Wearable technologies to predict and prevent and heart failure hospitalizations: a systematic review

Heart failure (HF) is a global pandemic and accounts for substantial morbidity and healthcare expenditure, largely due to frequent hospitalizations. While traditionally HF patients are followed with intermittent clinical assessments, wearable technologies offer continuous, real-time monitoring, potentially enabling earlier detection and tailored interventions to prevent hospitalization. This systematic review evaluates the impact of non-invasive wearable devices on hospitalizations in HF. Following PRISMA guidelines, literature searches were conducted in PubMed and Scopus using keywords related to HF, hospitalization, and wearable technology on 1 March 2024, and re-run on 3 December 2024. Studies assessing the link between wearable devices and HF-related hospitalization rates were included. Data extraction covered population characteristics, study design, type of device, and hospitalization rates. Risk of bias was assessed using ROBINS-I and ROB-2 tools. Meta-analysis was attempted but not performed due to significant heterogeneity (I²>90%). From 2247 records, eight studies involving 1823 patients were finally analysed. Devices included ReDS, VitalPatch, ZOLL LifeVest, and ZOLL-HFMS, with follow-up ranging from 30 to 646 days. Wearable devices allowed prediction of HF hospitalization within 6.5–32 days in advance. Wearable-guided therapy compared to traditional assessment showed an 89% relative reduction at 30 days in a single-blind randomized-controlled trial, and 78% and 87% reductions in 30-day and 90-day hospitalization rates in observational studies. Although these data highlight the potential of wearable devices in HF management, future research should test predefined wearable-guided treatment algorithms on strong endpoints and address cost-effectiveness and data security in large randomized-controlled trials with longer follow-up.

Registration This review was registered with PROSPERO (CRD42024519282).