Apple Watch Can Detect An Abnormal Heart Rhythm

[Greg Bernhardt]

As I get older I am very closely keeping track of smart watches for their medical purposes. As someone who has heart disease in their family I am very interested in smart watches tracking cardio properties. Seems at last there is now real progress. Does anyone think this is worth getting a smart watch for or still not worth it?

http://www.macworld.com/article/319...an-detect-an-early-sign-of-heart-disease.html

 

[jim mcnamara]

I do not have a good answer... would tend toward 'no'. Regular health care + checkups, along with diet and lifestyle changes are about as good as it gets.

 

[Greg Bernhardt]

I do not have a good answer... would tend toward 'no'. Regular health care + checkups, along with diet and lifestyle changes are about as good as it gets.

Yeah I think we are a generation or two "technologically" away from it being actually reliable. Checkups are good. However, my father's second heart attack came two weeks after a stress test that he passed, so...

 

[Dr. Courtney]

I'm a fan of more continuous monitoring and working hard for individual ownership of one's health and fitness rather than over-reliance on doctors. In most cases, it is rare for people to see a doctor for a given health area more than once or twice a year. There is an awful lot of opportunity for acquisition and analysis of accurate data between those doctor visits.

After being diagnosed with pre-diabetes (and with diabetes running in the family), I'm something of a health and fitness data junkie. I'm sticking my finger once or twice daily now to monitor blood glucose, as well as tracking bike mileage, exercise, and weight daily. The continuous (5 minute intervals) blood glucose monitors are appealing, but the costs are still to high (thousands $) and accuracy still marginal.

If I had a family history of heart disease, I would probably be using one of the continuous heart rate monitors. I'm not really a fan of iPhones or other iType products, and I also have some privacy concerns with the way these things work and handle data. But I would figure out something that fit within my cost and privacy concerns and technological preferences. The heart rate monitors seem to be a few years ahead of the blood glucose monitors and much more cost effective.

Thanks for the link. It was an enjoyable couple of hours checking out these devices and lots of related gear running down various rabbit trails on internet health and fitness device searches. I kinda hope the trend here is more toward individual responsibility rather than insurance companies tethering us to those gadgets and raising our rates for behaviors they deem as unhealthy.

 

[jim mcnamara]

Hmm. There are multiple problems that a physician will call a heart attack when talking to patients. For example if your Dad had a hyperlipidemia problem and subsequent CHD ; versus some kind of familial or congenital 'malformation' like a heart valve problem you might still hear the words 'heart attack'. And physicians are good about explaining in non-technical terms what happened. What most patients remember seems to be the heart attack part.

Did the stats work on a large dataset of PHS patient interviews about health care they received. My take on the data. I am not a physician. So asking your Dad may not be the best possible approach. You decide. But not all heart attacks are equal.

 

[Greg Bernhardt]

What most patients remember seems to be the heart attack part.

I don't know the details, but he went into cardiac arrest and they needed paddle shock him 8 times

 

[jim mcnamara]

@Dr. Courtney - type I or type II diabetes? Type II does have a strong environmental component, and from what you describe you are opting for lifestyle changes.
Public Health people talk about 'metabolic syndrome'. You may want to google that to see what I mean. Type II is now poised to become an epidemic in the US.
There are subpopulations where the rate exceeds 40% of adults, and in some, adolescents with rates above 30% -ex. Papagos, Navajos.

Edit: In the US medical system as it exists now, it is REALLY difficult to become over-reliant on physicians.
My opinion only.

 

[Dr. Courtney]

Edit: In the US medical system as it exists now, it is REALLY difficult to become over-reliant on physicians.
My opinion only.

Maybe we mean different things. But in my current state (pre-diabetes, type 2), my insurance company is probably only going to pay for 2 visits to my doctor each year with the usual lab tests (fasting blood glucose and A1C). And really, I don't see why they should pay for more, because I can monitor my own blood glucose several times a day every day of the year for less than one panel of lab tests. (At home A1C tests are also available on the shelf at Walmart.) The twice a year fasting blood glucose and A1C really only provide a big picture view of how the overall program is working. I've learned much more about which foods cause blood sugar to spike and also more about when those foods are eaten in relation to sleep and exercise by monitoring my own blood glucose.

Most of the physicians I've had in my adult life tend to be reactive: lab tests, diagnose, prescribe. Their success rates by suggesting personal ownership and more healthy lifestyle modifications are so low that they hardly bother any more. I bet my doc is surprised next time I see him that I've lost 25 lbs, biked 1900 miles, and taken personal ownership of my diabetes risk rather than just taking the pills and maintaining the same lifestyle that has diabetes and metabolic syndrome approaching epidemic levels. My doctor didn't say anything about reducing my risk of diabetes through exercise and behavioral modifications (eating habits). He just prescribed metformin. I think I have likely reduced my risks considerably by not only relying on my physician's advice, but by many hours of research and care to formulate and own my own personal health plan. (And I've taken the same approach to other identified health risks.)

 

[Ygggdrasil]

According to the Macworld article (perhaps not an unbiased source on the issue, the watch can detect atrial fibrilation. According to Wikipedia (also not necessarily a reliable source), most episodes of atrial fibrlation produce no symptoms, so I would worry about false positives. Would the increased stress and worry over false positives have more of a negative impact than any benefits gained for monitoring? One would probably have to consult with a doctor to see whether monitoring for atrial fibrilation is likely to be beneficial and provide more useful information than one would get from regular check up exams.

 

[berkeman]

they needed paddle shock him 8 times

Ouch. Was that pre-hospital or in-hospital? He's lucky he survived -- pre-hospital protocol in the county where I work EMS is 3 shocks max before you call it.

On your heart rate monitoring question, it's pretty easy to check your heart rate via your radial pulse, and keep a record of it. I would suggest also taking it a few times during your workouts, to get a feel for what your heart is doing near your max effort and during your recovery. Just count your pulse for 15 seconds and multiply by 4 to get your HR. Whatever the rate, the pulse should be regular, with no skipped or delayed beats. At max effort, you may get a skipped beat every once in a while, but that can be fairly normal -- talk to your doc if you detect skipped beats at max effort just to be sure.

At several of the athletic events where I work EMS Standbys, I make it a point to do lots of "Free Blood Pressure Screenings". I've been able to catch a number of folks with high blood pressure that did not know they had it, but just as important, I've been able to catch a number of folks with irregular heat rhythms, especially after they had completed their athletic event. Some heart rhythms may be fine when resting, but can show arrhythmias during/after exercise. Several patients have come back to me in future years at the same events and let me know that when they showed my notes to their doctor and got further tests, they ended up being diagnosed with A-Fib or PVCs. It's nice to catch stuff like that early, so the doc can start treating for it and doing closer monitoring.

 

[Greg Bernhardt]

Ouch. Was that pre-hospital or in-hospital? He's lucky he survived -- pre-hospital protocol in the county where I work EMS is 3 shocks max before you call it.

In hospital and he was like 50 so they didn't want to "give up".

 

[jim mcnamara]

There other factors in Type II. C-reactive protein levels are an indicator of inflammatory processes. Physicians may test for that as well. A1-C hemoglobin is an OTC test you can do at home. Clinicians are great for looking at how a patient presents and making inference about things you and I would never guess.
@Dr. Courtney - Your comment about insurance was a major component of what I was referring to in terms of access to medical care.

 

[Fra]

As I get older I am very closely keeping track of smart watches for their medical purposes. As someone who has heart disease in their family I am very interested in smart watches tracking cardio properties. Seems at last there is now real progress. Does anyone think this is worth getting a smart watch for or still not worth

For more advanced self checks or for gadgetfun i think many regular hrv-kind of apps that just use the phone cam does a good job to check hr and ectopic beats.

If you find some deviations an ecg vill reveal what kind of ectopic beats there is and more. You can buy a hand to chest ecg monitor for less money than a apple watch I am sure. The type of ectopics in combination with your other history will indicate the severity. Some ectopics beats are quite benign. To learn howto interpret ecg is not too hard. There are lots of good online training material.

Also there are great bluetooth arm bp meters now. They are also nice for feedback during relaxing. You can train yourself to lower the bp.

A stetoscope is also nice to have. There are great phone apps that trains you to detect normal and abnormal sounds.

So for selfmonitoring an selfstudy an appleclock is the last thing i would buy.

Of course this does not replace doc visits though.

/Fredrik

 

[Fra]

One more comment on apps that do HRV - while "fun" they are of limited use for a technical reason.:

Pulse rate variability is not a surrogate for heart rate variability.
-- https://www.ncbi.nlm.nih.gov/pubmed/10491338

The vagal tone(the "rest and digest" mode of the nervous system) which happens to be "the least questionable measure" of ANS levels from HRV is associated with the high frequency part of the spectrum, and this is poorly estimated using pulse pressure. For accurate vagal estimates you need to have a real ECG.

The low frequency spectrum can be measured more reasonably with pulse pressure variations (which is what the iphone and cam gadgets do) but unfortunatley this part of the variability is also harder to interpret, as its influences by a mix of conflicting parameters.

/Fredrik

 

[Fervent Freyja]

I think the watch is worth it regardless whether you use it to monitor your fitness and health. I will be getting one soon. Some sort of device like this that can track heart health, fitness, and weight should be prescribed to patients after cardiac surgery! My FIL recently had open heart surgery and stayed with me- I had to track all of that daily by hand for 2 weeks and report it back during the followup (the surgeon was very happy with the information). Having a daily log over a period of days would tell healthcare providers a lot about how the heart is recovering and could cue them to running more tests.

Of course, it shouldn't replace any in office testing, but it would be a good preventative measure and improve the outcomes for patients after surgery. I'm not very sure how much prevention value it would carry for someone that hasn't had a heart attack yet. We cannot always predict that, some healthy people with no signs do have them. You would think though, that if you could pull a log of how the heart is functioning every few hours, and especially during exercise, then you might be able to tell if there are abnormalities over a long period, but I don't know, I'm no specialist.

Right now, my little brother is using a smart watch (not apple) to track his cardio, he's in his mid 20's and has congestive heart failure and COPD. My sisters and I are planning on geting him to get the Apple Watch with Kardia band for Christmas (you add the band to the apple watch for $200, I think), it has built in EKG technology. His cardiologist only gives him one of those tests a year and is one of the primary tools they use to keep track of his heart health and to diagnose abnormalties. I think you would feel better by getting both, really if you just used both of them a few days a week then it might be helpful in monitoring your heart health, in addition to your normal healthcare followups.