Apple Watch Series 4 ECG spots AFib in owner, leading to life-saving procedure

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Comments

  • Reply 21 of 34
    MplsP said:
    The headline and parts of the article are overblown and/or incorrect. 

    Atrial fibrillation is not directly fatal. in fact, a large number of people live for years or even decades with chronic atrial fibrillation. The two main risks imparted by the condition are thromboembolic stroke and heart failure/other issues caused by tacky cardia typically associated with atrial fibrillation. The risk for stroke is significant, but not huge and can be significantly reduced with blood thinners. The other complications are dependent on the heart rate and how long it is elevated. 

    "His heart was restarted under sedation" - wrong. HIs heart never stopped. He had a DC cardioversion to convert him from atrial fibrillation to sinus rhythm.


    Big deal. We got the point. The writers here on AI are not cardiologists.

    False positives are always a worry, and can drive up health care costs. But when someone has had a brain injury (as this person has), it’s probably better to be safe than sorry. 
    OK,  I am an Apple Series 4 owner that purchased the watch four weeks ago for it’s health tracking.  Especially fall detection but also the EKG.  Being 67 one of the first things I did was run the EKG app and was relieved to see I was in Sinus Rythm.  I ran it every day with the same result. Two weeks ago I got my morning coffee, sat down and my watch told me I was in A-fib.  The app must have been running in the background.  I re-ran the test several times manually, re-booted the watch, changed wrist with the same result.  So I made an appointment to see My doctor.  He is a runner and is therefore familiar with heartbeat monitors and aware of the Series 4 technology which is different. I was the first patient of his however that he had seen that had a positive for A-fib.
    I was tested on a real EKG which confirmed and we performed several more tests and he ordered an Echo-cardio graham which is ultrasound of the chest area. Being Friday after Christmas in America’s wonderful health care system I didn’t get to see my doctor again until two days after New Years (Although he left a voicemail that the Echo detected I have an enlarged Aorta and a leaky valve. Which scared the be-Jesus out of me not knowing what that meant.  While waiting I continued to run the app every day and although it continued to show A-fib the entire day Friday it has been showing Sinus Rythm every day since.  When I finally did get to talk to my doctor again I was told that it was more likely that the watch would show a false negative for A-fib than a false positive but it was a good sign that I might merely have intermittent A-fib.  
    I finally saw a cardiologist Tuesday who confirmed the readings, looked at all my on watch tests and fortunately told me that although I have some symptoms they are not serious and the only major concern is stroke.  He said we need to watch it and I was given a course of action, I was told that I should take a blood thinner but I could either take a prescription medicine such as warfarin or just full dose Aspirin.  For now I’m taking aspirin and I was told unless I saw other symptoms a follow up Echo and meeting with him would be in “six months or so”.  Since I’m returning to Thailand today we set te appointment for a year from now.
    I would say the watch has probably saved my life in pointing out an issue that without detection could have gotten much worse with me even knowing it.
    svanstromanantksundaramking editor the gratewatto_cobra
  • Reply 22 of 34
    GeorgeBMacGeorgeBMac Posts: 4,127member
    gherman22 said:
    MplsP said:
    The headline and parts of the article are overblown and/or incorrect. 

    Atrial fibrillation is not directly fatal. in fact, a large number of people live for years or even decades with chronic atrial fibrillation. The two main risks imparted by the condition are thromboembolic stroke and heart failure/other issues caused by tacky cardia typically associated with atrial fibrillation. The risk for stroke is significant, but not huge and can be significantly reduced with blood thinners. The other complications are dependent on the heart rate and how long it is elevated. 

    "His heart was restarted under sedation" - wrong. HIs heart never stopped. He had a DC cardioversion to convert him from atrial fibrillation to sinus rhythm.


    Big deal. We got the point. The writers here on AI are not cardiologists.

    False positives are always a worry, and can drive up health care costs. But when someone has had a brain injury (as this person has), it’s probably better to be safe than sorry. 
    OK,  I am an Apple Series 4 owner that purchased the watch four weeks ago for it’s health tracking.  Especially fall detection but also the EKG.  Being 67 one of the first things I did was run the EKG app and was relieved to see I was in Sinus Rythm.  I ran it every day with the same result. Two weeks ago I got my morning coffee, sat down and my watch told me I was in A-fib.  The app must have been running in the background.  I re-ran the test several times manually, re-booted the watch, changed wrist with the same result.  So I made an appointment to see My doctor.  He is a runner and is therefore familiar with heartbeat monitors and aware of the Series 4 technology which is different. I was the first patient of his however that he had seen that had a positive for A-fib.
    I was tested on a real EKG which confirmed and we performed several more tests and he ordered an Echo-cardio graham which is ultrasound of the chest area. Being Friday after Christmas in America’s wonderful health care system I didn’t get to see my doctor again until two days after New Years (Although he left a voicemail that the Echo detected I have an enlarged Aorta and a leaky valve. Which scared the be-Jesus out of me not knowing what that meant.  While waiting I continued to run the app every day and although it continued to show A-fib the entire day Friday it has been showing Sinus Rythm every day since.  When I finally did get to talk to my doctor again I was told that it was more likely that the watch would show a false negative for A-fib than a false positive but it was a good sign that I might merely have intermittent A-fib.  
    I finally saw a cardiologist Tuesday who confirmed the readings, looked at all my on watch tests and fortunately told me that although I have some symptoms they are not serious and the only major concern is stroke.  He said we need to watch it and I was given a course of action, I was told that I should take a blood thinner but I could either take a prescription medicine such as warfarin or just full dose Aspirin.  For now I’m taking aspirin and I was told unless I saw other symptoms a follow up Echo and meeting with him would be in “six months or so”.  Since I’m returning to Thailand today we set te appointment for a year from now.
    I would say the watch has probably saved my life in pointing out an issue that without detection could have gotten much worse with me even knowing it.
    Great real-life story!   Two points:
    The series 4 monitors heart rhythm 2 ways:   continuously with the optical monitor and specifically with the electronic sensor when you trigger it.   The electronic is not only more sensitive and accurate, but it can record the EKG as well.   Your alert likely came from the optical sensor as a warning.

    As a (now retired) home health nurse, I would advise avoiding the prescription meds (namely Warfarin) if at all possible.  I saw them as a a nightmare:   You have to get your blood coagulabiity tested every few weeks and, not only is that a hastle but:  If the amount of vitamin K you consume changes, then the blood test changes and the doctor changes the dose of Warfarin you are getting.  That can throw everything onto a life threatening roller coaster ride with each blood test where your blood is either too "thick" or too "thin" depending on how much vitamin K you consume versus what your current dosage is...   If its safe to stay on the Aspirin then, do so.
    watto_cobra
  • Reply 23 of 34
    AppleExposedAppleExposed Posts: 623unconfirmed, member
    MacPro said:
    Rayz2016 said:
    AppleZulu said:
    This is, of course, just anecdotal evidence. It neither confirms nor refutes the hypothesis proposed that Apple Watch ECGs creating false positives will do more harm to more people than they will do good through true positives, as described in this story.

    It’s also true that there doesn’t seem to be the anecdotal evidence turning up that would at least provide some support for that ‘false positives’ hypothesis. You would also imagine that for the ‘false positives’ hypothesis to have much chance to be correct, that there would need to be a pretty significant number of anecdotes turning up of people who experienced some sort of harm or at least temporary anxiety resulting from a false positive reading. This is because the amount of good as described in the story atop this thread is significant: a life saved, or at least a life-changing health crisis averted. To offset that, the harm to an individual with a false positive would either have to be just as significant (unneeded treatment resulting either in death or in a life-changing health crisis), or there would have to be a large number of people experiencing lesser, but still significant harm (e.g., large medical bills, or significant anxiety resulting from false diagnosis of ‘heart problems’).

    So far, we’re not seeing those horror stories, and it seems pretty likely we would if there were any. Remember when Apple Watch 0 came out and a handful of people discovered that the pulse reader couldn’t see through dark tattoos? A tiny number of people experienced a problem and you would’ve thought that the Apple Watch was a complete failure and Apple was going to go out of business. Generally when there is even a small problem with an Apple product, there is a disproportionate if temporary uproar about it. 
    Well said. 

    The notion that a doctor would order open heart surgery on the strength of an Apple Watch reading is both laughable and insulting to medical practitioners everywhere. 
    I would not be surprised if the same thing was said about those darn home thermometers in their day.  People taking their own temperatures gee, imagine the burden on doctors.
    I said it in another thread:
    We are at the "TV will make ye blind!" stage of the Apple Watch.

    Every groundbreaking tech goes through this paranoid teething stage. Remember peoples fingers were gonna get chopped by thieves who want your 5s iPhone?

    BTW
    "Color TV will make ya blind!" and "Cartoons will make ya blind!" were also concerns.
    anantksundaramStrangeDayswatto_cobra
  • Reply 24 of 34
    AppleExposedAppleExposed Posts: 623unconfirmed, member
    AppleZulu said:
    This is, of course, just anecdotal evidence. It neither confirms nor refutes the hypothesis proposed that Apple Watch ECGs creating false positives will do more harm to more people than they will do good through true positives, as described in this story.

    It’s also true that there doesn’t seem to be the anecdotal evidence turning up that would at least provide some support for that ‘false positives’ hypothesis. You would also imagine that for the ‘false positives’ hypothesis to have much chance to be correct, that there would need to be a pretty significant number of anecdotes turning up of people who experienced some sort of harm or at least temporary anxiety resulting from a false positive reading. This is because the amount of good as described in the story atop this thread is significant: a life saved, or at least a life-changing health crisis averted. To offset that, the harm to an individual with a false positive would either have to be just as significant (unneeded treatment resulting either in death or in a life-changing health crisis), or there would have to be a large number of people experiencing lesser, but still significant harm (e.g., large medical bills, or significant anxiety resulting from false diagnosis of ‘heart problems’).

    So far, we’re not seeing those horror stories, and it seems pretty likely we would if there were any. Remember when Apple Watch 0 came out and a handful of people discovered that the pulse reader couldn’t see through dark tattoos? A tiny number of people experienced a problem and you would’ve thought that the Apple Watch was a complete failure and Apple was going to go out of business. Generally when there is even a small problem with an Apple product, there is a disproportionate if temporary uproar about it. 
    The problem is, Apple Watch can save 100 lives in a row but if just ONE person gets a false positive or someone flat out LIES about one then it's the next "#GATE", "Apple is doomed", "Buy a crappy android instead" and "DUMP STOCK NOW!!!!"
    GeorgeBMacwatto_cobra
  • Reply 25 of 34
    MacPro said:
    MplsP said:
    The headline and parts of the article are overblown and/or incorrect. 

    Atrial fibrillation is not directly fatal. in fact, a large number of people live for years or even decades with chronic atrial fibrillation. The two main risks imparted by the condition are thromboembolic stroke and heart failure/other issues caused by tacky cardia typically associated with atrial fibrillation. The risk for stroke is significant, but not huge and can be significantly reduced with blood thinners. The other complications are dependent on the heart rate and how long it is elevated. 

    "His heart was restarted under sedation" - wrong. HIs heart never stopped. He had a DC cardioversion to convert him from atrial fibrillation to sinus rhythm.


    Exactly my thoughts. Atrial fibrillation is not a life threatening condition, so saying the guy's life was saved by the watch is way overblown.
    Lots of people live with AF for months or years without even recognizing they have it.
    AF typically affects the older population who in general already have significantly increased risk for cardiovascular diseases. On top of that, according to Wikipedia, AF increases the risk of heart failure by 1.1%, kidney problems by 0.6%, death by 0.4%, stroke by 0.3%, and coronary artery disease by 0.1%. Not insignificant, but not an emergency either.

    In the end the Apple Watch's built in ECG may have a a worse negative effect on healthcare than prostate cancer screening. For those who don't know that story, most urologist now agree that screening for prostate cancer causes more harm than benefits because of over-diagnosis. The issue stems from the fact that the screening is not 100% accurate, so a small number of people will be diagnosed with the condition even when they don't have it, and they will go through invasive procedures to cure a problem that doesn't need to be cured, resulting in high cost and complications. All in all more people are harmed by the over-diagnosis than the number of people who are harmed by undetected cancer.
    Utter bullshit.

    What the doctor does with that data is the issue. Not the watch.
    I agree with you with one caveat.  In the USA one always has to have half an eye for any financial motives for treatment since medicine is practiced for profit, not altruism.
    Actually, most medical services (hospitals, skilled nursing facilities,Medicare/Medicaid, etc.)  in the US are in the non-profit or government sectors, but surely there are things in the for-profit sector too (pharma, insurance, medical products).

    However, the big incentive problems arise from the dominant payment system: "fee for service" or FFS (yes, that's what the health care profession calls it!). The more stuff you do, the more you get paid. That means more jobs, more resources, more power to spend. That is the source of the financial motive.
  • Reply 26 of 34
    AppleZulu said:
    This is, of course, just anecdotal evidence. It neither confirms nor refutes the hypothesis proposed that Apple Watch ECGs creating false positives will do more harm to more people than they will do good through true positives, as described in this story.

    It’s also true that there doesn’t seem to be the anecdotal evidence turning up that would at least provide some support for that ‘false positives’ hypothesis. You would also imagine that for the ‘false positives’ hypothesis to have much chance to be correct, that there would need to be a pretty significant number of anecdotes turning up of people who experienced some sort of harm or at least temporary anxiety resulting from a false positive reading. This is because the amount of good as described in the story atop this thread is significant: a life saved, or at least a life-changing health crisis averted. To offset that, the harm to an individual with a false positive would either have to be just as significant (unneeded treatment resulting either in death or in a life-changing health crisis), or there would have to be a large number of people experiencing lesser, but still significant harm (e.g., large medical bills, or significant anxiety resulting from false diagnosis of ‘heart problems’).

    So far, we’re not seeing those horror stories, and it seems pretty likely we would if there were any. Remember when Apple Watch 0 came out and a handful of people discovered that the pulse reader couldn’t see through dark tattoos? A tiny number of people experienced a problem and you would’ve thought that the Apple Watch was a complete failure and Apple was going to go out of business. Generally when there is even a small problem with an Apple product, there is a disproportionate if temporary uproar about it. 
    Just for the sake of example, let's flip that:   Let's assume that there IS actually a problem with "too many" false positives.  The result would be a number of people going in for some very cheap, simple, routine EKG's.  That is a relatively minor problem -- particularly when compared to the risk of living the remainder of one's life with a debilitating stroke.  

    Compare that to the millions going in for routine colonoscopies that cost thousands but yet 99% find nothing -- while far cheaper, simpler and safer methods that are 90% as effective are available.

    The American healthcare industry only cares about "false positives" when they don't reap the benefit.  Colonoscopies bring in BIG bucks to the healthcare profession -- so they have no problem spending millions of our dollars for a 0.1% improvement in diagnostic effectiveness.

    But, let one person go to their doctor with a false positive EKG and its headline news!
    Actually, the issue of false positives is not so simple. Especially in colonoscopies (and in areas like mammograms).

    There is a large, credible literature on this issue and how it drives up health care costs. See, for example, the coverage of the work in NPR by a Gil Welch, a well-known researcher. He also has a well-received book on the topic, that gets into a lot more detail on this issue.
  • Reply 27 of 34
    AppleZulu said:
    This is, of course, just anecdotal evidence. It neither confirms nor refutes the hypothesis proposed that Apple Watch ECGs creating false positives will do more harm to more people than they will do good through true positives, as described in this story.

    It’s also true that there doesn’t seem to be the anecdotal evidence turning up that would at least provide some support for that ‘false positives’ hypothesis. You would also imagine that for the ‘false positives’ hypothesis to have much chance to be correct, that there would need to be a pretty significant number of anecdotes turning up of people who experienced some sort of harm or at least temporary anxiety resulting from a false positive reading. This is because the amount of good as described in the story atop this thread is significant: a life saved, or at least a life-changing health crisis averted. To offset that, the harm to an individual with a false positive would either have to be just as significant (unneeded treatment resulting either in death or in a life-changing health crisis), or there would have to be a large number of people experiencing lesser, but still significant harm (e.g., large medical bills, or significant anxiety resulting from false diagnosis of ‘heart problems’).

    So far, we’re not seeing those horror stories, and it seems pretty likely we would if there were any. Remember when Apple Watch 0 came out and a handful of people discovered that the pulse reader couldn’t see through dark tattoos? A tiny number of people experienced a problem and you would’ve thought that the Apple Watch was a complete failure and Apple was going to go out of business. Generally when there is even a small problem with an Apple product, there is a disproportionate if temporary uproar about it. 
    Just for the sake of example, let's flip that:   Let's assume that there IS actually a problem with "too many" false positives.  The result would be a number of people going in for some very cheap, simple, routine EKG's.  That is a relatively minor problem -- particularly when compared to the risk of living the remainder of one's life with a debilitating stroke.  

    Compare that to the millions going in for routine colonoscopies that cost thousands but yet 99% find nothing -- while far cheaper, simpler and safer methods that are 90% as effective are available.

    The American healthcare industry only cares about "false positives" when they don't reap the benefit.  Colonoscopies bring in BIG bucks to the healthcare profession -- so they have no problem spending millions of our dollars for a 0.1% improvement in diagnostic effectiveness.

    But, let one person go to their doctor with a false positive EKG and its headline news!
    Actually, the issue of false positives is not so simple. Especially in colonoscopies (and in areas like mammograms).

    There is a large, credible literature on this issue and how it drives up health care costs. See, for example, the coverage of the work in NPR by a Gil Welch, a well-known researcher. He also has a well-received book on the topic, that gets into a lot more detail on this issue.
    The problem is real, BUT… Essentially this whole scare about false positives is based not on information being available to people, but that their doctors end up treating people in a suboptimal way once at their office.

    Are there risk about going to see a doctor? Absolutely; there's no doubt about that. But if you can't trust your doctor, then you end up putting yourself in charge of having the medicial expertise needed to keep you healthy and alive. And that's almost as bad as putting Trump in charge of ending global warming.

    As an individual your job is to go see a doctor if you're worried; and it's all our jobs, as part of society, to make sure that the licensed medical professionals have the right skills needed to treat their patients right. We can't start going "you can't see doctors about [these medical conditions], because doctors can't be trusted diagnosing/treating those".
  • Reply 28 of 34
    svanstrom said:
    AppleZulu said:
    This is, of course, just anecdotal evidence. It neither confirms nor refutes the hypothesis proposed that Apple Watch ECGs creating false positives will do more harm to more people than they will do good through true positives, as described in this story.

    It’s also true that there doesn’t seem to be the anecdotal evidence turning up that would at least provide some support for that ‘false positives’ hypothesis. You would also imagine that for the ‘false positives’ hypothesis to have much chance to be correct, that there would need to be a pretty significant number of anecdotes turning up of people who experienced some sort of harm or at least temporary anxiety resulting from a false positive reading. This is because the amount of good as described in the story atop this thread is significant: a life saved, or at least a life-changing health crisis averted. To offset that, the harm to an individual with a false positive would either have to be just as significant (unneeded treatment resulting either in death or in a life-changing health crisis), or there would have to be a large number of people experiencing lesser, but still significant harm (e.g., large medical bills, or significant anxiety resulting from false diagnosis of ‘heart problems’).

    So far, we’re not seeing those horror stories, and it seems pretty likely we would if there were any. Remember when Apple Watch 0 came out and a handful of people discovered that the pulse reader couldn’t see through dark tattoos? A tiny number of people experienced a problem and you would’ve thought that the Apple Watch was a complete failure and Apple was going to go out of business. Generally when there is even a small problem with an Apple product, there is a disproportionate if temporary uproar about it. 
    Just for the sake of example, let's flip that:   Let's assume that there IS actually a problem with "too many" false positives.  The result would be a number of people going in for some very cheap, simple, routine EKG's.  That is a relatively minor problem -- particularly when compared to the risk of living the remainder of one's life with a debilitating stroke.  

    Compare that to the millions going in for routine colonoscopies that cost thousands but yet 99% find nothing -- while far cheaper, simpler and safer methods that are 90% as effective are available.

    The American healthcare industry only cares about "false positives" when they don't reap the benefit.  Colonoscopies bring in BIG bucks to the healthcare profession -- so they have no problem spending millions of our dollars for a 0.1% improvement in diagnostic effectiveness.

    But, let one person go to their doctor with a false positive EKG and its headline news!
    Actually, the issue of false positives is not so simple. Especially in colonoscopies (and in areas like mammograms).

    There is a large, credible literature on this issue and how it drives up health care costs. See, for example, the coverage of the work in NPR by a Gil Welch, a well-known researcher. He also has a well-received book on the topic, that gets into a lot more detail on this issue.
    The problem is real, BUT… Essentially this whole scare about false positives is based not on information being available to people, but that their doctors end up treating people in a suboptimal way once at their office.

    Are there risk about going to see a doctor? Absolutely; there's no doubt about that. But if you can't trust your doctor, then you end up putting yourself in charge of having the medicial expertise needed to keep you healthy and alive. And that's almost as bad as putting Trump in charge of ending global warming.

    As an individual your job is to go see a doctor if you're worried; and it's all our jobs, as part of society, to make sure that the licensed medical professionals have the right skills needed to treat their patients right. We can't start going "you can't see doctors about [these medical conditions], because doctors can't be trusted diagnosing/treating those".
    Again, not so simple as a Trump analogy. In the US doctors often practice defensive medicine because of the threat of litigation and worries about how it will drive up their (personal) insurance costs. The US system is broken at so many different levels, and it’s all connected. It is impossible to fix just some piece of it here or there (as Obamacare has now discovered). The entire thing needs dismantling and rebuilding.

    That said, I have no problems at all with — indeed, I applaud and celebrate — AppleWatch’s ECG app and capabilities. I hope that this sort of functionality grows into other areas of testing over time. 
  • Reply 29 of 34
    MacPro said:
    MplsP said:
    The headline and parts of the article are overblown and/or incorrect. 

    Atrial fibrillation is not directly fatal. in fact, a large number of people live for years or even decades with chronic atrial fibrillation. The two main risks imparted by the condition are thromboembolic stroke and heart failure/other issues caused by tacky cardia typically associated with atrial fibrillation. The risk for stroke is significant, but not huge and can be significantly reduced with blood thinners. The other complications are dependent on the heart rate and how long it is elevated. 

    "His heart was restarted under sedation" - wrong. HIs heart never stopped. He had a DC cardioversion to convert him from atrial fibrillation to sinus rhythm.


    Exactly my thoughts. Atrial fibrillation is not a life threatening condition, so saying the guy's life was saved by the watch is way overblown.
    Lots of people live with AF for months or years without even recognizing they have it.
    AF typically affects the older population who in general already have significantly increased risk for cardiovascular diseases. On top of that, according to Wikipedia, AF increases the risk of heart failure by 1.1%, kidney problems by 0.6%, death by 0.4%, stroke by 0.3%, and coronary artery disease by 0.1%. Not insignificant, but not an emergency either.

    In the end the Apple Watch's built in ECG may have a a worse negative effect on healthcare than prostate cancer screening. For those who don't know that story, most urologist now agree that screening for prostate cancer causes more harm than benefits because of over-diagnosis. The issue stems from the fact that the screening is not 100% accurate, so a small number of people will be diagnosed with the condition even when they don't have it, and they will go through invasive procedures to cure a problem that doesn't need to be cured, resulting in high cost and complications. All in all more people are harmed by the over-diagnosis than the number of people who are harmed by undetected cancer.
    Utter bullshit.

    What the doctor does with that data is the issue. Not the watch.
    I agree with you with one caveat.  In the USA one always has to have half an eye for any financial motives for treatment since medicine is practiced for profit, not altruism.
    Actually, most medical services (hospitals, skilled nursing facilities,Medicare/Medicaid, etc.)  in the US are in the non-profit or government sectors, but surely there are things in the for-profit sector too (pharma, insurance, medical products).

    However, the big incentive problems arise from the dominant payment system: "fee for service" or FFS (yes, that's what the health care profession calls it!). The more stuff you do, the more you get paid. That means more jobs, more resources, more power to spend. That is the source of the financial motive.
    "Non-Profit" is really just a accounting protocol -- where the organization does not record "retained earnings" as such.   They can be every bit as greedy and malicious as any "for-profit".   But many hide behind that label.

    And yes, while "fee for service" promotes more services and more fees -- and more profit.  These greedy organizations know how to suck the system dry regardless of the payment mechanism.   I worked for a Home Health agency that was paid a set, fixed amount to care for each client for 9 weeks regardless of the services delivered.  And, every month we had an "employee meeting" where we were trained in how to suck more money out of the system.  Medicare even has a name for it: "Gaming the system".

    Our healthcare system -- both for-profit and non-profit segments are driven by their profit not your health.
  • Reply 30 of 34
    AppleZulu said:
    This is, of course, just anecdotal evidence. It neither confirms nor refutes the hypothesis proposed that Apple Watch ECGs creating false positives will do more harm to more people than they will do good through true positives, as described in this story.

    It’s also true that there doesn’t seem to be the anecdotal evidence turning up that would at least provide some support for that ‘false positives’ hypothesis. You would also imagine that for the ‘false positives’ hypothesis to have much chance to be correct, that there would need to be a pretty significant number of anecdotes turning up of people who experienced some sort of harm or at least temporary anxiety resulting from a false positive reading. This is because the amount of good as described in the story atop this thread is significant: a life saved, or at least a life-changing health crisis averted. To offset that, the harm to an individual with a false positive would either have to be just as significant (unneeded treatment resulting either in death or in a life-changing health crisis), or there would have to be a large number of people experiencing lesser, but still significant harm (e.g., large medical bills, or significant anxiety resulting from false diagnosis of ‘heart problems’).

    So far, we’re not seeing those horror stories, and it seems pretty likely we would if there were any. Remember when Apple Watch 0 came out and a handful of people discovered that the pulse reader couldn’t see through dark tattoos? A tiny number of people experienced a problem and you would’ve thought that the Apple Watch was a complete failure and Apple was going to go out of business. Generally when there is even a small problem with an Apple product, there is a disproportionate if temporary uproar about it. 
    Just for the sake of example, let's flip that:   Let's assume that there IS actually a problem with "too many" false positives.  The result would be a number of people going in for some very cheap, simple, routine EKG's.  That is a relatively minor problem -- particularly when compared to the risk of living the remainder of one's life with a debilitating stroke.  

    Compare that to the millions going in for routine colonoscopies that cost thousands but yet 99% find nothing -- while far cheaper, simpler and safer methods that are 90% as effective are available.

    The American healthcare industry only cares about "false positives" when they don't reap the benefit.  Colonoscopies bring in BIG bucks to the healthcare profession -- so they have no problem spending millions of our dollars for a 0.1% improvement in diagnostic effectiveness.

    But, let one person go to their doctor with a false positive EKG and its headline news!
    Actually, the issue of false positives is not so simple. Especially in colonoscopies (and in areas like mammograms).

    There is a large, credible literature on this issue and how it drives up health care costs. See, for example, the coverage of the work in NPR by a Gil Welch, a well-known researcher. He also has a well-received book on the topic, that gets into a lot more detail on this issue.
    Yeh, I agree that its not as simple as false-postives  Partly because the large providers, once they have the scent will keep following it (running tests) till they get a positive.

    3 weeks ago a poor guy in a group I run with got dizzy while he was running and, despite his objections, his fellow runners called an ambulance to take him to the hospital.   As soon I heard that I knew he would end up with a bypass or a stent.  And, I was right.  It took them almost 2 weeks and over a half dozen tests before they found something and told him:   "If we don't do a ($150K) bypass you will have a heart attack".  

    Not only did they look until they found something in this pretty fit and healthy guy.  But, accepted evidence shows that doing bypasses in non-emergency situations does NOT prevent heart attacks!  (A healthy lifestyle and medical management (meaning drugs) are more effective.)
  • Reply 31 of 34
    svanstrom said:
    AppleZulu said:
    This is, of course, just anecdotal evidence. It neither confirms nor refutes the hypothesis proposed that Apple Watch ECGs creating false positives will do more harm to more people than they will do good through true positives, as described in this story.

    It’s also true that there doesn’t seem to be the anecdotal evidence turning up that would at least provide some support for that ‘false positives’ hypothesis. You would also imagine that for the ‘false positives’ hypothesis to have much chance to be correct, that there would need to be a pretty significant number of anecdotes turning up of people who experienced some sort of harm or at least temporary anxiety resulting from a false positive reading. This is because the amount of good as described in the story atop this thread is significant: a life saved, or at least a life-changing health crisis averted. To offset that, the harm to an individual with a false positive would either have to be just as significant (unneeded treatment resulting either in death or in a life-changing health crisis), or there would have to be a large number of people experiencing lesser, but still significant harm (e.g., large medical bills, or significant anxiety resulting from false diagnosis of ‘heart problems’).

    So far, we’re not seeing those horror stories, and it seems pretty likely we would if there were any. Remember when Apple Watch 0 came out and a handful of people discovered that the pulse reader couldn’t see through dark tattoos? A tiny number of people experienced a problem and you would’ve thought that the Apple Watch was a complete failure and Apple was going to go out of business. Generally when there is even a small problem with an Apple product, there is a disproportionate if temporary uproar about it. 
    Just for the sake of example, let's flip that:   Let's assume that there IS actually a problem with "too many" false positives.  The result would be a number of people going in for some very cheap, simple, routine EKG's.  That is a relatively minor problem -- particularly when compared to the risk of living the remainder of one's life with a debilitating stroke.  

    Compare that to the millions going in for routine colonoscopies that cost thousands but yet 99% find nothing -- while far cheaper, simpler and safer methods that are 90% as effective are available.

    The American healthcare industry only cares about "false positives" when they don't reap the benefit.  Colonoscopies bring in BIG bucks to the healthcare profession -- so they have no problem spending millions of our dollars for a 0.1% improvement in diagnostic effectiveness.

    But, let one person go to their doctor with a false positive EKG and its headline news!
    Actually, the issue of false positives is not so simple. Especially in colonoscopies (and in areas like mammograms).

    There is a large, credible literature on this issue and how it drives up health care costs. See, for example, the coverage of the work in NPR by a Gil Welch, a well-known researcher. He also has a well-received book on the topic, that gets into a lot more detail on this issue.
    The problem is real, BUT… Essentially this whole scare about false positives is based not on information being available to people, but that their doctors end up treating people in a suboptimal way once at their office.

    Are there risk about going to see a doctor? Absolutely; there's no doubt about that. But if you can't trust your doctor, then you end up putting yourself in charge of having the medicial expertise needed to keep you healthy and alive. And that's almost as bad as putting Trump in charge of ending global warming.

    As an individual your job is to go see a doctor if you're worried; and it's all our jobs, as part of society, to make sure that the licensed medical professionals have the right skills needed to treat their patients right. We can't start going "you can't see doctors about [these medical conditions], because doctors can't be trusted diagnosing/treating those".
    Good points!  But, the best way is maintain your own health is with a healthy lifestyle:  Not smoking, little or no alcohol, normal weight, healthy diet and exercise.    Doing those things reduce the chances of needing a doctor by more than half (at least for the standard chronic diseases like heart disease, cancer, diabetes, etc...)

    A hospital is likely THE single most dangerous place to be in.   Far worse than any dark alley. 

    In addition:  People need to realize that we Do Not Have a Healthcare system.   We have a DiseaseManagement system.   You are your own healthcare provider.  You only need to see a Diseasemanagement specialist (aka "physician") when you fail in maintaining your health.
  • Reply 32 of 34
    svanstrom said:
    AppleZulu said:
    This is, of course, just anecdotal evidence. It neither confirms nor refutes the hypothesis proposed that Apple Watch ECGs creating false positives will do more harm to more people than they will do good through true positives, as described in this story.

    It’s also true that there doesn’t seem to be the anecdotal evidence turning up that would at least provide some support for that ‘false positives’ hypothesis. You would also imagine that for the ‘false positives’ hypothesis to have much chance to be correct, that there would need to be a pretty significant number of anecdotes turning up of people who experienced some sort of harm or at least temporary anxiety resulting from a false positive reading. This is because the amount of good as described in the story atop this thread is significant: a life saved, or at least a life-changing health crisis averted. To offset that, the harm to an individual with a false positive would either have to be just as significant (unneeded treatment resulting either in death or in a life-changing health crisis), or there would have to be a large number of people experiencing lesser, but still significant harm (e.g., large medical bills, or significant anxiety resulting from false diagnosis of ‘heart problems’).

    So far, we’re not seeing those horror stories, and it seems pretty likely we would if there were any. Remember when Apple Watch 0 came out and a handful of people discovered that the pulse reader couldn’t see through dark tattoos? A tiny number of people experienced a problem and you would’ve thought that the Apple Watch was a complete failure and Apple was going to go out of business. Generally when there is even a small problem with an Apple product, there is a disproportionate if temporary uproar about it. 
    Just for the sake of example, let's flip that:   Let's assume that there IS actually a problem with "too many" false positives.  The result would be a number of people going in for some very cheap, simple, routine EKG's.  That is a relatively minor problem -- particularly when compared to the risk of living the remainder of one's life with a debilitating stroke.  

    Compare that to the millions going in for routine colonoscopies that cost thousands but yet 99% find nothing -- while far cheaper, simpler and safer methods that are 90% as effective are available.

    The American healthcare industry only cares about "false positives" when they don't reap the benefit.  Colonoscopies bring in BIG bucks to the healthcare profession -- so they have no problem spending millions of our dollars for a 0.1% improvement in diagnostic effectiveness.

    But, let one person go to their doctor with a false positive EKG and its headline news!
    Actually, the issue of false positives is not so simple. Especially in colonoscopies (and in areas like mammograms).

    There is a large, credible literature on this issue and how it drives up health care costs. See, for example, the coverage of the work in NPR by a Gil Welch, a well-known researcher. He also has a well-received book on the topic, that gets into a lot more detail on this issue.
    The problem is real, BUT… Essentially this whole scare about false positives is based not on information being available to people, but that their doctors end up treating people in a suboptimal way once at their office.

    Are there risk about going to see a doctor? Absolutely; there's no doubt about that. But if you can't trust your doctor, then you end up putting yourself in charge of having the medicial expertise needed to keep you healthy and alive. And that's almost as bad as putting Trump in charge of ending global warming.

    As an individual your job is to go see a doctor if you're worried; and it's all our jobs, as part of society, to make sure that the licensed medical professionals have the right skills needed to treat their patients right. We can't start going "you can't see doctors about [these medical conditions], because doctors can't be trusted diagnosing/treating those".
    Again, not so simple as a Trump analogy. In the US doctors often practice defensive medicine because of the threat of litigation and worries about how it will drive up their (personal) insurance costs. The US system is broken at so many different levels, and it’s all connected. It is impossible to fix just some piece of it here or there (as Obamacare has now discovered). The entire thing needs dismantling and rebuilding.

    That said, I have no problems at all with — indeed, I applaud and celebrate — AppleWatch’s ECG app and capabilities. I hope that this sort of functionality grows into other areas of testing over time. 
    Obamacare never tried nor claimed to fix the actual healthcare system -- it is only a way to insure that everybody has access to it via insurance.   Yes, it did make a few token efforts at improving efficiency.  But 90% of it -- and a 100% of the debate -- is over who pays, how they pay and how much they pay.

    It was needed.   50 million Americans were locked out of the system.  But it was a bandaid covering a few wounds on a very beat up patient.

    But we continue the debates over payment mechanisms without fixing a Diseasemanagement system that is running and spending out of control.   We are like a family with run away credit card bills juggling payments to stay out of bankruptcy.  Until we control the spending, managing the payments only buys time but does nothing to fix the problem.
  • Reply 33 of 34
    I look at the Apple Watch as a way to get more data points under real world usage. The problem with doctor offices is it is slow to get an appointment and then the readings are not the same as usual due to change in environment, not under stress of work etc. 

    something I the untrained, noticed with my Apple Watch, is ever so often in my readings my heart rate drops below 60 BPM, sometimes below 50 BPM. My range over the last year and a half is 38 to 190. I’m not athletic. Sometimes it happens at night, but it happens during the day when I’m active. It is like a dip of 15-25BPM from the surrounding readings during the day. Sometimes my resting rate during the day is lower than at night. This happens several times a week. 

    Does anyone else else experience this? I know this isn’t a heath forum, but there seems to be knowledgeable people on here. I can’t seem to find information on dipping of the heart rate like this.  

    E: currently have the series 4, ECG hasn’t picked up anything bad, but is nice to have. I had the series 2. 
    edited January 11 GeorgeBMac
  • Reply 34 of 34
    GeorgeBMacGeorgeBMac Posts: 4,127member
    I look at the Apple Watch as a way to get more data points under real world usage. The problem with doctor offices is it is slow to get an appointment and then the readings are not the same as usual due to change in environment, not under stress of work etc. 

    something I the untrained, noticed with my Apple Watch, is ever so often in my readings my heart rate drops below 60 BPM, sometimes below 50 BPM. My range over the last year and a half is 38 to 190. I’m not athletic. Sometimes it happens at night, but it happens during the day when I’m active. It is like a dip of 15-25BPM from the surrounding readings during the day. Sometimes my resting rate during the day is lower than at night. This happens several times a week. 

    Does anyone else else experience this? I know this isn’t a heath forum, but there seems to be knowledgeable people on here. I can’t seem to find information on dipping of the heart rate like this.  

    E: currently have the series 4, ECG hasn’t picked up anything bad, but is nice to have. I had the series 2. 
    Below 50 or 60 -- for no apparent reason -- is termed "bradycardia".   And, technically, it should "looked at".   But I would be very careful about doing so.  In and of itself, bradycardia is not harmful (it's in fact normal for athletes and those on beta blockers or digitalis).  But, a cardiac surgeon or interventionist (which is 99% of the profession these days) are paid to find ways to cut you open.  Once they have a foot in the door, they'll keep looking till they find a reason.  Then they'll scare you into a $100K operation or "procedure" that often leaves you with lifelong issues that you didn't have previously.  

    If you do decide to have it checked, try to find a "preventive cardiologist" who can check it out without a financial incentive (or bias) to cut you open.
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