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Seems that the Apple smartwatch can do it all – check email, send an SOS, connect to your car, get directions, open your garage door and order a pizza — but checking your heartbeat for atrial fibrillation might not make sense.
Dr. Steven Zweibel, director of electrophysiology at the Hartford HealthCare Heart & Vascular Institute, said the Apple watch’s newest application, recently approved for limited use by the Food and Drug Administration, has the potential to cause more anxiety, healthcare-related costs and even harm for patients who may not even have a problem at all by subjecting them to unnecessary treatments.
The application can take a recording of the wearer’s heart rhythm, known as an electrocardiogram (EKG), and detect AFib, or a rapid or skipped heartbeat.
While that sounds like a great help for people who have or are at risk for AFib – which is known to cause fatigue, dizziness or chest pain and can otherwise go undetected – Dr. Zweibel said the danger lies in the false positive readings the app will certainly generate.
“The risk to benefit ratio is not yet proven,” he said. “My concern is that there are too many variables. The average person who buys an Apple watch is not our patient age 65 or higher with risks of cardiac disease. It’s more the lower-risk population with a much lower incidence of AFib.”
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Dr. Zweibel says the condition only occurs in 1 or 2 percent of the population under the age of 65, but if the watch notices a disconnect between the wearer’s activity and his or her heart rate — no matter the person’s age — it can send an alert about the possibility that the wearer is in AFib. That, Dr. Zweibel predicted, will possibly lead to significant anxiety and emergency doctor’s appointments to be checked.
“The Apple watch is approved for monitoring heart rhythms,” he said. “It specifically states during device setup that it is not to be used in patients with known AFib.”
As one who wears the watch himself, Dr. Zweibel said Heart & Vascular Institute cardiologists recommend that people with AFib get a different type of wearable device to monitor their heartbeat. The device attaches to their smartphone and is used with an accompanying application. The user can open the app and place their fingers on the pad attachment to the phone. The device then records a single-lead EKG that can be read by the company and sent along to the wearer’s doctor for any necessary follow up.
To use these devices – or an Apple watch app – for screening would require defining the population that should be screened because he said it should not be anyone sporting the watch itself.
Once clearly identified, however, people meeting certain criteria can benefit greatly from wearables tracking biometric data like heart rates, blood pressure and blood sugar levels. These will eventually, he hoped, be pulled from the wearable device into the person’s medical chart and messages sent to appropriate providers when needed.
“There is a lot of potential for gathering information from our patients and we are looking into the use of artificial intelligence to process data and alert doctors about problems,” Dr. Zweibel said. “But, we need to be realistic about what the Apple watch app is because it could open Pandora’s Box.”
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