Wearable Devices in Cardiovascular Care: A Narrative Review of the Transition Toward Predictive, Preventive, Personalized, and Participatory Medicine

Cardiovascular diseases remain the leading cause of global mortality, yet conventional diagnostics are episodic and clinic-centered, missing the dynamic physiological events that unfold between encounters. Wearable devices offer continuous, real-world monitoring and, together with artificial intelligence, digital biomarkers, and telecardiology, increasingly support a shift toward predictive, preventive, personalized, and participatory (P4) cardiovascular care. This narrative review synthesizes the contemporary evidence base for wearable cardiovascular technology and organizes it around the four pillars of P4 medicine, with the explicit aim of distinguishing what is clinically proven from what remains aspirational. The wearable ecosystem now spans consumer smartwatches, medical-grade ECG patches, smart textiles, and emerging soft bioelectronics, generating an expanding repertoire of digital biomarkers. Evidence is strongest where validation is most mature: atrial fibrillation screening, supported by large-scale studies, and structured heart-failure telemonitoring, associated with reductions in heart-failure hospitalization of 18–32% in structured programs. For acute coronary syndrome triage, cuffless blood pressure, cardiac rehabilitation, and AI-derived prognostic markers, the supporting evidence is growing but rests largely on analytical and early clinical validation rather than on demonstrated improvements in hard cardiovascular outcomes. Across all four pillars, translation is constrained by accuracy variability across demographic subgroups, regulatory fragmentation, data privacy concerns, interoperability deficits, and inequitable access for elderly, low-income, and low- and middle-income populations. Realizing the P4 promise will require harmonized validation standards, demographic-stratified accuracy reporting, equitable access strategies, and a clinical infrastructure capable of converting continuous wearable data into actionable decisions.