{"doi":"10.1016/j.cvdhj.2020.06.004","title":"When smartwatches contribute to health anxiety in patients with atrial fibrillation","abstract":"Landmark studies have demonstrated that wrist-worn wearable devices (eg, smartwatches, fitness bands) can provide potentially actionable data to improve real-time surveillance of respiratory diseases, such as influenza,1Radin J.M. Wineinger N.E. Topol E.J. Steinhubl S.R. Harnessing wearable device data to improve state-level real-time surveillance of influenza-like illness in the USA: a population-based study.Lancet Digital Health. 2020; 2: E85-E93Abstract Full Text Full Text PDF PubMed Scopus (144) Google Scholar and facilitate the detection of irregular heart rhythms.2Perez M.V. Mahaffey K.W. Hedlin H. et al.Large-scale assessment of a smartwatch to identify atrial fibrillation.N Engl J Med. 2019; 381: 1909-1917Crossref PubMed Scopus (655) Google Scholar Although these tools undoubtedly will transform health care and energize scientific research, important ethical, legal, and social issues have been raised and require careful public deliberation.3Sim I. Mobile devices and health.N Engl J Med. 2019; 381: 956-968Crossref PubMed Scopus (208) Google Scholar We have identified another aspect of the digital health revolution that has not yet received due attention: the unanticipated and potentially negative effects of wearable devices on patients’ psychological health, quality of life, and health care utilization. Although unlimited access to digital health information can motivate some individuals to engage in healthy behaviors, these data may inadvertently contribute to pathologic symptom monitoring and impaired function in others. Patients with intermittent atrial fibrillation (AF) may be especially susceptible to excessive cardiac monitoring with a wearable device given the transient, unpredictable nature of arrhythmias and the ongoing risk of recurrence despite medical or procedural therapy. Anxiety is prevalent among those with AF and has been associated with a higher AF symptom burden, worse quality of life, and increased health care consumption.4Kivimaki M. Steptoe A. Effects of stress on the development and progression of cardiovascular disease.Nat Rev Cardiol. 2018; 15: 215-229Crossref PubMed Scopus (414) Google Scholar,5Baumgartner C. Fan D. Fang M.C. et al.Anxiety, depression, and adverse clinical outcomes in patients with atrial fibrillation starting warfarin: Cardiovascular Research Network WAVE Study.J Am Heart Assoc. 2018; 7: e007814Crossref PubMed Scopus (20) Google Scholar Thus, technologies that heighten awareness and attention to normal and potentially abnormal fluctuations in heart rates may lead to substantial increases in anxiety in predisposed persons and prompt unnecessary medical care. To illustrate this point, we describe a case from our cardiology clinic of a 70-year-old woman with paroxysmal AF. One year after her initial AF diagnosis, a clinical health psychologist (LR) diagnosed her as having new-onset health anxiety that was primarily triggered by excessive cardiac monitoring with a commercially available smartwatch. No evidence of previous mental health problems was noted in her medical records. She had hypertension, a moderate risk of stroke (CHA2DS2-VASc score 3), and arrhythmia burden <1%, and she was compliant with oral anticoagulation and antihypertensive therapies. Smartwatch data provided by the patient revealed that she had performed 916 electrocardiograms (ECGs) over a 1-year period. Of those ECG recordings, 701 were sinus rhythm, 55 were possible AF, 30 indicated low or high heart rate, and 130 were inconclusive. As shown in Figure 1, smartwatch ECG monitoring increased over time. Acute escalations in ECG-taking behaviors were frequently triggered by smartwatch notifications that were either innocuous (eg, transient exercise-induced elevations in heart rate), inconclusive, or indicative of possible AF. Notably, irregular rhythm notifications and findings of uncertain significance (“inconclusive” ECG) produced a relatively similar behavioral response, suggesting that ambiguous data may hav","journal":"Cardiovascular Digital Health Journal","year":2020,"id":61199,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":58,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9438,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":323291,"name":"Anil K. Gehi","orcid":"0000-0002-6724-5294","position":1,"is_corresponding":false},{"id":323292,"name":"Rachel Lampert","orcid":"0000-0003-3313-0939","position":2,"is_corresponding":false},{"id":323290,"name":"Lindsey Rosman","orcid":"0000-0002-0944-6864","position":0,"is_corresponding":true}],"reference_count":9,"raw_metadata":null,"created_at":"2026-07-18T21:09:27.985420Z","pmid":"34386784","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}