Heart failure (HF) is a substantial global health problem that is characterised by significant mortality and poor quality of life. It is a lifelong condition in which the heart muscle is unable to pump enough blood around the body properly. Patients with HF experience elevated risks of adverse health outcomes, indicating a need for better prognostic markers to enable more effective and timely intervention. In a study published in Nature Medicine in March 2026, Yuan Gao and colleagues investigated whether a wearable device such as an Apple Smartwatch could be used to estimate the cardiopulmonary fitness of HF patients, and whether daily fitness monitoring markers could predict worsening patient health. They found that smartwatches could measure cardiopulmonary fitness accurately and could aid in predicting HF exacerbations.
To investigate whether smartwatches could predict cardiopulmonary fitness and whether they could play a role in the remote monitoring of HF, the Canadian-based Ted Rogers Understanding Exacerbations of HF (TRUE-HF) study cohort was used. The cohort consisted of 217 HF patients. They were provided with Apple watches and compatible iPhones for the duration of the study if they did not already own compatible devices. Throughout the study, daily self-administered surveys about health status and unplanned healthcare utilisation were conducted. Unplanned healthcare utilisation was defined as hospital admissions, unscheduled clinic visits, or intravenous furosemide treatment. Unscheduled events were verified using electronic health records and physician notes. Cardiopulmonary fitness was estimated through peak oxygen consumption rates (pVOâ‚‚). Patients were excluded from the primary analysis if they wore their watch for fewer than ten days of the scheduled 90-day monitoring period. Predictive modelling and survival analyses were used to assess the accuracy of the watch measurements. The study authors found that after applying their developed predictive model, watch measurements showed high agreement (r=0.85) with gold-standard measurements. Additionally, clinically meaningful drops in pVOâ‚‚ predicted unplanned healthcare utilisation in HF patients, with each 10% drop in pVOâ‚‚ being associated with a 3.62 times higher risk of unplanned healthcare utilisation.
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This study shows how smartwatches that can reliably measure pVOâ‚‚ levels could be of use in remote HF monitoring. If patients can monitor their own cardiovascular health, as opposed to relying on infrequent clinical check-ups, this could enable the early identification of at-risk patients and the utilisation of proactive measures, such as expedited clinical visits. Proactive measures could help reduce adverse outcomes in HF patients and improve their quality of life. GlobalData epidemiologists forecast that in the seven major markets (7MM: US, France, Germany, Italy, Spain, UK, and Japan), the diagnosed incident cases of HF will grow from 3.2 million cases in 2026 to 3.7 million cases in 2032.
