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Apple Watch shows promise in heart study, but doctors sceptical

Study important for Apple's ambitions in healthcare

Apple watch

Preliminary results from an Apple Watch study were released over the weekend, showing the tech giant’s wearable device accurately detected atrial fibrillation (AF or a-fib) in those with an irregular heartbeat - but many physicians will take more convincing of its usefulness.

Apple and its research partner Stanford Medicine say the trial is the “largest study ever of its kind”, and sought to evaluate the efficacy of its irregular rhythm algorithm in an observational 'real world' setting.

The endpoint was the identification of atrial fibrillation, the heart condition that’s the leading cause of stroke yet often remains undiagnosed as many people don’t present symptoms.

Apple’s new feature however is designed to occasionally check the users’ heart rhythm in the background, and if an irregularity is identified during five out of the six checks then a notification will be triggered to send to the user’s watch and iPhone.

As part of the trial, participants also received a telehealth consultation with a doctor and had to wear an electrocardiogram (ECG) patch for a week for additional monitoring should they receive the notification.

Out of the (almost) 419,297 people that participated during the study, only 2,161 of those received an irregular pulse notification. According to Stanford, this was an important finding as there were initial concerns with over-notification.

Those who received that notification were found to be in atrial fibrillation at the time of the notification 84% of the time, however only a third (34%) of those who received a notification and followed up with an ECG patch had an AF diagnosis confirmed. This means that there were still a relatively high number of 'false positives' among these users.

Nevertheless, the data is reasonably encouraging to Apple and Stanford Medicine. The investigators add that the 34% figure was “unsurprising”, suggesting that it might not be accurate as the condition can go undetected in subsequent ECG monitoring.

The number was also low due to participants’ failure to complete the study accurately, with researchers reporting that only one in five who received the notification followed through the ECG monitoring and booked a telehealth appointment.

“The results of the Apple Heart Study highlight the potential role that innovative digital technology can play in creating more predictive and preventive health care,” said Lloyd Minor, dean of the Stanford School of Medicine.

“Atrial fibrillation is just the beginning, as this study opens the door to further research into wearable technologies and how they might be used to prevent disease before it strikes — a key goal of precision health.”

Digging deeper into the results and researchers found that 3.2% those who are more likely at risk of developing an atrial fibrillation (those 65 and older) received a notification, compared to around 2% of those who were younger than 65 and received a notification.

Mintu Turakhia, one of the trial’s principal investigators, said: “The study’s findings have the potential to help patients and clinicians understand how devices like the Apple Watch can play a role in detecting conditions such as atrial fibrillation, a deadly and often undiagnosed disease.

“The virtual design of this study also provides a strong foundation upon which future research can be conducted to explore the health implications of wearable technology.”

However, the study was only an observational one and not a randomised controlled one, but Apple has plans to move ahead with this kind of study after it announced it has partnered with pharma giant Johnson and Johnson to assess the impact of wearable technology on earlier detection of atrial fibrillation.

That multi-year research programme is due to be launched later this year, and will be designed for individuals aged 65 years and older.

The tech giant is still ahead of its rivals Samsung and Alphabet when it comes to introducing new health features to its products, but has a long way to go to win over the health community.

Writing an op-ed in Stat, health journalist Larry Husten wrote:

"Even if the Apple Watch does work correctly, it is by no means clear it will generate benefit to the public's health....the medical community has no idea how to respond appropriately or efficiently to the large number of people who will be identified as having a-fib by the Apple Watch alone. Most of these people  - young and tech savvy - will almost certainly be at low risk for a stroke or other harmful consequence of a-fib."

Article by
Gemma Jones

19th March 2019

From: Healthcare

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