Hughes, Andrew

Heart failure (HF) is a complex clinical syndrome that represents one of the leading causes of morbidity and mortality in developed nations. It is well established that every HF-related hospital admission leads to worsened quality of life for the patient and their caregiver and also imposes a significant financial burden on society. Therefore, reducing hospital admissions for this population has emerged as a critical tactic over the past decades. Initial attempts at remote monitoring focused on self-reported vital signs and symptoms, yet these proved ineffective. Meanwhile, subsequent technological advancements have enabled the development of miniature sensors capable of detecting and monitoring a wide range of physiologically relevant parameters; some of these advancements have been integrated into implantable devices, such as pacemakers and defibrillators. However, noninvasive monitoring has recently emerged as an alternative option for patients with HF, offering early congestion detection without requiring an invasive procedure. This review aims to summarize implanted and noninvasive devices, their characteristics, monitored parameters, and potential limitations and challenges around their integration into routine clinical practices.

ABSTRACT Reduced functional capacity and poor sleep quality are common in pulmonary arterial hypertension (PAH). Wearable devices are an emerging, user‐friendly tool to capture activity and sleep information. We aimed to determine whether Fitbit‐derived activity and sleep trends provide clinically meaningful information in patients with PAH. Our prospective observational study recruited patients with PAH from across the United States using remote enrollment strategies and in‐person efforts. Participants wore a Fitbit device for 12 weeks at baseline and a subgroup with 1‐year follow‐up. A matched control cohort was generated from the All of Us Research Program and we evaluated changes in patients with PAH compared to matched controls. Among 110 patients with baseline monitoring, average daily steps correlated with 6MWD ( r = 0.61, p < 0.001) and percent rapid eye movement (REM) sleep ( r = 0.28, p = 0.008). In 44 PAH participants who completed baseline and 1‐year monitoring, there was a group‐time interaction for percent light sleep ( p = 0.024) and percent REM sleep ( p = 0.034), which demonstrated that sleep quality worsened in patients with PAH over 1 year compared to matched controls. Average daily steps decreased in patients with PAH from 5200 [IQR 3212–7458] at baseline to 4651 [IQR 2912–6827] at 1 year ( p = 0.008). In conclusion, our study demonstrated the potential clinical value of wearable devices by showing that activity and sleep quality are reduced in PAH compared to matched controls and these measures decline over time. Future studies should investigate if monitoring these health behaviors detects early functional decline and whether targeted interventions may improve outcomes.