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When will doctors buy into Apple Watch's AFib potential?

ECG results on Apple Watch Series 4
ECG results on Apple Watch Series 4 (Image credit: iMore)

What you need to know

  • Apple Watch keeps saving lives while doctors refuse to admit it's up to snuff.

Yesterday I told you about someone whose Apple Watch warned them about an AFIb situation that they weren't already aware of. The notification that the wearer's heart rhythm wasn't what it should be could have saved their life. That's a very real situation. But one thing caught my eye – the doctors' response.

They *scoffed" at the Apple Watch, according to the story.

The doctors at emerg scoffed at the Apple Watch ECG saying it wasn't accurate enough to use as a diagnostic tool. I retorted that at least it warned me to get medical assistance whereas without the watch I could have had a stroke.

This isn't the first time we've heard this, either. On more than a few occasions I've read stories that involved medical professionals telling people that an Apple Watch isn't capable of the readings needed to correctly identify the potential for a heart-related issue. This as, seemingly every month, we're writing about the exact opposite. I can only imagine there are plenty of other instances that aren't finding their way into headlines, too.

Which begs the question – when will medical professionals accept Apple Watch and its ability to detect the potential for AFib? Maybe it need someone to rock up on their doorstep with a watch strapped to their wrist while they have a stroke. Let's hope not.

Apple Watch Afib Notification

Apple Watch Afib Notification (Image credit: u/Merrick63)

Equally concerning is the possibility that doctors are telling people not to get an Apple Watch when asked whether it could be of benefit. At this point, we can all agree that wearing an Apple Watch means you're more likely to be alerted to AFib than not wearing one at all. Surely that's all the information needed, right?

Now, I get it. Doctors don't want thousands of people in their waiting rooms all claiming their Apple Watch told them they're going to die. And that was a valid point when these features first went live. But I've yet to see a story of a hospital being overrun because of Apple Watch false positives.

Maybe I'm just not looking in the right places.

Oliver Haslam
Contributor

Oliver Haslam has written about Apple and the wider technology business for more than a decade with bylines on How-To Geek, PC Mag, iDownloadBlog, and many more. He has also been published in print for Macworld, including cover stories. At iMore, Oliver is involved in daily news coverage and, not being short of opinions, has been known to 'explain' those thoughts in more detail, too.

Having grown up using PCs and spending far too much money on graphics card and flashy RAM, Oliver switched to the Mac with a G5 iMac and hasn't looked back. Since then he's seen the growth of the smartphone world, backed by iPhone, and new product categories come and go. Current expertise includes iOS, macOS, streaming services, and pretty much anything that has a battery or plugs into a wall. Oliver also covers mobile gaming for iMore, with Apple Arcade a particular focus. He's been gaming since the Atari 2600 days and still struggles to comprehend the fact he can play console quality titles on his pocket computer.

13 Comments
  • Oliver, your article is a little over the top and melodramatic, especially the part about showing up on the doorstep with a stoke. Some things to keep in mind: one issue is liability, another is false positives (like you mentioned) and another is false negatives (which you didn’t). If doctors tell people to wear the apple watches to monitor their heart rate, the provider is medically endorsing this and could be held liable in court if the watch fails to pickup on an abnormal rhythm, and a patient can have a false sense of security if their watch is telling them nothing is wrong. But the main reason that doctors scoff when you show up to the ER is that you really need EKG leads placed across the chest in order to be able to effectively diagnosis and treat abnormal rhythms in a clinically meaningful way. The watch is just monitoring your heart rate, it isn’t picking up on electrical abnormalities in your heart except by proxy. I don’t really care what your Apple Watch is saying until I get an EKG to actually get a look. Apple watches are great for exercise management, and it is always good to hear stories of it helping people (calling when they have fallen, picking up on irregular heart beats). But bashing on the medical system for not promoting apple watches for monitoring your heart rate is a little over the top.
  • Thank you because he left me speechless with nothing nice to say.
  • I get that liability-wise it isn’t the best idea for medical professionals to recommend the Watch, but to outright deny its capabilities is dangerous to the patient.
  • Wise providers aren't denying the capabilities. Wise providers say, "I'm glad your watch told you to come in today. Let's get an EKG and other workup to look and see if there is anything going on with your heart". Just as they would say, "I'm glad you checked your pulse and came in today. Let's get an EKG..."
  • Yea...but no. Apple itself says the AppleWatch is not a diagnostic tool, but rather a reference tool (not in those exact words, but very clearly). What the watch apps say, explicitly, is the watch does NOT monitor for heart attacks, either. Oliver is arguing that doctors take the AppleWatch more seriously, not advocate outright that these devices be used as diagnostic tools. Medicine is overrun with stories of doctors (and nurses) who don’t listen to patients or take their complaints seriously, often leading to complications and sometimes fatal events. In one such example, last year a friend was complaining of a number of respiratory issues that his doctors ignored until he fell severely ill with an illness requiring him to be placed in a medically induced coma, a tracheotomy, and on a ventilator in a high tech ICU for 3 weeks followed by extensive inpatient and outpatient rehabilitation. If they had only listened to him the first times he told them what was wrong instead of dismissing his symptoms as a bad cold or the flu or asthma (which he’s never had), almost all of that could have been avoided. The point being, that I believe Oliver is correctly making, is that doctors should be more open to the AppleWatch as a reference tool that they can use as a starting point toward narrowing down a diagnosis, not an end of and to itself.
  • Definitely not optimal care for your friend. Physicians are taught that about 80-90% of diagnosis is history, and that comes from the patient and their family members. They definitely should have listened to your friend, and if they didn't and if they missed critical data points that a reasonable provider would have picked up on, they did malpractice. But sometimes things can't get diagnosed until the patient's condition has worsened. I hope his rehab goes well. As for the watch, what I am saying is that no reputable physician is going to treat a patient based upon what their watch is saying - they will get a true EKG that can show them what the specific arrhythmia is and treat them accordingly - hence we don't care what your watch is saying if the EKG shows something different. I'm not saying that we aren't going to take into account that you showed up in the ER because your watch told you that your heart isn't beating correctly. Just like if you showed up saying your pulse feels weird when you check it, we are going to take that information into account. An Apple Watch is just another history data point. I was pointing out how ridiculous it is that Oliver is claiming the medical system won't believe your watch until you show up on the doorstep with a stroke wearing your watch (and as as aside the watch isn't going to diagnose your stroke, but it can give a history of irregular heartbeat such as A-Fib that can place you at risk for a stroke). None of my fellow physicians would tell a patient to go home without checking into whether an Apple Watch's warning of A-Fib is correct. Likewise, none of my fellow physicians would start treating A-Fib based upon the Apple Watch's reading - hence the "scoffing" from the previous story - I bet if I could have been a fly on the wall the patient was telling them he had A-Fib, and the doctor "scoffed" by saying something like "the Apple Watch can't diagnose this, let's get an EKG [and likely many other tests] so we can tell what's going on." And as for your comment about "use as a starting point toward narrowing down a diagnosis" - that is a very dangerous thing to do in medicine. Always start broad, take a full history and do a full exam if time and urgency allow, and then start narrowing things down. Good physicians don't use one data point as a "starting point". That is how many things get missed and people get poor medical care.
  • ICUs are overflowing. Emergency departments are overrun. The staff working at hospitals are under constant threat of infection for them, as well as their families at home...I mean, gee whiz, I can’t imagine why doctors might not have any time or patience for ever single ***** with a flashing gizmo on their wrist.
  • (Ugh, previous commenters gonna comment, I guess.) I get it. My Apple Watch caught my AFib when I was just ignoring the symptoms. In the lead up to and during recovery from the correct procedure, my cardiologist would ask if the watch had given any warnings and would review the readout on my phone with me pointing out details. He said he wouldn't rely on it but that looking at multiple readings over time would help me notice anything troubling. Maybe younger are just more likely to look at how it can be additive versus those comparing it to medical equipment.
  • My watch found my afib which is the reason I wear a smartwatch, the doctor in the emergency room said people come in all the time due to their watch warnings.
  • “ When will doctors buy into Apple Watch's AFib potential?” When it is accurate enough - and gone through real clinical studies - to be endorsed by the A.M.A. Until then, it is in the same category as cures for hiccups. Anecdotes are not the same as actual research.
  • You mean like this: https://www.forbes.com/sites/jeanbaptiste/2018/09/14/apple-watch-4-is-no...
  • Three weeks ago, I had a cardiac event that was not flagged as AFib by my AppleWatch 6, but it did track my irregular heartbeat all night prior to me going to the ER the next day. There wasn’t much out of the ordinary in terms of how I was feeling except for a flushed feeling. When I told the intake nurse my heart rate fluctuation numbers, she incredulously asked how did I know and I showed her the watch. Tellingly. The duty nurse smiled approvingly. When the doctors finally saw me hours later (10, to be be exact), I told them my story. Three cardiac surgeons looked at me at they ran multiple tests. The lead surgeon of the cardiac unit also scoffed when I told him I used my AppleWatch to track my heart rate. What did they find? Apparently I have something called a tortuous aorta, which is a twisted or enlarged or narrowed blood vessel in my heart. I won’t find out exactly until I meet with my cardiologist in a week. So for the naysayers, unless you’ve actually been in my shoes or others like me, your opinions aren’t worth spit. On several checkups, I have compared my blood oxygen reading to the medical equipment used to measure my vitals and the BO has been off by literally 1 point each time. My heart rate most always matches between the watch and the machine. And, like another commenter said, I would not have really known to go in to the ER if not for my watch — specifically given that EVERY doctor no nurse has said to come to the ER if I experience anything out of the ordinary with my heart. So, there you have it. But don’t criticize unless you have the facts yourself.
  • The physicians I work with think the Apple Watch is useful and can detect atrial fibrillation. Heck, the Apple Heart Study, from Apple and Stanford, studied 400,000 patients (the largest heart study, ever) and was published in the NEJM in 2019. The Apple Watch was designed by physicians and engineers. For a watch, it has saved lives. For many reasons, physicians do recommend the watch: for notifications, for communications, for fall surveillance, for motivation, and for fun. The argument for home/personal monitors has already been won by the devices: glucose monitoring, BP monitoring, pulse oximetry, and the capabilities of the Apple Watch. Feel an irregular pulse but no other ominous symptoms? Call the doctor's office for an appointment in two weeks, or just check the Apple Watch. The ease and potential for reassurance alone is huge, and it can send the rhythm strip to the doctor. It is not perfect. Again, it's a watch. It truly can pick up some potential problems before they're catastrophic. If a physician ignores such data without reviewing it, it could be a signal the physician might ignore other significant data...