Devices and digital health

Risposta: In recent years, ‘digital health’ has become an increasingly integral part of everyday life. Smartwatches, wristbands, rings, patches, sensors linked to smartphones and health and wellbeing apps represent a market that is constantly expanding.

Wearable devices can measure parameters such as the number of steps and physical activity, thereby helping to motivate people to increase their physical activity. The situation is different when the device is used for diagnostic purposes relating to changes in heart rate and rhythm. In this case, caution is required, as is an assessment of the device’s reliability. In the specific field of heart rhythm disturbances – that is, arrhythmias – it should be emphasised that some smartwatches and sensors can indeed offer practical assistance. The most common ones use optical sensors, which use an LED light to estimate blood flow at the wrist, or electrical sensors capable of recording an electrocardiogram (ECG) trace. These wearable devices can alert the user to an abnormally high heart rate or an irregular rhythm and, in some models, can record and store an ECG, which a cardiologist can then analyse for a specialist assessment. This can certainly be useful in the event of occasional palpitations. However, not all wearable devices are of the same quality, and only some have been validated for medical use. Furthermore, a reading taken by a smartwatch does not automatically equate to a diagnosis. An alarm may indicate a genuine arrhythmia, but it could also be an artefact or an inaccurate reading. For this reason, if you are considering using a wearable device for heart rhythm issues, it is advisable to discuss this with your cardiologist, both to choose a reliable device and to agree on how to interpret and manage the information collected. It is important to emphasise that smartwatches and sensors are not tools for managing emergencies. In the event of chest pain, severe shortness of breath, fainting or prolonged palpitations, you must never use these devices as a reason to delay seeking urgent medical assessment. There is ample evidence to suggest that the indiscriminate and unplanned use of these technologies can cause anxiety and lead to unnecessary medical investigations.

A separate, though related, area is that of telemedicine. This term refers to the use of digital technologies to deliver healthcare services remotely. It includes video consultations between doctors and patients, teleconsultations between specialists, telemonitoring of clinical parameters and remote home care. The aim is not to replace the face-to-face relationship with the doctor, but to complement it, particularly in the management of chronic conditions.

In cardiology, the potential is significant. In patients with heart failure, for example, remote monitoring of certain parameters can help to detect early signs of deterioration and enable a reassessment of treatment before hospitalisation becomes necessary. Pacemakers, implantable defibrillators and certain external devices fitted with specialised sensors can transmit useful information to the referral centre regarding new arrhythmias or a worsening of heart failure. This is particularly important for people living far from hospitals, in mountainous areas or on small islands.

However, there are still practical obstacles: regional differences, difficulties in using digital tools – particularly for some older people – and the need for training for patients, family members, carers and healthcare professionals. Furthermore, for telemedicine to work effectively, data must be able to be integrated with medical records and with the organisation of care between hospitals and the local community.

These innovations are promising: wearables and telemedicine can improve prevention, follow-up and access to care, but only if used correctly. Technology is an asset when it provides useful information and facilitates the relationship with healthcare professionals. It does not replace the doctor: however, it can help them to identify what is happening to the patient more clearly and at an earlier stage, and consequently make the most appropriate decisions.