Can you trust your heart health to smartphones and apps?
Dr. Thosani
Courtesy of AHN
Dr. Amit Thosani uses a tablet to interact with a patient.
Courtesy of MetroCreative
Smartwatches are increasingly equipped with health monitoring apps.
Most of us have become inseparable from our smartphones, and a growing segment of the population wears smartwatches that connect with their phones. They’re not only a neat way to send and receive calls and messages, since smartwatches and smartphones are increasingly equipped with health monitoring apps. More than simply counting your daily steps and calories burned, these devices can also track heart rate and other functions, including irregular heartbeats and arrhythmias. The question is, how accurate are they?
“Wearable technology in heart rhythm monitoring currently lives in two worlds,” explains Dr. Amit Thosani, a cardiac electrophysiologist and director of cardiac electrophysiology at Allegheny Health Network (AHN). “One world is the prescription at-home system and the second, which is more visible and accessible to the public consumer, is like the Apple Watch and KardiaMobile.”
Thosani does say the Apple Watch and KardiaMobile are both highly accurate and FDA approved for detecting irregular heart rhythms like atrial fibrillation. “We see a significant number of our heart patients using these wearable tech devices and frankly, the pace of use has in some ways outpaced our understanding of its application,” Thosani says. “The results to this point have been accurate, but the question on if they compare to clinical implant technology, I think it’s safe to say that’s still to be determined.”
Data so far shows that most heart rate tracking apps are pretty accurate measuring the heart at rest, only missing a beat or two per minute. The problem comes when measuring heart rate while exercising, with some studies showing up to 20 beats missed each minute. A study published in the National Library of Medicine shows substantial differences in accuracy among four different heart rate monitoring apps on smartphones. Heart rates measured by an electrocardiography monitor showed a difference of more than 20 beats per minute in 20% of the results.
Heart rate is one thing, but what about the ads you see for those little finger pads that connect to a smartphone to run an EKG on your heart? Thosani believes they can be very helpful to doctors.
“The KardiaMobile device, for example, will show a single-lead personal EKG, which is sufficient for a cardiologist to confirm a normal heart rhythm or alternatively, detect an irregular heart rhythm, extra beats and/or associated factors that could lead to an atrial fibrillation diagnosis,” he says. “It’s a good solution for many heart rhythm abnormalities, but it’s not a comparable alternative to a 12-lead electrocardiogram that may be needed in complex cardiovascular cases where a more in-depth learning of the heart’s electrical activity is required.”
In other words, they work well for baseline readings but should not be a substitute for those with more serious cardiac concerns. In those cases, however, technology has advanced so that patients can monitor at home using higher grade equipment. “For the more advanced at-home systems which require a prescription, they are extremely accurate in their detection of abnormal heart rhythms,” says Thosani. “However, in these instances, the patient may only have the device at home for the allotted time prescribed. If the concerning symptom or incidence doesn’t take place within that specific window of time, we don’t have insight into what may be at play.” In these cases, he says consumer-based wearable tech such as smartwatches can actually help your doctor monitor you for a longer period of time. “Wearable devices, like a smartwatch, don’t have a finite time for patient use and therefore, can provide insight into what is causing a patient’s heart symptoms in real-time.”
As for the accuracy of the Apple watch and other app readings, Thosani believes they are generally accurate. Still, he cautions that sometimes they will not yield a clear tracing read or definitive diagnosis. “It’s important to underscore that if an individual is experiencing concerning cardiac symptoms or if there’s ever a question or some ambiguity surrounding notifications on a wearable device, it’s always recommended to consult with a primary care physician or cardiologist,” Thosani adds. “Even with all of this information right at your fingertips, it can’t replace being seen by a physician.”
As for what he recommends and uses with patients, the Apple Watch and KardiaMobile are his go-to products. “In my practice, we very frequently care for patients who use the Apple Watch or KardiaMobile,” he says. “If those are not available or accessible to the patient, we’ll diagnose based on symptoms, prescribe an at-home monitoring system to detect irregularities or schedule more advanced testing.”
Overall, Thosani thinks the new trend of wearable health technology can go hand in hand with your doctor’s checkups.
“What’s great about wearables is that patients can store tracings for a certain period of time and upload them onto their electronic health record or bring them to their office appointments,” he says. “So, if there is something that take place – a specific complaint or concern – we may have the ability to correlate a rhythm to it based on the readings from their device.”
He says in today’s world of virtual health options, wearable technology has played a tremendous role in increasing access and ability for cardiologists to better understand cardiac patients, their vital signs, and symptoms of concern.
“The boom of wearable technology has come at a time when patients are ultimately expecting more virtual, on-demand services, and the ability to have this type of smart insight is an accelerant,” says Thosani. “There is a convergence taking place of what patients expect from their care team and how innovative technology is further advancing that, all at an exciting pace.”