Apple Watch Series 4 Review. How will it help atrial fibrillation patients?
In today’s article I will discuss the Apple Watch Series 4 and the new ECG features on the watch. How beneficial could this be for atrial fibrillation patients?
Apple made a big splash in September 2018 when they announced that the latest generation of the Apple Watch would be able to detect atrial fibrillation through a single lead ECG. That announcement came in September 2018 and then in December 2018 the software update was released that was needed in order to be able to detect Atrial Fibrillation.
Soon after all the software updates came out, there were big splashy news articles describing ‘Apple Watch saves man and helps detect life-threatening arrhythmias’ and lot of other good press regarding the Apple Watch Series 4.
But what does the Apple Watch Series 4 actually do and how well is it reportedly to work?
The Apple Watch Series 4 has a sensor underneath the watch which is used for not only checking your heart rate but also the irregularity for detecting atrial fibrillation. Also, with the crown, if you put your finger on the crown the watch can record a single lead EKG which can help detect atrial fibrillation over a period of a 30 second analysis.
Now the watch itself has several potential results after the 30-second analysis. One result it could say is that you're in normal rhythm; another read out could say that you're in atrial fibrillation, or you can get a notification in regards to a heart rate that is too low or too high. The last result could be inconclusive which means it doesn't fall into any of those categories that have been preset on the Apple Watch.
Apple does have several pointers on its website about how to get optimal results and having managed patients with similar types of wearable technology, listening to these and abiding by these best practices can really help you get the best results so that you can get the best information as well as having accurate information that you can transmit over to your doctors office if needed.
Some of the best practice recommendations to get good EKG recordings are: make sure the watch is tight; make sure the watch is nice and snug onto your skin. It needs to really be pressing onto your skin well in order to be able to get an accurate EKG reading. In addition, make sure that there's no water on your wrist, for example if you just washed your hands, make sure everything is dry and there's good contact between the watch sensor and your skin.
Also, a very important part when you're wearing a watch to get an EKG analysis is to actually rest your arm. If you're holding your arm in the air, your arm is actually moving very slightly and it can actually cause inconclusive readings. So rest it on a table or a desk that makes your arm nice and still when you're getting the EKG analysis.
Now, what does the Apple Watch not do?
So it's mostly a heart rate tracker, and through the irregularity of the heartbeat as well as the single lead EKG it's able to detect atrial fibrillation.
However, it does not detect a heart attack. It does not detect a stroke. It does not detect high blood pressure. It also does not detect other heart conditions such as congestive heart failure.
What I do find the most interesting about this Apple Watch is the alert system that is on the watch. So it has spontaneous alerts, which are something very new that can alert somebody if they’re potentially having episodes of atrial fibrillation, and these are alerts that you can set up on your watch for either low heart rates, high heart rates or even irregular heart rates.
So the watch itself isn't constantly looking for atrial fibrillation, but if it does sense an irregular heartbeat it can alert you and encourage you to do a proper EKG, which is, when you put your finger on the watch crown and initiate the EKG yourself.
So the alerting system may not necessarily detect atrial fibrillation, but it may detect an irregular heart rhythm, which then can initiate yourself to be able to do a transmission or record an EKG through your watch.
How Accurate is the Apple Watch Series 4?
Well Apple reports that in a study that it did with 600 people that it had a 98 percent sensitivity for detecting atrial fibrillation which is pretty good and the fact that it was FDA cleared tells me that this Apple Watch will likely be more accurate than not in order to be able to detect atrial fibrillation.
In addition, at a recent conference of the American College of Cardiology, the Apple Heart Study was published. This was a study co-sponsored with Stanford University. In this study, over 400,000 people were studied over 8 months. This study used the older generation Apple Watch, not the series 4. With the irregular rhythm notifications the watch was able to detect atrial fibrillation in a little over 2,000 people with about 84% accuracy.
What Other Options Are Available to Perform a Single Lead ECG?
For those of you who have older generations of Apple Watch, only the Apple Watch Series 4 is able to do the single lead EKG on the actual watch as well as detect atrial fibrillation.
For those of you who have older generations of Apple Watches, there are other accessories that are available, which can do similar things that can do a single lead ECG and detect atrial fibrillation. There's an accessory called a Kardia Band, which has been around for several years which I think is an excellent accessory especially if you have an older generation Apple Watch. I have a blog article on my website called the Dr. AFib review or the Kardia mobile and Kardia Band, which describes the Kardia accessory in a little bit more detail.
My Final Thoughts:
So what do I think about the Apple Watch? Well I'm excited about it. I think that this is something that has a lot of potential. Do I expect it to be 100 percent accurate all the time? No, I think that there will be some false positives out there, but I think over time it will get better and better. There still need to be more studies to determine the accuracy of the Apple Watch Series 4 in a real world setting.
From a cardiologists' standpoint, what happens if you Google ‘what does a cardiologist think about the Apple Watch?’ I actually feel that a lot of my colleagues are very skeptical about the Apple Watch. They think that it's going to lead to a lot of false positives and a lot of anxiety about people's atrial fibrillation, but I view it in another way. One fair criticism is that atrial fibrillation statistically affects older people, are older people going to use an Apple Watch? More likely younger people will have the watch so statistically there may be more false positives through watch detection.
But overall I think that it's going to be very beneficial for a lot of patients. I think it helps patients be able to get more control of their own data, and be able to get more accurate recordings which can then be transmitted over to their doctor, so I think it's good to have patients have more control over their own healthcare and their own healthcare data.
So I look forward to seeing where things go with the Apple Watch, and the results of any future studies. We will all see how it gets better over time, and how at-home wearable technology will change the overall management of atrial fibrillation.
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