In this article, we are going to talk about self-monitoring your heart rhythm; the two most commonly used devices are the Apple Watch and the AliveCor system. Do you need one of these devices? And what are the potential benefits and limitations that you need to know?
Technological advances now allow you to monitor your heart rhythm without a medical device or a prescription from a doctor. The two most commonly used devices to self-monitor heart rhythm are the Series 4 Apple Watch and the AliveCor devices, although there are several others. These devices can record a simple electrocardiogram (or ECG) - although AliveCor now has a 6-lead ECG - and have a rhythm monitoring app capable of detecting “atrial fibrillation” or Afib.
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Can these devices help prevent stroke?
The hope for these heart rhythm monitoring devices is that they can prevent stroke. Here’s why. Although Afib is a heart rhythm problem, the main reason it is dangerous is because it increases the risk of stroke. Because the top chambers of the heart are not beating in a coordinated fashion in Afib, blood clots can form in the crevices of the heart. If these blood clots break off and travel to the brain, they cause a stroke. For people in Afib who have a high risk for stroke, certain blood thinners have been shown to markedly decrease the risk of stroke. However, since Afib often doesn’t cause symptoms and it can be intermittent (meaning it can come and go), many people have Afib but aren’t aware of it.
The idea behind remote monitoring for Afib is that by detecting Afib, those patients who otherwise would not know they have Afib could be put on blood thinner medication and, subsequently, avoid a stroke.
Cardiologists are skeptical, here’s why
If these devices can detect a problem that people would otherwise not be aware of and potentially get them to lifesaving therapy, why are many cardiologists concerned that the Apple Watch may create more problems than it solves?
Cardiologists are uneasy because we know when a test that isn’t perfect (which is all of them) is applied to a group of people where the disease is uncommon, it’s more likely that a positive test is, in fact, a false positive and not a true positive. The result could be that many people are told by the device that they are in Afib, when, in fact, they are not. And this could lead to many worried people in cardiologist’s offices and emergency rooms who don’t have a heart problem getting a lot of expensive testing to prove they are healthy.
But, wouldn’t that be a small price to pay for the “lifesaving” benefits of these devices?
Well, that’s one of the problems. We don’t know that these devices are lifesaving. Doctors are trained to be cynical about “lifesaving” claims that haven’t been demonstrated in a quality clinical trial, particularly from commercial interests.
This is how it should be. Physicians should protect their patients from unproven interventions. “First, do no harm” is a fundamental principle of quality medical care.
And as of now, there is no data about the effect of these devices on mortality or death rates.
Yes, these devices can detect Afib in people that unaware that they have it, and those people will go on stroke-preventing blood thinners. But what if there are unintended consequences of these devices? What if there are people who stay home during a heart attack because their Apple Watch didn’t say they were having a problem (which it is not designed to detect heart attack)? Or, if the testing done to evaluate the people with false-positive readings causes harm? Or people are put on blood thinners that don’t need them and have bleeding complications? These are the questions we don’t have answers to at this time and why we can’t use the word “lifesaving” when talking about these devices yet.
A logical outcome is not enough. There are many situations in medicine where what is logical wasn’t confirmed in clinical trials.
However, I believe there is a role for these devices currently. In people who are at high risk for Afib, who are under the supervision of a physician, these devices can potentially make detecting Afib easier.
Personally, I’m excited about the possibilities of remote monitoring and technology in healthcare. Healthcare needs to be more accessible and affordable, and we need to become partners with our patients to promote better health. I applaud the companies that are seeking innovative ways to improve the care I deliver to my patients.
But we can’t lose sight of one of the fundamental principles of medicine.
“First, do no harm.”