What are the biggest benefits and limitations of wearables from a cardiologist’s perspective?
The biggest benefit is general health awareness. Wearables can encourage people to pay attention to activity, sleep and exercise habits, and in very specific situations they can be useful. For example, helping document palpitations that are otherwise hard to capture.
The biggest limitation, by far, is added stress. Most of the data these devices collect is low quality and rarely clinically actionable. Some patients can recognize that and move on, but many fixate on individual “findings,” which creates anxiety. I see this psychological impact all the time in cardiology clinic. Once someone is told there might be something wrong with their heart, sensations they previously ignored, like chest discomfort or brief palpitations, suddenly become alarming.
Another frustration is that wearable companies rarely prioritize clinical accuracy. Many results returned to patients, such as “stress levels” or biological age estimates, are poorly supported by evidence even though they’re presented with confidence.
Have wearables changed the types of concerns patients bring to you?
Yes. I now routinely see patients showing me heart rate trends and alerts for “irregular rhythm” or “possible atrial fibrillation.” Common worries include things like, “My heart rate used to be in the 60s and now it’s in the 80s,” or “My heart rate went over 100 when I walked up the stairs.” In most cases, these are normal, physiologic responses, but the way the information is framed makes them feel abnormal.
What do you wish patients better understood about what wearables can and can’t tell them?
First, not all sensors are equal. Some devices include an ECG feature (electrocardiogram, a test that records the heart’s electrical activity) that allows users to capture a single-lead tracing similar to one part of a standard clinical ECG. In certain situations that can be genuinely useful. Other sensors, especially PPG-based heart rate monitors (devices that shine a light into the skin and measure how much light is reflected back) worn below the elbow are highly inaccurate and rarely validated. At best, they provide information similar to checking your pulse once a day. At worst, motion, sweat or interference can create abnormalities that don’t actually exist.
Second, most wearable companies are focused on sales and engagement, not clinical validation. Smartphone apps often present large amounts of data without clear explanations of how it was derived or what it means.
Third, and most important, how a patient feels matters more than what their device reports. If someone feels well, there’s rarely something a wearable will detect that changes management. Conversely, if someone doesn’t feel well, they shouldn’t assume everything is fine just because the device didn’t flag anything.
How reliable is wearable data compared to clinical testing?
ECG tracings from some wearables can be useful and, in limited situations, comparable to clinical ECGs. Other wearable data is much less reliable. Many derived measures, such as heart rate variability or sleep scores, are based on proprietary algorithms and are generally not very helpful clinically.
Symptoms should guide decisions. If you feel well, it’s probably fine regardless of what the device says. If you don’t feel well, you should contact your provider even if the device doesn’t detect anything.
Who benefits most from wearables and who might not?
I haven’t seen clear differences based on age or medical history. If a device helps someone exercise more or build healthier habits that’s a good thing. But if someone is the type of person who will see a number or alert that ruins their day, the device may do more harm than good.
How should patients bring wearable data into an appointment?
The most useful data I’ve seen are ECG tracings recorded during symptoms, especially for palpitations that are hard to capture in clinic. Those tracings can help guide further testing. Alerts suggesting atrial fibrillation can also be useful as a reason to investigate, but I wouldn’t treat based on wearable data alone.
Which features actually matter and which are overhyped?
For medical monitoring, ECG capability is the only feature that consistently adds value. For general health, activity and sleep tracking can be helpful. Most other metrics fall into the realm of pseudoscience. I often compare them to phrenology or palm reading.
Do you personally use a wearable?
Yes, mainly for research. It’s made me more skeptical but also curious. Devices now report more and more data that doesn’t appear to be clinically validated, reinforcing the need for caution.
How do you see wearables fitting into preventive cardiology?
Beyond ECG recordings, wearables may be useful for guiding exercise programs and tracking activity related to weight loss or fitness. Anything that supports known risk-reducing behaviors has potential value. Beyond that, it’s unclear. Most people don’t want to be patients – they want to live their lives without constantly worrying about their health.
Anything you want to add?
If commercial vendors meaningfully engage clinicians in research, wearables could eventually integrate into care for areas like sleep or cognitive health. For now, many companies seem more focused on promoting questionable metrics than producing clinically useful tools.
