Apple Watch detects irregular heart beat in large U.S. study
reuters.com
reuters.com
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I'm curious since I don't know anything about Cardiogram at all; is DeepHeart a part of Cardiogram? That is, are all of those detection capabilities part of your app if I have an Apple Watch?
Does this mean insurance companies are interested in this heart rate data stream, and are making inferences from it? Are they already collecting it? Do any of these wearables provide this data to these companies without the user's express permission?
Is this a good thing?
I'm curious about your service, but without knowing if it's compatible with my smartwatch etc, I wouldn't go as far as downloading the app.
https://www.reddit.com/r/AppleWatch/comments/a40qm5/heading_...
https://www.reddit.com/r/AppleWatch/comments/9zrdq5/how_an_a...
I'm sure there is a lot more.
(Also all the people losing weight)
“Closing the rings” which means completing 100% of the move, stand and exercise targets adds a competitive element to fitness which has worked well for many users.
But ... like I said, everyone has their own needs. And if you don't want all the smart crap, it's a pretty expensive heartbeat monitor.
[1] Or it crashes, or randomly starts draining its battery insanely faster because Google decided to force feed it an update or due to other reasons I can't fathom... but that's another story.
I don't want to baby multiple devices, one main work tool is fine to manage battery on a daily basis for instance AirPods charge roughly once a week or less depending on usage pattern. There's plenty of tech that balances battery and powerdraw appropriately. I find apple watch misses this mark unless a lot of functions are turned off.
I bought it for her primarily for the hypnograms.
I wanted something a bit smaller, to fit under the shirt cuff, so got the Mi Band 3 ($50) which lasts about 10 days (probably 20 days if you don't allow it to display notifications and set a higher HR interval).
The Mi app is pretty bad, which forces you to buy an extra app (for me, Notify & Fitness, for Google Fit sync).
On iOS, I use AmazTools [1] to sync the heart rate data to the Health app.
[1] https://itunes.apple.com/us/app/amaztools/id1386033880?mt=8
Some Garmin and Fitbit models have good battery life — often about a week.
Aneceotally, because the watch isn't really water resistant (not least because the bands bubble if they get wet often), I have had it run out twice in that time and both times I was on holiday somewhere with no power. Because you are unlikely to actually wear it in the shower, just leave the charger permanently in your bathroom and get in the habit of taking it off and putting it on the charger when you shower. Even if you forget for one or two days it will almost always be sufficiently charged.
The Garmin Forerunner 645 Music covers what I need short of the app support. The Nike Apple Watch Series 3 looks very tempting but I really don't like the aesthetic and I feel like it's just perpetuating the problem of being too online all the time. Though it's a far more feature rich device for less than the 645.
I'm thinking I'll sit back and wait for broader app support.
The interactions of early detection and medical benefits and downsides are complicated and it will require a lot more science to figure out whether a device like an Apple Watch can provide benefit.
There's more information on this here:
https://www.apple.com/healthcare/site/docs/Apple_Watch_Arrhy...
ECGs are also less comfortable to wear than watches, so it's possible the people they sent them to didn't wear them as often (it's even possible that they didn't wear them at all).
But if you have a perfectly boring, normal heart, I can see not using it very often. At least it's unobtrusive if you aren't interested in it.
Though maybe it gets even better than that and we just all start wearing watches again.
I want that feature but I'm not a watch wearer.
Right now, the right choice is to combat this problem before it becomes a real problem. Before it sets root as cultrually acceptable to hand over your biometrics data to private companies without the right payment and compensation.
I agree with your premise about the point of insurance. How is the discussed idea any different than insurance companies giving different rates to older people and denying coverage for pre existing conditions, in terms of discrimination against the non healthy?
Incentives to make people healthier should not be a problem with these constraints (max premium rations and guaranteed coverage for everyone). It’s no different than offering a lower car insurance premium to someone that doesn’t drive drunk.
Though there are still questions of how strong the firewall is in cases where the Wellness programs and Insurance providers share parent companies or even just C-Suite members. Arguably, the separation allows corporate plan buyers to pick and choose Insurance and Wellness program separately, allowing for some competition between them on things like privacy. Yet, being employer-driven "benefits" first and foremost, it's hard to say how much the end consumer/user/employer's privacy is always prioritized, as it is an indirect need of the market.
(Also, every employer I've seen the Wellness program didn't define HSA contributions but rather "discounts" on Insurance premiums, which does seem to indicate that Insurance companies are probably using the Wellness program for risk pools, even with what little data they supposedly are being fed across the firewalls.)
The same thing happened with various forms of cancer screening. If we were to test everybody for everything very few people would be found to be 100% and a lot of unnecessary procedures would be the result.
Given the obesity problem this result should not be a surprising finding anyway.
> Screening test results may appear to be abnormal even though no cancer is present. A false-positive test result (one that shows there is cancer when there really isn't) can cause anxiety and is usually followed by more tests (such as biopsy), which also have risks. [1]
[1] https://www.cancer.gov/types/colorectal/patient/colorectal-s...
Here's a piece on the subject; http://www.journalgazette.net/features/20180604/anomalies-in...
By all means, don't ignore symptoms! Just don't go looking for them.
For example, prostate cancer can kill, but more people die with prostate cancer than of prostate cancer, in the latter case often with minor symptoms.
Detecting it before it bothers people helps those it would kill, but subjects lots of others to testing, and those tests will initially have false positives that unnecessarily stress those it wouldn’t kill.
Worse, the side effects of treatment can include incontinence and erectile dysfunction that can significantly affect quality of life for those were follow-up tests also produce false positives.
Thats’s why there is discussion on whether screening for prostate cancer makes sense, and if so, for whom. See for example https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD....
I’m not saying that to automatically disqualify and increase in the availability of testing – but it does have to be implemented with the proper care and caution.
I doubt the tests they are running here will actually go that far. But pervasive testing does need different trade-offs to targeted testing. At least we may have more complete data from which to understand this.
That is the issue that should get resolved with time. The watch will receive a lot of feedback from medical professionals to adjust its reporting because now we'll know so much more about what symptoms are really worth paying attention. But of course, there will be an adjustment period like what we are seeing now. This has always been true of new technologies introduced in medicine.
So, for a heart monitor, you'd only have the test run if you had another symptom, such as shortness of breath, an irregular heart beat, etc... Otherwise, you will end up with many more false positives, which can be dangerous in and of itself. What if someone who legitimately has a heart condition had an Apple watch and ran the test. But what if that person then ignored the watch because all of their friends tried the same thing, and went to the doctor only to find out it wasn't anything to worry about. Their false positives could have a real impact on someone who had a true positive result.
The more you test, the more you'll find. Now, it's perfectly possible that many of the subjects in this study bought the watch specifically because they suspected that they had a heart condition. In which case, the study pool could be skewed away from the general population.
There is no way to adjust for this. The more people you screen, the more you'll find. Whether or not it's a true positive or false positive is another question. And I'd argue that Apple would need to skew their reporting towards removing false negatives instead of removing false positives, just from a liability point of view. You're much more likely to see Apple sued over this than a typical medical device manufacturer.
Bear in mind that this hasn't happened for the other major overdiagnosis issue (cancer screening), and the best solution found so far there is to screen less. This really isn't the sort of thing where natural technological progress is enough to be comfortable saying things like "it'll get resolved with time". There are already counterexamples to what you're saying, it's not a matter of an "adjustment period".
The hope with widespread cheap screening would be that it might avoid this. If heart-rate smartwatches become as common as smartphones, we could train our treatment model on everyone, and do better. Or at least this sounds mathematically plausible to me (not an expert).
Whether it will come to pass, or whether doctors will continue to treat as now (anything which an eyeball test says looks like an early stage of a known disease) I don't know.
It sounds like many of those who got a bleep from their iWatch subsequently had some effect detected by standard tests. But that isn't the right number. We don't necessarily know that we should treat everyone who fails standard tests. Especially if our previous knowledge about such tests was limited to patients where there was other evidence.
At least 84% of the positives were correct.
> It sounds like many of those who got a bleep from their iWatch subsequently had some effect detected by standard tests. But that isn't the right number. We don't necessarily know that we should treat everyone who fails standard tests. Especially if our previous knowledge about such tests was limited to patients where there was other evidence.
I agree, but there is a very important distinction to make here. When we don't know what to do with the results of a test, it can be wasteful and negative even when the results of the test are completely accurate.
That is the much bigger risk here. That the true positives are a waste of time and net negative all by themselves. They have the real potential for issues here, not the false positives.
Because the true positives outweigh the false positives by so much, for there to be net harm because of false positives, each one would have to do more damage than the effect of five true positives. I doubt that's the case. I'm pretty confident that either the test is an overall good thing, or the test is a bad thing because of true positives.
There are other situations where it actually is a huge problem that the test makes a mistake some percent of the time. It's important to distinguish the two problems.
A) Everyone is told nothing.
B) 5% of people are told “Here’s something. It’s serious.” And, 45% of people are told “Here’s something. But, it’s not serious.”
Option B sounds greatly preferable.
And then, if you knew that 45% of people got a false positive, how likely is the 5% (the true positives who really need it) going to believe their initial result and even get the followup?
When you have a ton of people getting their hearts checked because their watch told them to (and only for that reason), you’re going to get a lot of false positives. There are many reasons better explained in these comments for why that’s not a good thing.
One major reason is the extra stress on the medical system that can’t handle it. There has been much talk about medical genetics clinics having issues dealing with people calling in about 24 and me (etc) test results. It’s a major load for these clinics.
Now, an easy test like this — in the presence of other symptoms — is a great thing to have. I just worry about all the people getting needlessly checked out. But for those who already have a concern or family history, this type of test can be great.
Here's a good overview:
https://sciencebasedmedicine.org/a-skeptical-look-at-screeni...
Info about thyroid cancer over diagnosis:
https://www.npr.org/sections/health-shots/2017/05/09/5275692...
Obesity screening
Blood pressure screening
Cervical cancer screening (pap test) though most medical providers test at the wrong intervals.
My Apple Watch was a few hundred bucks. My latest ER visit for tachycardia (idle heart rate over 100) came to over $3000, with health insurance. And all they did was tests.
For less than three grand, you could fly to Europe for a weekend, stay in a five star hotel, and have all the tests done while you're there.
Medical tourism might become a more common thing.
Medical tourism is a thing that people do. All the time.
You can pay top private clinics for medical services, and it can cost far less than the equivalent would cost in the US, even after insurance.
(edit: I'm not in the US so no idea what is typical outside the stories I see in the media)
That $3k out-of-pocket cost was ECG, blood tests, urine tests, chest x-rays and talking to a doctor for 5 minutes. I wish I was kidding. Healthcare in America is an abomination.
I should, add, too, that the $3k cost was because I had insurance. The total bill came out to around $23,000 and I would have had to pay that if I didn't have insurance.
Seeing a cardiologist is a totally separate visit/bill.
Also: The heart beat monitoring features account for some portion of the Apple Watch's price, surely, but I suspect for most people this feels like a "free" benefit.
I've heard this line parroted a lot but a robust Bayesian analysis should mitigate this.
Like by setting appropriate thresholds you should be able to either
* do the same amount of interventions with more of them being helpful
* maintain the rate of helpfulness but doing more procedurees.
or even a mix of the two. Testing all the things all the time on all the people would be a boon if we just did it correctly.
Super underrated channel (British humor, anyone)--shows how the Apple Watch's ECG feature can be actually bad for overall health.
edit: though the amount of positive outcomes (the reddit thread) makes me reassess this...
> It should be noted though that this study does not say that an Apple Watch will overall provide medical benefits. It also doesn't follow automatically from the fact that it detects things with a certain reliability. The interactions of early detection and medical benefits and downsides are complicated and it will require a lot more science to figure out whether a device like an Apple Watch can provide benefit.
The only thing I would add is the last thing I mentioned in this comment, namely that you might consider buying one for a higher risk person like your grandpa rather than yourself.
--- (original comment) ---
Watched the whole thing, basically the argument is that overdiagnosis leads to people worrying (increasing stress) when the doctor says "based on this I can't give you drugs since the drugs aren't completely harmless", or the doc might recommend follow up tests that give ambiguous results and escalate (in the example) to an operation to test a certain thing where the patient has a 1 in 3k chance of dying from the procedure itself. Additionally, experiments where they strap a bunch of such devices to healthy patients (basically what apple's watch does as well, especially the young and modern people will buy it) and while it lead to more diagnoses, it didn't decrease the chance of stroke or heart attacks in that group.
I don't think any of this is a significant reason not to buy it. I'm not going to buy one for various reasons, but this isn't one of them. It is good to be aware of the arguments, though: it might lead to someone buying one for their grandma rather than healthy and young(ish) self.
But what I am concerned about is that this kind of stuff is a Pandora's box that can cause some undeserved panic...
I don't want to live in a world where insurance companies and employers force us to hand over this data.
Just feels really creepy to me. Like way over the line.
The notion that the authoritarian-creep and spy-on-everyone mentality that continues rapidly spreading in most developed nations, won't apply to this type of healthcare data, is obviously false. There is no entity that wants to track people more than governments (and in all possible regards), it's not even remotely close. It doesn't matter whether we're talking about the US, France, UK, Australia, South Korea, Japan or Germany.
You want a specific medication, or a non-generic medication in Australia? Too bad. It's not that it costs more, you just can't get it. Things like Wellbutrin are as illegal as crack. And if you do something like tell your doctor that you tried a bunch of medications and Vyvanse is what works best... they'll literally treat you like someone trying to score opiates. They don't like it when you have an opinion on medications, and you get all sorts of lectures about how bad drug advertising is. It's a very dated, "I'm the doctor, you have to do what I say..." mentality.
And the wait times... "Oh, did you need back surgery? Because you're under 65 and you are over weight, that means you're now bottom on the list... and you'll have to wait for 1-2 years to have this done." A co-worker of mine here is a larger woman, but she just paid out of pocket rather than go on a 2-year wait list. Oh, and the recovery room... there were like 4 people crammed in one room sharing one bathroom. Doctors came in and were talking about care and medical details, in front of total strangers and her visiting guests. No privacy at all. The government would absolutely use health / fitness data to prioritize care... it's not that everyone gets unlimited treatment, they still have budgets.
What else? Remember those classes in college where you couldn't understand the professor because he had such a thick accent? Yeah, that's pretty much every doctor here now. You go to the ER and you need stitches, you end up waiting for a few hours and when you're finally seen the doctor is like, "Why weren't you escalated faster?" "I couldn't understand what your triage nurse was saying, she doesn't speak English... and I haven't got a clue if she understood me... she just told me to sit and wait..." My friend needed 14 stitches and waited over 3 hours in the ER holding a bloody towel on her hand. Only got someone to do something when she started dripping blood on the floor after it had soaked through the towel.
Anyway I know health care sucks in the US, and I do want to get to a point where governments pick up the bill... but holy hell, if the choices at present are what we have in the US or what they have in Australia... man, they both really suck. If you're someone with a job, and with any money, the US model works slightly better.
I'll add another thing to my experience in Australia. As an immigrant, I'm not covered by national health care. Taxed at a higher rate, plus paying for a visa, and a small fortune if I apply for a PR... and they do nothing to cover me during this time period. Employers don't cover people here, so all I can get is private insurance.
But... private insurance doesn't really cover anything for a year after you pay for the tier you want. So you can get like just emergency coverage -- things like simple ER visits, but things like minor surgery, or anything they can deem is a "pre-existing" condition will take a least a year of paying premiums before you're eligible for benefits. Things like an appendicitis are not covered, there's a cap of like $5k or something on everything in the first year. Luckily I didn't need much coverage... but I'm the best plan I can find here, and if you get seriously ill the first year you're over here you're really just fucked. There's medical screening before your visa can be accepted, but they don't at all cover you if you get in trouble here.
An American friend needed hernia surgery, and he had to pay entirely out of pocket because his insurance wouldn't cover it. Health care... not like it's a regular service you can price compare when you need treatment. You just say, "Fix it!" and I think it cost him something like $18k to have the surgery. Mind you he had health insurance, but, again, it doesn't cover anything the first year you have it.
And it's next to impossible to get anything around mental health covered, even with the top tier private insurance here. Want to maintain your prescription of Adderall? Good luck finding a doctor here who will give you a script. It's all pretty shitty. On top of that... it's all a digitized system, where the government gets full access to your records. There's a question on the visa applications if you've ever seen a psychiatrist. The lawyers strongly caution you not to answer yes on it, as it supposedly makes it harder to get a visa approved... but since it's all data the state has access too... pretty hard to keep any of it a secret.
Anyway look, is the US perfect? No, and I've never been through immigration in the US. But the Australian system is pretty far from perfect. Take people, put them a billion miles away from their friend and family, and then penalize them for getting homesick and seeking mental health... that's insane. (=
I've ranted enough, but a lot of this strikes home for me. I've come to the other side of the world so I can score my long-term medication, medication that something like 10% of the people in the US are on, illegally from prep school kids. That's my experience with the Australian system.
And there won't be any transparency because the people administering the system have all the power and don't like being embarrassed. Meanwhile then public schools and public broadcasts will bang the drum for that system on a daily basis making sure most citizens feel dependent on it, no matter how bad it really is.
And just to make it real, I personally know someone who was told to wait half a year for an appointment. They personally knew a doctor who told them "you can't wait that long, I am going to pull some strings". Turns out it was cancer. This is in Germany, btw, and it's not an isolated case.
No one is handing over health data to insurance companies or employers.
Dongle+app supports Android and iOS.
No prices on En page though, but the official price for the Russian market is 3500 RUB ~ $54
Apple Watch 3 was pretty bad too. It would give inaccurate often enough that I couldn't use it for training in a heart rate zone. For example, I'd be walking for warm up and it would give a reading of 160 at the beginning, then back down to 110, then 10 mins later back to 160. I can't imagine the Apple Watch being a medical device with lives depending on it.
Garmin 935 has been great. It has the most accurate HR and GPS readings.
I'm a runner so it gets a bit upset when my resting heart rate gets below 50 but other than that ...
It’s possible yours was just faulty. Fitbit aren’t known for their quality control.
https://h4labs.wordpress.com/2015/07/28/in-the-future-everyo...
https://www.hhs.gov/hipaa/for-professionals/faq/190/who-must...
For example, the company I work at is not a covered entity because we do have access to PHI we have certain regulations we have to follow. Further, we have to sign BAAs with any covered entity we work with defining who is responsible for what.
Any company which deals with heathcare information should always assume they fall under HIPAA until they've hired lawyers who tell them otherwise.
In a future where smartwatch companies integrate with a health plan/hospital’s medical records system, I would expect HIPAA to cover them. But in a case where a company is generating the data (via user consent/input), it might not be the case.
For example, what is Apple's exposure here? I doubt any... they keep your data private because it's good for business (and they can then advertise how privacy conscience they are and get people to buy more watches). They aren't doing it because they have to follow HIPAA regulations.
A more interesting question is -- if the Apple watch was purchased as a medical device (maybe even with insurance or a prescription), does Apple's data processing need to change at all? What about if people got a watch as part of a medical study (not people that already had the watch). Would that be different?
Rule of thumb is if it's not an insurance company or medical facility (hospital, doctor's office) HIPAA doesn't apply.
HIPAA is great- enforcement of it is not.
The market for luxury watches is growing every year and despite the arrival of different technologies e.g. Quartz, Digital they are still around. I actually think this will be an emerging market as people start to revolt against technology being everywhere.
And for me smart watches are on whole detrimental to a person’s health since they raise stress levels through constant notifications.
(Either way, kudos to Apple for contributing to health science.)
We’ve monitored hearts for a long time. It is common for a heart to skip a beat or maybe double a beat occasionally (a stethoscope on your own heart for 30 mins would demonstrate that).
I don’t think Atrial Fibrillation is ever a normal sign.
If you don’t then battery life is really irrelevant because you can rest your watch on a pad and have it charge just like if it were a normal watch.
Things like congenital issues should be protected (not a choice), but if someone leads an unhealthy lifestyle and actuaries can work out a good expected cost, why not? Is that so different from a risky driver?
So it’s WAY behind the chip in Apple watches in terms of performance.
Even if wear OS was better (never used it myself) it couldn’t compete.
† Granted spam filters literally deal with junk..
I'm curious how that was tested. And if there is a source for this.
The premise isn't exactly junk - hardware lie detectors are basically trying to identify a fight or flight reaction, which some people will exhibit when lying. Have you ever been confronted with a fact (did you eat that cookie?), lied, and felt a rush or a feeling of panic? That's what lie detectors try to detect.
The problem is it's possible to fool a polygraph and it's prone to bias. For example some people get nervous when asked a question, even if innocent. It's theatre in some sense, and it shouldn't be assumed as 100% accurate, but there are plenty of people who will break out into a cold sweat when you ask them a question they don't want to answer truthfully.
I'm not stating that this has happened, but yeah, I worry.
As as comparing cancer to AFIB it's definitely not accurate to compare the two directly. A very common cause of AFIB in people younger than 60 for example is 'holiday heart' short-term AFIB related to binge drinking, it is generally self-resolving and transitory, and generally does not require treatment especially if asymptomatic. Cancer to my knowledge generally does not self-resolve.
Not continuously throughout the day, you can't.
I'm just trying to say if you want to buy one that's cool but the premise that's it some kind of must-have life-saving accessory is questionable to me for the majority of people.
The trouble is really when you're first getting to grips with it. That's the scary time.
Everyone's AF is somewhat different though I imagine.
Monitors tend to be potentially less accurate than manual apical pulse when there is an arrhythmia present, the gold standard for any cardiac is auscultation, aka stethoscope, for a full minute by trained professional.
Medicine is really complex is the short version. Also Sinus Arrythmia is not uncommon.
I hope this tech reaches more people with less restrictive hardware options.
1. https://hub.jhu.edu/2015/12/15/industry-funded-clinical-tria...
Of course they do. It's just that if they did, there would likely be huge consequences for them, which makes one hope that they didn't do so in this case.
A third of those whose watches detected an irregular pulse were confirmed to have atrial fibrillation using the ECG technology, researchers said.
Some 84 percent of the irregular pulse notifications were later confirmed to have been AF episodes, data showed.
What is it then, 1/3 or 4/5?
Essentially, using appropriate image analysis, they can sense the pulse of blood moving through the skin