Apple is partnering with Johnson & Johnson to discover if its Apple Watch can reduce the risk of strokes. Using an iPhone app, the Heartline study will give participants heart-health education and tips, designed for over-65s, aiming to reduce the risk of cardiac incidents. Participants will also download an electrocardiogram (ECG) app, which will test if the Apple Watch can detect irregular heart rhythms and early signs of atrial fibrillation (AFib), a leading cause of strokes.
The app-based study could lead the way for future research and digital health, with recent research finding that many of the best fitness trackers could help you detect health issues sooner through their continued monitoring of heart rates. We reported on this news last week, but have since had comment from leading healthcare professionals that give an alternative view on the study's ambitions.
Digital health: Is this the future?
Speaking to Top Ten Reviews, Dr. Richard Zane, Chief Innovation Officer of UCHealth, was skeptical about the role smartwatches can play in detecting heart problems, saying "this is really developing a solution to a problem that may not exist".
Discussing the use of the Apple Watch in health research, he asked: "are these medical-grade devices? Eventually, it’s easy to see that they all will be, but for now, do these devices report results with the same fidelity as devices with which doctors are used to and confident are right?"
The nationwide study aims to find out if increasing awareness and engagement with heart-health, through the Heartline Study app, in combination with the ECG app and its irregular rhythm notification feature, can improve health and reduce the likelihood of strokes through earlier detection of AFiB.
Myoung Cha, Apple's Head of Health Strategic Initiatives, has said in a press release that: "The Heartline Study will help further understanding of how our technology could both contribute to science and help improve health outcomes, including reducing the risk of stroke".
However Dr. Zane, who is the co-founder of UCHealth’s CARE Innovation Center, emphasized the complexity of AFiB. "Specifically for atrial fibrillation, we have to weigh the risk of not treating – usually stroke, recurrent palpitations, occasional light-headedness and maybe chest pain – with the risk of treating: bleeding events from the medicines, some of them life-threatening or fatal."
"Currently, when a patient is evaluated with a remote monitor for the possible presence of atrial fibrillation, it’s because we have some reason to suspect it. If we start monitoring all people for atrial fibrillation regardless of having a reason to suspect it, we likely will find a large group of people who, on occasion, have asymptomatic transient atrial fibrillation where we would never have found it or maybe been concerned about it because it isn’t associated with any bad outcome.
"Think of 'holiday heart syndrome' – eating too much, drinking way too much, being hung over and running to catch that early flight home from Las Vegas – and I bet there are a bunch of folks who are on the plane with atrial fibrillation and as soon as they drink some fluids and get some rest, it’s gone. And, likely much sooner."
It would seem that features such as electrocardiogram apps could actually cause more harm than good in creating undue panic for regular and sometimes minor AFiB. Concerned about some of the potential outcomes of the study, Dr Zane added:
"Now we are faced with the decision of treating someone with a medicine that can have major side effects because we found it. Essentially, we may have put the diagnostic cart before the horse and do far more harm by treating a category of people who would never have been diagnosed nor treated."
Others, however, have spoken favorably of the role wearables can play in the future. Dr. C. Michael Gibson, co-chair of the Heartline executive committee and professor of medicine at Harvard Medical School, said that "Heartline is a study that has the potential to fundamentally change our understanding of how digital health tools, like the ECG app and irregular rhythm notification feature on Apple Watch, could lead to earlier detection of AFib, helping patients understand and directly engage in their heart health, prompting potentially lifesaving conversations with their doctors, and improving health outcomes".
The study will include monitoring of participants for two years, and an additional year of data collection. This means we won't know for sure if the Apple Watch can be used to detect strokes for at least three years.
Apple produces some of the best smartwatches available, and we were impressed in our Apple Watch 4 review by its health features, which shows that Apple is clearly set on leading the way through ventures such as the Heartline study, even if this one doesn't work out.
If you're concerned about your heart-health and risk of strokes, the American Heart Association offers a free support network with educational resources. To learn more about how to prevent strokes, check out the American Stroke Association.