The technician is PART of the equipment. Technician error comes with the machine the Apple Watch doesn’t have that technician error possibility. Amazing Apple does it again.
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Apple Watch ECG Helps Detect Case of Coronary Ischemia Missed by Hospital ECG
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It's simply far more likely that you have one. It's basically "The Best Camera Is The One You Have With You" applied to medical devices.
How many people will skip the call-an-ambulance step because they don't want the embarrassment that it's actually nothing?
I went in last year because of chest pain, high pulse rate and difficulties breathing. They didn’t find anything but my AW ecg was reviewed. But when they hooked up the 12 lead system they took about 5 seconds of data. Maybe. Each time. They found no issues but after reviewing the finding with my local dr he was not only impressed but told me although the 12 lead had ‘more data’ it was much shorter and less clear. I think the fact that you can take multiple reading yourself rather than a nurse popping in for 10 seconds and getting 3-5 seconds of data is a huge win.
The “best camera” analogy is true to a point only. It may show something but even then it’s not diagnostic. It may however prompt further investigation which if it’s indicated is fine.
It takes years to master ECG interpretation and to appreciate subtle findings. ECGs can often be obscured with artifacts and one lead out of 12 can give you the answer.
It’s not very clear which of the conventional leads, the Apple Watch even records. It’s probably Lead I vector given that you touch the crown with your right finger (assuming watch worn on left wrist). If that’s the case, it would look at the high lateral leads, which are often electrically silent and difficult to detect even with a full 12-lead.
Imagine, taking someone to the cath lab based on changes in one lead, diagnosing a coronary lesion which may not correlate anatomically (and may not be the cause of symptoms) and then subjecting that patient to twelve months of antiplatelet therapy for a stent they may not have needed.
Regarding your second point, I have no idea but I’d hope that they’d seek medical review than rely on a watch diagnosis with current S5 tech.
Interesting. Rather than speculating on why the medical grade EKG didn't pick up the condition...to me it's amazing the Apple Watch did. Good job Apple.
When looking at an ECG on the watch you have know what you are looking at. The watch will only tell you if you have Afib or not. It officially will not tell you anything else but heart rate. If you know how to read ECG's you might be able to detect another arrhythmia. I was a paramedic for 10 years and I would tell anyone with even subtle heat attack symptoms to go and be checked. One big symptom of heart attack is denying that you are having it.
My main question is that this article is from Germany and I thought the ECG functionality was only available in the US? So was the patient a US national travelling to Germany?
The ECG functionality has spread to several countries including Germany over time. They're still rolling it out, bit by bit.
I don't think that was implied at all with the first sentence being: "The single-lead ECG function on Apple Watch isn't meant to be as informative or as sensitive as the multi-lead ECGs you might get in a doctor's office or hospital, which use several points of contact."
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See above.
Obviously a 12 lead EKG is going to be more accurate. That’s not the point. The fact that something on your wrist can monitor these things at a moment’s notice,
and you don’t have to wait at a hospital to get a test is really impressive. I’ve gotten an EKG at a hospital before, the wait times were ridiculous. I’d still go there if I needed one, but I can take it on the watch and show it to a doctor later on.
Exactly.
The condition didn't present in the office, but did multiple times over an extended period of monitoring.
This why, they will often send you home with a portable monitor.
The hospital 12-lead EKG didn't fail to detect ischemia. She probably had a tight lesion that wasn't completely occluded and wasn't suffering ischemia at the time her hospital EKG was taken.
I see it all the time with prehospital EKG's. They have a STEMI or ST depression on the prehospital EKG, EMS/fire gives the person nitro, pain goes away and their hospital EKG is normal. This is why it's crucial for EMS to leave copies of their EKG's.
A single-lead EKG like a monitoring lead can sometimes "make up" the ST segments to eliminate 60 Hz interference. Therefore, they aren't that reliable. I see it all the time when the monitor techs print off a strip with a substantial amount of ST depression in lead III, II, etc., but when we do a 12-lead it's completely normal at the same time.
Doesn't sound like this person was rushed urgently to the cath lab. I imagine she had a scheduled cath once admitted to the hospital. I know the cardiologists at my hospital wouldn't take a patient urgently to the cath lab unless they have a STEMI diagnosed by a 12-lead EKG, elevated troponin with pain unrelieved with nitro/opiates, or their schedule was clear for the day.
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Nobody is ever sent home from a hospital with a portable monitor (unless it's a LifeVest defibrillator). Sometimes people get event recorders/Holter monitors from cardiologists, but they aren't discharged from an ER or hospital with one. Those are to detect arrhythmias though and not to detect ischemia.
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Wait times? There are metrics for door-to-EKG times of 10 mins in many hospitals. Not sure if it's a CMS metric or just one of our health system and several others I know of.
I see it all the time with prehospital EKG's. They have a STEMI or ST depression on the prehospital EKG, EMS/fire gives the person nitro, pain goes away and their hospital EKG is normal. This is why it's crucial for EMS to leave copies of their EKG's.
A single-lead EKG like a monitoring lead can sometimes "make up" the ST segments to eliminate 60 Hz interference. Therefore, they aren't that reliable. I see it all the time when the monitor techs print off a strip with a substantial amount of ST depression in lead III, II, etc., but when we do a 12-lead it's completely normal at the same time.
Doesn't sound like this person was rushed urgently to the cath lab. I imagine she had a scheduled cath once admitted to the hospital. I know the cardiologists at my hospital wouldn't take a patient urgently to the cath lab unless they have a STEMI diagnosed by a 12-lead EKG, elevated troponin with pain unrelieved with nitro/opiates, or their schedule was clear for the day.
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Nobody is ever sent home from a hospital with a portable monitor (unless it's a LifeVest defibrillator). Sometimes people get event recorders/Holter monitors from cardiologists, but they aren't discharged from an ER or hospital with one. Those are to detect arrhythmias though and not to detect ischemia.
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Wait times? There are metrics for door-to-EKG times of 10 mins in many hospitals. Not sure if it's a CMS metric or just one of our health system and several others I know of.
Well it could’ve been an isolated thing. I waited maybe 10-15 minutes in the waiting room. Then I actually had to spend another 15 minutes setting up a profile, because knock on wood, I haven’t had any health issues and I wasn’t in the system. Then I waited about another 10 minutes to actually get the EKG itself.
I wouldn't trust anything from Apple Watch regarding heart rate monitoring. It currently has huge spikes in reading normal pulse. It can go from 45bpm to 92 bpm to 44 bpm in less than a second. This happens frequently. Who knows what else is happing inside application and watch. Good luck Johnson and Johnson with the quality and accuracy of you study.
I’ve seen 3 cardiologists, worn one 24 hour holter and still am trying to get my issue sorted out. I have an ortho static heart rate issue. Dr 1 doing some training with my actual doctor listened to my issues, made some great observations and reassured me there was a doctor that would listen to a woman. Then main Doctor came in, erased all that we had agreed on and sent me on my way. I went from testing and a trial of a beta blocker to.... nothing. Because, you know, the holter I wore after an exhausting day and rested all weekend showed nothing based on when I pushed the darn button (which was after the events. Ugh.) Main Doctor left the Practice (oh, this is at a teaching hospital btw) and I took who they assigned me too. Wowza, pay dirt- he again listens (and read) and wanted to try The beta blocker and wanted to learn how to read my watch readings in EPIC. Because I do have episodes... at home. And I can’t bend over, my heart rate goes crazy and I get somewhat dizzy feeling. Turns out, that might actually be a Trigeminal Neurolgia. But without my watch (or the pulse is I own), *I* might not have the data needed to say - what is this? What is going on when I do X?
So get off your high horses and actually use data that your patients might have to complement your tools. Why can’t this be a freaking team? And why must it also be: anxiety, depression, de-conditioning? on the later, if the woman is telling you she does intense interval water aerobics, standing up and a 40-50bpm raise isn’t normal. Nor is the bending over/TN crap. Cardiologist 3 said last week on zoom: “ouch, I hear that is very painful”. Made me love him more, he was human and admitted that he has “heard” it hurts.
Listen. We know our bodies, not all of us are Hypochondriacs And you create anxiety and depression and drag out our diagnosis’s longer than needed.
can Apple get into the autoimmune game, I need some help there next.
So get off your high horses and actually use data that your patients might have to complement your tools. Why can’t this be a freaking team? And why must it also be: anxiety, depression, de-conditioning? on the later, if the woman is telling you she does intense interval water aerobics, standing up and a 40-50bpm raise isn’t normal. Nor is the bending over/TN crap. Cardiologist 3 said last week on zoom: “ouch, I hear that is very painful”. Made me love him more, he was human and admitted that he has “heard” it hurts.
Listen. We know our bodies, not all of us are Hypochondriacs And you create anxiety and depression and drag out our diagnosis’s longer than needed.
can Apple get into the autoimmune game, I need some help there next.
This is awesome!
I hope that scenarios like these and the global crisis we’re in force every country into giving Apple blanket approval for the EKG. Each country can have their own asterisk explanations and warnings, but there is no reason to disallow access to this feature.
Over time, the EKG within the Apple Watch will improve. It stayed the same for S4 and S5, but now that the entire world is taking health more seriously, I’m hoping to see an even more accurate EKG in the S6. Also hoping for the blanket approval of allowing people to take their own blood oxygen saturation readings from the hopefully implemented pulse oximeter.
I believe the future of human health is the continuous monitoring of vitals and that wearables must play an important role in that. Dexcom and Abbott Laboratories are starting to do that with blood sugar monitoring, but until they fully partner with Apple, Google, or Samsung, it’s not going to be widespread.
Long before smart watches, fitness watches were still made, and the heart rate monitors imbedded in the watches weren’t very accurate. Polaris had a watch that wirelessly paired with a chest band so that it gave very accurate readings. Today, the heart rate monitors in watches have greatly improved, making those chest bands obsolete.
What if we brought back the chest strap for the sake of more precise and more accurate monitoring of our hearts? Let’s say you wear an Apple Watch on one wrist, a Bluetooth LE wrist band on the other wrist, and a Bluetooth LE chest band. Now you have the pulse of both wrists and the beat of the heart all being pushed to the Apple Watch. From that, you could potentially get an EKG of an entire workout or jog. Correlate that with other data, like elevation, speed, or weather/humidity, to see exactly how your heart reacts to certain stress tests.
What if there was a wireless Bluetooth LE fingertip clip that continuously monitors your blood oxygen saturation and pushes it to the Apple Watch? You could see how workouts and jogs effect that as well!
The possibilities are endless!
I hope that scenarios like these and the global crisis we’re in force every country into giving Apple blanket approval for the EKG. Each country can have their own asterisk explanations and warnings, but there is no reason to disallow access to this feature.
Over time, the EKG within the Apple Watch will improve. It stayed the same for S4 and S5, but now that the entire world is taking health more seriously, I’m hoping to see an even more accurate EKG in the S6. Also hoping for the blanket approval of allowing people to take their own blood oxygen saturation readings from the hopefully implemented pulse oximeter.
I believe the future of human health is the continuous monitoring of vitals and that wearables must play an important role in that. Dexcom and Abbott Laboratories are starting to do that with blood sugar monitoring, but until they fully partner with Apple, Google, or Samsung, it’s not going to be widespread.
Long before smart watches, fitness watches were still made, and the heart rate monitors imbedded in the watches weren’t very accurate. Polaris had a watch that wirelessly paired with a chest band so that it gave very accurate readings. Today, the heart rate monitors in watches have greatly improved, making those chest bands obsolete.
What if we brought back the chest strap for the sake of more precise and more accurate monitoring of our hearts? Let’s say you wear an Apple Watch on one wrist, a Bluetooth LE wrist band on the other wrist, and a Bluetooth LE chest band. Now you have the pulse of both wrists and the beat of the heart all being pushed to the Apple Watch. From that, you could potentially get an EKG of an entire workout or jog. Correlate that with other data, like elevation, speed, or weather/humidity, to see exactly how your heart reacts to certain stress tests.
What if there was a wireless Bluetooth LE fingertip clip that continuously monitors your blood oxygen saturation and pushes it to the Apple Watch? You could see how workouts and jogs effect that as well!
The possibilities are endless!
I agree with what you are saying. Being able to collect tons of data of HR, ECG, Oxygen and hopefully sugar would advance medical research. If they find a reliable way to measure sugar with a watch that would fantastic for diabetic patients. The problem is you need a reliable diagnostictian to take those readings and get a diagnosis. Today with internet I worry about someone going to apple watch diagnosis site and plugging their info into it and maybe getting a false diagnosis.
Depends.
First, there is no reliable method to measure blood glucose non-invasively — so either we're discussing a hypothetical breakthrough, or something that already exists today, but perhaps Apple could do more seamlessly, namely wireless transmission from an invasive sensor (e.g., FreeStyle Libre, implanted into the arm and replaced about every other week). The latter is obviously impractical for non-diagnosed patients.
But second, if we also include the former, i.e. a non-invasive method, that could also be interesting for those who don't know that they have diabetes, or have only been diagnosed with various forms of "pre-diabetes". For those, casually measuring your blood sugar either continuously, or interactively as is the case with the ECG, would be quite interesting and could prove quite useful to diagnose diabetes earlier.
I wouldn't worry too much about false diagnoses. Both the ECG and this hypothetical feature can prove to be useful data to pop up a warning, "hey, you may have a health problem; please go see a doctor". And then maybe, the doctor can look at the same data — or maybe not, and they do measurements of their own. That's about it. (In the case of blood sugar, temporary spikes aren't that important, and an approximation of the average value of ~10-12 weeks can be done by drawing blood and measuring Hba1c. So, the Watch data isn't actually that useful for the doctor, but could be for the patient. In the case of ECG, short-term data can prove useful even for doctors, as this story shows.)
Got an Apple Watch for the husband. Better late than never :/ He is now wearing a Zio Patch for another week in addition to the Watch. He has been under a microscope yearly/biannually due to his job yet he still had a massive heart attack Sunday before last. We were in such denial that I simply drove him to the emergency room still thinking it was food poisoning. Ugh. Sooo stupid.