Last year, to much fanfare, Apple announced two new additions to the Apple Watch. There's an ECG app exclusive to the Series 4 that can indicate whether your heart rhythm shows signs of atrial fibrillation (AFib) -- the most common type of irregular heartbeat and a major risk factor for stroke -- and the irregular heart rhythm notification (for all Apple Watches) which will alert you of irregular heart rhythms suggestive of AFib.
Heart disease and stroke, despite being preventable, remain the leading cause of death for both men and women in the US, so it makes sense that people would be eager to adopt any sort of preventative heart-related technology. Stories about the Apple Watch's ECG feature saving lives certainly haven't hurt either.
But how helpful are these AFib features really? And are they right for you or a loved one? If you're considering buying a Series 4 -- or holding out for a Series 5 -- just for the ECG app, here are a few things cardiologists want you to know.
Apple Watch ECG vs. hospital EKG: Not the results I was expecting
AFib is a serious problem, but probably not among Apple Watch wearers
Sales research from the NPD Group shows that adults aged 18 to 34 are buying smartwatches more than any other age demographic. And EMarketer predicted that in 2019 consumers aged 25 to 34 will remain the largest group to purchase wearables.
Contrast that with the fact that the CDC estimates AFib affects somewhere between 2.7 million and 6.1 million Americans, but the majority of those people are over the age of 65. In fact, only approximately 2% of people younger than age 65 have AFib and it's estimated that only 1% of the population may have undiagnosed AFib. In the latter two groups, AFib episodes are often brief, cause no symptoms and may not require treatment.
Now playing: Watch this: We tested the Apple Watch EKG against a hospital EKG
4:28
This is all to say that if you're young, healthy and don't already have any diagnosed health problems, you might not experience significant benefits from the ECG app, or the watch's other heart rate features. However, the Apple Watch has, on multiple occasions, alerted people both young and old about heart issues they didn't know existed.
Experts are unsure whether widespread screening for AFib is beneficial
The American Heart Association and the American Stroke Association has found that screening for AFib in the primary-care setting among people older than 65 years of age using pulse assessment followed by ECG, if warranted, can be useful.
But when the US Preventive Services Task Forceweighed the potential benefits (early detection) against the potential harms (misdiagnosis, additional testing, invasive procedures and overtreatment), it found that the available evidence was too inadequate to support a conclusion one way or the other.
And because most of the AFib and stroke prevention studies have focused on the older populations who are most at risk, even less is known about the value of screening for AFib in healthy individuals under age 65. For instance, Dr. Venkatesh Murthy, professor of preventive cardiology at the University of Michigan, estimates that 90% of irregular rhythm alerts in younger groups are false alarms.
As a result, experts worry that putting Apple's screening technology on the wrists of millions of people who are likely to be young and healthy could increase the risk of overtreatment. Especially when that technology is still so new and based on studies that haven't been published in peer-reviewed journals. You can read some of the comments from the medical community here, hereand here.
"I'm an advocate of identifying asymptomatic atrial fibrillation, especially in high-risk populations," says Dr. Anthony Pearson, a Missouri-based board-certified cardiologist. "But we have to have a highly sensitive and specific way of doing it. In the younger population, if they don't have two or more risk factors [for stroke] then identifying them is nice but it's not going to prevent a stroke."
The Apple Watch is not a replacement for medical care
The Apple Watch can be a useful tool for monitoring your heart health, but it has limitations.
It's able to check your heart rhythms, or the electrical impulses that coordinate your heartbeat, for any irregularities. Occasionally throughout the day -- about every two hours, depending on your activity levels -- the Apple Watch will check your heart rhythms, looking for arrhythmia, which occurs if these impulses don't work properly, causing your heart to beat too fast, too slow or irregularly. If the Apple Watch detects signs of an irregular rhythm five out of six times in a row within 48 hours, you'll receive an irregular rhythm notification.
The Apple Watch can also detect possible AFib via its ECG app. This feature replicates a single-lead ECG with a titanium electrode in the watch's Digital Crown and a layer of chromium silicon carbon nitride on the back of the watch. When you place your fingertip on the electrode, it creates a closed circuit from finger to heart to wrist and allows the watch to record the electrical impulses that make your heart beat.
While these features are a big step in giving everyday consumers access to preventative medical tests outside of the doctor's office, neither of these methods are a replacement for going to the doctor or using any monitor that your doctor may give you (and Apple agrees). Here's why:
To properly diagnose when someone is in AFib, doctors use 12-lead ECG machines. (Doctors in the US usually call them EKGs, but it's the same thing, an electrocardiogram.) They use electrodes placed on different parts of the body to evaluate the heart's electrical activity in three directions (right to left, up and down, and front to back), which provides a clearer picture of its movement through the heart's four chambers.
Because AFib is known to come and go, if it's not present during an appointment, a doctor may ask a patient to wear a simplified version of the 12-lead ECG at home so they can monitor their heart rhythms over a longer period of time. However, even these mobile monitors typically use two to three leads and run continuously over days, weeks or even months, says Murthy.
AFib is the only heart issue the ECG app can detect
A woman recently wrote to Dr. Pearson, the cardiologist, asking whether the Apple Watch could help detect a future heart attack in her husband, who had already had one at age 36. "The answer is a resounding and unequivocal NO!" Pearson responded via his blog, The Skeptical Cardiologist.
The Apple Watch can only detect irregular heart rhythms, which are a risk factor for stroke. As Apple's website states: The ECG app can't detect a heart attack, blood clots, stroke or other heart-related conditions, including high blood pressure, congestive heart failure, high cholesterol or other forms of arrhythmia.
These irregular rhythm features aren't for everyone
Apple's main disclaimer about the ECG app is that it should only be used by people 22 years old or above. But it also states that heart rates under 50 or over 120 beats per minute can affect the app's ability to check for AFib, leading to inconclusive results.
Low heart rates are common among fit, athletic individuals, but can also be caused by certain medications. High heart rates may be caused by exercise, stress, alcohol, dehydration, infection or AFib itself.
The irregular rhythm notification feature is only cleared for use in people who are at least 22 years old and have no prior history of AFib. Apple is also careful to point out that the watch is not constantly looking for AFib, stating, "This means the Apple Watch cannot detect all instances of AFib, and people with AFib may not get a notification."
The Apple Watch's ECG app isn't your only option
Portable and home-based ECGs are becoming increasingly common and have the potential to transform medical care, according to a 2018 study in the Journal of Arrhythmia. But, as the study authors note, research supporting their accuracy and ease of use is still scant.
If you think you could benefit from an at-home ECG monitor, talk to your doctor about whether that strategy is right for you and what device they'd recommend.
Pearson has been using AliveCor's KardiaMobile single-lead ECG device with dozens of AFib patients since 2013 and Kardia Pro, a cloud-based software platform that allows him to monitor their results, since 2017. He says the combination is "eliminating any need for short- or long-term cardiac monitors."
"It's like night and day how much more information I get and how I'm able to manage their atrial fibrillation without bringing them into my office or an emergency room or putting expensive monitors on them," says Pearson, who does not receive any compensation from AliveCor. "It's dramatic how improved my care is with these devices."
Last month, AliveCor also launched KardiaMobile 6L, the first FDA-cleared direct-to-consumer six-lead ECG. It can detect AFib, bradycardia (abnormally low heart rate), tachycardia (abnormally high heart rate) and more.
The bottom line
If you're healthy and haven't been diagnosed with AFib or any conditions that put you at risk for it -- such as high blood pressure, diabetes or heart failure -- Murthy says the best thing you can do to take care of your heart is to follow what the American Heart Association calls Life's Simple 7. "Exercise, eat right, stop smoking and lose weight. If you have high blood pressure, high cholesterol or elevated blood sugar, manage that under the care of a doctor."
If an Apple Watch can help you or motivate you to do those things, great. If not, using one isn't necessary.
If you've already been diagnosed with AFib or are experiencing prolonged periods of heart palpitations or a racing heartbeat, talk to your doctor about whether at-home monitoring is right for you. For now, both Murthy and Pearson are holding off on recommending that their patients get an Apple Watch solely for its irregular heart rhythm features.
"I generally recommend devices that can record continuous ECGs over long periods of time rather than the intermittent snapshot of the Apple Watch," says Murthy. "That said, future data may help us decide if that's necessary or if intermittent ECGs coupled with photoplethysmography-based rhythm monitoring [like what the Apple Watch does] is sufficient."
Note: The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.
The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a physician or other qualified health provider regarding any questions you may have about a medical condition or health objectives.
FAQs
Which Apple Watch can read ECG? ›
Apple Watch Series 4 and later has an electrical heart rate sensor that, along with the ECG app , allows you to take an electrocardiogram (or ECG). To use the ECG app, update your iPhone 8 or later to the latest version of iOS and Apple Watch to the latest version of watchOS.
Is ECG free on Apple Watch? ›Available today as part of a free update to watchOS 5.1. 2, the ECG app1 and irregular heart rhythm notification feature2 will help users identify signs of AFib, the most common form of irregular rhythm.
Does Apple Watch check for irregular heartbeat? ›The irregular rhythm notification feature on your Apple Watch will occasionally look at your heartbeat to check for an irregular rhythm that may be AFib. This usually happens when you're still to ensure a more accurate reading.
Which Apple Watch is best for heart patients? ›The Apple Watch Series 6 has everything you need in a heart rate monitor and health-tracking watch which is why we selected it our best overall pick.
Is Apple Watch 6 or 7 better? ›Overall, the Apple Watch Series 7 is a minor upgrade over the Apple Watch Series 6, offering larger displays and casing sizes, new color options, improved durability, the S7 chip, and faster charging.
How reliable is Apple Watch ECG? ›The ECG app on the Apple Watch, for example, was shown to have 99.3% specificity for classifying sinus rhythm and 98.5% sensitivity for classifying Afib in a clinical trial using 12-lead ECG as the gold standard. However, other studies have introduced some skepticism around the accuracy of smartwatch-measured ECG.
How often does Apple Watch look for AFib? ›The Apple watch can detect irregular heart rhythms, and if it does so 5 times, it will prompt you to record your rhythm. And in that way, it can also be used to diagnose atrial fibrillation.
Does Apple Watch automatically detect AFib? ›The irregular rhythm notification occasionally checks for signs of irregular rhythms that may be suggestive of atrial fibrillation (AFib). This feature won't detect all instances of AFib, but may catch something that can provide your patients with an early indication that further evaluation may be warranted.
How much does ECG app cost? ›There is no extra cost for ECG. The hardware/software support is part of the Apple Watch Series 4.
Is Apple Watch ECG FDA approved? ›As reported or My Healthy Apple, the FDA's 510(k) approval allows the company to use the Apple Watch to keep track of the user's atrial fibrillation history as part of the ECG app. Currently, the ECG app can only detect atrial fibrillation (which is a type of cardiac arrhythmia) between 50 and 150 BPM.
Can Apple Watch measure blood pressure? ›
Although the wristwatch is not able to measure your blood pressure on its own, you can link it with other tools and devices that are. These are often wireless sensors that connect to your Apple Watch and come with an arm cuff and its own app.
Will my Apple Watch call 911 if my heart stops? ›Will Apple Watch call 911 if my heart stops? No, the Apple Watch will not call 911 if your heart stops. The Apple Watch can alert you to high or low heart rates and irregular heart rhythms through its notifications feature, but it cannot detect a heart attack or alert someone if your heart stops.
What is a dangerously low heart rate? ›If you have bradycardia, your heart beats fewer than 60 times a minute. Bradycardia can be a serious problem if the heart rate is very slow and the heart can't pump enough oxygen-rich blood to the body. If this happens, you may feel dizzy, very tired or weak, and short of breath.
Can Apple Watch detect sleep apnea? ›Like Fitbit and other wearables, the Apple Watch can detect certain parameters like heart rate and blood oxygen saturation that may indicate sleep apnea, but it cannot comprehensively detect or diagnose sleep apnea.
Which Apple Watch can detect atrial fibrillation? ›With watchOS 5.1. 2 or later, Apple Watch Series 1 and later are able to use PPG signals combined with an algorithm to identify periods of irregular pulse suggestive of AFib.
Is Apple Watch worth buying? ›You should buy an Apple Watch if you want to spend less time on your iPhone, and more time out and about. If you love the idea of super convenient tap-to-pay, and advanced health and fitness tracking appeals to you, it's an invaluable tool.
Can Apple Watch 7 take blood pressure? ›Apple Watch alone cannot take a blood pressure reading. The only medically accurate and validated way to do so today is by stopping the blood flow by inflating a blood pressure cuff around your upper arm and then deflating it while listening for changes in your arteries.
Is it worth upgrading to Apple Watch 8 from 7? ›Overall, the Apple Watch Series 8 is a very minor upgrade over the Series 7, with the body temperature sensor and Crash Detection being the only significant changes, meaning that it is difficult to recommend upgrading.
Is the new Apple Watch 8 worth it? ›Apple Watch review: Series 8 isn't worth an upgrade. The SE is the best value. The second-generation SE Apple Watch is $30 cheaper than the first generation. The SE comes with a new S8 chip, sleep tracking and crash detection.
Can you shower with Apple Watch? ›Is my Apple Watch waterproof? Your Apple Watch is water resistant, but not waterproof. For example, you can wear and use your Apple Watch during activities such as exercise (exposure to sweat is OK), walking in rain, and washing your hands.
Is Apple Watch blood oxygen accurate? ›
Even under ideal conditions, your Apple Watch may not be able to get a reliable blood oxygen measurement every time. For a small percentage of users, various factors may make it impossible to get any blood oxygen measurement. Skin perfusion (or how much blood flows through your skin) can impact measurements.
Is Apple Watch 7 oxygen accurate? ›Researchers observed a strong positive correlation between the smartwatch and the standard commercial device in the evaluation of SpO2 measurements (r = 0.89, p < 0.0001) and HR measurements (r = 0.98, p < 0.0001).
Is there an app to detect an irregular heartbeat? ›CardioSignal is a mobile application and a CE marked class IIa medical device available for iOS and Android. Just place your phone on your chest for one minute and relax. A powerful tool for atrial fibrillation detection now accessible to you anywhere with internet access.
What heart problems can Apple Watch detect? ›The FDA has already approved the Apple Watch's built-in ECG tool for detecting atrial fibrillation (afib), a rapid, irregular heart rhythm that raises the risk of stroke.
Can anxiety be mistaken for AFib? ›Anxiety or Atrial Fibrillation? In stressful situations, anxiety can cause the body to mirror similar symptoms of AFib, but it's important to note that both are different medical issues. Anxiety is an intense feeling of worry or unease prompted by pressure or stress from an everyday situation.
What does it mean when your heart rate rises above 120 while inactive? ›Heart rates that are consistently above 100, even when the person is sitting quietly, can sometimes be caused by an abnormal heart rhythm. A high heart rate can also mean the heart muscle is weakened by a virus or some other problem that forces it to beat more often to pump enough blood to the rest of the body.
Why is heart rate red on Apple Watch? ›How Apple Watch measures your heart rate. The optical heart sensor in Apple Watch uses what is known as photoplethysmography. This technology, while difficult to pronounce, is based on a very simple fact: Blood is red because it reflects red light and absorbs green light.
What is a good resting heart rate? ›A normal resting heart rate for adults ranges from 60 to 100 beats per minute. Generally, a lower heart rate at rest implies more efficient heart function and better cardiovascular fitness. For example, a well-trained athlete might have a normal resting heart rate closer to 40 beats per minute.
Can Apple Watch 3 Do ECG? ›Apple Watch Series 3 or later with watchOS 7 sends a notification if an irregular heart rhythm such as AFib is identified. The ECG app's ability to accurately classify an ECG recording into AFib and sinus rhythm was validated in a clinical trial of around 600 participants.
Does Apple Watch 5 have ECG? ›The ECG and irregular rhythm notification features were first announced in September 2018, with the ECG feature specific to the Apple Watch Series 4, though it is also available on the Watch Series 5 and the Watch Series 6.
Does Apple Watch 4 have ECG and fall detection? ›
Apple Watch Series 4 with watchOS 5 brings advanced activity and communications features, along with revolutionary health capabilities, including a new accelerometer and gyroscope, which are able to detect hard falls, and an electrical heart rate sensor that can take an electrocardiogram (ECG) using the new ECG app,1 ...
Is Apple Watch 7 ECG accurate? ›The ECG app on the Apple Watch, for example, was shown to have 99.3% specificity for classifying sinus rhythm and 98.5% sensitivity for classifying Afib in a clinical trial using 12-lead ECG as the gold standard. However, other studies have introduced some skepticism around the accuracy of smartwatch-measured ECG.
Which Apple watches detect AFib? ›In a study done by the Cleveland Clinic found that in a study of 50 postoperative cardiac patients, the Apple Watch Series 4 connected to a waveform PDF was about to detect 98% of AFib occurrences. In the same study, the Apple Watch display alone was only able to diagnose 41% of the instances of AFib.
Can Apple Watch measure blood pressure? ›Although the wristwatch is not able to measure your blood pressure on its own, you can link it with other tools and devices that are. These are often wireless sensors that connect to your Apple Watch and come with an arm cuff and its own app.
How do I download ECG on Apple Watch? ›- On your iPhone, open the Watch app.
- Choose the My Watch tab.
- Scroll down and tap on the Heart app.
- Check if ECG is listed as installed, or tap the INSTALL button if you need to install it.
As reported or My Healthy Apple, the FDA's 510(k) approval allows the company to use the Apple Watch to keep track of the user's atrial fibrillation history as part of the ECG app. Currently, the ECG app can only detect atrial fibrillation (which is a type of cardiac arrhythmia) between 50 and 150 BPM.
Why is the ECG app on my Apple Watch not working? ›If your Apple Watch ECG isn't working as accurately as it should (or at all), it may be due to difficulties with the sensor. If the Digital Crown is being impeded by a buildup of dust or other debris, it may not be able to sense your finger when attempting to record your ECG.
How often does Apple Watch look for AFib? ›The Apple watch can detect irregular heart rhythms, and if it does so 5 times, it will prompt you to record your rhythm. And in that way, it can also be used to diagnose atrial fibrillation.
Will my Apple Watch call 911 if my heart stops? ›Will Apple Watch call 911 if my heart stops? No, the Apple Watch will not call 911 if your heart stops. The Apple Watch can alert you to high or low heart rates and irregular heart rhythms through its notifications feature, but it cannot detect a heart attack or alert someone if your heart stops.
Is Apple Watch good for seniors? ›For many seniors, the Apple Watch is a way to stay connected with friends and family. The Watch can easily supplement or even replace your phone. While Apple does offer Watch models with built-in cellular connectivity, you don't have to pay extra to use the regular Apple Watch as a phone.
Can Apple Watch detect fainting? ›
Open the Settings app on your Apple Watch. Go to SOS > Fall Detection, then turn on Fall Detection. You can also open the Apple Watch app on your iPhone, tap My Watch, tap Emergency SOS, then turn on Fall Detection.
Can Apple Watch 7 take blood pressure? ›Apple Watch alone cannot take a blood pressure reading. The only medically accurate and validated way to do so today is by stopping the blood flow by inflating a blood pressure cuff around your upper arm and then deflating it while listening for changes in your arteries.
Does Apple Watch automatically detect AFib? ›The irregular rhythm notification occasionally checks for signs of irregular rhythms that may be suggestive of atrial fibrillation (AFib). This feature won't detect all instances of AFib, but may catch something that can provide your patients with an early indication that further evaluation may be warranted.
How accurate is Apple Watch for blood oxygen? ›Therefore, our data did not show higher values with the Apple Watch compared to standard oximeters. Our data demonstrated a very good concordance between the SpO2 measured by the smartwatch compared with the standard commercial device (bias, −0.2289; SD, 1.66; lower limit, −3.49; and upper limit, 3.04).