Transcription:
The New Apple Watch and Other Monitoring Devices - Should I Get One

Melanie Cole, MS (Host): We have such a cool topic today and something pretty unique. The Apple Watch is getting a new feature that can monitor heart health. Here to tell us why that matters is my guest Dr. David Joseph Cho. He’s a cardiologist and a member of the medical staff at Henry Mayo Newhall Hospital. Dr. Cho, personal health tech is pretty common already with wearable devices for fitness and sleep studies for sleep disorders and Holter monitors. I mean so at home technical devices that involve our health are already on the market. Tell us a little bit about the new wave of wearable monitoring devices. What are you seeing going on?

David Joseph Cho, MD (Guest): Hi Melanie. Thanks for having me on the program today. It’s a great honor to be here. This is a very exciting time to be in medicine. I think one of the greatest things about the rise of these more mobile technologies that are connecting patients and physicians and patients with other patients is really how in the long term this has the power to potentially change how we interact with patients and how patients manage their own disease. As many readers or patients may be familiar with, the usual standard is you go into your doctor, you have a 10/15 minute—sometimes five minutes—visit with your physician. It’s sort of this brief touchpoint where they give you a set of instructions and then you go home, and you're sort of released to the wild. One of the great things about this with the rise of new technologies is our ability to, hopefully, improve our outcomes by being able to keep track of disease more mobiley and more convenient to the patient as well.

Host: Well I think even telemedicine fits into that description Dr. Cho. And really, it’s kind of definitely a burgeoning situation with telemedicine, but we’re talking today about the new Apple Watch. What’s unique about this watch and how do cardiologists feel about it?

Dr. Cho: So, the new Apple Watch is, to my knowledge, the first integrated smart watch that also have the capability to record a single lead EKG. For the listeners, an EKG is usually just an electrical rhythm analysis of the heart. It’s sort of is able to tell us if you're in a normal rhythm, abnormal rhythm. This is one of the first direct to consumer devices that integrates with a smart watch directly from a big player, such as Apple. There is another device on market currently called Alivecor, which is about the size of two bubblegum sticks, which is also able to record a single lead EKG. They also, before they Apple Watch came out, modified their product to be able to record an EKG through the Apple Watch band. Apple has sort of one upped them by vertically integrating it directly into the watch itself, which is a bid deal and can change our field drastically moving forward.

Host: Who would it help? I mean where do you see this making the most difference? If someone has a single lead EKG on their wrist, are they looking at a constant lead? Do they even know what they're looking at? Who is this for do you think?

Dr. Cho: That’s been one of the great issues that’s been having great discussion online through social media, through cardiologists, and even patients wondering who this benefits. I like to think of the Apple Watch as almost a double-edge sword. No news is sometimes good news. If patients are suddenly getting EKG alerts that they may have atrial fibrillation without properly understanding the context, you can imagine that that could lead to a whole rush of influx of patients coming to the doctor’s office in fear saying I have atrial fibrillation. Do I really have this? What does this mean?

For physicians, we’re a little hesitant as well because a lot of this is not really atrial fibrillation. Meaning it’s a false positive screen where the Apple Watch tells you you have atrial fibrillation and you do not can actually lead to a lot downstream testing which may or may not be necessarily appropriate. You can imagine that could potentially lead to wasted dollars, inefficient care, and potential harm to the patient if they undergo procedures that carry some risks which have limited benefit.

On the flipside, however, having the access to people who would benefit from having an EKG, it’s a very limited population. I see it having the greatest use in patients who have what’s known as paroxysmal atrial fibrillation where they’re not always in atrial fibrillation, but it sort of comes and goes here and there. Patients can be pretty symptomatic when they have this. To be able to catch it and make sure that they're on appropriate treatment. If they’re already on treatment, whether they're responsive to the therapy.

The accuracy of the watch, the studies are still coming out right now, but it seems to be most accurate in middle age to elderly patients who have this condition. Less accurate and less sensitive for the younger patients. Best for a small subset of highly symptomatic paroxysmal or sudden atrial fibrillation, which I see this having the greatest benefit. However, Apple doesn’t necessarily see that as their target demographic. They're trying to unroll and enroll as many patients as they can to sell as many watches as they can. So, it will be up to the clinician and a well-informed patient, I think, to really make use of who benefits from the Apple Watch and how to interpret that data.

Host: Well as I was doing my research for this segment, AFib and paroxysmal atrial fibrillation is what I thought of because then somebody knows if they're having an episode. That would help them for their stroke risk and all of those other things. Can it also cause unnecessary anxiety? You mentioned false positive tests, which could lead to unnecessary further tests. I think that the anxiety of staring at an EKG lead all day or exercising and stopping to look at it, see what’s going on, would cause anxiety that’s better left not there.

Dr. Cho: I can totally see that view point. Part of me definitely agrees with that as well. I honestly also think that it’s up to the patient or whoever is wearing the watch and a lot of their personality. If they're someone who’s constantly going to monitor and look for problems, certainly this watch would not be really good for them as well. There are certain other people who may just wear the watch, say you may have an abnormal rhythm, and they will just say okay. I’ll just get this checked out. So, it’s kind of hard to predict who would have a lot of anxiety and who wouldn’t. I feel that if someone is predisposed, maybe having an anxious personality about their medical problems, I definitely think it could potentially enhance their anxiety.

I also see that it could potentially relieve a lot of patient’s anxiety. If they're having palpitations, they think they're in atrial fibrillation and their EKG says no atrial fibrillation detected, it can also be reassuring as well. I think it’s really just about educating and informing patients that this may not necessarily change outcomes because that evidence is definitely not there. This is all about being able to detect atrial fibrillation, silent or symptomatic, and sort of figuring out now we have these dumps of data. How can we parse through this to figure out what’s relevant and irrelevant?

So, I like to think of this as the early days of the internet where people were just sort of figuring out how to use it, what this is for, and how it fits into their day to day life and how this fits into our day to day life as a physician. It definitely is exciting.

Host: Who reads it? I mean the average person doesn’t know how to read an EKG. Who’s reading it? Since this is a healthcare device, and we’re talking about AFib in a way here as well, does Apple need approval from federal regulators?

Dr. Cho: They already, I believe, have gotten FDA approval for their device to be able to detect atrial fibrillation. From my understanding, they're able to save their EKG as a PDF to share with their providers and also to keep for their own personal record. There’s also a big study that I believe is either wrapping up or has already been completed up at Stanford lead by Dr. Mintu Turakhia at Stanford University with a collaboration with Duke as well where Apple Watch wearers can enroll in a mobile clinical health study where their EKGs are uploaded to Apple to be identified and shared with Stanford for analysis. But for the average user, you can save your EKG and share it with your provider when you go to the visit as a PDF file.

Host: Okay. So, if you can share it with your provider but you don’t necessarily know… I mean maybe you see something different than the normal waves that you see. That’s when you would maybe share it with your provider. How do you see physicians involved in this? As you wrap it up for us Dr. Cho, what would you like the listeners to know about a cardiologist’s point of view for something that may help you in the long run to identify something with a patient. And yet also might be a little bit of a sketchy fine line between patients being their own best health advocate and doctors being the experts.

Dr. Cho: That’s an excellent point and a difficult question to answer. I’ll do the best that I can. I believe that there’s a fine line between too much data and too little data. How do you parse out clinically relevant data and how do you not? I think physicians, ourselves, are not personally perfect at that either. I believe that physicians also need to keep in contact about the accuracy of the Apple Watch as it relates to people who have risk factors for atrial fibrillation; and knowing that this thing will be more accurate in their older patients more at risk for atrial fibrillation than younger people who are just having a palpitation here or there. Knowing that can sort of help screen one way or the other looking for possibly downstream health effects.

I do believe that from a cardiologist’s point of view, I am sort of a mixed bag. I'm very excited that we have this capability and this technology because I have a lot of patients who come in with palpitations. They don’t know what it is and whether they should be concerned or not. By having caught their EKG at a point in time when they're symptomatic and reviewing it with them together, should provide reassurance by being able to provide a diagnosis or provide reassurance. If it’s normal, that’s reassurance. If they have something abnormal and needs further testing, then we can talk about what that means and how we go from there.

So, from a cardiologist point of view, I think it’s imperative that we, as a specialty and as practitioners, are very well versed in the pros, the cons, the shortcomings, and the benefits about these technologies so that we can help patients put it into context to treat them and moreover provide reassurance I think in the long term.

I’d like to add one more thing. I just wanted to let your listeners know that while the Apple Watch has this capability to do EKG recordings, this is not live yet and will become live sometime in the near future. I also wanted to stress the importance that the Apple Watch and all these digital health tools are no replacement for a well-informed patient and a well-informed discussion with your provider. Really highlighting the importance of shared decision making.

Host: Well it certainly does. I think that that’s the main point, right? I mean Apple may make a lot of money or whatever, but I think the main point is about patient satisfaction and being your best advocate and working with your provider to see if you're somebody with AFib. So, thank you so much Dr Cho for coming on and explaining what this watch is all about. And so that people can do their own research. As you said near the beginning, a well-informed patient is one that you physicians prefer. So, thank you for saying that and thank you, again, for joining us today. You're listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, please visit henrymayo.com. That’s henrymayo.com. This is Melanie Cole. Thanks so much for tuning in.