Should Your Watch Monitor Your Heart?

The new Apple Watch, unveiled yesterday in Cupertino, California, possesses a new and startling capability: It can monitor the electrical pulses that drive the heart’s activity, and proactively alert users who it has determined might have a condition called atrial fibrillation. The FDA has voiced its approval, Apple said, and the new product goes on sale this fall.

Reaction was predictably positive: Atrial fibrillation is the most common type of heart arrhythmia in the United States, and the most common cause of embolic stroke. The president of the American Heart Association graced the stage at the company’s product announcement. People tweeted about Apple saving lives. “It won’t catch every instance of [atrial fibrillation], but we believe this is going to help a lot of people who didn’t otherwise know they had an issue,” said Apple COO Jeff Williams onstage of the feature, which is opt-in.

It seems like the most obvious thing in the world: Generating more data about how your heart is working must be good, right? But in many cases—prostate cancer being the most famous example—checking (and monitoring and treating) people for a disease does not make their health outcome better. Screening can lead to overdiagnosis and overtreatment, and all medical interventions come with their own set of risks, especially in a health-care system as expensive and inefficient as ours. At the very least, it can provoke unneeded panic. Counterintuitively (at least to those in Silicon Valley), sometimes it is better not to know.

Last November, when a company called AliveCor released a heart-monitoring Apple watchband, the cardiac electrophysiologist John Mandrola worried about the ways the technology would intersect with a medical system that does not serve everyone well. “At least in the U.S., the upcoming watch-driven explosion of AF diagnoses will happen in a fee-for-service environment that pays doctors and hospitals to test and treat,” Mandrola wrote in the trade publication Medscape. Diagnosis by watch not only generates an expensive trip to the doctor, he argued, but introduces the possibility that a person will proceed unnecessarily down the medicalization path.

“Every time a person with a watch-driven encounter with the medical establishment suffers a complication from downstream testing or treatment, this acts as a drag on the net benefits for screening. Turning people into patients should be done with great caution,” Mandrola concluded.

Imagine getting a ping from your new watch that says, “You may have atrial fibrillation, a heart condition.” How will people around the world respond to such a notification sitting in between Slack messages and tweets and news alerts from The Washington Post? Is there any way to deliver that message in a don’t-freak-out kind of way?

“This is going to create such a massive headache” for physicians, Ethan Weiss, an associate professor at the Cardiovascular Research Institute at the University of California at San Francisco, told us, adding that he’s not “an alarmist” about unnecessary tests.

“I’m dealing with a number of patients who were found to have certain conditions because of inappropriate screening,” he said. “Maybe we are saving that person’s life. But we don’t know that, and what we do know is that we’re causing them this stress. Every worried [healthy] Tom, Dick, and Harry are going to be freaking out about every blip thing that shows up on their Apple Watch.”

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