UPDATE March 20, 2019: The results of the “Apple Heart Study” were just released at the annual meeting of the American College of Cardiology. Read my comment at the end of this post for an update.
Today, Apple released its ECG app and irregular heart rhythm notification feature.
The announcement about the technology was made with great fanfare a couple of months ago, when Apple also revealed that the device had received approval by the FDA. This raised some eyebrows because—according to some—the technology was being approved and released to the public without evidence of effectiveness or harm.
What is so unique and novel about the product is that it claims to be able to detect atrial fibrillation, or “a.fib,” which is a common irregularity of the heart rhythm. A.fib is not usually fatal but it can be a problem for two reasons.
First, the arrhythmia causes and irregularity and rapidity of the pulse that can provoke palpitations and also impair the pumping capacity of the heart. This typically causes symptoms, so that people who develop a.fib typically become aware of the problem and seek medical attention relatively promptly.
But not everybody is necessarily aware that they have a.fib. Some people may not be aware because the arrhythmia is short-lived (a few seconds) while others may not be aware because—for some reason—their body handles the arrhythmia sufficiently well.
And if people have a.fib for a long enough period of time and are unaware of it, then they may be at risk for another serious complications: a clot can form in the atrium (the upper chamber of the heart), and then travel to the brain to cause a stroke. In fact, a. fib is one of the most common causes of stroke.
So that’s what a lot of the excitement is about: Apple and supporters of the device claim that the Apple Watch can help detect a.fib earlier than it would be detected otherwise and help avoid many strokes.
A counterclaim, however, is that many more people will be falsely alarmed, either because the device may over-detect pulse irregularities as a.fib (no medical technology is 100% accurate, and the inaccuracy is amplified if it is applied to people who are not at any particular risk of having a problem), or because it will detect a.fib in people who are not at any particular risk of having a stroke.
The fear is that when millions of people who wear the Apple Watch turn on the irregular rhythm notification feature, the inaccuracy of the device will cause unneeded anxiety, phone calls to doctors, and perhaps unnecessary follow-up testing. (For articles taking a pessimistic view about the Apple Watch, see here, here, or here)
I share those concerns. Most people who own and wear the Apple Watch are usually at very low risk for either a.fib to begin with, or for having a stroke even if they have a.fib. Conversely, most people who are at risk for a stroke are elderly people who are less likely to don an Apple Watch (but that could change!).
At any rate, there’s not much to stop the train at this point. I suspect that if the false alarm rate is very high, the word will get around and people who are otherwise at low risk for arrhythmias, or those for whom detecting the arrhythmia immediately is not so critical will just turn off that feature.
But another way to deal with that problem is for people to have a good relationship and communication with their doctor! If a patient of mine has a concern about their heart rhythm, they can quickly get ahold of me and I usually can, over the phone, alleviate any concern or direct them to the appropriate next steps. That’s what direct care is about!
So, if you are living in the SF Bay Area and feel, gives us a call! We’d be happy to answer any question you may have not only about our direct cardiology care services, but also about our direct primary care clinic.
Thank you for reading!
–Dr. Accad
Discover Our Unique Cardiovascular Health Services!
UPDATE: Dr. Milton Packer wrote this very provocative—and negative—piece about the Apple Heart Study. I tend to agree with him. There is a lot of hype and, on the whole, people are not going to be helped by the device. But “on the whole” is one thing and doesn’t mean that a lucky few may not stand to gain.
