One doctor believes users under 65 should 'ignore' the ECG app on the new Apple Watch, your take?

[johnfree7]

There's a short article linked at the bottom about how a doctor thinks generally healthy people under 65 with an Apple watch 4 should "just ignore" Apple's new ECG app, and that they'll just cause undue burden on the medical system with false positives. However, the ECG app has been credited with saving some patients who had serious afib and they credit the watch to alerting them. This doctor believes these are "edge cases". Since more and more people, particularly under 65 are adopting smart watches, and ECG software will become more common, what's your opinion on the data these smart watches collect and how seriously people should pay attention to them?

One doctor believes healthy Apple Watch users under 65 should generally ‘ignore’ the ECG app

---

Members don't see this ad.

 

[medschol12344321]

The fact of the matter is, anyone who wears the watch and gets a notifcation that it may have detected Afib will (and should) see their doctor about the results. Even with it being a 1-lead ECG, it does have the possibility of saving lives. There will definetly be alot of false positives, but how accurate can a 1-lead possibly be? However, my take on the situation is that this is apple dipping their feet into the personal health craze. they already had the heart rate feature and wanted to expand the capabilities of the watch vs competitiors. I wouldnt be surprised to see in a few years apple adding more health related features to their watch (and headphones?) such as blood pressure. For most people, this is more of a “all systems are normal” versus a diagnosis

 

[907914]

The fact of the matter is, anyone who wears the watch and gets a notifcation that it may have detected Afib will (and should) see their doctor about the results. Even with it being a 1-lead ECG, it does have the possibility of saving lives. There will definetly be alot of false positives, but how accurate can a 1-lead possibly be? However, my take on the situation is that this is apple dipping their feet into the personal health craze. they already had the heart rate feature and wanted to expand the capabilities of the watch vs competitiors. I wouldnt be surprised to see in a few years apple adding more health related features to their watch (and headphones?) such as blood pressure. For most people, this is more of a “all systems are normal” versus a diagnosis

"New Iphone camera with a built in spectroscopy! Simply hold your finger over the lense and get STAT Oxygen saturation and Blood glucose levels!"

 

[LizzyM]

The fact of the matter is, anyone who wears the watch and gets a notifcation that it may have detected Afib will (and should) see their doctor about the results. Even with it being a 1-lead ECG, it does have the possibility of saving lives. There will definetly be alot of false positives, but how accurate can a 1-lead possibly be? However, my take on the situation is that this is apple dipping their feet into the personal health craze. they already had the heart rate feature and wanted to expand the capabilities of the watch vs competitiors. I wouldnt be surprised to see in a few years apple adding more health related features to their watch (and headphones?) such as blood pressure. For most people, this is more of a “all systems are normal” versus a diagnosis

Should they? One physician's opinion is that the likelihood that a healthy person under the age of 65 has afib on the basis of a positive result from the Apple watch is so low as to not merit a physician's time (and someone's money) to get it checked out. If every positive is checked out and one in 10,000 is a true positive, what will we have spent in time, money and lost productivity to diagnose one case of afib? As a society, do we want to spend that amount to identify a single case of afib? Will detection before the afib becomes symptomatic improve outcomes compared with waiting until the person becomes symptomatic and seeks medical care for symptoms? Read up on screening and medical decision making.

 

[mimelim]

The fact of the matter is, anyone who wears the watch and gets a notifcation that it may have detected Afib will (and should) see their doctor about the results. Even with it being a 1-lead ECG, it does have the possibility of saving lives. There will definetly be alot of false positives, but how accurate can a 1-lead possibly be? However, my take on the situation is that this is apple dipping their feet into the personal health craze. they already had the heart rate feature and wanted to expand the capabilities of the watch vs competitiors. I wouldnt be surprised to see in a few years apple adding more health related features to their watch (and headphones?) such as blood pressure. For most people, this is more of a “all systems are normal” versus a diagnosis

Did you go to Trump University? That isn't a fact. That is an opinion. I have no idea how much medical weight is behind it, but certainly from someone in the cardiovascular space, in my OPINION, they should not see their doctor about the results. It is a waste of time and money. I am not so presumptuous to know the solution to our broken healthcare system. But, I feel fairly confidently that the solution is not bloatware pushed by a company struggling to innovate these days.

 

[Lucca]

A cardiologist and physician scientist from U Michigan had an excellent Twitter thread breaking down why the new Watch app would have way too many false positives and indeed might be collecting very poor test data to improve its algorithm.

 

[libertyyne]

The fact of the matter is, anyone who wears the watch and gets a notifcation that it may have detected Afib will (and should) see their doctor about the results. Even with it being a 1-lead ECG, it does have the possibility of saving lives. There will definetly be alot of false positives, but how accurate can a 1-lead possibly be? However, my take on the situation is that this is apple dipping their feet into the personal health craze. they already had the heart rate feature and wanted to expand the capabilities of the watch vs competitiors. I wouldnt be surprised to see in a few years apple adding more health related features to their watch (and headphones?) such as blood pressure. For most people, this is more of a “all systems are normal” versus a diagnosis

This is an bad stance because.
1. This will lead to unnecessary psychological harm.
2. Will lead to unnecessary testing.
3. Will likely lead to iatrogenic harm
4. Is a bad use of resources.
5. Is unlikely to save a meaningful number of lives.

There is a reason why bad tests are not recomended. Because when follow-up tests are performed and unnecessary procedures they end up in the grand scheme of things causing more harm compared to good.
PSA for young men, and Mamography for women under 45 is an example of why not all testing is good.

 

[johnfree7]

Did you go to Trump University? That isn't a fact. That is an opinion. I have no idea how much medical weight is behind it, but certainly from someone in the cardiovascular space, in my OPINION, they should not see their doctor about the results. It is a waste of time and money. I am not so presumptuous to know the solution to our broken healthcare system. But, I feel fairly confidently that the solution is not bloatware pushed by a company struggling to innovate these days.

But Apple received FDA approval didn't they? Their hardware and software had to meet certain standards to be approved. To call the ECG capability "bloatware" seems a little unfair. Anecdotally, Apple claims it has received "Thousands" of letters of people claiming their Apple Watch alert lead them to alert their family doctors leading to specialists and further tests-and they were successfully diagnosed with afib, it's not like they're sprinting to the emergency room pointing to their apple watches demanding attention at the slightest hint of a problem. I would imagine most reasonable patients wouldn't become hypochondriacs overnight, but after several months of abnormal readings would bring up the concern at their next general scheduled appointment- is that such a bad development?

 

[seanm028]

But Apple received FDA approval didn't they? Their hardware and software had to meet certain standards to be approved. To call the ECG capability "bloatware" seems a little unfair. Anecdotally, Apple claims it has received "Thousands" of letters of people claiming their Apple Watch alert lead them to alert their family doctors leading to specialists and further tests-and they were successfully diagnosed with afib, it's not like they're sprinting to the emergency room pointing to their apple watches demanding attention at the slightest hint of a problem. I would imagine most reasonable patients wouldn't become hypochondriacs overnight, but after several months of abnormal readings would bring up the concern at their next general scheduled appointment- is that such a bad development?

I think the bigger issue here is health literacy in the general population. I agree with the spirit of your last sentence — that several, serial alerts should trigger a visit to the PCP. But does the general Apple Watch owner know this, or might they be concerned about a solitary alert and seek immediate, emergency treatment? I don't know the answer, but I suspect it's closer to the latter than the former.

 

[Matthew9Thirtyfive]

Moving to TIH, as it's more appropriate for that forum.

 

[mimelim]

But Apple received FDA approval didn't they? Their hardware and software had to meet certain standards to be approved. To call the ECG capability "bloatware" seems a little unfair. Anecdotally, Apple claims it has received "Thousands" of letters of people claiming their Apple Watch alert lead them to alert their family doctors leading to specialists and further tests-and they were successfully diagnosed with afib, it's not like they're sprinting to the emergency room pointing to their apple watches demanding attention at the slightest hint of a problem. I would imagine most reasonable patients wouldn't become hypochondriacs overnight, but after several months of abnormal readings would bring up the concern at their next general scheduled appointment- is that such a bad development?

That is incorrect. The FDA did NOT approve Apple watch EKG capabilities. They CLEARED them for use. There is substantial difference between the two. To be a class III product or 'FDA approved' there is a lengthy, expensive and relatively rigorous process with high standards. An Apple watch is class II, not nearly the same standard.

Apple can claim whatever they want about patient testimonials. In general, that is considered incredibly low level evidence for clinical decision making. I have my own foibles about 'evidence based medicine', but patient testimonials don't really make it onto the evidence pyramid. Frankly, it is pretty clear that this can and likely will cause more harm than good.

 

[doc05]

But Apple received FDA approval didn't they? Their hardware and software had to meet certain standards to be approved. To call the ECG capability "bloatware" seems a little unfair. Anecdotally, Apple claims it has received "Thousands" of letters of people claiming their Apple Watch alert lead them to alert their family doctors leading to specialists and further tests-and they were successfully diagnosed with afib, it's not like they're sprinting to the emergency room pointing to their apple watches demanding attention at the slightest hint of a problem. I would imagine most reasonable patients wouldn't become hypochondriacs overnight, but after several months of abnormal readings would bring up the concern at their next general scheduled appointment- is that such a bad development?

That's nonsense. The FDA has "cleared" lots of crap that doesn't do any good.

The EKG feature will lead to wasting of resources. Much like buying an Apple Watch is a waste of resources in the first place.

 

[johnfree7]

The EKG feature will lead to wasting of resources. Much like buying an Apple Watch is a waste of resources in the first place.

Not a waste here. "Apple Watch customer identifies A-fib heart condition after dismissing symptoms as ‘holiday anxiety’"

The Apple Watch Series 4’s ECG function has only been available for a month, but it’s already proving to be life-saving for some. WMUR reports today that a Nashua, New Hampshire man discovered he had atrial fibrillation with his Apple Watch, and rushed to the emergency room.


Barry Maden said he originally bought the Apple Watch to “keep a closer eye on his health after suffering a brain injury.” His wife concurred with this reasoning, citing the device’s Fall Detection feature:

“He originally got it because they have a new fall risk app where, if he were to fall and I’m not nearby, the fall sensor will sense that he fell and call 911,” said his wife, Tara Maden.

When he experienced what he originally thought was “anxiety around traveling for the holidays,” Madden’s Apple Watch Series 4 alerted him that his heart appeared to be in A-fib.

It’s not clear if Maden initially used the ECG and found out his heart was in A-fib, or if the Apple Watch sent him an irregular heartbeat notification. Either way, it was enough for Madden to go to double-check the result with the ECG app itself and head to the emergency room.

At the hospital, doctors performed another ECG with more advanced equipment to verify the Apple Watch’s findings. From there, Maden was sedated and his “heart was essentially stopped and restarted by doctors.”

“And it said, ‘It looks like your heart is in A-fib. You should contact your doctor,” Maden said.

With the watch showing Maden what his actual heartbeat looked like, he decided to go to a hospital. “When I got to the ER, they did an actual EKG on a cart — the real deal,” he said.

Sure enough, medical professionals told Maden that he was, in fact, in A-fib. “It would’ve probably taken me longer had I not had something actually telling me that something’s not right,” he said.

This is only the latest story showcasing the health functionality of the Apple Watch. Back in December, another Apple Watch user said they discover their heart was in A-fib, with a doctor remarking that the Apple Watch test “probably saved” them.

 

[907914]

Not a waste here. "Apple Watch customer identifies A-fib heart condition after dismissing symptoms as ‘holiday anxiety’"

The Apple Watch Series 4’s ECG function has only been available for a month, but it’s already proving to be life-saving for some. WMUR reports today that a Nashua, New Hampshire man discovered he had atrial fibrillation with his Apple Watch, and rushed to the emergency room.


Barry Maden said he originally bought the Apple Watch to “keep a closer eye on his health after suffering a brain injury.” His wife concurred with this reasoning, citing the device’s Fall Detection feature:

“He originally got it because they have a new fall risk app where, if he were to fall and I’m not nearby, the fall sensor will sense that he fell and call 911,” said his wife, Tara Maden.

When he experienced what he originally thought was “anxiety around traveling for the holidays,” Madden’s Apple Watch Series 4 alerted him that his heart appeared to be in A-fib.

It’s not clear if Maden initially used the ECG and found out his heart was in A-fib, or if the Apple Watch sent him an irregular heartbeat notification. Either way, it was enough for Madden to go to double-check the result with the ECG app itself and head to the emergency room.

At the hospital, doctors performed another ECG with more advanced equipment to verify the Apple Watch’s findings. From there, Maden was sedated and his “heart was essentially stopped and restarted by doctors.”

“And it said, ‘It looks like your heart is in A-fib. You should contact your doctor,” Maden said.

With the watch showing Maden what his actual heartbeat looked like, he decided to go to a hospital. “When I got to the ER, they did an actual EKG on a cart — the real deal,” he said.

Sure enough, medical professionals told Maden that he was, in fact, in A-fib. “It would’ve probably taken me longer had I not had something actually telling me that something’s not right,” he said.

This is only the latest story showcasing the health functionality of the Apple Watch. Back in December, another Apple Watch user said they discover their heart was in A-fib, with a doctor remarking that the Apple Watch test “probably saved” them.

That’s the thing about case studies, they’re great at explaining what can happen but not about showing overall trends.

 

[johnfree7]

That’s the thing about case studies, they’re great at explaining what can happen but not about showing overall trends.

Well it's a damn good thing Barry Maden had an Apple Watch or he might not be alive.

 

[907914]

Well it's a damn good thing Barry Maden had an Apple Watch or he might not be alive.

This is an overall medical ethics/cost benefit analysis: Does 1 true positive in 10,000 reports justify the cost of those 9,999 other reports? Each of those 10,000 cases will need $100 of testing, So a million dollars per Apple-detected AFIB diagnosis? I don’t have an answer, but good question to ask.

 

[Goro]

Not a waste here. "Apple Watch customer identifies A-fib heart condition after dismissing symptoms as ‘holiday anxiety’"

The Apple Watch Series 4’s ECG function has only been available for a month, but it’s already proving to be life-saving for some. WMUR reports today that a Nashua, New Hampshire man discovered he had atrial fibrillation with his Apple Watch, and rushed to the emergency room.


Barry Maden said he originally bought the Apple Watch to “keep a closer eye on his health after suffering a brain injury.” His wife concurred with this reasoning, citing the device’s Fall Detection feature:

“He originally got it because they have a new fall risk app where, if he were to fall and I’m not nearby, the fall sensor will sense that he fell and call 911,” said his wife, Tara Maden.

When he experienced what he originally thought was “anxiety around traveling for the holidays,” Madden’s Apple Watch Series 4 alerted him that his heart appeared to be in A-fib.

It’s not clear if Maden initially used the ECG and found out his heart was in A-fib, or if the Apple Watch sent him an irregular heartbeat notification. Either way, it was enough for Madden to go to double-check the result with the ECG app itself and head to the emergency room.

At the hospital, doctors performed another ECG with more advanced equipment to verify the Apple Watch’s findings. From there, Maden was sedated and his “heart was essentially stopped and restarted by doctors.”

“And it said, ‘It looks like your heart is in A-fib. You should contact your doctor,” Maden said.

With the watch showing Maden what his actual heartbeat looked like, he decided to go to a hospital. “When I got to the ER, they did an actual EKG on a cart — the real deal,” he said.

Sure enough, medical professionals told Maden that he was, in fact, in A-fib. “It would’ve probably taken me longer had I not had something actually telling me that something’s not right,” he said.

This is only the latest story showcasing the health functionality of the Apple Watch. Back in December, another Apple Watch user said they discover their heart was in A-fib, with a doctor remarking that the Apple Watch test “probably saved” them.

This is what we call "anecdata".

I love the term "bloatware"!!

 

[VA Hopeful Dr]

Well it's a damn good thing Barry Maden had an Apple Watch or he might not be alive.

Umm, no. A fib is very very rarely life threatening.

 

[johnfree7]

Umm, no. A fib is very very rarely life threatening.

His heart stopped in the emergency room. He was lucky to get the alert when he did.

 

[VA Hopeful Dr]

His heart stopped in the emergency room. He was lucky to get the alert when he did.

Read better.

At the hospital, doctors performed another ECG with more advanced equipment to verify the Apple Watch’s findings. From there, Maden was sedated and his “heart was essentially stopped and restarted by doctors.”

The key part there is in bold. There are certain medications that temporarily (6-10 seconds) stop the heart which then restarts hopefully in a normal rhythm. We do generally sedate people for that as I'm told its a somewhat uncomfortable experience.

 

[KidPharmD]

Has anyone seen specificity information for the alert? How frequent are false positives? I haven't seen any information on how good it really is. I think it would really matter if it was a 99% or a 5% false positive rate.

 

[dpmd]

Well it's a damn good thing Barry Maden had an Apple Watch or he might not be alive.

Not necessarily. Plenty of people have intermittent afib (even with some episodes of rapid ventricular response) and live just fine.

 

[dpmd]

His heart stopped in the emergency room. He was lucky to get the alert when he did.

No it says they stopped and restarted his heart in the er. Probably a cardioversion and I gotta wonder how strictly indicated it might have been for a minimally symptomatic guy. Might have done just fine with some beta blockade.

 

[dpmd]

Ok I guess I could have saved some responding effort by reading the whole thing before responding. But whatever, I guess I will just leave it.

 

[Treebeard]

If only scientists and physicans had some means to test products like this and see how they influence costs and outcomes. Something like a "trial" done in a "clinical" setting.....

In seriousness, that is my biggest issue with the apple ECG - it was just released to the public with zero legitimate research backing it's use.

 

[Atreus21]

Not necessarily. Plenty of people have intermittent afib (even with some episodes of rapid ventricular response) and live just fine.

Exactly! And we would never know about it if it wasn't for these watches. As others have said it just causes undue stress/anxiety and drives unnecessary healthcare costs as people go to see a doc. That is the last thing that we need in our current healthcare environment.

What is the pre-test probability? Especially when there were no other signs and symptoms like SOB, diaphoresis, etc.

What is the ROC curve? Sensitivity, specificity, PPV, NPV, etc? I think doctors need to really focus on educating the public more like in those tweets above.

This is only going to get worse with these useless tests. The same is true with these direct to consumer laboratory tests. The way reference ranges are established, 5% of all people are going to be above and below the reference range, but will be completely healthy. So if a bunch people walk into CVS, etc and order up a CMP just because they feel like it with no clinical indication to do so and low pre-test probability this is going cause more harm than good as people flood into doctor's offices.

I remember this interesting story about a guy who urinated on a pregnancy test as a joke (I think he and his partner were trying to conceive) and it was positive. He posted it online and a friend suggested he go to a doctor. Sure enough he had choriocarcinoma. So should all men do this once a year? Of course not.

Why don't we just go crazy? PSA when you're in your 20's? SPEP when you're in your 30's? Mammogram when you're 25?