Atrial fibrillation (Afib) is a cardiac arrhythmia that is characterized by the abnormal electrical signaling in the atria of the heart. This arrhythmia increases the risk of other cardiac events and mortality because the heart is not pumping blood efficiently. Treatment of Afib however greatly decreased these risks. Therefore it is important to diagnose and treat the arrhythmia to mitigate risk of mortality.
The Apple watch is changing the field of Cardiology and
Primary Care. This watch is able to record not only heart rate, but it can also measure a 1 lead ECG. As more people are purchasing fitness trackers including the Apple watch, an increasing number of people being alerted to possible heart arrhythmias including Afib. While there has been praise for the new technology,
there are still questions of the ethics and whether the beneficence to patients
outweighs non-maleficence of the product. If patient’s
are being falsely alerted about an arrhythmia, this could cause unnecessary harm
in the form of stress. Also if people are being falsely alerted this may put
unnecessary strain on resources available including ECHO work up. Recently the Apple Heart Study was results were released. The study was able to enroll over
400,000 and alerted 0.52% of participants of a possible arrhythmia. Of the
participants alerted, 34% were confirmed to have an arrhythmia through EKG patch
monitoring. These values are less accurate than other monitors currently available on the market. Is it ethical for Apple to
be marketing the watch for this specific benefit when it is not as accurate as
other devices to monitor heart health?
References:
Apple Heart Study
Identifies AFib in Small Group of Apple Watch Wearers. (2019, March 16).
Retrieved from
https://www.acc.org/latest-in-cardiology/articles/2019/03/08/15/32/sat-9am-apple-heart-study-acc-2019.
Giebel, G. D., & Gissel,
C. (2019). Accuracy of mHealth Devices for Atrial Fibrillation Screening:
Systematic Review. JMIR MHealth and UHealth, 7(6). doi:
10.2196/13641
I think that the apple watch's ability to alert people to possible heart arrhythmias is a good idea in theory but without accuracy, I don’t think it is ethical. Altering to people to heart arrhythmias may cause stress and panic for no reason. This would not serve as non-malfeasance and would potentially cause more harm in scaring people and making them think they need unnecessary testing. Many people have palpations that occur randomly and are not harmful, “most palpitations are caused by a harmless hiccup in the heart's rhythm. A few reflect a problem in the heart or elsewhere in the body” (Harvard Health, n.d.). I think that until this function of the apple watch is perfected it is not ethical to use because it will cause more harm than good. If people feel like they are having arrhythmias and have symptoms they should go to the ED or make a doctor’s appointment and not stress too much over what their watch says.
ReplyDeleteHarvard Health Publishing. (n.d.). Skipping a beat - the surprise of heart palpitations. Retrieved from https://www.health.harvard.edu/heart-disease-overview/skipping-a-beat--the-surprise-of-palpitations.
We must remember that medical tests are never perfect - false positives and negatives will always be present. However, it seems that the Apple watch heart monitor feature is providing more benefits than negatives to the public. In one case, a Tampa Bay teenager was admitted to the ER after her Apple Watch alarmed her that her resting heart rate hit 190 bpm - the watch alarm saved the teenager's life(Smith, 2018). Furthermore, the watches accuracy does increase with the age of the user. Positive predictive values for A-fib are above 60% percent among users of age 55+ (Yazdi, 2019). As such, I believe Apple is doing a great service by releasing this feature.
ReplyDeleteSmith, Ryan. “Hillsborough Teen: Apple Watch Saved My Life.” WFTS, 1 May 2018, https://www.abcactionnews.com/news/region-hillsborough/hillsborough-teen-apple-watch-saved-my-life.
Yazdi, Daniel. “Apple Watch 4 Is an Iffy Afib Detector in People under Age 55.” STAT, 7 Jan. 2019, https://www.statnews.com/2019/01/08/apple-watch-iffy-atrial-fibrillation-detector/.