Background Over the recent years, technological advances of wrist-worn fitness trackers heralded a new era in the continuous monitoring of vital signs. So far, these devices have primarily been used for sports. Objective However, for using these technologies in health care, further validations of the measurement accuracy in hospitalized patients are essential but lacking to date. Methods We conducted a prospective validation study with 201 patients after moderate to major surgery in a controlled setting to benchmark the accuracy of heart rate measurements in 4 consumer-grade fitness trackers (Apple Watch 7, Garmin Fenix 6 Pro, Withings ScanWatch, and Fitbit Sense) against the clinical gold standard (electrocardiography). Results All devices exhibited high correlation (r≥0.95; P<.001) and concordance (rc≥0.94) coefficients, with a relative error as low as mean absolute percentage error <5% based on 1630 valid measurements. We identified confounders significantly biasing the measurement accuracy, although not at clinically relevant levels (mean absolute error<5 beats per minute). Conclusions Consumer-grade fitness trackers appear promising in hospitalized patients for monitoring heart rate. Trial Registration ClinicalTrials.gov NCT05418881; https://www.clinicaltrials.gov/ct2/show/NCT05418881

BACKGROUND Over the recent years, technological advances of wrist-worn fitness trackers heralded a new era in the continuous monitoring of vital signs. So far, these devices have primarily been used for sports. OBJECTIVE However, for using these technologies in healthcare, further validations of the measurement accuracy in hospitalised patients are essential but lacking to date. METHODS We therefore conducted a prospective validation study in 201 patients after moderate to major surgery in a controlled setting to benchmark the accuracy of heart rate measurements in four consumer-grade fitness trackers (Apple Watch 7, Garmin Fenix 6 pro, Withings ScanWatch, Fitbit Sense) against the clinical gold standard (ECG). RESULTS All devices exhibited high correlation (r≥0.95; P<.001) and concordance (rc≥0.94) coefficients, with a relative error as low as MAPE<5% based on 1630 valid measurements. We identified confounders significantly biassing the measurement accuracy, although, not at clinically relevant levels (MAE<5bpm). CONCLUSIONS In conclusion, consumer-grade fitness trackers appear promising in hospitalised patients for monitoring heart rate. CLINICALTRIAL clinicaltrials.org (accession no. NCT05418881)