I was surprised to see how many home blood pressure monitors also claim to detect heart arrhythmias. I suspect that a lot of what’s picked up results in unnecessary worry and testing.
Still it’s a drop in the bucket compared to what people are scaring themselves with on the Internet.
I recently read (in The Age of a case in which a woman noticed that the heart rate on her wearable was unusually high. (Apologies if this is behind a paywall.) This elevated heart rate persisted, so she asked her son, an emergency department doctor. The high reading was indicating atrial flutter, something that had happened while she was asleep. Atrial flutter is not harmful in itself, but left untreated for 48 hours can turn into something more serious, such as a stroke.
People can get a bit obsessed by their smart watches, and, in some cases I have heard about, get worried about not sleeping as much as the device recommends – causing them to sleep poorly! However, the odd case like the one above shows that these devices can be helpful in bringing some anomaly to the wearer’s attention which would otherwise have gone unnoticed. (The lady had no idea there was anything amiss.)
No question. There are cases where positive outcomes result. (Thanks BTW for putting a pro data post up; all this agreement unnerves me!) And the potential for harms also exist. The concerns for this specific application of constant mass screening are well expressed here, but could have been written by @Dr_Paprika:
Personally I experience the allure of data. In another thread I asked for help choosing a heart rate monitor fitness app. But playing with it I am back to concluding it tells me little that I don’t already know by whether or not I am gasping or breathing easily. Lots of the data these toys give are like that. Probably listening to my body is more accurate than watching the number … akin to med school adage to treat the patient not the lab result?
Well, I should stress the OP specified the worried well. These devices can be helpful in the unworried well, and can provide reassurance to the worried unwell. But there are assumptions behind frequent testing that, though helpful in certain conditions, professionals understand counterintuitively can do more harm than good. It may seem doing a full body MRI of everyone would solve a lot of problems, for example.
I’m trying to keep that squarely in mind.
However.
My mother was one of those “worried well” who felt breathless during the pandemic when wearing a mask. Worse with an N95.
Lots of people told her that “healthy people don’t suffer any ill effects from proper use of an N95 mask,” her physician included.
I wasn’t quite so sure.
Cardiology referral. Echocardiogram.
Mild Pulmonary Hypertension.
So, I think we have to be circumspect about that term, “worried well.”
My wife is a Family Nurse Practitioner in a Residency Program. Over years and years, I’ve ‘coached’ her not to say there’s “nothing wrong with you” (not her default verbiage, incidentally), but to preference statements like “your tests were all normal, but we can only test for the things we can test for, and it’s mostly a snapshot of a single point in time.”
Some “worried well” are worried about something, and – for some subset of those folks – there’s probably a reason, vague and sporadic though it may be.
“When you hear hooves, think horses, not zebras.” I’m a unicorn. I have a unique perspective on all this. I try very hard to remember not to extrapolate to the many from the vanishingly few (ie, me), but …
Most emergency physicians will tell you that many of the most severe problems present in vague ways, most famously the “weak and dizzy” elderly patient. I have seen three cases of heart attack that presented atypically with hiccups.
However, the difference is often the amount of reassurance they get after doing most of the reasonable tests. Some people are never reassured. Many of the people buying advanced diagnostics out of an abundance of caution rather than with a specific reason may be hearing zebras, and concerns like anxiety, false reassurance and the consequences of too many tests cannot be eliminated with reassuring tautologies like “data is data”. It is what it is.