Sunday, December 30, 2018

Using the Smartphone to monitor heart rate: This is the future

Smartphones have become an integral part of our daily life now, so much so that a world without smartphones now seems inconceivable.

As technology has evolved, the use of phones has undergone a revolution. Each new version of the smartphone is equipped with better and often some mind-boggling features. Physical keypads have made way for touch screen. You can video chat with someone anywhere in the world. All you need is an internet connection on your smartphone. Apps like Google Assistant make it possible to interact with the phone through natural voice. Phones today, therefore, can perform many more functions beyond just making calls.

Apple has now taken a step ahead leaving a trail for the future with two new features in Apple Watch Series 4.

An ECG app on Apple Watch Series 4 is now available. As the first direct-to-consumer product, it helps people to take an ECG right from their wrist, whenever they experience symptoms such as rapid or missed heart beat and also share the data with their doctors.

The irregular rhythm notification feature on Apple Watch can now also monitor heart rhythms in the background and send a notification if an irregular heart rhythm is detected on five rhythm checks over a minimum of 65 minutes

According to a news release from Apple, “New electrodes built into the back crystal and Digital Crown on Apple Watch Series 4 work together with the ECG app to enable customers to take an ECG similar to a single-lead reading. To take an ECG recording at any time or following an irregular rhythm notification, users launch the new ECG app on Apple Watch Series 4 and hold their finger on the Digital Crown. As the user touches the Digital Crown, the circuit is completed and electrical signals across their heart are measured. After 30 seconds, the heart rhythm is classified as either AFib, sinus rhythm or inconclusive. All recordings, their associated classifications and any noted symptoms are stored securely in the Health app on iPhone. Users can share a PDF of the results with physicians”.

Rhythm classification from a 12-lead ECG by a cardiologist was compared to the rhythm classification of a simultaneously collected ECG from the ECG app in around 600 participants. The ECG app on Apple Watch showed 98.3% sensitivity in classifying AFib and 99.6% specificity in classifying sinus rhythm in classifiable recordings; 87.8% of recordings could be classified by the ECG app.

In a sub-study of the Apple Heart Study, which included participants that received an irregular rhythm notification on their Apple Watch while simultaneously wearing an ECG patch, 80% showed AF on the ECG patch and 98% showed AF or other clinically relevant arrhythmias. With over 400,000 participants, the Apple Heart Study was the largest screening study on atrial fibrillation ever conducted, also making it one of the largest cardiovascular trials to date.

The ECG App and the irregular heart rhythm notification have been provided De Novo classification by the US FDA. They are available as part of a free update to watch OS 5.1.2.

Health care today has shifted from being ‘paternalistic’ to ‘patient-centric’. The patient now wants to be a part of decision making. He has literally all information related to his illness at his fingertips because he has a smartphone.  

Technology has again empowered patients, who can use the App to monitor themselves for signs of AF and be alerted about the event right at the time it is occurring.

It’s a promising tool indeed, yet it needs to be used cautiously.

(Source: Medscape, Apple News)

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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