Digital Health in Motion: Innovations in Wearable Rhythm Monitoring and Remote Cardiac Care

Cardiovascular care is facing increasing pressure due to population ageing, chronic disease, and growing demand for specialist care. Wearable technologies offer new opportunities to monitor cardiovascular health beyond the hospital and to support more continuous, patient-centred models of care. This thesis investigates how such technologies can be integrated into cardiovascular care and applied to arrhythmia detection, monitoring of high-risk patients, and physiological assessment. In the EQUAL trial, six months of Apple Watch monitoring in older adults at increased risk of stroke resulted in approximately four times more newly detected atrial fibrillation and earlier diagnosis than standard care. Expert review of smartwatch ECGs labelled unclassified by the algorithm also identified clinically relevant arrhythmias beyond atrial fibrillation. A ring-type photoplethysmography wearable detected loss of arterial pulse flow during induced ventricular arrhythmias with high sensitivity, supporting the potential for future automated cardiac arrest detection. A systematic review identified female sex and arrest at home as consistent determinants of unwitnessed out-of-hospital cardiac arrest. In patients with congenital long QT syndrome, mobile QTc assessment was feasible using handheld and wearable ECG devices, although device-specific validation against the standard 12-lead ECG remains recommended. Finally, wearable-derived heart rate variability measurements showed favourable changes during white noise and classical music. Overall, this thesis shows that wearables, when carefully validated and embedded in clinical workflows with expert review, can support earlier diagnosis, remote monitoring, and more proactive cardiovascular care. Show more