Wearable devices, ischemic heart disease and cardiovascular outcomes: A systematic review and meta-analysis

•This is the first systematic review to evaluate how wearable devices impact major adverse cardiovascular events.•Use of wearables was associated with a reduced incidence of major adverse cardiovascular events and all-cause mortality, as well as with improved arrhythmia detection.•The certainty of the evidence in the literature was low or very low.•Ongoing studies may produce evidence to help us better understand the full impact of MACE. To evaluate the impact of wearable devices when associated with usual care on the incidence of major adverse cardiovascular events (MACE) in patients with ischemic heart disease compared with usual care alone. Randomised clinical trials with patients aged 18 years and above with ischemic heart disease, using wearable devices and assessing at least one of the primary outcomes (myocardial infarction, stroke, cardiovascular mortality, or major adverse cardiovascular events) or secondary outcomes (all-cause mortality, hospitalisation, all arrhythmias, heart failure, unstable angina or revascularisation procedures) were included. MEDLINE, EMBASE, Cochrane Library, CINHAL, INAHTA and the Web of Science Core Collection were searched in April 2024. Studies were also identified via citation searching. Cochrane Risk of Bias version 1 was applied as provided in Covidence. Meta-analyses were performed when possible. Six studies of moderate quality were included. Wearables showed positive effects in reducing major adverse cardiovascular events (RR 0.75, 95 % CI 0.57–0.98, two studies) and all-cause mortality (RR 0.64, 95 % CI 0.43–0.96, three studies); no significant effects were found on myocardial infarction (RR 0.89, 95 % CI 0.59–1.34, four studies), cardiovascular mortality (RR 0.35, 95 % CI 0.07–1.73, three studies), hospitalisations (RR 0.77, 95 % CI 0.56–1.07, five studies), all arrhythmias (RR 1.10, 95 % CI 0.49–2.48, two studies), and heart failure (RR 0.85, 95 % CI 0.61–1.18, two studies). Meta-analysis could not be performed for stroke, unstable angina, and revascularisation procedures. Grading of Recommendations Assessment, Development and Evaluation (GRADE) certainty of evidence was deemed low or very low. While wearables seem to have some positive effects for patients with ischemic heart disease, only weak recommendations for use are possible. More large-scale, high-quality randomised clinical trials are needed to recommend the routine use of wearables in combination with usual care. CRD42024586137