Apple Watch 4

What are the advantage and disadvantage of the new features?

Is the Apple Watch protecting you?

By Nicolette Francey Asselin, MD

Last summer when my very active and independent engineer husband had an accidental fall and later some light signs of a potential stroke, following all the medical visits, I became weary and worried. That is, I did not want to find him at a place where it would be too late to do anything. So, I began my search for various ways to tame my concerns. I knew that a Life Alert pendant had little chance to be worn. After a few discussions and other feedback, I realized that the latest Apple Watch 4 coming out that fall had that feature. Knowing his propensity for technology, I planned a trip to New York City for his birthday that coincided with the release of the watch. Our first stop was at the Apple store where we receive a complete run of the many functions. Despite its apparent complexity, the alert function seemed simple enough; therefore, we ordered the watch he wanted.

Since that time, I learned that the rumor goes that 12 to 50 physicians are working with Apple to provide an array of health services and that, of course, piqued my curiosity. Is Apple committed to solving significant medical problems?

The FDA approved the new watch last September to monitor’s user’s health, just shortly before the time of our purchase. Scott Gottlieb, MD, commissioner of the FDA, and Jeff Shuren, MD, director of the FDA’s Center for Devices and Radiological Health, published a statement discussing FDA efforts to work with technology vendors to spur innovation in digital health. Their position is that “Due to the great promise of these technologies and the rapid pace of change, the FDA is working to modernize our regulatory approach to better enable and more efficiently spur innovation in this novel area to improve the health and quality of life of consumers and patients.” In the last few years, the FDA has been taking steps to encourage more development and greater innovation in the digital health space. The Digital Health Innovation Action Plan commits to implementing policies, adding expertise, and exploring a software precertification pilot program to bring clarity and efficiency to how digital health products are regulated.

This is an important step forward, bringing this new feature that will alert users to low heart rates in addition to high ones. The far larger news is the EKG (ECG), which is accomplished by adding electrodes to the digital crown and the back of the watch. In January 2019, Stanford University finished a study, sponsored by Apple, called the “Apple Heart Study.” It recruited more than 400,000 people with undiagnosed heart rhythm problems. This is an important step given that In the U.S., atrial fibrillation causes 750,000 hospitalizations a year and contributes to 130,000 deaths, according to the CDC.

So, what do doctors think of the Apple Watch 4? 

EKG:  

Reviews are mixed, and much concern is given to the over-diagnosing risks. A real EKG uses eight leads, that is 8 points on the body to take accurate measurements of the electric impulses going through your heart. With an Apple watch one is getting the equivalent of one lead; hence it isn’t a 3D but a minimal view of your heart’s function.

The Apple watch claims that it can detect Atrial Fibrillation (AF). AF usually will be accompanied with the following warning signs: Palpitations (Uncomfortable sensation of racing and irregular heartbeat or flip-flopping in your chest.), sudden weakness, fatigue, lightheadedness, dizziness, shortness of breath.

Dr. John Mandrola, MD, a cardiac electrophysiologist, a writer for @Medscape, Medium a cyclist and a skeptic expressed the following: “As a heart doctor, my opinion is that if you think an Apple Watch is nifty, buy one. But do not buy it for your health. It will not improve your health, and it could even bring you harm.”

The key concerns expressed by many physicians is the potential for many false positives. Dr. Mandrola’s point is that: “When you endeavor to make healthy people healthier, you always risk making them  worse.”  Even if the Apple Watch identifies accurate AF (Atrial Fibrillation), we can’t be sure the treatment will do more good than harm. To drive his position, he points to a 2017 Harvard research addressing deficits in AF knowledge. In their review of many studies of patients with AF treated with clot-blocking drugs, they found wide variation in the rate of stroke following a diagnosis.  Dr. Mandrola’s conclusion is that: “The truth is that preventive health is far more complicated than identifying irregular rhythms from a watch.” Some of the function of the watch might be better suited for people at risk but surely will increase visits to emergency rooms and potentially unnecessary treatments.

Fall Detection

I did not find much feedback on the fall detection. Here is how it works, after you enable it: Should you fall while wearing the Apple Watch Series 4, the watch will sound an alarm, when you tap your wrist it will ask you if you’re alright. If the watch doesn’t detect movement for “about a minute” after the fall, a 15-second countdown begins before it eventually calls emergency services, along with alerting emergency contacts that you’ve fallen and are unresponsive.  A cellular service watch is required for this feature.

Blood Pressure and other measurements

The Apple watch is compatible with Bluetooth measurement devices such as a blood pressure calf. It will record and keep a history of readings that you can share later with your doctor.

The advantage of Bluetooth is that you do not need to record your measurements manually. Some continuous glucose monitoring system may work with the watch as well, and one may be able to ask Siri for a blood glucose level or the blood pressure of their aging mother.

Water Reminder

Water intake is vital to one’s overall health. Keep in mind that the watch can’t measure water intake, it is only a reminder to drink.

Building Health Habits

Users can track daily habits and see how long they can keep them going by asking Siri to log almost any type of activity, such as hydration, exercise, flossing, sugar, and caffeine intake, even walking the dog or track sleep patterns. The list is endless, and one may not want to be reminded of every detail of their daily activities unless vital.

On January 30, 2019: CVS Health Corp’s health insurer Aetna announced that it is working with Apple Inc on a new health app for Apple Watches that uses an individual’s medical history to set personalized health goals. The App called “Attain” will reward Aetna customers for meeting goals and fulfilling recommended tasks. Aetna said the program is voluntary and that data gathered will not be used for premium pricing or coverage decisions.

All in all, I found the water reminder feature to be a real plus, the EKG a bit fuzzy due to the limitation of one lead readings. The fall alert function appears to work well. My husband has not experienced any falls; however, he has triggered the detection and confirmed that this function works well.

In conclusion, I am pleased to have invested in the watch. My husband finds the heart rate convenient and helpful therefore he is wearing the alert system as well. When using the EKG, we are careful to give close attention to his actual symptoms. He has not received any warning of irregular heartbeats.

Lloyd Minor, dean of Stanford University School of Medicine, stated in an interview: “One of the most exciting things in this revolution in digital health is the opportunity to reach vast numbers of people in a short period without huge expense.”

From a prevention point of view, having younger individuals develop healthy habits and be more aware of their practices is a plus. It might be a little complex, but one can simplify its use for what is at stake according to the age of the person using it.

 Ref: 

1. Mandrola Previews the 2019 ACC Meeting, by John Mandrola, MD, March 12, 2019, Medscape.

2. Wide Variation in Reported Rates of Stroke Across Cohorts of Patients with Atrial Fibrillation, by Quinn GR¹, Severdija ON¹, Chang Y¹, Singer DE². 2017 Jan 17;135(3):208-219. doi: 10.1161/CIRCULATIONAHA.116.024057. Epub 2016 Oct 31.

3. That New Apple Watch EKG Feature? There Are More Downs Than Ups by the New York Time

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