# A Survey on the Perceptions of Puerto Rican Cardiologists on the Use of Smartwatches and Implantable Loop Recorders

## TL;DR

This study explores how Puerto Rican cardiologists view smartwatches and implantable loop recorders for monitoring heart rhythm disorders like atrial fibrillation.

## Contribution

It provides insights into cardiologists' perceptions and preferences for wearable and implantable cardiac monitoring devices in Puerto Rico.

## Key findings

- 82% of cardiologists identified device cost as a limitation for smartwatch use in cardiac monitoring.
- 62.5% of cardiologists preferred implantable loop recorders over smartwatches for high-risk atrial fibrillation patients.
- Non-subspecialized cardiologists were more likely to perceive device accuracy as a limitation for smartwatch use (p = 0.0234).

## Abstract

A variety of portable monitoring devices have become available and have proven to be of use in the monitoring of atrial fibrillation (AF). Implantable loop recorders (ILRs) have been shown to have great sensitivity in recording arrhythmia events in long-term arrhythmia monitoring. Recently, smartwatches have gained prominence as an unobtrusive alternative for heart rhythm monitoring. The purpose of this study was to gain a better understanding of the perception of Puerto Rican cardiologists on the use of these devices in the management of AF, particularly when compared to more established long-term devices like ILRs. We administered a survey questionnaire to cardiologists currently practicing in Puerto Rico. Demographic information was collected through participant self-reporting. Participants were defined into subgroups as follows: having a cardiac subspecialty, being associated with academia, years of practicing as a cardiologist, and cardiologist age. Commonly identified limitations to smartwatch use in cardiac monitoring were device cost (82% of respondents) and patient’s technical knowledge (81.3% of respondents). There was a tendency to prefer the use of ILRs over smartwatches in higher risk AF patients (62.5% of respondents). The main perceived benefit of these devices is their capacity to provide continuous and unobtrusive rhythm monitoring (89.6% of respondents). Attitudes towards smartwatches and ILRs were evaluated through Likert scales (1 Strongly Agree - 5 Strongly Disagree), and the non-parametric approach was chosen for their assessment. The unadjusted relationship of attitudes within these defined subgroups was evaluated through the two-sample Wilcoxon-Mann-Whitney rank-sum test. Non-subspecialized cardiologists (mean Likert Scale answer 2.19 ± 0.83) when compared to sub-specialized cardiologists (mean Likert Scale answer 2.83 ± 0.94) were more likely to identify device accuracy as a limitation to smartwatch use for AF detection (p = 0.0234). All other differences in Likert scale ratings evaluating device cost, reliability, and sensitivity were nonsignificant between subgroups (p > 0.05).