DO SMARTWATCH HEART MONITORS STAND UP TO DOCTOR SCRUTINY?

Putting consumer smartwatch ECGs under the microscope

The fitness tracker and smartwatch industries are booming — CCS Insight, a research company, estimates that 140 million wearables will be sold every year by 2022.

But what impact does it have on healthcare, both for the individual and for their doctor?

Are companies like Apple, Samsung, and Fitbit angling to replace doctors, ECG machines, and medical computers?

What Are Fitness Wearables and What Can They Do?

Fear not: the trusty stethoscope and the electrocardiogram machine aren’t going anywhere. But, fitness wearables certainly can transform how patients and doctors communicate.

Fitness tracking devices get consumers moving, make them aware of their activity levels, and help them stay healthy and lose weight. And they aren’t just pedometers anymore — companies like Fitbit, Garmin, and Apple are integrating more sensors and fitness software practically every day.

Now that consumers have a constant feed of information about their activity levels, pulse rate, blood pressure — and can even discover if they’re suffering from heart arrhythmia — does that mean patients are healthier? At the moment, there isn’t enough data to tell.

Doctor’s should expect a flood of partially-informed, anxious patients all pointing frantically at their smartwatches. What are the best practices for handling this information, and, is it flooding doctors offices and urgent care units with false-positives?

Examining Wearable Accuracy

As a society, we’ve become more skeptical than ever — and that’s a good thing. So, when the glowing square on our wrist tells us that our heart rate just hit 220 and our ribcage is about to explode, should we trust it? How comparable is it really to a hospital EKG machine?

How can a device sitting on our arm detect that kind of thing with any real accuracy?

How the Sensors Work

Each smartwatch and high-end fitness tracker works a little differently.

At the low end, pedometers use a simple accelerometer to measure approximate step count.

For devices like the Apple Watch and the Fitbit Ionic, they deploy optical and electrical sensors against the skin to read the pulse and even blood oxygen levels, not unlike the same tech used in hospitals. These sensors are located either on the back plate of the watch, on a crown or button jutting out the side of the watchface (to be held while scanning), or in the watchband.

A Look at the Numbers

Studies have found that most fitness wearables are only right about half the time when it comes to step tracking, sleep monitoring, and energy-use estimations like calorie counts. While those features might not be such a big deal, the ECG and heartrate readings in wearables like the Apple Watch could have more dire consequences.

Lucky for consumers and worried doctors, the readings coming from the Apple Watch, the Fitbit Ionic, and the Garmin vivo line (to name a few) seem to be fairly accurate, depending on the model.

A thorough test and comparison by tech zine Tom’s Guide found that the Apple Watch and the Samsung Galaxy watch were the most accurate, with an overall variance of 0.67 for reading accurate heart rates when tested against clinical chest straps. No surprise, considering they’re both pretty much the top-of-the-line when it comes to smartwatches.

Fitbit’s and Garmin’s flagship offerings lagged behind, with their devices rating anywhere from 1 standard variance all the way up to the not-terribly-accurate 5.67.

The ECGs Are Coming

The ECG sensor in the new Apple Watch has physicians and tech experts concerned: are false positives, increased hospital traffic, and the constant anxiety of helpful “health alarms” doing more harm than good? In essence, the question is: should we freak out?

First off, it’s important to remember that the Apple Watch has only been cleared by the FDA, and not approved, which is a much more complicated and rigorous process. “Cleared” essentially means that there is some truth to the claims being made, and that it isn’t actively dangerous to the public. It could be some time before the Apple Watch — and the Samsung Galaxy Watch, and the other alternatives — are fully approved for actual medical use.

Secondly, there’s been no real data to support that an influx of concerned smartwatch users are flooding the ER. The rise of telehealth and patient portals means that while it’s conceivable that doctors may be getting a few more emails than normal because of fitness trackers — “Doc, do I have bradycardia? Should I be worried?” — but an epidemic it ain’t.

Thirdly, having more data — from sources that are at least accurate enough to be a good starting point — is nothing but good news for patient and clinician alike. Smartwatch users will have months (possibly years) of heart rate, blood oxygen, and sleep levels available to send to their doctor at any time.

For home health providers or nurses or aids in settings like an elder care community, they can use their normal computer or medical tablet to upload the data for the patients and send it to their doctor when needed.

Wearables won’t be replacing a good check-up, but they might be able to enhance one.

Giving Patients Better Data

It doesn’t seem fair to give healthcare professionals another responsiblity, but it may be wise to help guide patients toward more accurate solutions. And, for patients, this is a good opportunity to improve the data you’re gathering on your own fitness levels.

Accessories that Can Help

While wearable ECGs seem to be relatively accurate, a study by the Cleveland Clinic found that their sensing capabilities can actually be improved by accessories like the “KardiaBand,” a watch band with built-in sensors that are far superior to the ones in off-the-shelf smartwatches.

In fact, the KardiaBand increased the chance of detecting atrial fibrillation to 99 percent, which is comparable to a physician reading the same ECG data. That’s quite a boon for patients and doctors everywhere, especially considering that an estimated 2.7 million people in the US have regular afib, which can, in turn, lead to heart failure and stroke.

The Watches that Watch You Better

The Apple Watch and the Samsung Galaxy Watch rate the highest for heart rate accuracy, and should be recommended over the alternatives. However, for less expensive variants, the Fitbit Versa and the Garmin Fenix and Forerunner were relatively close in accuracy.

Informing patients of these more accurate options could give them a better sense of security, while at the same time reducing the number of false positives crowding up the waiting room.

An Apple Watch a Day

Whether you’re a patient or a clinician, it’s important to be aware that while consumer wearables can be incredibly useful (and even save lives on occasion), regular check-ups and physicals are far more important for long-term health.

Still, wearables can be treated as an additional tool in a doctor’s toolbelt, with a little planning and organization.

Contact Cybernet to find out more about strategies for implementing patient-gathered fitness data, and to learn about the medical computers and EMR software that can be used to store and process that data.