If someone's heart skips a beat, tech companies want to let you know.
Device companies, starting with Apple and now Google-owned Fitbit, sell wearable devices that monitor heartbeats and alert users when something is out of sync.
These products involve some technological prowess. Many use sophisticated optical sensors that look under the skin to monitor changes in blood volume, almost like following the tides, to count heartbeats. Other devices have a miniature EKG built in, which records the electrical activity of the heart. Either method can detect an irregular heartbeat and potentially atrial fibrillation, a condition that affects an estimated 2.7 million Americans and increases the risk of stroke and heart failure. When a person has it, the beats in the upper chambers of the heart are erratic and the blood does not circulate as well as it should in the lower chambers of the heart.
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However, while the devices are a technical feat, some cardiologists say the information they produce isn't always helpful. Device notifications are not definitive diagnostics.
This is an enigma, and a consequence, for the health system. Tens of millions of people are equipped with these devices, and if even a small fraction of them get a ping, it could mean a lot more care and cost for the system.
"Technology has outpaced us," said Rod Passman, a Northwestern University cardiologist who is involved in a study examining the Apple Watch's ability to track heart rhythm status. “The industry came out with these things because they could. We are now trying to catch up and trying to figure out what to do with this information.
Heart rate sensors are among the many tools built into these wearable devices. Users can count their steps, track their sleep and analyze their gait. Some products call 911 if the user has been in a car accident or had a bad fall.
These characteristics are intended to make patients the protagonists of maintaining their health.
At an event promoting Fitbit's atrial fibrillation feature, company co-founder James Park said it was one of many features of the brand's fitness trackers that "allow users to effortlessly control your health and well-being."
The laptop's atrial fibrillation ping, a "test that [doctors] didn't order," Passman said, tells patients there's something potentially irregular. Ultimately, however, any treatment is left to the doctor.
First visits don't always provide quick answers. To support a notification, a cardiologist equips patients with medical-grade diagnostics (a bulky patch or monitor) that are more accurate than wearable devices. (The Apple Watch, for example, is FDA-approved for "informational use only.") This more sophisticated device may need to run for a while to catch a momentary missed heartbeat. This wait means more time and money spent on more doctor visits.
Getting a diagnosis "can be quite an ordeal," said Ethan Weiss, a cardiologist at the University of California, San Francisco.
Patients can get anxious along the way. Social media forums like Reddit show that many users are wondering if their watches or doctors are more reliable. "It still scares me," wrote one user, even after being told by a doctor that he was probably fine.
“There is going to be a period of uncertainty,” acknowledged Tony Faranesh, a Fitbit researcher. He said the company provides educational materials for users aware of the possible arrhythmia.
Studies on the prevalence of anxiety resulting from atrial fibrillation pulses are difficult to find. Fitbit collected this information, Faranesh told KHN, as part of an investigation submitted to the FDA for approval of its device. But the full results of the study, which collected information from 455,000 patients, are not yet available.
Diagnosing is not the same as knowing what the best treatment should be. For example, treating healthy patients with anticoagulants, the standard treatment for atrial fibrillation, can put them at risk for side effects.
