February 21, 2023
With the Apple Watch, researchers are exploring new frontiers in heart health
In a day, the heart of a healthy adult person beats more than 100,000 times. After each day, an image begins to emerge—one that is largely unseen. Apple Watch can help make the invisible visible. With heart health features — including high and low heart rate notifications, Cardio Fitness, irregular heartbeat notifications, an ECG app, and AFib History — Apple gives users ever-evolving insight into their health through actionable insights.
The same advanced technology that provides insights to help users better understand their health also has the potential to open the door to discovery for the research and medical communities. Since Apple launched ResearchKit and CareKit in 2015, researchers, clinicians, and developers have found innovative new ways to study, track, and treat a wide range of conditions.
To broadly increase health-improving discoveries, Apple has launched the Investigator Support Program. Through this program, Apple provides researchers with Apple Watch devices, enabling them to break new ground in health research, including the scientific understanding of the heart.
Apple is highlighting the groundbreaking work of health researchers around the world who are using the Apple Watch to study the heart like never before.
Associate Professor Rachel Conyers and Dr Claudia Turrow are senior pediatric oncologists from Melbourne, Australia who spend their days primarily caring for children in the Tertiary Pediatric Oncology Clinic and researching toxicology related to pediatric cancer treatments within the Murdoch Children’s Research Institute. Together, they are looking at how treatment can affect the heart rhythm and trying to identify innovative approaches to intervention. Inspiration for their work comes from their patients’ stories of success and heartbreak.
Toxicity in cancer treatment can lead to heart rhythm disturbances, such as prolonged QT syndrome, which can be life-threatening. A prolonged QT causes an irregular heartbeat, which increases the time needed for blood to flow through the heart.
Because of their susceptibility to long QT, children receiving cancer treatment are routinely screened at least once a week with a 12-lead electrocardiogram, according to Dr. Conyers. However, outpatients still need to be monitored.
“I read about the Apple Heart Study and thought this might be important for pediatrics,” said Dr. Conyers. “We used to think of cardiotoxicity as something that happened 10 years after treatment. But we now know that new cancer treatments (such as certain inhibitors or immunotherapy) can cause arrhythmias within 48 hours of treatment – so there is a big gap as to what We know about the toxicities at the moment.”
In the coming months, Dr. Conyers and her team at Murdoch Children’s Research Institute will begin researching the sensitivity of the Apple Watch ECG app in 40 pediatric and adolescent patients.1 From there, the team will look for ways for patients to take their EKGs wherever they are, and when they are able to. With these insights, the team hopes to better understand the reality of cardiac toxicity and identify potential opportunities for intervention.
Every Bay Area resident remembers the day the sky turned orange. It happened on September 9, 2020. It was Dr. Su Min Cheung, Assistant Professor in the Department of Public Service and Management at the Bush School, Texas A&M University, in Palo Alto, California.
“I still have pictures of that day on my iPhone,” said Dr. Cheung.
California experienced a series of devastating wildfires in 2020 and 2021. Dr. Cheung, who researches the social and health consequences of environmental disasters and climate change, saw an opportunity to study the personal impact of wildfire smoke on the heart health of firefighters.
“General health recommendations or off-the-shelf interventions weren’t good enough for me,” explains Dr. Cheung. “People are unique. Everyone is different when it comes to their health, and I wanted to know more.”
Through her contacts in the research community, Dr. Cheung has learned that the Apple Watch can help capture the kind of health data she needs. “One of my colleagues at Stanford shared their experience using the Apple Watch, which is known for heart rate accuracy,” she adds. “I’ve always wanted to be able to do more non-invasive, sensor-based analyzes of people to get more accurate health measurements.”
Next month, Dr. Cheung of Texas A&M University and Dr. Brian Kim and Marco Perez of Stanford Medicine will begin equipping firefighters with an Apple Watch to study the effect of wildfire smoke on heart health. Wildfire season begins in spring in Texas and summer in California, and up to 200 firefighters at these locations will join the study.
From the Apple Watch, the study plans to monitor heart rate, cadence, sleep, blood oxygen, activity data, and more. Firefighters will also wear an air quality monitor and complete surveys regarding sleep, activity, and symptoms associated with wildfire smoke.
“Firefighters will benefit from this study,” shares Dr. Cheong. “We know that wildfire smoke directly affects their health and with a study like this, they will be able to see their results in real time.”
But she doesn’t want to generalize the potential findings of the study at this point, especially when the primary focus of the research is the kind of accurate individual health data the Apple Watch can provide.
“Such studies have not been done before, so it is not a matter of proving or disproving a hypothesis,” said Dr. Cheung. “It’s more exploratory and the results will help us understand the rigor of an analysis like this for generating personalized interventions. I also think a study of this type can help us better understand high-risk groups.”
According to epidemiologists in Europe, the estimated incidence of atrial fibrillation (AFib) in the European Union is expected to double by 2060. AFib is a common heart rhythm disorder that can have serious effects – such as an increased risk of stroke or heart failure – if left untreated.
At the University of Amsterdam Medical Centers, Dr. Sebastian Block, director of eHealth at Cardiology Centers in the Netherlands, and colleagues are exploring ways to detect AFib early. Researchers developed a randomized controlled study as part of a larger initiative called HartWacht, the first reimbursable e-health concept.
“There are about 300,000 people diagnosed with atrial fibrillation,” said Dr. Nicole van Stegen, an investigator on the research team, in the Netherlands. “But there are also an estimated 100,000 people who have it but don’t know, likely because they haven’t had symptoms.”
As part of their study, they plan to enroll more than 300 patients over the age of 65 who meet the risk threshold for AFib. Half of the participants – the intervention group – would wear an Apple Watch for at least 12 hours a day.
“The Apple Watch is such a widely used and reliable wearable device for the consumer that we thought it would be a great device for us to incorporate into our research to better understand how it fits into the larger health system,” shares Dr. Block.
As part of the group study design, participants are expected to have an EKG every three weeks, or if they begin to experience symptoms. If the participant receives an irregular rhythm notification, the researchers will contact the participant and instruct them to take an EKG and share the results.
Within three weeks of the study, the researchers were able to identify a participant with AFib in the intervention group who was not experiencing any symptoms.
This study marks the beginning of what they hope to understand with the Apple Watch. In the future, they plan to explore ways to identify possible opportunities to use an ECG app to monitor patients from home, since some medications can alter heart rhythms. They’re also considering how to use the Apple Watch to monitor heart failure patients from home, since it’s an expensive disease, and identify predictive biomarkers of disease progression.
“We continue to grow and innovate with new opportunities based on science and technology,” said Dr. Block.
- The ECG app has been cleared for use in adult patients. Children’s use is limited to experimental use only.
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