation (AF) may not exhibit any symptoms, making early detection of these arrhythmias difficult. However, not all individuals are convinced about the early detection of cardiac arrhythmia through smartwatches, as they still harbor concerns or negative perceptions regarding using smartwatches for this purpose.¹⁰ Ultimately, the ability of smartwatches to detect cardiac arrhythmia depends on a variety of factors, including personal experience, scientific evidence, and cultural attitudes toward technology.^3,11 Additionally, the risk of false positives or negatives can lead to unnecessary anxiety or even a misdiagnosis.¹²

Considering that cardiac arrhythmias are serious medical issues that affect mortality and morbidity, it is essential to detect any early signs of cardiac arrhythmias. Nonetheless, early diagnosis through smartwatches cannot be achieved if the population has a negative perception of the usage of smartwatches. Our study aimed to explore the use of smartwatches for the early detection of cardiac arrhythmia. By examining the attitudes and beliefs of individuals toward this technology, we hope to gain a better understanding of its potential benefits and limitations. Our findings may inform future research and development in this area, ultimately leading to improved healthcare outcomes for patients with cardiac arrhythmia.

2.1. Study sample and design

A cross-sectional study was conducted in Saudi Arabia from May to October 2023, including the five main regions. The questionnaire was utilized as a tool to gather the data. The study targeted all individuals aged 22 years or older in Saudi Arabia. The minimum number of participants in this study was 385, with a 5% margin of error, a 95% confidence level, and a population size of 1,338,585. The sample size was determined using the Raosoft program. During the interviews, we asked the participants to complete standardized questionnaires. The study involved a total of 459 participants after applying the exclusion criteria. To maintain a high level of accuracy. We excluded all individuals under 22 years of age and those who did not live in Saudi Arabia.

2.2. Study measures and tools

The demographic questionnaire collected information about the participants' demographic profile, including their age, gender, place of residence, nationality, marital status, occupation, and current educational level. To gain insight into the current usage of wearable technologies, a questionnaire was used to explore the participants' current and past usage of wearable technologies, which specific devices they have used or are currently using, their preferred method of recording health-related measurements, and their opinions on future usage of such technologies. Additionally, a semiconstructed tool consisting of five items was used to assess the participants' perceptions of the benefits and potential usage of wearable technologies in healthcare. The questionnaire utilized a 5-point Likert scale, where 1 indicated strong agreement and 5 indicated strong disagreement. The participants were asked to provide their opinions on the statements presented in the questionnaire based on the Likert scale.^11,12

2.3. Statistical analysis

The data were analyzed using the latest version of the Statistical Package for the Social Sciences (SPSS) on Windows 10. Descriptive analyses were conducted, and the results are presented as the means ± standard deviations and percentages. The differences in the responses provided for wearable technologies according to profession, age group, gender, and education group were analyzed using the chi-square test. A P value of < 0.050 was considered to indicate statistical significance.

2.4. Ethics

This project was assessed and certified by King Faisal University’s committee of ethics (KFU- REC-2023-MAY-ETHICS907). Informed consent was obtained from all participants. The scales used in this research were all completed anonymously, and a numeric code was used.

The study included 459 participants, 37.3% male and 62.7% female. The respondents' ages were grouped into categories, with the young age group (22–31 years old) comprising more than half of the respondents (59.5%), while only 7.4% were > 51 years old, indicating a greater representation of younger adults. The majority of the respondents were Saudi nationals (95.0%), with a small percentage being non-Saudi (5.0%). Geographically, the participants were distributed across different regions: central (16.3%), western (20.9%), eastern (24.8%), northern (19.6%), and southern (18.3%). In terms of marital status, 48.4% were single, and 45.3% were married. Educationally, a considerable proportion had a university education or above (80.2%), while smaller percentages had educational levels ranging from illiterate to high school. The occupations of the respondents varied, with more than half (56.0%) being employed and 20.0% being students. (Table 1)

Almost half of the respondents (46.4%) reported having used wearable technologies for health monitoring, while the remaining 53.6% had not. Among wearable technologies, smartwatches have emerged as the most popular choice, with 42.0% of respondents indicating their usage or interest. In comparison, 11.3% of the respondents mentioned using smartphones for health monitoring, and 8.1% mentioned using smart wristbands. Interestingly, a notable proportion (26.8%) did not utilize any device or app for health monitoring. When recording health measurements such as weight, heart rate, and blood pressure, saving data on smartphones was the preferred method for 30.7% of respondents (Fig. 1). Intriguingly, a substantial number (24.6%) admitted to not consistently recording or monitoring such data, while 30.9% did not use any device or app for this purpose. Furthermore, a majority (83.9%) expressed a desire to regularly record and monitor their health-related indicators. (Table 2)

The findings related to exploring perceptions of using smartwatches for the early detection of cardiac arrhythmia are displayed in Table 3. Several key trends emerge from the data. The majority (83.9%) of the respondents expressed a desire to consistently record and monitor their health-related indicators, reflecting a strong interest in proactive health tracking. When questioned about cardiovascular-related health issues, only 10.0% reported that they had such issues. Notably, a substantial percentage (76.5%) indicated their willingness to employ smartwatches for monitoring and detecting arrhythmia, which is a positive signal of the inclination toward using technology for potential health benefits. Moreover, among smartwatch users, 35.2% had received notifications of irregular heartbeats through their devices, underscoring the practical potential of smartwatches in detecting cardiac irregularities. However, 64.8% noted that they did not receive any notification of cardiac irregularities.

The respondents’ perceptions of the positive aspects of wearable technologies in the context of healthcare are highlighted in Table 4. Most respondents strongly agreed (61.2%) that wearable technology could effectively measure fitness and health improvement goals, as well as monitor various health parameters. Similarly, a substantial proportion (48.1%) strongly agreed that wearable devices could contribute to the early diagnosis and monitoring of arrhythmia. Furthermore, more than half of the participants (51.2%) strongly believed that wearable technology could provide access to and control healthcare appointments. This indicates a high level of confidence in the potential of wearable devices to enhance healthcare management. Moreover, a considerable percentage (40.1%) strongly agreed that online examination and follow-up opportunities for health issues could be considered, highlighting openness to remote healthcare options. The notion that data from wearable devices could facilitate remote patient monitoring and early arrhythmia detection also garnered substantial support, with 49.2% strongly agreeing and 24.6% agreeing.

Table 5 outlines the findings of a Poisson regression examination of the determinants of positive perceptions of wearable technologies. Several important trends emerge from the presented data. Gender (male or female) did not seem to have a significant impact on the perception of wearable technologies (p = 0.349). However, age group appears to play a significant role, with young age groups (22–31, 32–41, and 42–51) having a significantly greater relative risk of having a positive perception of wearable technologies than the oldest age group (>51 years old). Educational level also seems to contribute, with a trend toward higher education being associated with a more positive perception, but the association was not significant (p = 0.061).

The respondents' previous use of wearable technologies for health monitoring has a notable impact, as those who have used wearable technologies tend to have a more positive perception (p = 0.015). However, the presence of cardiovascular-related health issues did not significantly influence their perception (p = 0.233). Overall, these findings suggest that young age and previous usage of wearable technologies are important determinants of positive perceptions of these technologies for health monitoring, particularly in the context of early detection of cardiac arrhythmia among adults in Saudi Arabia.

With a longer life expectancy, older people are more likely to develop chronic diseases such as cardiovascular disease. People are more focused on living a healthy lifestyle as the trend grows. Technology is growing rapidly; thus, healthcare wearable technology research and development are increasing. We sought to understand the local community's acceptability and effectiveness of these devices and their potential use in healthcare.

Our research findings indicate a significant level of adoption of wearable fitness trackers. Approximately 46.4% of the participants indicated that they actively utilized wearable devices for the purpose of health monitoring. Eighty-two percent of the participants, totaling 378 individuals, expressed agreement and willingness to utilize wearable technologies for health advantages. These findings are consistent with a recent study conducted in Colombia involving 156 adult participants. All of them agreed to use health wearables. Among the participants, 89.1% expressed their intention to continue using the watch, and 76.9% indicated that they would recommend it to their friends or relatives. Additionally, 94% of the participants reported that the device encouraged them to think more often about their health.³

The utilization of these devices appears to be influenced by age, education level, and income. Young individuals are mostly drawn to these devices because of their visual appeal among their peers. Furthermore, wearable technologies would enable individuals to document and monitor the advancement of their exercise regimens. Although wearable devices offer clear advantages for elderly individuals, they primarily attract younger people. According to Farivar S et al.¹³, 17% of users in the United States fall between the age range of 25-34, while only 3.3% of users are 65 years old or older. Furthermore, a recent study determined that the use of wearable activity trackers is more widespread among older persons who are relatively younger, have higher levels of education and wealth, and enjoy better health status.¹⁴ On the other hand, the elderly population would choose what they find comfortable and easy to use rather than advanced, complicated technology.^16-22 Furthermore, education plays an important role in the perception and appreciation of the countless health-related features that wearable devices have to offer.

The higher a person's degree of education is, the more likely they are to be conversant with and realize the various helpful components of technology.²³ Detecting abnormal heartbeats was beneficial to 14.8% of the users, demonstrating the critical function of these devices in the early detection and prevention of cardiovascular disorders such as atrial fibrillation. A systematic review of smartwatches for arrhythmia detection revealed that they could accurately detect cardiac arrhythmias despite using a single electrode and not recording other irregularities. With an Apple Watch positive predictive value of 0.84, atrial fibrillation (AF) was easy to identify. However, smartwatches cannot detect arrhythmias within one minute, so those with cardiovascular risk factors for arrhythmias should still see a doctor regularly.⁵

Among the many wearable technologies, smartwatches are the most favored choice, preferred by 42.0% of respondents. The potential of smart watches to revolutionize health care lies in their ability to facilitate and assess individuals' well-being in daily life. This is due to their widespread familiarity, growing availability as consumer products, capacity for continuous monitoring of physical activity and physiological indicators in near real time, ability to offer personalized messaging and reminders, and ability to facilitate communication among patients, family members, and health care professionals.¹⁵

Our study also revealed that an overwhelming majority (83.9%) expressed a strong desire to consistently record and monitor their health-related indicators. This highlights the growing consciousness about the use of these devices for the purpose of developing a healthy lifestyle and the possibility of implementing these novel technologies in healthcare systems.

One of the key limitations of the study was the small sample size. Furthermore, even though the present study specifically examined a broad category of smartwatches, the functions of smartwatches might vary depending on factors such as brand, intended use, and specific features and functionalities.

The findings of our research demonstrated the growing interest in using wearable technology for monitoring health indicators. The appeal of wearables was examined across various demographic categories, including gender, age, and education level. These observations provided empirical evidence of the potential of wearable technology in the healthcare system for managing and preventing cardiovascular risk factors, including but not limited to body mass index (BMI), caloric intake, blood glucose levels, and blood pressure. We also gained insight into the potential of using smartwatches for the early detection of cardiac arrhythmia. The findings and observations made in this study will serve as a foundation for future research in this field, with a potential focus on practical applications rather than theoretical aspects. Further investigations in the field of clinical research are encouraged to assess the efficacy of smartwatches in the early detection of cardiac arrhythmias, with a particular focus on atrial fibrillation.

ECG, electrocardiography; PPG, photoplethysmography; AF, atrial fibrillation.

6.1. Ethical approval and consent to participate

This project was assessed and certified by the deanship of scientific research at King Faisal University (KFU-REC-2023-MAY-ETHICS907). Participation consent was obtained from all participants.

6.2. Consent for publication

Not applicable.

6.3. Availability of supporting data

The datasets that were used and/or analyzed in the course of this study are available from the corresponding author upon reasonable request.

6.4. Competing interests

The authors declare that they have no competing interests.

6.5. Funding

This research did not receive any grants from any funding agency in the public, commercial, or not-for-profit sectors.

6.6. Authors’ contributions

ES supervised the research project. WHM, FSH, FYS, and NHS provided the literature review. RAK and AMK chose and finalized the data collection tools. RAK, AMK, WHM, FSH, FYS, and NHS collected the data. RAK and AMK arranged, analyzed, and interpreted the data. RAK and AMK wrote the initial and final drafts of the article. All the authors have read and approved the final manuscript.

6.7. Acknowledgments

We would like to extend our thanks to all participants who participated in this study.

Hofmann B, Svenaeus F. How medical technologies shape the experience of illness. Life Sciences, Society and Policy. 2018 Dec;14(1):1-1. Available from: https://doi.org/10.1186/s40504-018-0069-y
Alice Barraclough. The best fitness trackers in 2023 to help you stay active [Internet] United Kingdom: The Telegraph; 2023 Dec 15 [Cited 2024 Feb 11]. Available from: https://www.telegraph.co.uk/recommended/leisure/best-fitness-trackers-watches/
Liverani M, Ir P, Wiseman V, Perel P. User experiences and perceptions of health wearables: an exploratory study in Cambodia. Global Health Research and Policy. 2021 Dec;6(1):1-0. Available from: https://doi.org/10.1186/s41256-021-00221-3
João Bocas. Healthcare: What are the Benefits for Patients, Hospitals and Caregivers? [Internet] United Kingdom: Digital Salutem; 2022 Oct 23 [Cited 2024 Feb 11]. Available from: https://digitalsalutem.com/wearable-technology-in-healthcare/
Pay L, Yumurtaş AÇ, Satti DI, Hui JM, Chan JS, Mahalwar G, Lee YH, Tezen O, Birdal O, Inan D, Özkan E. Arrhythmias Beyond Atrial Fibrillation Detection Using Smartwatches: A Systematic Review. Anatolian journal of cardiology. 2023 Mar;27(3):126. Available from: https://doi.org/10.14744/anatoljcardiol.2023.2799
Burke J, Haigney MC, Borne R, Krantz MJ. Smartwatch detection of ventricular tachycardia: case series. HeartRhythm Case Reports. 2020 Oct 1;6(10):800-4. Available from: https://doi.org/10.1016/j.hrcr.2020.08.003
Shabaan M, Arshid K, Yaqub M, Jinchao F, Zia MS, Bojja GR, Iftikhar M, Ghani U, Ambati LS, Munir R. Survey: smartphone-based assessment of cardiovascular diseases using ECG and PPG analysis. BMC medical informatics and decision making. 2020 Dec;20:1-6. Available from: https://doi.org/10.1186/s12911-020-01199-7
Desai DS, Hajouli S. Arrhythmias. InStatPearls [Internet] 2022 Apr 30. StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558923/
Inui T, Kohno H, Kawasaki Y, Matsuura K, Ueda H, Tamura Y, et al. Use of a Smart Watch for Early Detection of Paroxysmal Atrial Fibrillation: Validation Study. JMIR Cardio. 2020 Jan 22;4(1):e14857. Available from: http://dx.doi.org/10.2196/14857
Nazarian S, Lam K, Darzi A, Ashrafian H. Diagnostic accuracy of smartwatches for the detection of cardiac arrhythmia: systematic review and meta-analysis. Journal of medical internet research. 2021 Aug 27;23(8):e28974. Available from: https://doi.org/10.2196/preprints.28974
ÇİĞDEM M, ŞAHİN S. A research on the perceptions of individuals and health professionals about the wearable technologies used in healthcare services. Journal of International Health Sciences and Management. 2022 Jan 1;8(15):1-1. Available from: https://doi.org/10.48121/jihsam.903224
Al-Badi A, Khan A. Determining the constituents for the advancement of healthcare wearable technologies in Oman. International Journal of Electronic Healthcare. 2020;11(2):136-56. Available from: https://doi.org/10.1504/ijeh.2020.113200
Farivar S, Abouzahra M, Ghasemaghaei M. Wearable device adoption among older adults: A mixed-methods study. International Journal of Information Management. 2020 Dec;55:102209. Available from: http://dx.doi.org/10.1016/j.ijinfomgt.2020.102209
Schuster AM, Kadylak T, Cotten SR. Correlation between sociodemographic factors and adoption and use of wearable activity trackers in online American older adults. Educational Gerontology. 2022 Apr 18;49(1):1–11. Available from: http://dx.doi.org/10.1080/03601277.2022.2064688
Reeder B, David A. Health at hand: A systematic review of smart watch uses for health and wellness. Journal of Biomedical Informatics [Internet]. 2016 Oct;63:269–76. Available from: http://dx.doi.org/10.1016/j.jbi.2016.09.001
Papa A, Mital M, Pisano P, Del Giudice M. E-health and wellbeing monitoring using smart healthcare devices: An empirical investigation. Technological Forecasting and Social Change. 2020 Apr 1;153:119226. Available from: https://doi.org/10.1016/j.techfore.2018.02.018
Dehghani M, Kim KJ, Dangelico RM. Will smartwatches last? Factors contributing to intention to keep using smart wearable technology. Telematics and Informatics. 2018 May 1;35(2):480-90. Available from: https://doi.org/10.1016/j.tele.2018.01.007
Kim J, Park E. Beyond coolness: Predicting the technology adoption of interactive wearable devices. Journal of Retailing and Consumer Services. 2019 Jul 1;49:114-9. Available from: https://doi.org/10.1016/j.jretconser.2019.03.013
Ridgers ND, McNarry MA, Mackintosh KA. Feasibility and effectiveness of using wearable activity trackers in youth: a systematic review. JMIR mHealth and uHealth. 2016 Nov 23;4(4):e6540. Available from: https://doi.org/10.2196/mhealth.6540
Schaffarczyk L, Ilhan A. Healthier life and more fun? users’ motivations to apply activity tracking technology and the impact of gamification. InSocial Computing and Social Media. Communication and Social Communities: 11th International Conference, SCSM 2019, Held as Part of the 21st HCI International Conference, HCII 2019, Orlando, FL, USA, July 26-31, 2019, Proceedings, Part II 21 2019 (pp. 124-136). Springer International Publishing. Available from: https://doi.org/10.1007/978-3-030-21905-5_10
Spil T, Sunyaev A, Thiebes S, Van Baalen R. The adoption of wearables for a healthy lifestyle: can gamification help? Available from: https://doi.org/10.24251/hicss.2017.437
Brickwood KJ, Williams AD, Watson G, O’Brien J. Older adults’ experiences of using a wearable activity tracker with health professional feedback over a 12-month randomized controlled trial. Digital health. 2020 Apr;6:2055207620921678. Available from: https://doi.org/10.1177/2055207620921678
Lee SY, Lee K. Factors that influence an individual's intention to adopt a wearable healthcare device: The case of a wearable fitness tracker. Technological Forecasting and Social Change. 2018 Apr 1;129:154-63. Available from: https://doi.org/10.1016/j.techfore.2018.01.002

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You are reading this latest preprint version

Perceptions of using smartwatches for the early detection of cardiac arrhythmias

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Version 1

Abstract

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1. Introduction

2. Materials and Methods

2.1. Study sample and design

2.2. Study measures and tools

2.3. Statistical analysis

2.4. Ethics

3. Results

4. Discussion

5. Conclusion

Abbreviations

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Supplementary Files

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