Apple Watch, Fitbit users with heart conditions get more medical procedures

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People with irregular heartbeats who use wearable devices such as Apple Watches and Fitbits do not overwhelm doctors with concerned phone calls about their hearts, a new study shows. But they are more likely to be treated with a heart procedure called ablation, the analysis found.

The small study is one of the first to show how people with existing heart problems are using wearables. Devices like the Apple Watch have a heart monitoring feature that can alert users if they have an irregular heartbeat. Technically, those features on the Apple Watch are only authorized by the Food and Drug Administration (FDA) for people who: do not have underlying heart disease. But people with heart conditions, including a type of abnormal heart rhythm called atrial fibrillation, can still buy the watch and use the same features.

Cardiologists regularly see patients diagnosed with atrial fibrillation provides data from an Apple Watch or Fitbit, says study author Libo Wang, a cardiologist at the University of Utah School of Medicine. “There are a large number of patients using these wearables outside of the FDA-approved indication,” he says. “That was kind of motivation to get started, not sounding the alarm, but asking questions.”

When companies like Apple ask the FDA to approve a medical device, most of the emphasis is on making sure the device does what it promises — without producing too many false positives or negatives. Less attention is paid to what users and doctors do with the information. That’s what researchers study now, and this new study took an early look at what wearables could mean for people with atrial fibrillation.

The study looked at 125 people with atrial fibrillation who attended the University of Utah Health over a 90-day period and reported using a wearable, including an Apple Watch or a Fitbit. The team compared them to a group of 500 people with the same condition who didn’t use a wearable but had similar characteristics, including age, socioeconomic status and the number of times they typically saw a doctor.

“The people who wore wearables didn’t necessarily call the office more often,” Wang says. That was a welcome surprise, he says: Many doctors feared they would get more calls from concerned patients wearing a device like an Apple Watch.

Over the 90 days, the group using wearables had a similar average heart rate as the group that didn’t — indicating they had roughly the same average heart health. But people with wearables underwent more medical procedures in those three months. In particular, this group was more likely to have an ablation, a type of procedure that scars the heart to restore a normal heartbeat.

The study is small and only looks at patient visits from one hospital. It too can’t answer the chicken-or-egg question: It’s not clear from this study whether the people who wore wearables and had ablations actually had more severe symptoms than the control group and needed treatment, or whether the wearables urged them to have a doctor prematurely.

It could be that people with heart conditions who decide to buy an Apple Watch do so because they feel more symptoms and want a good way to report that to a doctor, Wang says. “That may be appropriate, and they may benefit from the ‘extra’ ablation.” Alternatively, patients may see their watch indicating an abnormal heart rate and worry that their atrial fibrillation is getting worse — even if it isn’t. “That can be a waste of time and risk for the patient,” he says.

Previous research found that the Apple Watch’s heart function led to unnecessary doctor visits for people who: not done have underlying heart disease. Only 10 percent of people who visited their doctor after having a a warning from their watch went on to get a new heart diagnosis, one study found.

There is more data on wearables in people without underlying conditions than in people with underlying conditions, because this is the group that the Apple Watch’s heart monitor was originally tested on. But cardiologists need more information about what the devices mean for people with atrial fibrillation, Wang says — these patients are already using them, and some doctors are even encouraging patients to wear one. He hopes that further research can provide more conclusive answers. “We need more clarity.”