Mr Deneke, you are the chief doctor of a cardio-vascular clinic. This week, Apple brings new features to the Apple Watch, the heart can more closely monitor, among other things, with the clock built-in ECG. They are afraid that the emergency ambulances will burst in German hospitals, therefore, soon bursting at the seams?
no, not a bit. This fear has not been fulfilled in the USA, where the functions are no longer available.
With the new functions, the Apple Watch will be able to independently recognize atrial fibrillation. What is it actually?
simply put, it is atrial fibrillation is a completely irregular pulse, is due to the Atria by an electrical Chaos in the Heart, where the pulse occurs. Atrial fibrillation is usually caused by incorrect spark plugs, which sit in the Atria. The can affect anyone. In General, the risk is increasing due to various risk factors, which occur in particular in the higher age, such as hypertension, heart failure, or scarring of the Atria.
As a young person, you have to make so no Worries?
atrial fibrillation can also meet 20-Year-old. Binge drinking is another risk factor. One of the classics of the big bachelor party is where you Wake up the next day with heart palpitations, it can also plug in atrial fibrillation. This can be very uncomfortable, but also completely asymptomatic. You can also find high-performance athletes, who train very much and intensive care, and atrial fibrillation.
In Germany are affected, estimates suggest that up to 1.5 million people.
Exactly, that’s the equivalent of just under two percent of the population. In the Over-80-Year-olds, the proportion rises to almost ten percent. This makes atrial fibrillation to suffer from a real people. And there is a very large dark figure, because there are many asymptomatic patients or patients who are diagnosed with, despite the discomfort yet still nothing.
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How dangerous is the disease?
First of all, it is not life-threatening. The great danger, however, lies in an increased risk for a stroke. We assume that 30 percent of strokes with atrial fibrillation. Therefore, you should detect it at an early stage.
And how the Apple Watch detects this cardiac rhythm disorder?
The watch automatically checks the heartbeat and pay attention to an irregular heart rhythm, atrial fibrillation could hide. The first is the great advantage of the Apple Watch in comparison to the conventional Monitoring: The watch continuously collects data, from which you can derive a lot of information. However, it is limited in the current Version. You must have five times seen in at least one-hour intervals, heart rhythm abnormalities before they warn the user. That is, you get caught, inevitably, more prolonged atrial fibrillation episodes, and not the very short, at the beginning of a disease is more likely. However, Apple reduced by the strict algorithm is also the risk to have false-positive results.
so You have to weigh.
We must first gain experience in clinical practice. I think, patients with longer episodes, or even permanent atrial fibrillation can be used to filter out very quickly now. In a large study, Apple has investigated, together with Stanford University, more than 400,000 people on heart rhythm disorders. The algorithm of the clock was long-time-ECG as compared. The result: The watch does not work perfectly, it will not be a 100% Match – but 85 per cent. That is, if the algorithm of the Apple Watch said, the heart rate is irregular, this was seen 85 per cent, with a synchronous-scale ECG as atrial fibrillation.
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this Is better or worse than you had expected?
That’s pretty good. Other systems, such as implants, are also not 100 percent. So, there are some people around extra beats of the heart, which can make the pulse very irregular, without which it is equal to atrial fibrillation. In this respect, the 85 per cent, are quite good. Of course, one can always hope that it will be even better. But for a first serve that is remarkable.
in addition to the detection for atrial fibrillation, there is still a further innovation: the latest Version of The Apple Watch provides an EKG.
I test the electrocardiogram already since last December, when the function has been activated in the United States. First of all, it is intuitive to use and is very fast. But above all it is extremely good in my opinion.
The Monitoring for heart rhythm disorders will happen automatically in the Background. The ECG is necessary to start active. When is that ever useful?
If you have complaints and don’t want to know if something is wrong with the heart rhythm in order, I would first feel the pulse. Ultimately, the Apple Watch does nothing else, even if by the Algorithms in a little more detail than you can as a layman with the fingers. As a young Non-heart patient, you do not need to write, however, regular ECG. This is only relevant if you have unclear complaints, which may indicate, possibly, a heart rhythm disorder. If you grass around suddenly, heart felt and difficult breathing, and barely the top of the hill, although it is actually fit. Then you should record in this period, ECG and these results then with the treating doctor to discuss.
The Apple Watch uses a one-channel ECG. The hospital standard is a Twelve-channel ECG. How reliable is the clock is working at all?
When it comes to diagnose atrial fibrillation, that’s good enough. For this you need a rule, not a dedicated Twelve-channel ECG analysis. For other arrhythmias, or for the detection of circulatory disorders of the heart however, you need twelve channels. But the Apple Watch is not designed. It is first and foremost necessary to recognize the widespread disease atrial fibrillation at an early stage. Drawing the consequences of this, is hard to say right now. We are only at the very beginning in this area.
Apple has claim to save with this watch life. You think that is realistic?
This is, of course, prove difficult to get. But if you will be so used, as you should, then I can imagine that to prevent strokes, and thereby perhaps also one ordere can save lives.
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The Valuable to watch what she’s doing in the Background.
Definitely Yes. The EKG is good and beautiful. The real Trick is the automated, user-friendly analysis of the collected data. When it comes to the ECG, one has to take care that the evaluation happens always paired with a doctor.
The watch is going to replace the doctor’s visit?
no. The claim the Apple Watch is not even, it is more of a Warning device. Would criticize, I already have a different aspect: In the Apple-heart study, many patients were detected with atrial fibrillation. But only a few are then also went to the doctor to discuss what these findings mean in concrete terms for you. There is a gap in Motivation is yet. Here you have to begin a closer connection to the medical field, in so far as it gets implemented in the country of data protection.
what is your conclusion?
We are at the beginning of a promising technology. I am delighted how well the ECG looks like and think that we are quite ahead in terms of strategies for the detection and treatment of atrial fibrillation. If it has, ultimately, a clinical value, it will be seen later. We will try to integrate it in our clinic everyday in the follow-up of treated patients. I also believe that we can overcome with these technologies, many of the problems in rural regions. We are a huge heart-the centre “in the country”, in the middle of the Rhön. Our patients have rather rural structures and have come a long way, sometimes just for an EKG to write. As it is very helpful if you can use the media actively to communicate with the patients as closely as possible and to allow you to still use all the freedoms. These things we must not close ourselves as Doctors, but we need to use it. This is the way of the future.
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