Q&A: Wearable devices may help IBD patients track flares in ‘the comfort of their homes’
Physiological metrics captured via wearable devices may help identify and predict flares in inflammatory bowel disease, Robert P. Hirten, MD, told Healio, and could potentially play a role in remote monitoring of disease activity.
“As gastroenterologists, one of the things that we find is that between office visits, there sometimes can be relatively little contact or interaction between patients and their doctors about how a person with IBD is doing,” Hirten, Clinical Director of the Hasso Plattner Institute for Digital Health and associate professor of medicine, AI and human health at the Icahn School of Medicine at Mount Sinai, said. “All the assessments that we use to monitor patients with IBD, like a blood test or colonoscopy, are cross-sectional and look at the disease in a single point in time. Additionally, they require the patient to interact in a health care setting.”
He continued, “We were interested to monitor how people with a chronic disease like IBD are doing outside of the health care setting and to monitor them remotely in the comfort of their homes.”
In the prospective, observational IBD Forecast Study, Hirten and colleagues enrolled 309 adult patients with IBD (mean age, 39.9 years; 67.3% women) from 36 states who wore an Apple Watch (n = 255), Fitbit (n = 53) or Oura Ring (n = 16). Of these, 196 had Crohn’s disease and 113 had ulcerative colitis.
The researchers collected several physiological metrics tracked with the devices — longitudinal heart rate, resting heart rate, heart rate variability, daily steps and oxygenation — to determine whether these metrics could help identify IBD flares. In addition, the patients answered daily surveys on their IBD disease activity using ulcerative colitis or Crohn’s disease patient-reported outcome scores. Participants collected inflammatory assessments, including C-reactive protein and fecal calprotectin, as part of their standard of care assessments.
In the study published in Gastroenterology, the researchers found that circadian patterns of heart rate variability were significantly different when patients experienced an inflammatory or symptomatic flare compared with inflammatory remission. Mean heart rate and resting heart rate were also higher during flares, whereas daily steps were lower.
“We saw changes in these metrics when people had inflammation present compared with no inflammation, and when they were having symptom flares compared with being in symptomatic remission,” Hirten said. “In addition, we found that these metrics were significantly altered over a 7-week period before inflammatory or symptom flares are identified, demonstrating a possible predictive ability for these parameters”
In an interview with Healio, Hirten expands on this research and discusses how wearable devices might be incorporated into disease management.
Healio: What were the key findings of the study?
Hirten: We found that many of the physiological metrics that are commonly measured by commercially available wearable devices like Apple Watches, Fitbits and Oura Rings could help distinguish how people are doing with their IBD.
Importantly, we found that with some of these metrics, we could identify whether underlying inflammation is present, meaning the disease is active, even among people without symptoms.
If people had symptoms, we demonstrated that these metrics could determine whether underlying inflammation was present, which could potentially provide an opportunity to use wearable devices to better discriminate whether symptoms are being driven by active IBD or some other cause.
Healio: How might these results inform patient care?
Hirten: We view this study as a first step in showing that wearables can be used to identify and potentially predict chronic inflammatory diseases like IBD, as well as help determine whether the disease is active or will become active in the near future. Our group has also completed a similar study in rheumatoid arthritis.
The next step we would like to take is to develop deep-learning AI models, which, on an individual level, could interpret an individual’s wearable device outputs and come up with a probability of whether someone’s disease will flare or worsen in the near future. In this way, we could provide a remote monitoring tool for IBD.
Healio: Could wearables help patients self-manage their disease?
Hirten: That is something we are interested in exploring, because when an individual is managing a chronic disease like IBD, it can be very burdensome: They have to manage a lot of things such as doctors’ visits, getting laboratory tests or colonoscopies, keeping up with how they are feeling and trying to identify flares.
The role or positioning that wearables could play, such as in remote monitoring, is something that needs to be explored. We need to understand whether this could help improve some of the burden of self-management or actually increase the burden.
This is an important next step in understanding how these types of monitoring tools could fit into the paradigm.
Healio: Could disease monitoring via wearables be easily implemented into practices?
Hirten: Remote patient monitoring is already implemented in practices and in health systems, usually for certain conditions like diabetes mellitus and for blood pressure monitoring. Additionally, we see it used in cardiology with monitoring for arrhythmias. There is already an infrastructure set up in many practices and hospitals to use remote monitoring.
We are hoping that our current study could lay the foundation for the future expansion of remote monitoring to chronic inflammatory diseases like IBD.
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