4 ms·

With due respect to the Cardiogram developers (hi guys) as a doctor I really can't see a huge amount of value in this - my patients who present to emergency dep

With due respect to the Cardiogram developers (hi guys) as a doctor I really can't see a huge amount of value in this - my patients who present to emergency departments with paroxysmal AF are all anticoagulanted or on rate control and there has only been one instance in the last 3 years and many thousand patients when someone has presented to emergency and we have had to run through the full spectrum of echo -> anticoagulante -> cardiovert. To the founders: what do you see as being he end game here? Are you just looking for validation (of the concept in itself, not the app- I use it on my watch)? Is the US market so different that this is particularly useful and cost effective for detection? Do you see this as eventually displaying early warning in the instance of an early warning? Thanks and I don't mean to denegrate your efforts, but I do see lots of Consumer Med tech as solving a problem that really isn't creating value (i.e. Proliferation of devices,wearables and algorithms that proclaim the ability to help with X but are really marginally helpful at best) and I'm wondering if I'm missing something about the actual medical benefit, or whether what I feel like is true- that they aren't after being a medical device at all but instead are chasing the consumer dollars by making medical claims

pm90 9y ago
Not the developer or founder, but a user of Apple Watch. I would like to see your questions answered as well. But as a hopeful consumer, I hope wearable devices / medtech startups direct more attention and funding to improving sensors and associated detection algorithms to such an extent that at some point in the future, it would actually be useful to real doctors and offer real medical benefits.
ithinkinstereo 9y ago
Wouldn't this help with pre-stroke detection? The article mentioned that 1 in 4 strokes are caused by AFib. I would imagine this would be helpful for in-patient Neuro-ICU and stroke hospitalists. On the patient side, shouldn't something like this - assuming the monitoring is in real-time - provide a preventative/detection benefits for patients with a high-risk for stroke?
- brandonb 9y ago
  This is exactly right—the benefit is to prevent strokes by detecting undiagnosed atrial fibrillation.
- caycep 9y ago
  Even before that - putting in on an Apple Watch potentially enables screening from a public health perspective. I'd rather prevent the stroke rather than regretfully putting the patient on coumadin after they've been paralyzed...
brandonb 9y ago
Circulation published a nice review this week on the rationale for atrial fibrillation screening: circ.ahajournals.org/content/135/19/1851.full?ijkey=StzSPk8eljGaP2G&keytype=ref The main reason is that 10% of strokes are associated with undiagnosed atrial fibrillation. The patients who present to the emergency room are a pretty biased sample--for one, they're experiencing symptoms. To prevent strokes, we need to have a way to catch AF in asymptomatic people. Part of the challenge here is that episodes of atrial fibrillation can be infrequent--in CRYSTAL-AF, for example, it took 84 days from randomization to first episode--and existing monitoring devices like Holters or Zio patches are only worn 24 hours to 2 weeks. The great thing about Apple Watch and other consumer wearables is that they're worn for months or years. That means if we can prove the algorithm is accurate, we can get higher time-coverage than a traditional medical device, catch more AF early, and prevent those 10% of strokes described in the Circulation article.
- robbiep 9y ago
  Thanks for taking the time to reply, I can now better see how this could be of benefit
  - tptacek 9y ago
    Thanks for taking the time to ask that question! This was super interesting.
- lbhnact 9y ago
  Hi Brandon- I can't find good tables in the article or on your teams site. [edited] I know you guys take your numbers seriously but I'd love to see anything allowed out pre-publication. [edit]Thanks to poster below I see this is AUC. Thanks!
- deleted 9y ago
  [deleted]
- wdewind 9y ago
  This is really cool. I have an ICM (Medtronic LINQ) for something I don't believe an iWatch could detect so this isn't an option for me, but I do know they are sometimes used for AF as well, and mine cost over $60,000 to implant (billed to insurance, though my part was still much more than an iWatch costs). I have to think doing the same with an iWatch massively increases the pool of people who are capable of affording continuous monitoring.
coldtea 9y ago
>With due respect to the Cardiogram developers (hi guys) as a doctor I really can't see a huge amount of value in this - my patients who present to emergency departments with paroxysmal AF are all anticoagulanted or on rate control and there has only been one instance in the last 3 years and many thousand patients when someone has presented to emergency and we have had to run through the full spectrum of echo -> anticoagulante -> cardiovert. Isn't this a version of survivorship bias? Who about to those who aren't that lucky to manage to overcome the attack and become patients...
- robbiep 9y ago
  AF is rarely fatal, although stroke is significantly disabling. Normally (well, I don't have any figure at hand and I'm not about to go and research it at the moment, but I'm using the term in the sense of >50% but <85%) of AF instances come with some sort of symptoms... feeling faint, pounding chest, shortness of breath... good questioning can be fairly diagnostic in the doctors clinic or emergency room. But yes, as the Cardiogram guys point out in their reply to me, and in the source article, a significant number of people have strokes secondary to AF.
caycep 9y ago
Actually this is a huge game changer from a neurology perspective: 1) for folks who show up in the hospital, with a stroke, often the cause is not clear. So they go home on aspirin but the latest studies seem to indicate that fully 30% of these folks with "cryptogenic stroke" end up being diagnosed with PAF after 3 months on a heart monitor. 2) this heart monitor is either a cumbersome external device they have to wear for 3 months, or the Medtronic LINQ implantable loop recorder, which is nice and under the skin, but costs a lot of money for a cardiologist to implant and monitor. 3) from a public health perspective, if the Apple Watch can automatically detect paroxysmal A-fib BEFORE a stroke (i.e. permanent paralysis, inability to speak, etc)...think of the massive societal benefits this could be...
jrnichols 9y ago
As a Paramedic here in the US, I'd be happy to see more people alerted to unusual cardiac conditions via their Apple Watch early as possible rather than finding out weeks later after damage has been done. We don't convert afib in the field, but having an Apple Watch catch someone that's in SVT would be great. Reading down in the thread, I see that it's happened at least once.

pm90 9y ago

Not the developer or founder, but a user of Apple Watch. I would like to see your questions answered as well. But as a hopeful consumer, I hope wearable devices / medtech startups direct more attention and funding to improving sensors and associated detection algorithms to such an extent that at some point in the future, it would actually be useful to real doctors and offer real medical benefits.

ithinkinstereo 9y ago

Wouldn't this help with pre-stroke detection? The article mentioned that 1 in 4 strokes are caused by AFib. I would imagine this would be helpful for in-patient Neuro-ICU and stroke hospitalists. On the patient side, shouldn't something like this - assuming the monitoring is in real-time - provide a preventative/detection benefits for patients with a high-risk for stroke?

brandonb 9y ago
This is exactly right—the benefit is to prevent strokes by detecting undiagnosed atrial fibrillation.
caycep 9y ago
Even before that - putting in on an Apple Watch potentially enables screening from a public health perspective. I'd rather prevent the stroke rather than regretfully putting the patient on coumadin after they've been paralyzed...

brandonb 9y ago

Circulation published a nice review this week on the rationale for atrial fibrillation screening: circ.ahajournals.org/content/135/19/1851.full?ijkey=StzSPk8eljGaP2G&keytype=ref The main reason is that 10% of strokes are associated with undiagnosed atrial fibrillation. The patients who present to the emergency room are a pretty biased sample--for one, they're experiencing symptoms. To prevent strokes, we need to have a way to catch AF in asymptomatic people. Part of the challenge here is that episodes of atrial fibrillation can be infrequent--in CRYSTAL-AF, for example, it took 84 days from randomization to first episode--and existing monitoring devices like Holters or Zio patches are only worn 24 hours to 2 weeks. The great thing about Apple Watch and other consumer wearables is that they're worn for months or years. That means if we can prove the algorithm is accurate, we can get higher time-coverage than a traditional medical device, catch more AF early, and prevent those 10% of strokes described in the Circulation article.

robbiep 9y ago
Thanks for taking the time to reply, I can now better see how this could be of benefit
- tptacek 9y ago
  Thanks for taking the time to ask that question! This was super interesting.
lbhnact 9y ago
Hi Brandon- I can't find good tables in the article or on your teams site. [edited] I know you guys take your numbers seriously but I'd love to see anything allowed out pre-publication. [edit]Thanks to poster below I see this is AUC. Thanks!
deleted 9y ago
[deleted]
wdewind 9y ago
This is really cool. I have an ICM (Medtronic LINQ) for something I don't believe an iWatch could detect so this isn't an option for me, but I do know they are sometimes used for AF as well, and mine cost over $60,000 to implant (billed to insurance, though my part was still much more than an iWatch costs). I have to think doing the same with an iWatch massively increases the pool of people who are capable of affording continuous monitoring.

coldtea 9y ago

>With due respect to the Cardiogram developers (hi guys) as a doctor I really can't see a huge amount of value in this - my patients who present to emergency departments with paroxysmal AF are all anticoagulanted or on rate control and there has only been one instance in the last 3 years and many thousand patients when someone has presented to emergency and we have had to run through the full spectrum of echo -> anticoagulante -> cardiovert. Isn't this a version of survivorship bias? Who about to those who aren't that lucky to manage to overcome the attack and become patients...

robbiep 9y ago
AF is rarely fatal, although stroke is significantly disabling. Normally (well, I don't have any figure at hand and I'm not about to go and research it at the moment, but I'm using the term in the sense of >50% but <85%) of AF instances come with some sort of symptoms... feeling faint, pounding chest, shortness of breath... good questioning can be fairly diagnostic in the doctors clinic or emergency room. But yes, as the Cardiogram guys point out in their reply to me, and in the source article, a significant number of people have strokes secondary to AF.

caycep 9y ago

Actually this is a huge game changer from a neurology perspective: 1) for folks who show up in the hospital, with a stroke, often the cause is not clear. So they go home on aspirin but the latest studies seem to indicate that fully 30% of these folks with "cryptogenic stroke" end up being diagnosed with PAF after 3 months on a heart monitor. 2) this heart monitor is either a cumbersome external device they have to wear for 3 months, or the Medtronic LINQ implantable loop recorder, which is nice and under the skin, but costs a lot of money for a cardiologist to implant and monitor. 3) from a public health perspective, if the Apple Watch can automatically detect paroxysmal A-fib BEFORE a stroke (i.e. permanent paralysis, inability to speak, etc)...think of the massive societal benefits this could be...

jrnichols 9y ago

As a Paramedic here in the US, I'd be happy to see more people alerted to unusual cardiac conditions via their Apple Watch early as possible rather than finding out weeks later after damage has been done. We don't convert afib in the field, but having an Apple Watch catch someone that's in SVT would be great. Reading down in the thread, I see that it's happened at least once.