If someone’s heart skips a beat, tech companies want to let them know.
Gadget companies — starting with Apple and now Google-owned Fitbit — sell wearables that check heartbeats and alert users when something is out of sync.
These products involve some technological prowess. Many use sophisticated optical sensors that look under the skin to monitor changes in blood volume – almost like following the tides – and thus count heartbeats. Other devices have a miniature electrocardiogram – which records the electrical activity of the heart – built into it. Either method can detect irregular heartbeats — and potentially atrial fibrillation, a condition that affects an estimated 2.7 million Americans and increases the risk of stroke and heart failure. When a person ales the beats in the upper chambers of the heart are erratic and the blood does not circulate as well as it should in the lower chambers of the heart.
Yet while the gadgets are a technical feat, some cardiologists say the information produced by the devices isn’t always helpful. Device notifications are not definitive diagnoses.
This is a conundrum, and a consequence, for the health care system. Tens of millions of people are equipped with these devices, and if even a small fraction of them receive a ping, it could mean a lot more care and cost for the system.
“Technology has passed us,” said Rod Passman, a cardiologist at Northwestern University who is participating in a study examining the Apple Watch’s ability to track heart rhythm status. “The industry came out with these things because they could. Now we are trying to catch up and trying to figure out what to do with this information.
Heart rate sensors are among the many tools built into these wearable devices. Users can count their steps, track their sleep and analyze their gait. Some products call 911 if the wearer has been in a car accident or had a bad fall.
These features aim to make patients the protagonists of maintaining their health. At an event touting Fitbit’s atrial fibrillation feature, company co-founder James Park said it was one of many features of the brand’s fitness tracker bands that ” allow users to effortlessly control their health and well-being”.
The atrial fibrillation ping from the laptop – a “test [doctors] didn’t order,” Passman said — telling patients there is something potentially wrong. Ultimately, however, any treatment is left to the doctor.
First visits don’t always provide quick answers. To corroborate a notification, a cardiologist equips patients with medical-grade diagnostics — a bulky patch or monitor — that are more accurate than wearable devices. (The Apple Watch, for example, is cleared by the FDA for “informational use only.”) This more sophisticated device may need to run for a while to catch a momentary missed beat. This wait means more time and money spent on more doctor visits.
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Getting a diagnosis “can be quite an odyssey,” said Ethan Weiss, a cardiologist at the University of California, San Francisco. Patients may become anxious along the way. Social media forums like Reddit show that many users wonder if their watches or doctors are more trustworthy. “It still scares me,” one user wrote, even after a doctor told him he was probably fine.
“There is going to be a period of uncertainty,” acknowledged Fitbit researcher Tony Faranesh. He said the company provides educational materials for users aware of possible arrhythmia.
Studies on the prevalence of anxiety resulting from atrial fibrillation pings are hard to find. Fitbit collected this information, Faranesh told KHN, as part of an investigation submitted to the FDA for clearance of its device. But the full results of the study – which gathered information from 455,000 patients – are not yet available.
Diagnosis is not the same as knowing what should be the best treatment. For example, treating otherwise healthy patients with blood thinners – the standard treatment for atrial fibrillation – can expose them to unnecessary side effects.
According to doctors interviewed by KHN, atrial fibrillation is a general condition. Some patients have many episodes in a given year and symptoms such as fatigue or shortness of breath. Some patients do not notice anything.
In the past, transient fibrillation would have gone undetected, let alone treated. And wearable technology users are healthier and wealthier than the typical atrial fibrillation patient. A new Apple Watch costs around $400; the cheapest Fitbit is $50. (Company officials couldn’t say which Fitbit devices would have the atrial fibrillation detection feature, though they said they were committed to making the technology widely available.)
The combination of low health condition burden and healthier patients means cardiologists aren’t sure what to do with this cohort of patients.
Between anxiety and the unknown, tech companies have nonetheless launched the healthcare system on a massive scientific experiment.
Large groups of people have embraced wearable gadgets. Counterpoint Research analysts said the Apple Watch – which has included the atrial fibrillation scanning feature since 2018 – surpassed 100 million users worldwide last summer. Fitbit likely has tens of millions more users. How many of them will have the new feature once it becomes available is still unclear.
Other companies are coming. “Everyone wants to add next-level, higher-caliber medical-grade sensors” to their consumer gadgets, said Dr. Justin Klein, managing partner of Vensana Capital, a venture capital firm. This “is going to drive patients to clinics to have those diagnoses confirmed,” Klein said.
Companies are expanding the capabilities of wearable devices even further. Klein said big tech and startups are considering more conditions for gadgets to passively alert users to, from blood oxygen levels to high blood pressure.
It is up to patients and doctors to figure out what to do with these new gadgets.
Northwestern’s Passman considers himself an optimist when it comes to the devices’ potential. In an interview – sporting an Apple Watch on his wrist – he said the devices can help doctors and patients manage conditions and respond quickly to funny flutters. And doctors can use the devices to confirm if their atrial fibrillation treatments are working, say cardiologists like Passman.
Still, this feature is likely to cause headaches for cardiologists. “It resulted in increased load, handling phone calls, office visits,” Weiss said — and all for an as-yet-uncertain benefit.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.