TECHNOLOGY FOR CAREGIVING – WE REVIEW THE APPLE WATCH SERIES 4
Aiding Caregiving
Technology that benefits caregiving; the Apple Watch series 4 is a good example of technology for good.
The explosion in smart devices—phones, watches, fitness gadgets and the like—has unleashed a wave of apps designed to manage chronic illnesses, detect behavioral diseases and manage pain. Most recently, Apple announced that apps due later this year will allow its Series 4 watches to perform electrocardiogram readings or ECGs, and notify users of irregular heart rhythms.
The problem for consumers is knowing which apps—if any—actually work.
The Food and Drug Administration cleared the ECG app and irregular-rhythm notification feature on the Apple watch but noted that the apps aren’t intended to replace traditional diagnosis methods. The agency said the ECG data displayed on the Apple watch is for informational purposes only and isn’t intended to be interpreted by the user without consulting a health-care professional.
Most health apps on the market aren’t required to be reviewed by the FDA. That has raised concerns that some apps could expose consumers to harm.
The FDA last September started working with Apple and eight other tech and medical-device companies—including Fitbit , Samsung and Verily Life Sciences, a subsidiary of Google parent Alphabet —to streamline approval of mobile medical apps. In the meantime, here is a status check on some of the areas where health-monitoring tools might make the most difference.
Measuring Heart Health
Smartphones and watches can collect data on the heart continuously, which promises to improve the detection and treatment of heart disease.
For instance, devices that track heartbeat data can help doctors identify atrial fibrillation, a leading cause of heart failure and strokes. With a-fib, the upper two chambers of the heart beat erratically and at dangerously high speeds. Since symptoms come and go, it can be hard to detect, but watches worn for long periods have a chance of spotting it outside of a doctor’s office.
An ECG, the standard method of detecting a-fib, requires placing 12 electrodes on a patient’s body. The Apple Watch Series 4 will have electrodes built into the watch’s digital crown, which users touch for 30 seconds after opening the app to get an ECG reading, Apple says.
Another device, the KardiaBand watchband, also offers ECG capabilities and was cleared by the FDA in November. It was most effective in detecting a-fib when physicians looked at the results, rather than relying solely on the watch’s algorithms, according to a study by the Cleveland Clinic. The device’s instructions tell wearers to place their thumb over a spot on the watchband embedded with an electrocardiogram sensor, which records their heart rhythm.
But in the Cleveland Clinic study, about 35% of the recordings couldn’t be read by the watch’s algorithms, possibly because people didn’t press their thumbs down for the required 30 seconds. Electrophysiologists, however, looking at the same data, were able to accurately identify people with a-fib 100% of the time and people without a-fib 80% of the time. The electrophysiologists also beat the algorithm’s performance on recordings that it could read, correctly identifying people with a-fib 99% of the time, compared with the algorithm’s 93%.
Which is a reminder for all of us that patient compliance and adherence to protocol is the critical ingredient to determine the accuracy of these tests
With smartphone-based electrocardiogram monitors, clinics can access recordings of patients’ heart rhythms no matter where they are. Doctors can also use the monitors to diagnose patients with intermittent episodes of a-fib, which are hard to catch and follow up on patients who have had ablations, a procedure that removes diseased tissue from the heart to try to stop a-fib symptoms.
