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Accuracy of Apple Watch to Measure Cardiovascular Indices in Patients with Cardiac Diseases: Observational Study Cover

Accuracy of Apple Watch to Measure Cardiovascular Indices in Patients with Cardiac Diseases: Observational Study

Open Access
|Sep 2025

References

  1. Warren JM, Ekelund U, Besson H, Mezzani A, Geladas N, Vanhees L, et al. Assessment of physical activity – a review of methodologies with reference to epidemiological research: A report of the exercise physiology section of the European Association of Cardiovascular Prevention and Rehabilitation. European Journal of Cardiovascular Prevention and Rehabilitation. 2010;17(2):127139. DOI: 10.1097/HJR.0b013e32832ed875
  2. Odah MM, Alfakieh HO, Almathami AA, Almuashi IM, Awad M, Ewis AA. Public awareness of coronary artery disease and its risk factors among Al-Qunfudah governorate population. Journal of Umm Al-Qura University of Medical Sciences. 2022;8:3438. DOI: 10.54940/ms42784839
  3. Abdulrahman OA, Baaqeel RG, Alotaibi NF, Althebeti RR, Bahakeem RF, Tukruni OA, et al. Knowledge and perception of cardiac surgery among medical students in the Western region of Saudi Arabia. The Cureus Journal of Medical Sciences. 2023;15(5):e38605. DOI: 10.7759/cureus.38605
  4. Shammah AA. Umm Al Qura University students ideas about adult cardiopulmonary resuscitations. Journal of Clinical and Experimental Cardiology. 2021;11:694.
  5. Lee CM, Gorelick M. Validity of the smarthealth watch to measure heart rate during rest and exercise. Measurement in Physical Education and Exercise Science. 2011;15(1):1825. DOI: 10.1080/1091367X.2011.539089
  6. Vanderlei LCM, Silva RA, Pastre CM, Azevedo FM, Godoy MF. Comparison of the Polar S810i monitor and the ECG for the analysis of heart rate variability in the time and frequency domains. Brazilian Journal of Medical and Biological Research. 2008;41:854859. DOI: 10.1590/S0100-879X2008005000039
  7. Weippert M, Kumar M, Kreuzfeld S, Arndt D, Rieger A, Stoll R. Comparison of three mobile devices for measuring R-R intervals and heart rate variability: Polar S810i, Suunto t6 and an ambulatory ECG system. European Journal of Applied Physiology. 2010;109:779786. DOI: 10.1007/s00421-010-1415-9
  8. Etiwy M, Akhrass Z, Gillinov L, Alashi A, Wang R, Blackburn, G, et al. Accuracy of wearable heart rate monitors in cardiac rehabilitation. Cardiovascular Diagnosis and Therapy. 2019;9(3):262. DOI: 10.21037/cdt.2019.04.08
  9. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. The New England Journal of Medicine. 1999;341:13511357. DOI: 10.1056/NEJM199910283411804
  10. Crisafulli A, Pittau G, Lorrai L, Carcassi AM, Cominu M, Tocco F, et al. Poor reliability of heart rate monitoring to assess oxygen uptake during field training. International Journal of Sports Medicine. 2005:5559. DOI: 10.1055/s-2005-837504
  11. Porte P. Clinical indications for noninvasive positive pressure ventilation in chronic respiratory failure due to restrictive lung disease, COPD, and nocturnal hypoventilation—A consensus conference report. Chest. 1999;116(2):521. DOI: 10.1378/chest.116.2.521
  12. Kilgannon JH, Jones AE, Shapiro NI, Angelos MG, Milcarek B, Hunter K, et al. Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA. 2010;303(21):21652171. DOI: 10.1001/jama.2010.707
  13. Al Attar WS, Khushhal A. Soccer-related injuries pre-and post-COVID-19 lockdown in Saudi Arabia: An epidemiological study. The Journal of Sports Medicine and Physical Fitness. 2022;63(5):660666. DOI: 10.23736/S0022-4707.22.14073-9
  14. Khushhal A, Alsubaiei M. Barriers to establishing outpatient cardiac rehabilitation in the Western Region of Saudi Arabia: A cross-sectional study. Journal of Multidisciplinary Healthcare. 2023:653661. DOI: 10.2147/JMDH.S398687
  15. Schnapp LM, Cohen NH. Pulse oximetry: Uses and abuses. Chest. 1990;98(5):12441250. DOI: 10.1378/chest.98.5.1244
  16. Lipnick MS, Feiner JR, Au P, Bernstein M, Bickler PE. The accuracy of 6 inexpensive pulse oximeters not cleared by the Food and Drug Administration: The possible global public health implications. Anesthesia & Analgesia. 2016;123(2):338345. DOI: 10.1213/ANE.0000000000001300
  17. U.S. Food and Drug Administration. Establishment registration & device listing [Internet]. US: US Department of Health and Human Services. c2024 [updated 2024 Nov; cited 2023 Sep 28]. Available from: https://www.accessdata.fda.gov/scrIpts/cdrh/cfdocs/cfRL/rl.cfm?lid=205276&lpcd=DQA
  18. Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiological Measurement. 2007;28(3):R1. DOI: 10.1088/0967-3334/28/3/R01
  19. Temko A. Accurate heart rate monitoring during physical exercises using PPG. IEEE Transactions on Biomedical Engineering. 2017;64(9):20162024. DOI: 10.1109/TBME.2017.2676243
  20. Pipek LZ, Nascimento RFV, Acencio MMP, Teixeira LR. Comparison of SpO2 and heart rate values on Apple Watch and conventional commercial oximeters devices in patients with lung disease. Science Reports. 2021;11(1):18901. DOI: 10.1038/s41598-021-98453-3
  21. Windisch P, Schröder C, Förster R, Cihoric N, Zwahlen DR, Windisch PY. Accuracy of the Apple watch oxygen saturation measurement in adults: A systematic review. The Cureus Journal of Medical Sciences. 2023;15(2):e35355. DOI: 10.7759/cureus.35355
  22. Spaccarotella C, Polimeni A, Mancuso C, Pelaia G, Esposito G, Indolfi C. Assessment of non-invasive measurements of oxygen saturation and heart rate with an Apple Smartwatch: Comparison with a standard pulse oximeter. Journal of Clinical Medicine. 2022;11(6):1467. DOI: 10.3390/jcm11061467
  23. Khushhal AA, Mohamed AA, Elsayed ME. Accuracy of Apple watch to measure cardiovascular indices in patients with chronic diseases: A cross sectional study. Journal Multidisciplinary Healthcare. 2024;17:10531063. DOI: 10.2147/JMDH.S449071
  24. Chewning JM. Understanding aquatic heart rate deductions. Akwamagazine. 2010;32(4):29.
  25. Brawner CA, Ehrman JK, Schairer JR, Cao JJ, Keteyian SJ. Predicting maximum heart rate among patients with coronary heart disease receiving beta-adrenergic blockade therapy. American Heart Journal. 2004;148(5):910914. DOI: 10.1016/j.ahj.2004.04.035
  26. Heart Education Assessment Rehabilitation Toolkit. Pathophysiology of acute coronary syndrome and heart failure – classification of heart rate [Internet]. Australia: Heart Online; 2024. Available from: https://www.heartonline.org.au/articles/pathophysiology/pathophysiology-of-acute-coronary-syndrome-and-heart-failure
  27. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New York. Routledge; 1988.
  28. Shcherbina A, Mattsson CM, Waggott D, Salisbury H, Christle JW, Hastie T, et al. Accuracy in wrist-worn, sensor-based measurements of heart rate and energy expenditure in a diverse cohort. Journal of Personalized Medicine. 2017;7(2):3. DOI: 10.3390/jpm7020003
  29. Kooiman TJ, Dontje ML, Sprenger SR, Krijnen WP, Van der Schans CP, de Groot M. Reliability and validity of ten consumer activity trackers. BMC Sports Science, Medicine and Rehabilitation. 2015;7:24. DOI: 10.1186/s13102-015-0018-5
  30. Wallen MP, Gomersall SR, Keating SE, Wisløff U, Coombes JS. Accuracy of heart rate watches: implications for weight management. PLoS One. 2016;11(5):e0154420. DOI: 10.1371/journal.pone.0154420
  31. Bai Y, Hibbing P, Mantis C, Welk GJ. Comparative evaluation of heart rate-based monitors: Apple Watch vs Fitbit Charge HR. Journal of Sports Sciences. 2018;36(15):17341741. DOI: 10.1080/02640414.2017.1412235
  32. Boudreaux BD, Hebert EP, Hollander DB, Williams BM, Cormier CL, Naquin MR, et al. Validity of wearable activity monitors during cycling and resistance exercise. Medicine & Science in Sports & Exercise. 2018;50(3):624633. DOI: 10.1249/MSS.0000000000001471
  33. Chowdhury E, Western M, Nightingale T, Peacock O, Thompson D. Assessment of laboratory and daily energy expenditure estimates from consumer multi-sensor physical activity monitors. PLoS One. 2017;12(2):e0171720. DOI: 10.1371/journal.pone.0171720
  34. Khushhal A, Nichols S, Evans W, Gleadall-Siddall DO, Page R, O’Doherty AF, Carroll S, et al. Validity and reliability of the Apple Watch for measuring heart rate during exercise. Sports Medicine International Open. 2017;1(06):E206E211. DOI: 10.1055/s-0043-120195
  35. Theurl F, Schreinlechner M, Sappler N, Toifl M, Dolejsi T, Hofer F, et al. Smartwatch-derived heart rate variability: A head-to-head comparison with the gold standard in cardiovascular disease. European Heart Journal of Digital Health. 2023;4(3):155164. DOI: 10.1093/ehjdh/ztad022
  36. Leclercq C, Witt H, Hindricks G, Katra RP, Albert D, Belliger A, et al. Wearables, telemedicine, and artificial intelligence in arrhythmias and heart failure: Proceedings of the European Society of Cardiology Cardiovascular Round Table. Europace. 2022;24(9):13721383. DOI: 10.1093/europace/euac052
  37. Manninger M, Zweiker D, Svennberg E, Chatzikyriakou S, Pavlovic N, Zaman JA, et al. Current perspectives on wearable rhythm recordings for clinical decision-making: The wEHRAbles 2 survey. Europace. 2021;23(7):11061113. DOI: 10.1093/europace/euab064
  38. Mann T, Lamberts RP, Lambert MI. Methods of prescribing relative exercise intensity: Physiological and practical considerations. Sports Medicine. 2013;43:613625. DOI: 10.1007/s40279-013-0045-x
  39. Falter M, Budts W, Goetschalckx K, Cornelissen V, Buys R. Accuracy of Apple Watch measurements for heart rate and energy expenditure in patients with cardiovascular disease: Cross-sectional study. JMIR Mhealth Uhealth. 2019;7(3):e11889. DOI: 10.2196/11889
  40. Wang R, Blackburn G, Desai M, Phelan D, Gillinov L, Houghtaling P, et al. Accuracy of wrist-worn heart rate monitors. JAMA Cardiology. 2017;2(1):104106. DOI: 10.1001/jamacardio.2016.3340
  41. Parak J, Korhonen I. Evaluation of wearable consumer heart rate monitors based on photopletysmography. Conference Proceedings of IEEE Engineering in Medical and Biology Society. 2014;36703673. DOI: 10.1109/EMBC.2014.6944419
  42. Jo E, Lewis K, Directo D, Kim MJ and Dolezal BA. Validation of biofeedback wearables for photoplethysmographic heart rate tracking. Journal of Sports Science and Medicine. 2016;15(3):540.
  43. Gillinov S, Etiwy M, Wang R, Blackburn G, Phelan D, Gillinov AM, et al. Variable accuracy of wearable heart rate monitors during aerobic exercise. Medicine & Science in Sports & Exercise. 2017;49(8):16971703. DOI: 10.1249/MSS.0000000000001284
  44. Dooley EE, Golaszewski NM, Bartholomew JB. Estimating accuracy at exercise intensities: A comparative study of self-monitoring heart rate and physical activity wearable devices. JMIR mHealth uHealth. 2017;5(3):e7034. DOI: 10.2196/mhealth.7043
  45. El-Amrawy F, Nounou MI. Are currently available wearable devices for activity tracking and heart rate monitoring accurate, precise, and medically beneficial? Healthcare Informatics Research. 2015;21(4):315320. DOI: 10.4258/hir.2015.21.4.315
  46. Nelson BW, Allen NB. Accuracy of consumer wearable heart rate measurement during an ecologically valid 24-hour period: Intraindividual validation study. JMIR mHealth uHealth. 2019;7(3):e10828. DOI: 10.2196/10828
  47. Seshadri DR, Bittel B, Browsky D, Houghtaling P, Drummond CK, Desai M, et al. Accuracy of the Apple watch 4 to measure heart rate in patients with atrial fibrillation. IEEE Journal of Translational Engineering Health and Medicine. 2019;8:14. DOI: 10.1109/JTEHM.2019.2950397
  48. Apple Support. How to use the Blood Oxygen app on Apple Watch [Internet]. Saudi Arabia: Apple Inc; 2024. Available from: https://support.apple.com/en-sa/HT211027
  49. Pätz C, Michaelis A, Markel F, Löffelbein F, Dähnert I, Gebauer RA, et al. Accuracy of the Apple Watch oxygen saturation measurement in adults and children with congenital heart disease. Pediatric Cardiology. 2023;44(2):333343. DOI: 10.1007/s00246-022-02987-w
  50. Luks AM, Swenson ER. Pulse oximetry for monitoring patients with COVID-19 at home. Potential pitfalls and practical guidance. Annals of American Thoracic Society. 2020;17(9):10401046. DOI: 10.1513/AnnalsATS.202005-418FR
DOI: https://doi.org/10.5334/gh.1456 | Journal eISSN: 2211-8179
Language: English
Submitted on: Oct 28, 2023
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Accepted on: Jun 24, 2025
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Published on: Sep 2, 2025
Published by: Ubiquity Press
In partnership with: Paradigm Publishing Services
Publication frequency: 1 issue per year

© 2025 Alaa Abdulhafiz Khushhal, Ashraf Abdelaal Mohamed, Mahmoud Elshahat Elsayed, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.