Capturing hearts with wearable devices and smart home technology

The COVID-19 pandemic has shown just how important digital technologies are in helping us to remain connected, as families, communities, and workplaces.  

So, it’s no coincidence the theme of World Heart Day this year is all about harnessing the power of digital health to improve global awareness, prevention and management of cardiovascular disease.  

Digital health refers to a range of technologies that can be used to both provide healthcare and share a person’s health information. It’s a broad term that covers things like smartphone apps, electronic health records, telehealth, wearable devices (like smart watches), electronic prescriptions and even health reminders sent by text message.  

The past 18 months have shone a spotlight on ways that digital health can give people the opportunity to lead heart-healthy lives, no matter where they live. More cardiac rehabilitation programs are now available via telehealth, our Heart Age Calculator can help you understand your risk of a heart attack or stroke, and over 100,000 people have signed up to our Personal Walking Plans.  

Recognising the potential of digital health to improve Australians’ heart health, the Heart Foundation is currently funding a variety of digital health research projects. Read on to meet two of our talented researchers as they explain their innovative, life-saving work.

Go go gadget watch: wearable devices to detect abnormal heart rhythms

You might remember ‘Inspector Gadget’ and his savvy sidekick Penny with her video-enabled watch that today would be referred to as a smart watch. 40 years later, this cartoon wasn’t so far off the mark, and the features of smart watches today go beyond video-calling. They can also potentially be used to detect abnormal heart rhythms.

Meet Associate Professor (A/Prof) Saurabh Kumar who is a cardiologist and cardiac electrophysiologist (a cardiologist who specialises in treating electrical problems of the heart) at Westmead Hospital in Sydney. He is also a Clinical Associate Professor of Medicine at the University of Sydney.

In 2019, A/Prof Kumar was awarded a Heart Foundation Vanguard Grant to support his research on wearable devices (smart watches) and their ability to detect abnormal heart rhythms, such as atrial fibrillation. Atrial fibrillation is a common cause of blood clots which can travel to the brain and cause a stroke.

"People from all age groups will experience palpitations or irregularities in their heart rate at some point in their lifetime,” says A/ Prof Kumar. “The older you are, the more likely you are to have a heart rhythm problem, which can be serious and can lead to a stroke or even sudden death."

The standard way of diagnosing heart rhythm abnormalities is with an electrocardiogram (ECG; a test that records the electrical activity of the heart). An ECG is most often performed in a clinic or sometimes people may wear a portable ECG monitor for 24 hours or longer to record their heart rhythm.

“One of the problems is that palpitations are fleeting and can be unpredictable. A person must have an abnormal heart rhythm when they’re in a doctor’s office or in the emergency department having an ECG,” explains A/Prof Kumar. “The chances of diagnosing someone with episodic palpitations (palpitations that come and go) are very low.”   

And while portable ECG monitors may be more likely to detect an abnormal heart rhythm than a five-minute ECG, they can be bothersome for people to wear and in some parts of Australia can be difficult to access. This is where other handheld devices and smart watches could play a role.   

There are several types of handheld devices and smart watches available in Australia. Some have ECG capabilities and have been approved as a medical device by the Therapeutic Goods Administration as being able to detect abnormal heart rhythms. Notifications are sent to the wearer in real time if a rhythm abnormality is detected. They are convenient and can be worn throughout the day (and night), or can come with sensors that can be placed on the back of a smartphone, capable of recording a single lead (or multi-lead) ECG. 

While innovative wearable devices like these sound exciting, there’s more to the story. Even though ECG-enabled smart watches or handheld devices can detect abnormal heart rhythms, how they compare to a standard ECG (using 12 leads) and other gold standard tests isn’t entirely clear. A/Prof Kumar’s research is exploring this.   

“The first question we want to answer is how accurate and reliable these devices are, and as doctors, if we can be sure they’re telling us the right information,” says A/Prof Kumar.  

Part of his project involves comparing the results of different brands of smart watches with a traditional ECG. “We’ve found that certain smart watches may perform as well as a normal ECG,” explains A/Prof Kumar. “This is an exciting finding and suggests these user-friendly devices could possibly help improve detection and treatment of atrial fibrillation and other rhythm abnormalities. Larger studies are currently underway to explore this further.”   

The second part of A/Prof Kumar’s research is looking at the reliability of a handheld ECG device, which is easy to carry and much less cumbersome than a normal ECG or a portable monitor. A person also needs to lie down for a normal ECG, which is not ideal.  

“This isn’t the typical scenario where a person would necessarily feel palpitations. Often, they experience them during exercise or when walking around,” says A/Prof Kumar. “This is where a handheld ECG could be useful.” A/Prof Kumar is investigating how a handheld ECG performs compares to a normal ECG. “Again, we have found very good agreement between a normal ECG and a handheld ECG.”  

These are exciting early results, demonstrating the potential of digital health technologies to diagnose heart problems more conveniently and just as reliably. These types of digital health technologies can also improve accessibility for all Australians.  

“This is an example of how people who live in regional or remote parts of Australia can access healthcare without having to travel hundreds or thousands of kilometers,” says A/Prof Kumar.  

“This study funded by the Heart Foundation has the potential to transform healthcare in the current era, especially during the COVID-19 pandemic, but also in the future. We can empower people to take a central role in managing their heart health. I thank the Heart foundation again for the fantastic support in getting this project off the ground.”  

Science fiction or science? A smart home system for people living with heart failure

The term ‘smart home’ probably conjures up a range of different images. Something out of ‘The Jetsons’? Being able to turn the lights on by clapping your hands? Setting your coffee machine to turn on just as you’re about to get out of bed in the morning?  

Smart home devices can automate some of our daily tasks and make our life more convenient. What’s exciting is that they might also have a role to play in supporting people to manage heart conditions like heart failure.  

Heart failure is a condition where the heart muscle doesn’t pump blood to the rest of the body the way it should. It is a long-term condition that often needs lifelong management, including medicines.  In Australia, on average, one person is admitted to hospital for heart failure every 8 minutes. Nearly a quarter of people who are treated in hospital for heart failure are readmitted within 30 days of being discharged. The good news is that over half of these readmissions could be prevented by supporting people to manage their condition. This includes being able to recognise when their heart failure symptoms are getting worse and when to seek help.  

Dr Shariful Islam is a researcher at the Institute for Physical Activity and Nutrition at Deakin University. In 2017, he was awarded both a Heart Foundation Postdoctoral Fellowship and a Heart Foundation Vanguard Grant. Dr Islam is currently researching the role of a smart home system to help people living with heart failure to manage their condition.

“For a person with heart failure, their symptoms can change day by day,” says Dr Islam. “I am developing a smart home system to monitor behaviours like physical activity, daily weight measurements, and adherence to medicines. The system can also record blood pressure, heart rate and heart failure symptoms.”  

This means a person’s healthcare team can respond quickly to changes in a person’s condition before they become unwell. The system will also prompt people to check-in about their mood and mental health, food intake, and amount of time spent outdoors.  

Dr Islam describes his innovation as an ‘ecosystem’ which will use a combination of digital health technologies to give an overall picture of the person. These include wearable devices to measure blood pressure, heart rate and rhythm (which Dr Islam is also researching as part of his Vanguard Grant), along with apps and automated voice systems. The data are sent to the person’s healthcare team to review and intervene, if necessary.

The smart home system will also be able to send personalised voice and text messages to help motivate people and support them to stay on track. “We can empower the person with a simple tool to self-monitor and better manage their condition,” explains Dr Islam.  

The beauty of this smart home system is that it could also improve outcomes for people living in regional and remote parts of Australia, by connecting them more easily with their healthcare team.  

“The system could contribute to reducing readmissions to hospital, improving health outcomes and improving quality of life for people living with heart failure,” says Dr Islam.  

Dr Islam’s research is currently in the pilot phase. Support from the Heart Foundation has enabled him to secure a further $600,000 in funding from the National Health and Medical Research Council for the next phase of this project.  

While it’s still early days for some digital health technologies, it’s clear their part in the care of people with cardiovascular disease will continue to grow. This World Heart Day, the Heart Foundation would like to give a heartfelt thanks to our generous donors and supporters for their contribution to innovative and life-saving research like this.