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Technological innovations reach deeply into our daily lives and an emerging trend supports the use of commercial smart wearable devices to manage health. In the era of remote, decentralized and increasingly personalized patient care, catalysed by the COVID-19 pandemic, the cardiovascular community must familiarize itself with the wearable technologies on the market and their wide range of clinical applications. In this Review, we highlight the basic engineering principles of common wearable sensors and where they can be error-prone. We also examine the role of these devices in the remote screening and diagnosis of common cardiovascular diseases, such as arrhythmias, and in the management of patients with established cardiovascular conditions, for example, heart failure. To date, challenges such as device accuracy, clinical validity, a lack of standardized regulatory policies and concerns for patient privacy are still hindering the widespread adoption of smart wearable technologies in clinical practice. We present several recommendations to navigate these challenges and propose a simple and practical ‘ABCD’ guide for clinicians, personalized to their specific practice needs, to accelerate the integration of these devices into the clinical workflow for optimal patient care., In this Review, Elshazly and colleagues summarize the basic engineering principles of common wearable sensors and discuss their broad applications in cardiovascular disease prevention, diagnosis and management., Key points Smart wearables generate a plethora of data through various sensors and software algorithms and understanding their basic engineering principles and limitations can be helpful for clinicians and scientists.Evidence supports the use of wearable devices in cardiovascular risk assessment and cardiovascular disease prevention, diagnosis and management, but large, well-designed trials are needed to establish their advantages.Several challenges still hinder the widespread adoption of wearables in clinical practice, including a concern for device accuracy, patient privacy and cost, and how to separate actionable data from noise.Overcoming these challenges requires that various stakeholders come together to develop comprehensive evaluation frameworks, pragmatic regulatory policies, clinical trials and medical education curricula.A practical ‘ABCD’ guide for clinicians can facilitate the integration of these devices in routine clinical practice.

The COVID-19 pandemic has accelerated the adoption and acceptance of remote monitoring and other digital approaches to cardiovascular disease management across the world. We argue that considerable additional effort is required to ensure appropriate multi-stakeholder involvement in the development, evaluation and best use of an ever-increasing number of digital technologies.