On a recent Saturday, my 87-year-old mother was feeling a
bit woozy, so she pressed a button on the side of her Apple Watch to reveal her
ECG, a recording of her heart’s electric rhythm. Thirty seconds later, three
messages appeared on the watch’s screen. One showed the characteristic zigzag
spikes of the ECG, or electrocardiogram. The second revealed that her heart
rate, usually 80 beats per minutes, was down to only 40. The third said the
results were “inconclusive,” with the advice: “Call your doctor.”
اضافة اعلان
My mother is a hardy octogenarian. She walks about 1 mile
every day, works out with a trainer (currently via Zoom) three times a week
and, as she often used to say, planks nearly as well as her former sorority
sister Ruth Bader Ginsburg once did.
After leaving a message with her doctor’s office, my mother
called my brother, a doctor who lives nearby, and told him she was exhausted
and “just not feeling right.” He went over immediately and took her to the emergency
room.
There, the hospital’s electrocardiogram, which provides a
more detailed readout than the watch, showed that the electrical signals in the
top part of the heart were not being transmitted properly to the bottom. Her
heart was beating, but too slowly. Staff members rushed her to the cardiac care
unit, where doctors implanted a pacemaker the next morning.
When she called a longtime friend to tell her the story, the
friend responded that she’d likewise had a recent smartwatch scare: her heart
rate was sky-high, reaching 182. Her doctor had her wear a Holter monitor, a
medical-grade portable ECG device that monitors heart rhythm continuously, for
four days and advised her to keep a diary of symptoms, such as chest pain or a
skipped heartbeat. She didn’t notice any, and the report from the Holter device
revealed that everything was fine.
The advent of smartwatches that retrieve heart physiology
both excites and worries physicians.
In addition to Apple, a number of companies make wearable
ECG monitors for home use, including Samsung, Withings, Fitbit and AliveCor.
And for every story like my mother’s, in which a warning leads to the placement
a potentially lifesaving pacemaker, there are many more like her friend’s, in
which minor variations in heartbeats lead to needless work-ups, treatments with
risky side effects and lots of unnecessary anxiety.
So are these wearables worth it?
Conclusive evidence about their accuracy and cost
effectiveness is lacking, though an Apple-sponsored study from 2019 published
in
The New England Journal of Medicine suggested they might help to detect some
kinds of abnormal heart rhythms, particularly in older adults. A slew of
additional studies are underway, including ones to assess whether a smartwatch
can actually help to save lives, or whether mobility measures such as step
count lead to fewer heart attacks and hospitalizations.
Most of these at-home ECG watches are designed to record
heart rate and detect atrial fibrillation, the most common irregular heart
rhythm, which affects up to 6 million Americans. A-fib, as it’s called,
increases the risk of strokes, leading to 150,000 deaths and 450,000
hospitalizations a year. But doctors say that many people have an irregular
heartbeat every now and then that doesn’t have clinical implications.
Like many new technologies that uncover things in the body
that doctors don’t yet fully understand, these devices may alert the user about
an irregular heartbeat, but not all irregularities are dangerous.
“It’s like we just invented the microscope and are seeing
microorganisms, and we don’t know what they are,” said. Harlan Krumholz,
director of the
Center for Outcomes Research and Evaluation at Yale. “We are
seeing things, and we aren’t sure if it denotes extra risk.”
Most watches wait to send an alert until there have been
about five abnormal beats within an hour or so, rather than after every altered
rhythm. Still, that does not mean the abnormality is dangerous.
“As a cardiologist, I really like at-home devices,” said
Gary Rogal, medical director of cardiovascular services at RWJBarnabas Health
in West Orange, New Jersey, whose team cared for my mother. But he clarified
that he liked them only for patients in whom he felt there was an indication to
look for something, such as those with an existing heart condition or a family
history of heart disease.
“I would never subscribe to the concept that everyone should
be monitored,” he said. “You’ll see stuff and it will make you crazy, but
you’re probably fine.”
The American Heart Association agrees that smartwatch
monitors could be beneficial, even lifesaving, for some. But. Mariell Jessup,
the group’s chief science and medical officer, said, “We do not have enough
data yet to recommend it for everyone.”
And doctors worry that as more and more people wear these
devices that might spot meaningless heart arrhythmias, there could be a flood
of unnecessary follow-up testing and too much treatment.
“That’s what keeps me up at night,” said Joseph Ross, a
professor of medicine and public health at Yale who is among a team of
investigators conducting a randomized clinical trial that compares a group
wearing the Apple Watch with a control group wearing a smartwatch without the
ECG app. “If someone with an occasional abnormal rhythm that would never have
caused a stroke undergoes an extensive work-up or is put on a blood thinner,
the risk of a dangerous bleed or other harm outweighs the benefits of
potentially preventing a stroke.”
Two weeks after her surgery, my mother was doing her
one-minute planks and lifting weights with her Zoom personal trainer. Maybe,
without the watch, my mother would have been OK and just felt really tired
until she called her doctor on Monday. Or maybe not.
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