Heads Up! Introducing Wearable Health Technologies in Cardiology

Over the last decade, wearable health technologies have been incorporated into the remote monitoring of patients with cardiovascular disease. However, their use as point-of-care tools to support health-care professionals has only recently garnered attention. Clinical experiences of the utility of “smart” wearable technologies are surfacing across disciplines of medicine and surgery. In cardiovascular medicine, however, we have had limited exposure to these devices. For instance, only isolated reports have supported their role in educational, diagnostic,¹ or procedural settings.²

In this issue of the Journal of Invasive Cardiology, Duong et al³ present an interesting pilot experience expanding the potential of wearable health technology to the cardiac catheterization laboratory. Ten clinicians (mostly cardiology trainees) interpreted 15 angiograms visually captured using the Google Glasscamera (Google, Inc). Their diagnostic accuracy for major pathological findings using this device was comparable to direct interpretation of the original angiograms.³

The potential added value of this novel technology for operators is the possibility of real-time transfer of data outside of their immediate clinical environments. Wearable devices may facilitate live broadcasting of cases for teaching purposes or training. Remote technical assistance, electronic consultation, and improved communication and coordination with off-site colleagues may also be achieved with these wearable devices. Retrospective review of case feeds may promote operator self-assessment. Video capture may be used for effective documentation, while preserving sterility by obviating the need for burdensome hands-on cameras. With the full integration of these devices into contemporary electronic health records, they may be able to interact and relay key reminders and real-time patient-related information to optimize operator workflow.

Although the study by Duong et al is an exciting glimpse of the future, as acknowledged by the study investigators,³ this initial experience has several limitations, mostly stemming from the small number of participants. There was no statistical accounting for the patient profile, angiographic complexity, or physician (reader) experience. The same physicians sequentially participated in the interpretation of both sets of angiograms, giving rise to potential recall bias.³

Even beyond the cath lab, further development of these operator-targeted devices as a class faces a number of hurdles.⁴ First, high-quality data are lacking to validate the expeditious and seamless transmission of information with these innovative devices compared with standard health systems. It is concerning that in the present study by Duong et al,³ left main coronary artery lesions and coronary perforations were not successfully identified with high fidelity by clinicians using Google Glass compared with standard angiographic imaging, despite the severe implications of missing these findings; perhaps this was due to the trainee status of most of the readers, as these critical findings were also missed on the original angiograms more frequently than one would expect. Jeroudi et al recently demonstrated poor operator satisfaction and quality of interpretation of electrocardiograms with Google Glass.⁵ As such, secondary data visualization (reprocessing and recapture of primary data) does not appear to be fully effective at this stage of development. Second, more robust experiences are required to determine the efficiency by which health-care professionals of varying technological aptitude are able to assimilate these devices into their practices. Third, the mobile health revolution has posed serious threats to the safe portability, security, and privacy of transmitted health information. Fourth, rising health-care expenditures preclude the introduction of new technologies that do not add significant value or hold promise in reducing downstream costs. As in many cases of patient-centric wearable health technology, more information may not necessarily be better information and may not translate into improved patient outcomes.

We eagerly look forward to the continued development of the “smart” technological platform in cardiovascular medicine. Prior to widespread uptake of these wearable devices, more thorough evaluation of the practicality, feasibility, and clinical implications of their use is required. With further maturation of this technology and tailoring of these models to cardiovascular medicine, we hope that these wearable devices may be applied and integrated into the future care of our patients.

References

1. Russell PM, Mallin M, Youngquist ST, Cotton J, Aboul-Hosn N, Dawson M. First “glass” education: telementored cardiac ultrasonography using Google Glass – a pilot study. Acad Emerg Med. 2014;21:1297-1299.
2. Assad-Kottner C, Hakeem A, Fontenot E, Uretsky BF. “Tele-mentoring”: an interventional procedure using a wearable computer: first-in-man. J Am Coll Cardiol. 2014;63:1022.
3. Duong T, Wosik J, Christakopoulos GE, et  al. Interpretation of coronary angiograms recorded using Google Glass: a comparative analysis. J Invasive Cardiol. 2015;27(10):443-446.
4. Yu J, Ferniany W, Guthrie B, Parekh SG, Ponce B. Lessons learned from Google Glass: telemedical spark or unfulfilled promise? Surg Innov. 2015 Jul 29. (Epub ahead of print).
5. Jeroudi OM, Christakopoulos G, Christopoulos G, et al. Accuracy of remote electrocardiogram interpretation with the use of Google Glass technology. Am J Cardiol. 2015;115:374-377.

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From the Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts.

Disclosure: The authors report no relevant disclosures. Dr Bhatt is the editor-in-chief of JIC; his disclosures are available here.

Address for correspondence: Deepak L. Bhatt, MD, MPH, Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School. Email: dlbhattmd@post.harvard.edu