Scott Webb: You may have seen folks with Apple watches or fitbits and wondered how they're used to track our steps and monitor other Essential things like heart rate and more well my guest is here today to explain wearable technologies and discuss the many benefits for patients and providers and I'm joined today by dr. Britney Dixon she's a board certified cardiologist chooses to practice at Franciscan health.  

Scott Webb (Host): This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's so nice to have you here. I know this is the first of two podcasts that we're going to do. Today, we're going to talk about fitness trackers, Apple watches, all that good stuff. And I do know about my Apple watch, it's always reminding me to breathe and i always find that interesting. I'm like, "But I am breathing." I know it doesn't mean that. You know, it doesn't mean literally breathe. It's always reminding me to do things like that. So, I know that they're really cool, they're really smart. And through the lens of what we're talking about today, we're going to talk about this wearable technology. And I guess maybe there's two categories, right? There's consumer grade and medical grade. So, maybe you could explain the difference to listeners

Dr. Brittany Dixon: First, I want to thank you for having me. I think this is a very hot topic. I can tell you that my friends and family already ask me these questions all the time. So, happy to help provide some clarity for everyone out there.

Host: That's great.

Dr. Brittany Dixon: So, let's just give a few kind of basic definitions. So when we say consumer-grade products, we're really referring to those that are purchased directly by patients, so like at a retail store or online. You don't need any type of prescription. You don't have to see your physician or provider first. They're designed to be used with kind of little to no training. You don't necessarily need medical background or anything like that. And these are not necessarily subject to the same type of rigorous standards that we have to use when we're in the clinical setting, but they're generally safe and effective.

And the types of consumer-grade devices, there are some that, you know, are designed to give you alerts for something that's harmful. A common example is like, you know, patients will say, "My watch went off when my heartbeat was high," those type of things. Or opposite if your heart rate's too low, they'll go off. Some of them are just to help with like day to day kind of disease management. And a good example is like a blood pressure cuff. I always recommend patients get those just in case they're having any symptoms at home or they're changing their medications. Those are helpful to have.

And then, there's like a whole category of kind of preventative care and wellness, kind of general wellness, and that's where, you know, things like meditation apps or like sleep trackers or maybe reminders to breathe come in for general wellness. So, that's what i would kind of put in that category.

Then, medical-grade just in comparison, the difference is really that those are specifically tested for safety to be used in a medical setting to diagnose and treat patients. So, there's more rigid standards and is regulated by the FDA. I really don't want to get really technical. There's kind of different classes that they fall into. Some examples for those are things like Holter monitors or loop recorders. Those are things that, you know, we will use in the hospital and in the office.

Host: Yeah. I'm just checking the boxes. I'm like, "All right. I have some of the consumer stuff. I have used some of the medical grade stuff. And, Doctor, I know that consumer-grade apps and devices are so plentiful, right? They track data, activity, sleep patterns, all sorts of good stuff. So from your perspective, an expert's perspective, which do you find the most helpful or educational for patients?

Dr. Brittany Dixon: Yeah. That's a great question. There is such a thing as too much information, right? So, you want to tailor it to your individual needs, because otherwise you get alert fatigue or you can get irrelevant information. An example I will use is, you know, patients always ask me about purchasing pulse ox for their fingers. And some cases like if you have lung disease or if you wear oxygen, supplemental oxygen, it's a useful tool, right? But not everyone needs to walk around with a pulse ox on their finger. That's just too much information at once. So, you know, you really have to kind of think about what's most useful.

But to answer your question, what's most helpful is when we can identify problems that are kind of subclinical, so things before they become an issue where you have to come into the hospital or come into clinic for subtle warning signs and picking up with these devices that's helpful. Ideally, the goal is to prevent you from having to go to the emergency department or having any worsening symptoms. So if there's something that can tell us like, "Hey, you may be retaining some extra fluid. Maybe we should adjust your medications" or "Your heart rate's running high. Maybe we should increase your medication," that would be very helpful and it helps to save time in the long run.

Host: Yeah. I want to talk about tracking activity, Doctor, and why it's important in setting goals and that kind of thing. And I just want to reference, you know, my wife, for a long period of time, she was really into tracking her steps. She would give me frequent updates, you know, she would say, "Oh, my God. I had so many steps today." And I just don't know how to respond to that. I'm like, "I have steps too. i just didn't count them" or "My Fitbit didn't count them for me." So, maybe you could just sort of explain here, you know, the importance of tracking activity and what does it mean? Like what do I do with that information? "I got five thousand steps today." Okay, what does that mean?

Dr. Brittany Dixon: Yeah. So, I think I'm similar to your wife. I also track my steps as well. But there's a lot of different activity trackers out there, right? There's traditional pedometers, there's now watches, there's rings you can wear. Even phone apps that all track, you know, your steps, your elevation, how many stairs you take. So, they really help you to stay on target and provide motivation for, you know, living an active lifestyle and just talking about that, what does that mean.

So, the American Heart Association has standards for what your target should be. So, we generally recommend that everyone get at least a 150 minutes of moderate intensity aerobic exercise per week, and that can be divided up. So like, five days, thirty minutes or, you know, if you want to do it all at once, sure, go ahead. But that's the general recommendation from the Cardiology group. We want people to get at least 150 minutes of that. Alternatively, you could be more intense and do 75 minutes of vigorous activity. So, that's consider heart-healthy standard to maintain over time. And, you know, a lot of this sounds great in theory, but how often are we really keeping track of this? And so, these trackers really help us to kind of really stay in target and also kind of remind us to get moving.

In terms of steps, you know, I know this is a hot topic and the whole 10,000 steps a day is like a really, you know, good mantra that everyone follows. Believe it or not that actually is a made-up statistic so that was actually form of a marketing tool than something based on data. But there there is data to show that, you know, one article said that 7,000 steps a day can lower your risk of death by 50-70% compared to those who have fewer steps.

Host: Wow. Okay.

Dr. Brittany Dixon: Yeah, that's a pretty impressive statistic. In comparison, 9,000 steps, it can lower your risk by 60%. So, it's important to get those steps. Those steps are just, you know, some minor number. Those steps over time are potentially improving your overall life span. And the benefits start at even as low as 2,500 steps. So, you know, any steps that you can get in as long as you're not sitting in a chair, sitting on your couch all day, that's all helpful for general heart health. And so, you know, of course, why does this matter? You want to avoid heart disease. You want to help control your blood pressure and help control your blood sugars, help control your weight. That all matters in the long run.

Host: Right. Yeah. No good comes from a sedentary lifestyle. And obviously, all these devices rather than us using-- I don't know, do people still use paper and pen, you know, and writing things down? This thing will do all the heavy lifting for us, right? Which is just amazing and I want to move from the consumer-grade into the more medical-grade. You know, I know the implant, the pacemakers and fibrillations and all sorts of cool stuff and wearable devices that monitor diabetes, which obviously is you talking about heart disease, a big risk for heart disease. So, I guess my point is I know that the medical-grade wearable devices have gotten smaller. Maybe you can tell us a little bit about that because they've gotten smaller, because they're easier for people to use, you know, which ones do you most commonly prescribe, we call it, for patients?

Dr. Brittany Dixon: So, they've gotten smaller, but they've also gotten more advanced, which pretty cool. So within, you know, being a cardiologist, I will just kind of focus on my role and what I use. So, one common thing, probably the most common device that we give patients, are heart monitors. And at one point, they used to be very bulky and have leads that you had to attach to patients. But nowadays, many monitors on the market are kind of small, weightless patches that can be worn on the skin, even under clothes. So, that's kind of nice. And it's still giving very useful information that we use in the clinical setting. So, that's one example of how these device have been kind of optimized, you know, to a point where, you know, patients can walk around, and it's barely detectable that they even have this device on them.

Some other examples, kind of more broad are for heart failure patients. Not tiny, but still given what it does, is still useful. The defibrillator vest that we put patients on, not only can it save lives, but it provides information about monitoring heart failure. So like, if you're, what i mentioned earlier, retaining fluid or your heart rate's high. All that can be detected by these devices, and it's just like a simple vest that goes underneath clothes. And then, there are some that we still implant. The implantable loop recorder is a device and it's about the size of a USB drive. It's pretty cool, and it just goes underneath the skin, and it's kind of like an in-and-out type procedure that we do. They've gotten smaller, but they still have great functionality. And I think it's going to continue to improve in the future.

Host: Yeah. I've worn one of those Holter monitors years and years ago, and it just was so big and bulky and really couldn't be worn under your clothes. And it just made me kind of not want to go outta the house. So, it's good to know that some of these wearable stuff, the medical-grade stuff, is you know a little more discrete, right?

Dr. Brittany Dixon: Yes.

Host: That's great. So, I'm wondering, back to consumer-grade stuff, watches, Fitbits, whatever it might be, can they help patients with serious heart conditions like AFib?

Dr. Brittany Dixon: Absolutely. I can actually testify that myself. So, you know, the watches frequently monitor these heart rate trends, and they can detect irregular rhythm. Some even have EKG strips. They're like a step more advance. They can have EKG strips that can either be printed or shared with others. I'll use my mother as an example, she uses those. You know, sometimes patients will come in, and they'll say my watch keeps alerting me that my heart rate's irregular. And I'll say, like, "Oh, interesting. Can i see?" And they'll pull it up right there in clinic during the visit. Some people even have rhythm strips. And so, it's very helpful to actually have, you know, tangible data that I can look at real time with the patients and kind of see what they are seeing at home.

For heart failure, I would say probably the best consumer device, and I know this probably is going to sound atypical, but a scale honestly, that's technically a consumer device. So, monitoring their weights at home and there's sometimes fancy scales. But, you know, just knowing like if there's any change in weight from day to day or within a week gets us a lot of information about how they're doing overall in their process. So, I would say that's important for heart failure. Also, blood pressure cuffs, like I mentioned earlier, especially when we're adjusting medication changes. I always have patients frequently picking up pen and paper. I have them write down their blood pressure, keep a log for me, so I can look at the trends over time. So, it definitely helps when we use these on a regular basis.

Host: I mentioned as we got rolling here, you know, we're going to do two podcasts. So, we've finished up the first one today and just talk a little bit more about the consumer-grade stuff, the Fitbits, Apple watches. They give us so much data as we've kind of talked about today, and they can help to motivate us and keep us motivated to stay heart-healthy. But for someone who's just getting started, how would you suggest they get started, whether it's setting goals, whatever it might be?

Dr. Brittany Dixon: I think a good place to start is just to see your provider. So for most people, that means seeing their primary care provider. If you do happen to have a specialist, you can also see your specialist as well. But questions to ask, you can say to your provider, what will be useful to do at home? Because that usually segues into conversations about what you should be monitoring or what you should be looking for. But patients asked me what are signs they should look for when they go home. And I think that naturally, you know, brings up topic of like what are the important vital signs to monitor what are some other things to monitor.

 And so, I think, yeah, just having a conversation with your provider. This is very individualized, so it's not one-size-fits-all. Just starting there and, you know, I like when patients are proactive. And they ask me these questions because that means that they're going to be more on top of things and they're going to be able to call us and alert us sooner than later if they're having issues and that just leads to better outcomes long term.

Host: Yeah. For sure. When in doubt, speak with your provider. I've gotten to speak with a provider today, not necessarily my provider, but a great provider, an expert. Great to pick your brain today. I know we're going to talk again soon. Thanks so much.

Dr. Brittany Dixon: Thank you.

Host: And to learn more about heart health, please visit franciscanhealth.org/heartcare. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.