Patient Experiences With Smartwatch ECG Monitoring Compared to Traditional Holter Devices
3 min read
Introduction
Wearable ECG technology is increasingly used to support ambulatory cardiac rhythm monitoring, but questions remain about how these tools fit into patients’ daily lives.
A recent qualitative study conducted in the Netherlands explored this issue by comparing patient experiences using a smartwatch with single-lead ECG (1L-ECG) capability and a traditional Holter monitor over the course of one week.
The findings offer useful insights into the practical benefits and limitations of smartwatch-based ECG monitoring and what matters most to patients when rhythm monitoring moves beyond the clinic.
Study Overview
The study included 18 adults referred for ambulatory rhythm monitoring at a diagnostic center in the Netherlands, specifically through referrals from primary care to the cardiology outpatient clinic of the Dijklander Hospital in Hoorn. Participants were aged 32–85, with a median age of 66.
Each participant wore both:
A smartwatch with 1L-ECG capability (Withings ScanWatch), and
A conventional chest-worn Holter monitor
for seven days. Afterward, researchers conducted semi-structured interviews to understand their experiences with usability, comfort, confidence, and perceived clinical value.
Rather than focusing on diagnostic accuracy, the study centred on how patients experienced the monitoring process itself, an increasingly important consideration as wearable technologies become more common in routine care.
What Patients Reported
Comfort and Ease of Use
Participants consistently described the smartwatch as easier to wear and less intrusive than the Holter monitor. Wearing the watch felt familiar and fit naturally into daily routines, including sleep and regular activities. In contrast, the Holter monitor’s electrodes and wiring were more noticeable and, for some, uncomfortable over time.
Several participants noted skin irritation or inconvenience associated with adhesive electrodes, whereas the smartwatch was generally described as something they could wear without significant disruption to daily life.
“It’s a bit heavier than my own smartwatch. That takes a minute to get used to, but after that you don’t even notice it anymore. It’s waterproof, so you barely notice you’re wearing it — not even at night, since I always sleep with a watch on. I don’t feel the difference anymore. Other than that, it does what it’s supposed to do: tell the time. Which is pretty handy, too.” P16, male patient, 48 years
Capturing Symptoms in Real Life
One of the key differences between the two approaches is how data are captured. The Holter monitor records continuously, while the smartwatch requires users to actively initiate an ECG recording.
Participants appreciated having control over recordings but also expressed uncertainty about when to trigger them, particularly when symptoms were brief, unexpected, or occurred during sleep or activities like driving. This highlights a trade-off between passive continuous monitoring and more user-driven approaches.
Automated ECG Results: Reassurance and Uncertainty
Some participants found algorithm-based ECG feedback reassuring, especially when results were reported as normal. Others described moments of uncertainty or anxiety when the smartwatch flagged potential abnormalities without immediate clinical context.
This finding underscores the importance of clear patient education and pathways for clinical follow-up when wearable ECG data are shared directly with users.
Integration With Clinical Care
Across interviews, participants emphasized that wearable ECG data felt most valuable when it could be reviewed by a healthcare professional. Many expressed a desire for smoother integration between smartwatch ECG recordings and clinical systems, as well as clearer guidance on how and when clinicians would review their data.
Patients generally viewed the smartwatch as a helpful complement to traditional monitoring, particularly when combined with clinician oversight, rather than a complete replacement.
Implications for Wearable ECG Monitoring
Overall, the study suggests that smartwatch-based 1L-ECG monitoring is acceptable to patients and may reduce some of the burden associated with traditional Holter monitoring, particularly in terms of comfort and day-to-day wearability.
At the same time, the findings point to areas where wearable ECG programs can improve:
Providing clearer guidance on when and how to record symptoms
Reducing uncertainty around automated ECG interpretations
Ensuring timely clinician review and communication
As devices like the Withings ScanWatch continue to be used in real-world clinical settings, patient experience will remain a critical factor alongside clinical validation.
Looking Forward
This study adds to a growing body of evidence showing that wearable ECG devices can support ambulatory rhythm monitoring in ways that align more closely with everyday life. Designing these tools and the care pathways around them with patient experience in mind will be key to realizing their full potential in clinical practice.
For more research-driven insights on connected health and remote monitoring, explore the latest updates on the Withings blog.
Electrochemical skin conductance (ESC) is a non-invasive measurement of the sudomotor function. It measures sweat gland nerve supply and assesses disorders of the autonomic nervous system, which is part of the peripheral nervous system.
Why is ESC important?
A significant number of diabetes patients will be affected by diabetic peripheral neuropathy (DPN) in their lifetime, and the percentage of diabetes patients who might develop a diabetic foot ulcer (DFU) is also considerable. In addition, studies have shown that the 5-year mortality rate of DFU is comparable to cancer mortality. Given these urgent concerns, electrochemical skin conductance is a crucial tool for health care providers.
But this key measurement doesn’t just provide an essential health care solution. Consider the increased average medical costs for patients with diabetes, the billions of dollars in costs for patients with DFU in addition to the costs of the diabetes itself, and the tens of thousands of dollars in per-patient Medicare reimbursement and reimbursement per patient with diabetes-related foot amputation. It’s clear that electrochemical skin conductance can reduce the costs of diabetes patient care, as well as many of the risks to patient health.
Unfortunately, the current diabetes patient journey presents significant roadblocks, including the low percentage of diabetes patients who actually have an annual foot exam, the number of patients who are misdiagnosed due to unreliable tools, and the lack of patient monitoring. These issues highlight the need for connected health products that can measure ESC and other key biomarkers. These devices and systems can empower patients to take charge of their home health monitoring and motivate them to make beneficial lifestyle changes. They can provide care teams the consistent, accurate data they need to make the right treatment decisions, elevating overall care and improving health outcomes. And of course, they can lower care costs. The health risks to diabetes patients are real and significant — but real and significant solutions exist that can create positive impacts all around.
Click the button below to download the infographic.
Download Now
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Partner
HabitNu
Challenge
Meet targeted 5% weight loss goal per member with a connected scale that would seamlessly integrate into existing workflow.
Solution
Withings Body Scale
Results
57% of active participants had a 5% of more weight loss and achieved a group weight loss of 11.8%
‘‘Ongoing participant engagement is key to the success of the HabitNu program, and the Withings scale is an essential component. We value the top-of-the-line scale and the support our participants receive from Withings Health Solutions.’’
Dr. Sindhu Rajan, CEO of HabitNu
BACKGROUND
HabitNu is a digital health company that provides Centers for Disease Control (CDC) recognized lifestyle modification programs designed to help members with diabetes prevention and chronic disease management. As part of delivering a successful program, HabitNu required to achieve a targeted 5% weight loss for each member. As a result, the company needed a best-in-class and trusted scale vendor to partner with to ensure members could easily and consistently track their weight throughout the program.
CHALLENGE
HabitNu sought an accurate and automated way to collect members’ weight data and demonstrate the targeted 5% or more weight loss for each member. They were also looking for a connected scale vendor that would seamlessly integrate with their existing workflow and provide them with extensive technical and member troubleshooting support.
SOLUTION
HabitNu partnered with Withings Health Solutions to provide the Wifi-based Body scale, along with the Withings HealthMate app that syncs seamlessly with HabitNu’s app. Once the member steps on the Body scale, the data is captured by the Withings HealthMate app and flows directly to HabitNu’s app. Members can track their meals, physical activity, as well as their daily weigh-in data. With the help of Withing’s onboarding team, HabitNu had their app sync with Withings devices in a matter of days.
The sleekly-designed connected scale instantly provides HabitNu with accurate weight and BMI data from its members. The member’s data is then analyzed and displayed for HabitNu health coaches to assess and guide each member’s progress along their health journey.
The scale’s intentionally designed habit-forming features, like displaying the weather forecast when a member steps on the scale, seamlessly becomes part of their daily routine. Members are also empowered to make healthier choices when seeing their weight trends over time and not just the latest number at weigh in.
‘‘The scale provides awesome features. I am so grateful for not only being able to continually see my weight loss progress in terms of pounds and the decreased BMI, but the icing on the cake is the weather notification.’’
- HabitNu member
‘‘The Withings scale was quick and easy to set up. It syncs easily with my phone and the HabitNu app. I also like that it shows gains and losses each time I weigh myself.’’
- HabitNu member
Withings dropships the scales directly to HabitNu members via an API integration, streamlining the logistics process and removing the headache and cost of operating a fulfillment center. “Having a smooth workflow is very important to us,” said Dr. Rajan. “With Withings, we can place orders for new members with just a click of a button. The whole process is very easy.”
RESULTS
Since 2017, HabitNu has offered a Withings Body scale to each of their new members, resulting in healthier life choices and increased program engagement. “The data we’re collecting demonstrates high levels of member adherence and improved health outcomes,” said Dr. Rajan.
In fact, a recent study of a year-long HabitNu Diabetes Prevention Program consisting of 4635 participants using the Withings Body scale showed that 79% of the participants actively engaged with the scale and the HealthMate app. With this program, HabitNu effectively demonstrated that 57% of the active participants had a 5% or more weight loss, and achieved a total group weight loss of 11.8%.
5%
more weight loss among participants actively engaged with the Withings Body Scale
Interested in partnering with us?
Contact Us
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What is Electrochemical Skin Conductance?
Electrochemical skin conductance (ESC) is a non-invasive measurement of the sudomotor function. It measures sweat gland nerve supply and assesses disorders of the autonomic nervous system, which is part of the peripheral nervous system.
Why is ESC important?
A significant number of diabetes patients will be affected by diabetic peripheral neuropathy (DPN) in their lifetime, and the percentage of diabetes patients who might develop a diabetic foot ulcer (DFU) is also considerable. In addition, studies have shown that the 5-year mortality rate of DFU is comparable to cancer mortality. Given these urgent concerns, electrochemical skin conductance is a crucial tool for health care providers.
But this key measurement doesn’t just provide an essential health care solution. Consider the increased average medical costs for patients with diabetes, the billions of dollars in costs for patients with DFU in addition to the costs of the diabetes itself, and the tens of thousands of dollars in per-patient Medicare reimbursement and reimbursement per patient with diabetes-related foot amputation. It’s clear that electrochemical skin conductance can reduce the costs of diabetes patient care, as well as many of the risks to patient health.
Unfortunately, the current diabetes patient journey presents significant roadblocks, including the low percentage of diabetes patients who actually have an annual foot exam, the number of patients who are misdiagnosed due to unreliable tools, and the lack of patient monitoring. These issues highlight the need for connected health products that can measure ESC and other key biomarkers. These devices and systems can empower patients to take charge of their home health monitoring and motivate them to make beneficial lifestyle changes. They can provide care teams the consistent, accurate data they need to make the right treatment decisions, elevating overall care and improving health outcomes. And of course, they can lower care costs. The health risks to diabetes patients are real and significant — but real and significant solutions exist that can create positive impacts all around.
Click the button below to download the infographic.
Our patient-centric care solution utilizes portable Withings cellular devices that are not tied to a single patient. Instead, care teams can use one device to collect and transmit data for an unlimited number of individuals. The integrated cellular connectivity automatically directs the data into the correct patient’s medical record, simplifying data collection and improving care delivery regardless of the setting.
