Jessica R Golbus1, Nicole A Pescatore2, Brahmajee K Nallamothu3, Nirav Shah2, Sachin Kheterpal4. 1. Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. 2. Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. 3. Division of Cardiovascular Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Michigan Integrated Center for Health Analytics and Medical Prediction, University of Michigan, Ann Arbor, MI, USA; The Center for Clinical Management and Research, Ann Arbor VA Medical Center, MI, USA. 4. Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA. Electronic address: sachinkh@med.umich.edu.
Abstract
BACKGROUND: Wearable technology has rapidly entered consumer markets and has health-care potential; however, wearable device data for diverse populations are scarce. We therefore aimed to describe and compare key wearable signals (ie, heart rate, step count, and home blood pressure measurements) across age, sex, race, ethnicity, and clinical phenotypes. METHODS: In the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) prospective observational study, we enrolled participants from Michigan Medicine, Ann Abor, MI, USA, and followed them up for at least 90 days. Patients were included if they were aged 18 years or older, were fluent in English, owned an iPhone 6 or newer model with a supported iOS version, and had regular access to the internet throughout the study period. All participants were provided with an Apple Watch Series 3 or 4, an Omron Evolv Wireless Blood Pressure Monitor, and the MyDataHelps study smartphone application. Participants were asked to wear their watch for 12 h per day or longer and to do daily or weekly tasks, including home blood pressure measurements and breathing tasks. Heart rate, blood pressure, step counts, and distance walked were collected. The study was divided into two phases: an intensive 45-day collection phase (phase 1); and a 3-year longitudinal monitoring phase (phase 2). Here we report the first 90 days of data for all participants, which includes all of phase 1 and the first 45 days of phase 2. Participants' electronic health records were used to establish clinical diagnoses for analysis. FINDINGS: We enrolled 6765 eligible participants between Aug 14, 2018, and Dec 19, 2019, of whom 6454 participants from Michigan Medicine completed the phase 1 study protocol and were included in this analysis (3482 [54%] women and 2972 [46%] men; 3657 [57%] participants were White, with 1094 [17%] Asian and 1090 [17%] Black participants). On days when participants wore their smart watches, median daily watch wear time was 15·5 h (IQR 14-17). Participants contributed a total of 1 107 320 blood pressure and 202 198 347 heart rate measurements over 90 days, with 172 (SD 50) blood pressure and 31 329 (SD 24 620) heart rate measurements per participant. Mean systolic blood pressure was 122 mm Hg (SD 10) and mean diastolic blood pressure was 77 mm Hg (SD 8), with 167 312 (15%) measurements having a systolic blood pressure higher than 140 mm Hg or diastolic blood pressure higher than 90 mm Hg. Mean resting heart rate was 64 beats per min (SD 8). Blood pressure and resting heart rate varied by sex, age, race, and ethnicity, with higher blood pressures in males and lower heart rate in participants aged 65 years or older (p<0·0001). Participants took 7511 steps per day (SD 2805) and walked 6009 metres per day (SD 2608), varying across demographic and clinical subgroups. INTERPRETATION: These data could inform clinical trial design, interpretation of wearable data in clinical practice, and health-care interventions. FUNDING: Apple, University of Michigan.
BACKGROUND: Wearable technology has rapidly entered consumer markets and has health-care potential; however, wearable device data for diverse populations are scarce. We therefore aimed to describe and compare key wearable signals (ie, heart rate, step count, and home blood pressure measurements) across age, sex, race, ethnicity, and clinical phenotypes. METHODS: In the Michigan Predictive Activity & Clinical Trajectories in Health (MIPACT) prospective observational study, we enrolled participants from Michigan Medicine, Ann Abor, MI, USA, and followed them up for at least 90 days. Patients were included if they were aged 18 years or older, were fluent in English, owned an iPhone 6 or newer model with a supported iOS version, and had regular access to the internet throughout the study period. All participants were provided with an Apple Watch Series 3 or 4, an Omron Evolv Wireless Blood Pressure Monitor, and the MyDataHelps study smartphone application. Participants were asked to wear their watch for 12 h per day or longer and to do daily or weekly tasks, including home blood pressure measurements and breathing tasks. Heart rate, blood pressure, step counts, and distance walked were collected. The study was divided into two phases: an intensive 45-day collection phase (phase 1); and a 3-year longitudinal monitoring phase (phase 2). Here we report the first 90 days of data for all participants, which includes all of phase 1 and the first 45 days of phase 2. Participants' electronic health records were used to establish clinical diagnoses for analysis. FINDINGS: We enrolled 6765 eligible participants between Aug 14, 2018, and Dec 19, 2019, of whom 6454 participants from Michigan Medicine completed the phase 1 study protocol and were included in this analysis (3482 [54%] women and 2972 [46%] men; 3657 [57%] participants were White, with 1094 [17%] Asian and 1090 [17%] Black participants). On days when participants wore their smart watches, median daily watch wear time was 15·5 h (IQR 14-17). Participants contributed a total of 1 107 320 blood pressure and 202 198 347 heart rate measurements over 90 days, with 172 (SD 50) blood pressure and 31 329 (SD 24 620) heart rate measurements per participant. Mean systolic blood pressure was 122 mm Hg (SD 10) and mean diastolic blood pressure was 77 mm Hg (SD 8), with 167 312 (15%) measurements having a systolic blood pressure higher than 140 mm Hg or diastolic blood pressure higher than 90 mm Hg. Mean resting heart rate was 64 beats per min (SD 8). Blood pressure and resting heart rate varied by sex, age, race, and ethnicity, with higher blood pressures in males and lower heart rate in participants aged 65 years or older (p<0·0001). Participants took 7511 steps per day (SD 2805) and walked 6009 metres per day (SD 2608), varying across demographic and clinical subgroups. INTERPRETATION: These data could inform clinical trial design, interpretation of wearable data in clinical practice, and health-care interventions. FUNDING: Apple, University of Michigan.