Accuracy of a Wrist-Worn Wearable Device for Monitoring Heart Rates in Hospital Inpatients: A Prospective Observational Study
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BACKGROUND: As the sensing capabilities of wearable devices improve, there is increasing interest in their application in medical settings. Capabilities such as heart rate monitoring may be useful in hospitalized patients as a means of enhancing routine monitoring or as part of an early warning system to detect clinical deterioration. OBJECTIVE: To evaluate the accuracy of heart rate monitoring by a personal fitness tracker (PFT) among hospital inpatients. METHODS: We conducted a prospective observational study of 50 stable patients in the intensive care unit who each completed 24 hours of heart rate monitoring using a wrist-worn PFT. Accuracy of heart rate recordings was compared with gold standard measurements derived from continuous electrocardiographic (cECG) monitoring. The accuracy of heart rates measured by pulse oximetry (Spo2.R) was also measured as a positive control. RESULTS: On a per-patient basis, PFT-derived heart rate values were slightly lower than those derived from cECG monitoring (average bias of -1.14 beats per minute [bpm], with limits of agreement of 24 bpm). By comparison, Spo2.R recordings produced more accurate values (average bias of +0.15 bpm, limits of agreement of 13 bpm, P<.001 as compared with PFT). Personal fitness tracker device performance was significantly better in patients in sinus rhythm than in those who were not (average bias -0.99 bpm vs -5.02 bpm, P=.02). CONCLUSIONS: Personal fitness tracker-derived heart rates were slightly lower than those derived from cECG monitoring in real-world testing and not as accurate as Spo2.R-derived heart rates. Performance was worse among patients who were not in sinus rhythm. Further clinical evaluation is indicated to see if PFTs can augment early warning systems in hospitals. TRIAL REGISTRATION: ClinicalTrials.gov NCT02527408; https://clinicaltrials.gov/ct2/show/NCT02527408 (Archived by WebCite at http://www.webcitation.org/6kOFez3on).
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Some studies have used the gold-standard reference method of electrocardiogram, which directly measures heart rate via electrical impulses from the heart and is used for clinical accuracy.
“Although some studies have attempted to address wearable HR accuracy using the gold-standard reference method of ECG, which directly measures HR via electrical impulses from the heart and is used for clinical accuracy38–44”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [41]
On average, wearables slightly and negligibly underestimate absolute heart rate (−0.9 to −7.2 bpm) compared with gold-standard electrocardiogram.
“Current research verifying wearables to the gold-standard ECG, which uses electrodes to directly measure cardiac muscular contractions from electrical activity of the heart, have shown that on average wearables slightly and negligibly underestimate (−0.9 to −7.2 bpm) absolute HR40,41,44,52”
From Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research (2020) · cites this paper as [41]
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References 29 · Cited by 123
- Authors
- Kroll, R. R., Boyd, J. G., & Maslove, D. M.
- Affiliations
- Queen's University (CA)
- Corresponding author
- Maslove, David M
- Venue
- Journal of Medical Internet Research
- Publisher
- JMIR Publications Inc.
- Published
- 2016-09-20
- Volume
- 18
- Issue
- 9
- Pages
- e253
- ISSN
- 1438-8871 (ISSN-L)
- PMC
- PMC5050383
- OpenAlex
- W2479978653
- Cited by
- 123
- References
- 29
- Citations by year
- 2026: 7 · 2025: 8 · 2024: 8 · 2023: 10 · 2022: 19 · 2021: 8 · 2020: 16 · 2019: 16 · 2018: 19 · 2017: 12
- FWCI
- 7.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- Journal of Medical Internet Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Physical Sciences › Engineering › Biomedical Engineering › Non-Invasive Vital Sign Monitoring
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › ECG Monitoring and Analysis
- Keywords
- wearable devices, heart rate monitoring, wrist-worn sensors, accuracy, hospitalized patients, intensive care unit, electrocardiogram, pulse oximetry, sinus rhythm, early warning systems, clinical deterioration
- MeSH terms
- Biometry, Female, Heart Rate, Humans, Inpatients, Male, Middle Aged, Monitoring, Physiologic, Prospective Studies, Wrist, Cohort Studies
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