Wearable devices may increase anxiety in atrial fibrillation patients despite perceived safety

By Dr. Priyom Bose, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Jul 29 2024

A recent Journal of the American Heart Association study investigates whether wearable devices impact patients' health and psychological well-being with atrial fibrillation (AF).

Study: Wearable Devices, Health Care Use, and Psychological Well-Being in Patients With Atrial Fibrillation. Image Credit: jSep / Shutterstock.com

AF and wearable devices

AF, a common cardiac condition associated with an irregular heart rate, is estimated to affect over 33 million adults worldwide. The presence of AF increases the risk of stroke, heart failure, cognitive dysfunction, and premature death.

Smartwatches and fitness bands are common wearable devices used by AF patients to continuously monitor vital health parameters such as stress, physical activity, weight, heart rate, and sleep patterns. Several commercially available wearable devices, such as the Apple Watch, are equipped with medical‐grade sensors and software to monitor irregular heartbeats associated with AF. Some of these devices also generate single‐lead electrocardiogram (ECG) data and have been approved by the United States Food and Drug Administration (FDA) for medical use.

Continual health-related information provided by wearable devices is widely believed to motivate individuals to follow a healthy lifestyle. Nevertheless, several studies have indicated that patients with AF are more likely to monitor cardiac parameters through their wearable devices excessively. Importantly, excessive monitoring and continuous health-related data flow increase anxiety and obsessive symptoms.

Approximately 25% to 45% of patients with AF experience psychological stress and anxiety that affects their quality of life. Therefore, wearable devices may increase the risk of anxiety and prompt unnecessary medical care, which necessitates investigation to determine the extent to which these technologies may affect the psychological well-being of patients with AF.

About the study

The current study combined survey data with longitudinal data to evaluate the psychiatric and clinical characteristics of patients with AF who use wearable devices. The study cohort comprised adult AF patients who were outpatients at an academic medical center in North Carolina between December 1, 2022, and February 27, 2023.

Patients were screened based on their electronic health records (EHR), and all patients were enrolled in the EHR‐based patient portal. EHR provided important information about cardiovascular risk factors, comorbidities, medication history, and AF‐related procedures.

All study participants who were proficient in English and had access to internet-enabled devices were considered for the study. The selected participants completed survey questionnaires regarding psychological well-being and sociodemographic characteristics, which included their educational background, employment status, race, household income, and marital status.

Wearable device usage patterns and behavioral and psychological responses to cardiac monitoring features were assessed using a questionnaire. All responses were scored on a five‐point Likert scale, with a higher score indicating a greater frequency of a particular behavior or psychological response.

In the Cardiac Anxiety Questionnaire, three subscale scores were evaluated, including cardiac fear, avoidance, symptom monitoring, and preoccupation. A higher score indicated greater anxiety for cardiac conditions.  

All study participants were also asked to complete additional questionnaires, such as the Atrial Fibrillation Effects on Quality of Life Questionnaire (AFEQT).

Study findings

Although 756 patients with AF met the eligibility criteria, 178 completed the online survey, and the final cohort comprised 172 candidates. The mean age of the study participants was 73 years.

Most of the participants were White with paroxysmal AF and had a history of underlying cardiovascular disease, such as coronary artery disease and hypertension. Furthermore, most patients were prescribed anticoagulation medications, β blockers, or statins.

Of the 172 study participants, 83 used wearable devices, such as an Apple Watch or Fitbit, most of whom wore these devices almost daily. Compared with nonusers, the majority of participants who used wearable devices had implanted cardiac devices at banon-usersPatients with AF who regularly used wearable devices were significantly preoccupied with their cardiovascular symptoms, excessively engaged in monitoring cardiac parameters, and more concerned about their AF treatment. In contrast, AF patients who did not use wearable devices were less anxious about their condition.

AF patients who used wearable devices were also significantly more likely to undergo ECGs/transesophageal ECGs and ablation procedures. These individuals were also more likely to utilize informal and AF-specific healthcare services than those who did not use wearable devices. For formal and informal healthcare use by users and non-users of wearable devices, sex did not significantly influence the results.

The current study failed to determine the directionality between wearable devices and adverse psychological outcomes. AF patients may become hypervigilant about monitoring cardiac parameters due to fear, uncertainty, or the drive to control or mitigate distress associated with their condition.

Conclusions

Although most wearable device users indicated that their device helped them feel safe, about 20% of the study participants reported extreme anxiety when they received irregular rhythm notifications, following which they would immediately contact their physicians. Anxiety levels among non-users were significantly lower than among wearable device users.

Additional research is needed to understand the downstream effects of wearable devices on clinic workflow and healthcare systems.