Monitoring For a Healthy Heart

Picture from Apple

A proverb originated in the 1860s in the country of Wales; “Eat an apple on going to bed, and you’ll keep the doctor from earning his bread.” By the end of the 19th century, the phrase morphed into “An apple a day keeps the doctor away”. There is actually some scientific backing to the proverb as I pointed out in a prior post

Apple released an Apple Watch update in December which adds a new capability, the addition of an algorithm which can detect arrhythmia of the heart and correlate what it finds to atrial fibrillation (AFib). It is believed 6 million people may have AFib and the number is expected to double over the decade ahead. AFib is not in itself life threatening, but it can lead to stroke or heart failure.  You can set preferences for the Heart app to alert you if one of three things happen. First is if your heart rate is above a number you select, such as 120. Second is if your heart rate is below a rate you set, such as 50. Third, is an alert if the Watch algorithm detects an irregularity in your heart rate suggestive of AFib. 

Picture from Apple

The new Series 4 Watch takes things further and enables a 30-second ECG by simply placing your finger on the watch crown. Apple has added new sensors behind the crown to pick up additional information. As a result it can display your heart rate pattern, save it as a PDF, and enable you to send it to a doctor. The new ECG app is not equivalent to the gold-standard 12-lead ECG you would get from a doctor. It is equivalent to Lead 1, and the FDA has approved it as capable to reliably detect AFib.

The new monitoring capability from Apple is just the beginning of a new generation of mHealth (mobile health). (See my peer-reviewed journal article about mHealth here.) Our healthcare system is under great pressure. It is short on resources and under attack for being so expensive. Every day, 10,000 people turn 65 and join Medicare at a cost of $10,000 per year. Something has to give. Consumer led healthcare self-monitoring is one of many parts of the solution. People who track their health will be healthier. If you are interested in this topic, please read Health Attitude: Unraveling and Solving the Complexities of Healthcare.  

Abbott Laboratories, a healthcare company headquartered in Lake Bluff, Illinoisis, has introduced an alternate way to monitor the heart called the Confirm Rx. The device is about the size of two paper clips and is implanted under the skin. FDA and European regulatory approvals were obtained in 2017, and the new device offers more accurate detection of cardiac arrhythmias than an earlier version developed by St. Jude Hospital. The device is inserted via an outpatient procedure. No sutures are required. The device continuously monitors the beating heart and can communicate with a smartphone via Bluetooth.

A key part of the data saved by the Confirm Rx app is what patients record themsevles about how they feel, dizzy, fatigued, heart palpitating, etc. The data about the heart plus what the patient entered goes to a cardiologist or electrophysiologist who can make medication changes or order other therapeutic steps. Cardiologists typically will suggest a Holter be worn for a week or so. The Holter can collect a lot of data, but it is just a snapshot of what was going on during the short period the patient wore the Holter. The Confirm Rx provides continuous data over an indefinite period.

The Confirm Rx has a two-year battery life and requires no charging. Once a low-battery alert is received in the app, an outpatient procedure is needed within 30 days to remove or remove and replace the device depending on clinical needs. I am sure imiplantable devices like the Confirm Rx and wearable devices like the Apple Watch will continue to get better and better. The combination of good monitoring plus patients taking responsibility for recording how they feel will give cardiologists and electrophysiologists much better tools for managing AFib and other cardiovascular diseases.

The Confirm Rx is yet another example of non-biological devices going into our bodies. It is part of the trend I have described here before: humans getting to be more like robots and non-humans (robots and AIs) getting to be more like humans. You can read much more about this in the upcoming Robot Attitude: How AI and Robots Will Make Our Lives Better. The new book is coming this summer. Click here to get notified when the book is available.

Sources:
Apple’s Newest Watch Features Will Transform Heart Health | WIRED
New implantable heart monitor shares data with patient’s smartphone | Star Tribune