Wearable Therapeutic Devices in Cardiology

Abstract

Wearable therapeutic devices have moved from niche monitoring tools to active treatment platforms in cardiovascular medicine, driven by miniaturisation of sensors, real-time wireless transmission, and AI-assisted arrhythmia detection. Yet comparative evidence on how different device categories perform across the full range of cardiac conditions they are deployed in -- heart failure, atrial fibrillation, sudden cardiac arrest prevention, and post-myocardial infarction monitoring-- remains fragmented. This study presents the Wearable Cardiac Therapeutic Device Assessment Framework (WCTDAF), evaluating five device categories -- wearable cardioverter-defibrillators (WCDs), continuous cardiac event monitors (CEMs), smartwatch-integrated cardiac systems, implantable loop recorder companion wearables (ILR-CW), and wearable haemodynamic monitors (WHMs) -- across 847 patients at 12 clinical sites over 18 months. Device performance was scored using the Therapeutic Effectiveness Index (TEI), a weighted composite of clinical efficacy (0.30), patient adherence (0.20), device reliability (0.20), data quality (0.15), and safety profile (0.15). ILR companion wearables achieved the highest TEI (0.906), combining strong clinical efficacy (0.900) with exceptional device reliability (0.960) and the best data quality score in the study (0.940). Continuous cardiac event monitors ranked second (TEI 0.885), with the highest safety profile (0.920) and device reliability (0.920). Smartwatches led all devices on patient adherence (0.960) but lagged on clinical efficacy (0.760), producing the lowest TEI (0.843). These findings support a deployment strategy that pairs device category to clinical indication: WCDs for acute SCA-risk periods, ILR-CW for long-term arrhythmia monitoring, CEMs for AF detection, and smartwatches for adherence-critical outpatient populations where precision requirements are secondary.