An Apple a Day For a Healthy Heart
In the 1860s, a proverb originated 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.
A 2011 study found consumption of apples and pears might prevent strokes. A 2012 study found apple consumption significantly lowered bad cholesterol levels in middle-aged adults. In 2013, leading general medical journal BMJ published a study as part of its humorous Christmas issue comparing the effects of prescribing everyone in the UK over age 50 either an apple or a lipid-lowering statin a day. The study concluded that both interventions had the same effect. A 2015 study looked directly at the relationship between apple consumption and physician visits and found no evidence that the proverb was true. The study did, however, find that people who ate an apple a day did use fewer prescription medications. A Cupertino, California based company hopes the phrase means everyday more people buy an Apple Watch to monitor their health.
As promised to happen before end of the month, Apple released an Apple Watch update which adds a new capability, the addition of an algorithm which can detect arrhythmia of the heart. It was not obvious from the announcement, but the new capability is available for existing Apple Watches, not just the new Series 4 Watch.
The pre-Series 4 watches will have a new capability in the Heart app. In addition to measuring heart rate, the app will apply an FDA approved algorithm which can detect irregularities in the heart rate 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 your heart rate is above a number you select, such as 120. Second is 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.
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.
In my opinion, Apple approached this new strategic area for them in exactly the right way. They collaborated with Stanford University and designed a study meeting all the standards of a clinical study including clearance by an Institutional Review Board to ensure there would be no harm to study participants. I can attest this is a rigorous process, as I went through the same thing as part of my research and doctoral dissertation in 2014. The Apple study The study was able to identify with 98% accuracy the patients who had AFib, and with 99% accuracy the patients who had healthy heart rates. This is the beginning of Apple’s understanding, not the end. With millions of Apple Watch users, the potential for learning is unprecedented to say the least.
I view the new features in the Series 4 Watch as important healthcare breakthroughs, but not without controversy. Some doctors are skeptical. An electrophysiologist at a leading university said the new Apple capability puts tech ahead of medicine. I agree, but don’t feel the progress should be slowed down to allow medicine to catch up. The biggest concern of the medical community is the Watch will produce false positives among the millions of people who have not been diagnosed with AFib. The concern is undue anxiety will be created, people will seek unneeded medical care, and in some cases medication will be prescribed which can have negative effects. I agree with this concern also, but how about the people who may have afib, not be aware of it, and have even more serious consequences. Apple has received multiple communications from people who believe the Watch saved their life because of previously unknown rapid heart rate or arrhythmias.
I view the new monitoring capability as release 1.0 of a new generation of mHealth. (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 monitoring is part 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.