Cardiac Arrest Wearable Detection Devices And Motivated Patient Compliance
Overview
When an out-of-hospital cardiac arrest (OHCA) occurs, the initial step in the chain of survival is early detection. However, 75% of OHCAs go unwitnessed, which creates a significant barrier to triggering the necessary life-saving interventions. Wearable devices have the potential to act as “artificial bystanders,” identifying OHCAs and notifying emergency services. This study aimed to explore factors influencing individuals’ willingness to continuously wear such devices, using an online survey to guide future applications of wearables for automated cardiac arrest detection.
Data collection occurred between October 2022 and June 2023 through a voluntary online survey. The survey assessed user preferences regarding convenience and perceived urgency to evaluate design preferences and the likelihood of continuous use across varying hypothetical risk levels. Relationships between categorical variables and willingness were assessed using nonparametric tests, while logistic models were employed to analyze the association between continuous variables and willingness at different risk levels.
A total of 359 individuals participated in the survey. Participants expressed a preference for hand-based wearables (wristbands: 87%, watches: 86%, rings: 62%) and prioritized factors such as comfort (94%), cost (83%), and size (72%). Willingness to use the devices increased with higher hypothetical risk levels. At a baseline risk of 0.1%, older participants and those with prior experience using wearables were more likely to adhere to continuous use.
Users demonstrated a willingness to consistently wear wearable devices for OHCA detection, especially when the perceived risk was higher. Enhancing adherence to these devices requires not only addressing user preferences but also raising awareness and understanding of OHCA to improve the perception of urgency.
Introduction
Out-of-hospital cardiac arrest (OHCA) is a significant global health issue, with an average incidence of 111 adults per 100,000 person-years. When an OHCA occurs, rapid detection is crucial, followed by immediate cardiopulmonary resuscitation (CPR) and defibrillation, ideally before emergency medical services (EMS) arrive. However, a major challenge in unwitnessed OHCAs is the delay in detection, as approximately 75% occur when no bystander is present. This delay dramatically reduces survival rates, with the chances of survival decreasing by 13% for each minute without recognition. As a result, nearly half of unwitnessed OHCAs go untreated, and survival to hospital discharge is as low as 2-4% in these cases.
OHCA triggers several physiological changes, including cessation of cardiac output and body motion, irregular breathing, and dangerous cardiac rhythms such as ventricular fibrillation or asystole. Blood oxygen levels plummet, and blood pressure falls to zero. These changes are detectable and can be monitored through wearable devices equipped with sensors such as electrocardiography (ECG), photoplethysmography (PPG), and inertial measurement units (IMUs). While wearables have gained popularity in health monitoring, there are currently no commercially available devices designed to specifically detect OHCA.
The widespread adoption of wearables for cardiac arrest detection faces challenges, particularly in ensuring continuous usage. Wearable adherence is influenced by two key factors: user convenience, such as form factor and ease of use, and the perceived urgency of the need for such devices, shaped by personal or family medical history. Understanding these factors is essential for developing wearables that can improve cardiac arrest detection and survival outcomes.
The bottom line is that 75% of OHCAs go unwitnessed, leading to a sharp decline in survival rates when recognition and intervention are delayed. Wearable sensors hold the potential to serve as artificial bystanders, detecting these events and improving outcomes. However, designing a wearable device that users are willing to wear continuously remains a challenge. This study surveyed a pan-Canadian population to explore user preferences and adherence to such devices, offering insights and recommendations for future wearable development to enhance OHCA detection.
Method
This study conducted a pan-Canadian online survey to explore participants’ willingness to continuously use a wearable device designed to detect out-of-hospital cardiac arrest (OHCA). The focus was on willingness to adhere to wearable use rather than actual adherence.
The survey, approved by the university’s Research Ethics Board (H21-03589), was developed using Qualtrics and modeled after validated adherence surveys, such as the Morisky Medication Adherence Scale. It was shaped through consultations with cardiac arrest experts and individuals with and without OHCA experience. After a pilot phase to ensure clarity, the survey was distributed from October 2022 to June 2023 via various channels, including posters, social media, and research platforms like ReachBC. A voluntary response approach was used, and participants provided informed consent prior to completing the survey.
The survey consisted of three sections:
- Background Questions: This section explored user preferences regarding different wearable forms (e.g., watch, ring, chest strap) and factors influencing their decision to use a device (e.g., cost, size, battery life). It also gathered information about participants’ prior use of wearable devices and their awareness of cardiac arrest through personal or familial experiences.
- Scenario-Specific Questions: These questions assessed how participants’ perceptions of urgency impacted their willingness to use a wearable device. They were presented with varying hypothetical risks of cardiac arrest: a baseline risk of 0.1%, a 2% increased risk (IR 1), and a 10% increased risk (IR 2). At each risk level, participants were asked to rate their willingness to use the device in different contexts, such as once, continuously, or during specific activities like exercise or sleep.
- Demographic Questions: This section collected data on participants’ age, gender, sex, geographic location, education level, and occupation. The survey also examined the relevance of gender identity to wearable device design preferences.
Data Analysis
Data analysis was performed using R (version 4.2.2). Participants were categorized by age groups (under 25, 25–45, 45–65, over 65) to identify age-dependent preferences. Incomplete responses in the first two sections were excluded, but demographic data alone were analyzed for general trends.
- User Convenience: Preferences for specific wearable forms and usability factors were assessed across demographics and status groups (previous wearable use and OHCA awareness). Participants could select multiple preferences.
- Perception of Urgency: Willingness to adhere to wearable use at each hypothetical risk level was evaluated, considering demographic subgroups (age, gender) and status groups. The Wilcoxon rank-sum test and Kruskal-Wallis test were applied for statistical comparisons, while logistic regression was used to analyze the influence of age on adherence at different risk levels.
- Impact of Urgency on Convenience: The study also explored how perceived OHCA risk affected participants’ willingness to use wearables during various activities, such as daily routines, physical exercise, sleep, and work. Associations between activities and willingness were tested using the Kruskal-Wallis test, with post-hoc Dunn’s test for pairwise comparisons. The Wilcoxon rank-sum test was used to examine the relationship between risk levels and willingness across different activities.
This comprehensive analysis provides insights into user preferences and the influence of perceived risk on adherence to wearable devices for cardiac arrest detection.
Result
The anonymized raw survey data, along with the analyses, are available on Dataverse. The survey included 414 participants, with an 86.7% completion rate (n = 359), and 355 respondents provided demographic data for analysis. Most participants were female (70%), with a median age of 47. A significant portion of respondents (82%) were wearable device users, and 94% had a high awareness of out-of-hospital cardiac arrest (OHCA).
In terms of design preferences, participants favored hand-based wearables, such as wristbands (87%), watches (86%), and rings (62%). Key factors influencing purchasing decisions included comfort (94%), cost (83%), size (72%), and battery life (70%).
The willingness to adhere to continuous wearable use increased with the perception of urgency, particularly when the risk of OHCA was considered higher. Across all age groups, a higher sense of urgency led to greater adherence, although younger participants were less likely to adhere when urgency was perceived as low. Gender and user status also influenced adherence, with wearable users showing higher adherence rates across all risk levels. Interestingly, high awareness of OHCA did not correlate with increased adherence at individual risk levels.
Convenience was less influential when urgency was perceived as high, with adherence increasing across all activities, such as sleep and physical activity. Even though the willingness to adhere varied depending on the activity, it still increased as the perceived risk rose.
The study acknowledges limitations, including the geographical concentration of participants in British Columbia and recruitment through a platform that may attract more informed individuals. This could limit the generalizability of the findings to less knowledgeable populations. Additionally, the survey measured hypothetical adherence to a perfectly accurate wearable, which could differ from real-world use when factors like false positives are considered. Lastly, some demographic subgroups, such as nonbinary, genderfluid, and low-awareness participants, were underrepresented, potentially affecting the results.
Conclusion
We conducted a survey to explore user convenience and perceptions of urgency that influence participants’ willingness to consistently wear health monitoring devices. The findings indicate several factors affecting adherence. First, users generally prefer hand-based devices, such as watches, wristbands, and rings, with preferences driven by comfort, affordability, small size, and long battery life. Additionally, increasing the perceived risk of out-of-hospital cardiac arrest (OHCA) significantly boosted adherence across all demographics, leveling out differences between age groups. This suggests that both improving wearable device design and raising awareness about OHCA risks could enhance adherence.
At a baseline risk of 0.1%, older adults with cardiovascular issues showed the highest adherence, likely due to their familiarity with wearables. However, as the perceived risk of OHCA increased, the willingness to adhere surpassed 90% across all age groups. Interestingly, even though the actual risk of OHCA might be low, the urgency perceived by individuals could still be significant, especially given the serious consequences of such events. Our survey, however, revealed that participants did not exhibit a high sense of urgency regarding OHCA at a baseline risk level.
Further findings highlight a mismatch between participants’ preferences and the most critical periods for OHCA detection. While users are most willing to wear devices during physical activity, OHCAs often occur during sleep, a time when wearables are less favored due to perceived discomfort. This discrepancy suggests a need for more comfortable devices designed for nighttime use.
In terms of design preferences, the survey indicated a strong preference for wrist-based devices, such as wristbands and watches, due to their comfort and ease of use. Comfort, mentioned by 94% of users, and size, noted by 72%, were the most important factors influencing device choice. Continuous use of these devices is crucial for improving OHCA survival rates, as previous studies have shown that early detection by biosensors could significantly increase survival rates.
In conclusion, the survey results underscore that a majority of participants are willing to consistently use wearables to monitor for OHCA, especially when the perception of risk is high. By improving both device design and public education on OHCA risks, we can further enhance adherence rates. These findings provide valuable insights into the factors influencing the adoption of OHCA-specific wearables.
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