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Accuracy of Wearable Heart Rate Monitors
Quick Takes
- Heart rate (HR) measured by commercial wearable devices varied in statistically and clinically meaningful ways from participants’ true HRs, particularly during exercise and for those in AF.
Study Questions:
What is the accuracy of commercially available heart rate (HR) monitors during exertion and at rest for patients in sinus rhythm (SR) and atrial fibrillation (AF)?
Methods:
Patients scheduled for a treadmill exercise stress test for clinical indications were recruited and asked to wear six wearable, photoplethysmography (PPG)-based HR monitors: Apple Watch Series 3, Fitbit Charge HR, Fitbit Blaze, Polar A360, Garmin Vivosmart HR, and Jabra Sport pulse headphones. HRs at each stage of exercise and at rest were compared to a gold standard electrocardiogram (ECG) monitor.
Results:
A total of 81 participants were included in the study (65% female, 25% in AF). At rest, the mean absolute differences between the ECG measured HR and the device displayed rate were 4.6 (8.4) bpm in SR and 7.0 (11.8) bpm in AF. At peak exercise, the mean difference was 13.8 (18.9) bpm for participants in SR and 28.7 (23.7) bpm for those in AF (p < 0.01) with variable performance by device type. Devices both overestimated (62%) and underestimated (25%) participants’ true HRs.
Conclusions:
HRs from commercially available monitors differed meaningfully from participants’ true HRs, and these differences were most pronounced for participants in AF.
Perspective:
While wearable devices are increasingly used to track home health data, important differences in HR may limit their use at present for monitoring patients during exercise, particularly for those in AF. Important limitations of this study should be noted. First, limited demographic information is provided, including that on race. As PPG-based sensors are known to have lower accuracy in patients with darker skin tones, it is important to understand the population evaluated so that these results can be placed in context. Second, many newer devices are on the market. Third, the study evaluated the accuracy of the HR monitors, but not their precision. Important information may still be ascertained from device-based HR trends over time when used for certain indications.
Clinical Topics: Arrhythmias and Clinical EP, Atrial Fibrillation/Supraventricular Arrhythmias
Keywords: Atrial Fibrillation, Exercise Test, Wearable Electronic Devices
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