The Latest Fashion: Wearables in Cardiology

Dr. Gregory Weiss discusses the topic of wearable technology for remote patient monitoring through the lens of a cardiovascular anesthesiologist.

Technology is ubiquitous in our lives from our smartphones to advanced artificial intelligence algorithms telling us what we want to buy on social media platforms. Nowhere has technology played a more crucial role in improving human lives than in the healthcare industry.

We, as clinicians, rely on countless technological instruments in the diagnosis, treatment, and long-term management of nearly every condition in the medical lexicon. Still, following the over 300 million operations taking place across the world yearly, over 4 million people die in the first month making postoperative mortality the third highest cause of death globally.1 Those numbers should sink in for a bit.

One reason this is occurring is that we are seeing a more diverse patient population undergoing more complicated surgical procedures. Add to this the fact that nursing shortages are at critical levels with one nurse often looking after more than a half-dozen patients on the hospital wards. Frederick Michard, MD, PhD, is a leading expert in the field of patient safety.

Dr. Michard believes that the evidence shows many of these deaths occur due to failure to rescue and could be prevented through continuous monitoring.1 Failure to rescue describes a foreseeable deterioration in a patient’s vital status that is missed by clinicians due to inadequate often intermittent monitoring and broadly timed nursing spot checks.

Nurses are stretched thin today. Nearly every nurse surveyed believes that poor nursing staffing and high patient-to-nurse ratios lead to reduced quality of care and reduced nursing job satisfaction.2 The current model on the wards has nurses rounding for spot checks and vital signs with gaps as large as 8 hours between checks unless something alerts them to a problem.

With patients encouraged to ambulate and warning signs often subtle and subclinical it is difficult to keep an eye on everyone all the time. This is where advances in technology can make the biggest difference.

If it were possible to continuously monitor patient vital data and even process it into a score that could predict a downward trajectory long before rescue becomes difficult; that would be a game-changer. If we had a choice on what to monitor on the wards to prevent failure to rescue what would we choose?

Several studies point to respiratory rate monitoring as the best predictor of adverse outcomes on hospital wards.3 The latest in continuous monitoring goes a step beyond. We already know that clinical staff are at a critical minimum necessitating a simplification tool as well as a way to alert the appropriate clinician when deterioration is suspected.

Enter artificial intelligence and edge computing technologies capable of processing gigantic volumes of patient data such as respiratory rate, oxygen saturation, and heart rate while accessing the patient’s lab values and imaging reports and alerting their nurse or physician in real-time when subtle signs of deterioration occur.

Unfortunately, even with AI and early warning algorithms, patients cannot be hooked up to a monitor all the time. Over the past year, a surge in small, wearable sensors have been in development that will allow patients to be monitored even when they are not in their rooms. Current best practices call for surgical patients to be on their feet as soon as possible after their procedure.

With robust, reliable wearable monitors and powerful new software and hardware solutions it is possible to catch patient deterioration before a point of no return, reducing costly intensive care admissions, hospital length of stay, and preventing significant morbidity and mortality.

We all rely on wireless communication in one way or another. New Bluetooth technologies, Wi-fi, and emerging technologies such as 5G transmission have applications far beyond social media and personal communications. With these technologies and increasingly miniaturized hardware, patients can comfortably wear sensors that transmit respiratory rate, blood pressure, heart rate, and blood oxygen levels even when they are in the bathroom or at physical therapy.

Furthermore, during the pandemic, clinicians are exploring monitoring patients continuously at home so that hospitals aren’t burdened by COVID-19 patients that do not require inpatient treatment. It’s a brave new world, to say the least.

References:

  1. Protecting ward patients. ICU Mgmt & Pract. https://healthmanagement.org/c/icu/issuearticle/protecting-ward-patients.
  2. Is the shortage of hospital registered nurses getting better or worse? Findings from two recent national surveys of RNs. Nurs Econ, 2005. https://www.researchgate.net/profile/Karen_Donelan/publication/7860597_Is_the_Shortage_of_Hospital_Registered_Nurses_Getting_Better_or_Worse_Findings_from_Two_Recent_National_Surveys_of_RNs/links/5711063108ae846f4ef05cb5/Is-the-Shortage-of-Hospital-Registered-Nurses-Getting-Better-or-Worse-Findings-from-Two-Recent-National-Surveys-of-RNs.pdf
  3. Predicting Cardiac Arrest on the Wards, A Nested Case-Control Study. Chest, 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3342781/