ECG Data

[nikkisharif]

As a clinician, I love the fact that Apple is taking health very seriously. The addition of the ECG technology is amazing and will prove vital to someone’s health. So many people don’t pay attention to their body’s signals of distress, so having this tech in a watch could possibly save someone’s life...IF they use the technology and IF they actually take/send that data to their practitioner.

With that being said, what are your thoughts?

 

[kataran]

This along is a reason to buy the series 4

 

[doogald]

I agree, but I don't need it so much that I will buy an S4 now. It will just be in my next AW.

 

[tcuprof]

I think this will create interest among a whole new segment of customers.

 

[jrsharp70]

As a clinician, I love the fact that Apple is taking health very seriously. The addition of the ECG technology is amazing and will prove vital to someone’s health. So many people don’t pay attention to their body’s signals of distress, so having this tech in a watch could possibly save someone’s life...IF they use the technology and IF they actually take/send that data to their practitioner.

With that being said, what are your thoughts?

I'm going to post this elsewhere, but...

The afib detection is cool. As far as the EKG goes, it's only of limited use. And it creates a lot of liability for any doctor you send it to. It's only 1 lead. It doesn't mean anything without a prior EKG to compare it to. And Any primary care physician you send it to is going to tell you to go to the emergency room no matter what it shows if you have any symptoms at all.

It'll be useful for
(if sinus) simply for rate, which the old watch showed anyway,
for SVT...
Maybe for QT prolongation?
Maybe AV block
Maybe new left bundle

But what will be cool is, basically you get a cardiac event monitor (if you are symptomatic and trigger it), but a continuous monitor is what you'd want, rather than patient triggered, so I don't see it replacing any current technology.

That being said, I love technology and it's super cool. Time to invest money in eliquis.

 

[nikkisharif]

I'm going to post this elsewhere, but...

The afib detection is cool. As far as the EKG goes, it's only of limited use. And it creates a lot of liability for any doctor you send it to. It's only 1 lead. It doesn't mean anything without a prior EKG to compare it to. And Any primary care physician you send it to is going to tell you to go to the emergency room no matter what it shows if you have any symptoms at all.

It'll be useful for
(if sinus) simply for rate, which the old watch showed anyway,
for SVT...
Maybe for QT prolongation?
Maybe AV block
Maybe new left bundle

But what will be cool is, basically you get a cardiac event monitor (if you are symptomatic and trigger it), but a continuous monitor is what you'd want, rather than patient triggered, so I don't see it replacing any current technology.

That being said, I love technology and it's super cool. Time to invest money in eliquis.

I’m a SICU Nurse by trade, so I know it’s not as accurate. I never even thought about using it in a emergency situation. Since I currently build and test medical software, I was thinking in basic terms. When a person goes to the doctor, they’re asked a series of quest about their activity and what’s been going on with their bodies. With all the new medical apps that are connected to your actual chart, you would be able to send your activity tracking directly to the doctors office, so you both can discuss it during the visit. It’s an added benefit for both the patient & the provider. The provider will not be liable for this information in this aspect as it will go into the patient’s record as subjective data.

 

[jrsharp70]

I’m a SICU Nurse by trade, so I know it’s not as accurate. I never even thought about using it in a emergency situation. Since I currently build and test medical software, I was thinking in basic terms. When a person goes to the doctor, they’re asked a series of quest about their activity and what’s been going on with their bodies. With all the new medical apps that are connected to your actual chart, you would be able to send your activity tracking directly to the doctors office, so you both can discuss it during the visit. It’s an added benefit for both the patient & the provider. The provider will not be liable for this information in this aspect as it will go into the patient’s record as subjective data.

Don't get me wrong, I think it is super cool. The more I think about it, the more instances I can think of where it would be useful. A lot of people have paroxysmal rhythms and never even mention symptoms.

I wonder about what happens when a patient sends a PDF of runs of VT to a PCP or cardiologist at 5 pm, then has an event at 4 a.m., and in court the doc gets torn apart because he didn't review the EKG in time. I'm not saying it's right, but it is going to worry some doctors. I wish we didn't live in that world.

In my mind, I share your enthusiasm though. I'd love to never see another stroke from undiagnosed afib. I got my mother a smart watch a while back, and it sat in a drawer. She was 60 at the time and just couldn't remember to charge it at night.

I definitely see a world where a doctor looks at your apple health data every visit and it improves patient care. One day I'd love to participate in something like that. It hasn't taken off for continuous glucose monitors the way I'd hoped it would.

 

[nikkisharif]

Don't get me wrong, I think it is super cool. The more I think about it, the more instances I can think of where it would be useful. A lot of people have paroxysmal rhythms and never even mention symptoms.

I wonder about what happens when a patient sends a PDF of runs of VT to a PCP or cardiologist at 5 pm, then has an event at 4 a.m., and in court the doc gets torn apart because he didn't review the EKG in time. I'm not saying it's right, but it is going to worry some doctors. I wish we didn't live in that world.

In my mind, I share your enthusiasm though. I'd love to never see another stroke from undiagnosed afib. I got my mother a smart watch a while back, and it sat in a drawer. She was 60 at the time and just couldn't remember to charge it at night.

I definitely see a world where a doctor looks at your apple health data every visit and it improves patient care. One day I'd love to participate in something like that. It hasn't taken off for continuous glucose monitors the way I'd hoped it would.

I totally agree with this!!! The technology integration has taken off in many healthcare facilities and its works great. The reason it’s not more widespread is because of the cost. CMS keeps extending these deadlines and a number of facilities aren’t even using an up to date EMR. It’s crazy!! Like you, I’m looking forward to more patient centered technological advances.

 

[jrsharp70]

I totally agree with this!!! The technology integration has taken off in many healthcare facilities and its works great. The reason it’s not more widespread is because of the cost. CMS keeps extending these deadlines and a number of facilities aren’t even using an up to date EMR. It’s crazy!! Like you, I’m looking forward to more patient centered technological advances.

Actually, I want to send people a box with an eko stethoscope, glucometer, BP cuff, thermometer, camera, and an apple watch. I'll live in the middle of nowhere and manage primary care patients through a video chat and EMR. I can see 20 people a day and have some company do my billing.

The activity tracker or apple watch can even tell me if people are being active, and I could have them use myfitness pall to log all of their food so they can see why they are not losing weight.

 

[tcuprof]

Wired.com posted an article this morning claiming:
THE NEW ECG APPLE WATCH COULD DO MORE HARM THAN GOOD

Frankly, their logic, which is that you don't need ECG because screening asymptomatic adults is not proven to be necessary, seems specious and I assert that the main goal of the article is to be click-bait. Still, I'd be interested in hearing the opinions of medical professionals.

 

[flyinion]

The new heart monitoring stuff is a huge reason I'm going after a Watch finally. I got diagnosed at a young age with AFib a few years ago so the monitoring and built in ECG is very attractive to me. I have a FitBit Charge 2 right now and a Charge HR before that. With both of those, when I had AFib events it just pretty much displayed a normal, maybe slightly elevated heart rate (vs my normal) but nothing anywhere near what professional equipment showed. Their sensors and software just aren't built for that, but they're not going after that capability either so I understand that.

Edit: Just to be clear, I understand of course that what Apple is doing is designed more as a warning that "hey, something might be wrong and you might want to get that looked at" and in my case it would allow me to say ok is this just a random common heart palpitation or am I slipping into a whacky rhythm and need to head out to the ER for a fun filled stay at hotel hospital for a couple days.

 

[jrsharp70]

Wired.com posted an article this morning claiming:
THE NEW ECG APPLE WATCH COULD DO MORE HARM THAN GOOD

Frankly, their logic, which is that you don't need ECG because screening asymptomatic adults is not proven to be necessary, seems specious and I assert that the main goal of the article is to be click-bait. Still, I'd be interested in hearing the opinions of medical professionals.

I read it. Thanks.
He does sort of present both sides. He basically said what I did. But you have to imagine that the data is useless without someone to interpret it for you. My question is, what happens when PCPs and cardiologists get flooded with PDF EKGs and don't have time to read them all? And moreover, an EKG is only useful in the context it is presented in (for most cases).

It's hard to explain... a lot of EKGs that look bad, aren't. And a lot that seem "normal" get looked at more thoughtfully based on the story of the patient, and things are found.

It is also hard to explain that a lead 1 EKG gives ONLY reliable rhythm data. That's it. Without different vectors (basically different pictures from different angles), you can't see what is really happening.

I actually think that a companion device that is worn on the other wrist and supplies a constant lead 1 EKG would be much more useful, but for obvious reasons we don't have that right now (battery life).

So the point of the article is this: you have to be selective in the people you test for things. We don't test every patient for every cancer, because it is a waste of resources and causes patient anxiety. The truth is that if it were free and cost no money and the results were instant, and there were no false positives, we would. And we would catch more cancer. But the state of technology right now means all we would do is create a LOT of anxious patients with no problems, and cost millions of man hours and billions of dollars. That is his basic point.

That being said, I still think it is super cool. Because I love tech.

 

[nikkisharif]

Actually, I want to send people a box with an eko stethoscope, glucometer, BP cuff, thermometer, camera, and an apple watch. I'll live in the middle of nowhere and manage primary care patients through a video chat and EMR. I can see 20 people a day and have some company do my billing.

The activity tracker or apple watch can even tell me if people are being active, and I could have them use myfitness pall to log all of their food so they can see why they are not losing weight.

I helped build an EMR for an eICU North Carolina & Texas. I love the fact that tech is so relevant in healthcare and is only getting better.

 

[tcuprof]

Thanks for your insights jrsharp70. You highlighted what for me is the key when you said, "The truth is that if it were free and cost no money and the results were instant, and there were no false positives, we would." What the article fails to mention is that a study (Stanford if I recall correctly) found 98% accuracy in finding subjects with known AFIB and 99% accuracy in a finding of Sinus Rhythm among subjects with no known AFIB. Those are pretty darned impressive Type 1 and Type 2 errors. I can see where a high false positive rate would be a resource problem, but I'd guess 2% is more than acceptable.

 

[nr2d]

My cardiologist just "blew me off" when I asked what he thought about the new smartwatch technology. A little over 2 years ago I was having episodes where I could feel my heart skipping beats every so often. It was only temporary and by the time I got to my cardiologist's office I was fine.

A little while later I was diagnosed with Afib when I was in the hospital for something else. Now when I had the episodes of where I felt my heart skipping a beat or 2 I would use a heart rate app on my iPhone and record my heart rate. And sure enough it showed a skipped beat but when I showed to my cardiologist he blew it off. Then I ended up in the hospital and the Afib was seen by chance.

So there are still some cardiologist that are not too accepting of the new technologies.

 

[bamf-hacker]

I am interested in the ECG, but that is because I am a quantifier. However I think that there will be many more visits to doctors because between the results and Google everyone will think they have a heart condition.

 

[doogald]

Now when I had the episodes of where I felt my heart skipping a beat or 2 I would use a heart rate app on my iPhone and record my heart rate. And sure enough it showed a skipped beat but when I showed to my cardiologist he blew it off. Then I ended up in the hospital and the Afib was seen by chance.

So there are still some cardiologist that are not too accepting of the new technologies.

I'm not being flip: Time to choose a new cardiologist?

 

[flyinion]

I'm not being flip: Time to choose a new cardiologist?

That was my thought as well when I read his post. Both my cardiologist and electrophysiologist are constantly staying up to date with the latest procedures/etc. If one of them had that reaction I'd be running to find a new one asap.

 

[nikkisharif]

This freaks me out that people are talking about this like it’s a seriously accurate thing. Apple should have said it’s just a more advanced activity tracker that will allow people to provide additional subjective data to their physicians.