When patients come to see me in the doctor’s office, I am aware that my examinations are just a snapshot of their lives. Over the years I have learned to ask the kind of questions that lead me to the motion picture of illness, where snoring and gasping may be a sign of sleep apnea, frequent urination an indication of diabetes or prostate trouble, and palpitations combined with lightheadedness an indication of a common heart arrhythmia such as atrial fibrillation which impacts between 2.7 million and 6 million people in the U.S., according to the Centers for Disease Control and Prevention.
So, the history-taking I do in the office is, by definition, a “retrospectoscope.” And too often a patient with a heart or a breathing problem never gets to see me in time — they end up in the hospital, or worse. Many of those millions with atrial fibrillation don’t know they have it until they suffer a stroke.
{mosads}In fact, a recent study concluded that “the total AF prevalence in 2009 was 5.3 million of which 0.7 million (13.1 percent of AF cases) were undiagnosed. Over half of the modeled population with undiagnosed AF was at moderate to high risk of stroke.”
Many practicing physicians like me are therefore glad to see the release of the new Apple Watch Series 4, which includes health applications that monitor not just your heart rate but also whether you are breathing properly or not. An alert that you aren’t breathing properly can be very useful for sleep apnea and chronic lung conditions, such as COPD, or even for overdose victims of medications (including opioids) that suppress breathing.
Another application of the watch uses Siri to automatically call 911 if you fall and remain unmoving for more than one minute. I am concerned this feature could prompt an overreaction, if you decide to rest or collect yourself before rising. On the other hand, it is bound to save lives if the fall is due to a blackout, seizure or stroke.
There have been similar pluses and minuses raised about an aspect of the watch that has received most of the attention so far — the heart feature, a single-limb-lead EKG. Though this feature will not reliably diagnose a heart attack (that would generally require a 12-lead EKG), it is much more likely to be useful and accurate in picking up a rhythm abnormality, including the irregular beat of atrial fibrillation.
So this app will save lives, too — though, as always, I will feel more comfortable if my patients push a button on the watch and email me the tracings, rather than trying to interpret those themselves. There is always the risk of error without an expert involved and, even when there is one, mistakes can and will occur.
Dr. Scott Gottlieb, the FDA’s commissioner, told me that the EKG app is accurate and represents a “watershed change” in how medical devices are approved. “The hardware doesn’t need to be a medical device to have medical functionality,” he indicated. “The individual software modules will be the components we regulate.”
The greatest impact of this exciting precedent won’t be seen for a while. It will take place in terms of how we collect health data and how we use it. If a patient can accumulate his or her own information and send it to physicians remotely, it will be a huge boon for both clinical practice as well as research. Earlier diagnoses will lead to a tremendous savings in both lives and dollars, as well as higher quality health outcomes for millions of users.
Marc Siegel M.D. is a professor of medicine and medical director of Doctor Radio at NYU Langone Health. He is a Fox News medical correspondent.