Apple's heart study is the biggest but catch

In November last year, Apple Watch owners began receiving Apple's email receipt. The company was looking for Apple Smart Heart Study smartphone owners – to understand the irregular heart rhythms revealed in Stanford's investigation.

Joining is easy: install the app and wear your hour. If clock optical sensors detect arrhythmia, you can send a dedicated fan monitor that meets the results of your Apple Watch. True Apple is coming, enrolling and participating, as friendly as possible: "Apple and Stanford's medicine are ready to take part in medical research," wrote research partners, "as more data can lead to life."

Now, for the first time, Apple's attention has been awarded with the user experience: according to paper that reflects the research design in this weekend American Heart JournalApple and Stanford managed 419,093 participants. Which is the study of the biggest screening of the atrial fibrillation. The study of this size is a big deal for researchers. But even if the results (which are to be published next year), it is still a great deal to prove that its popular wearable society benefits.

First let's learn the training size. 400,000 research subjects are huge. In comparison, Strokestop's research – Swedish research in massive arrhythmia screening – about 25,000 participants. To be fair, Strokestop training has things to do with it that Apple's research is not what we get. But the fact that Apple was able to research this size of the year is impressive.

Also, the main design of research design. The larger sample dimensions create a small margin of error and higher quality unanimity, two of which are important when studying the accuracy of the device in the time of heart problems. In the United States about 5 million people are atrial fibrillation and atrial flutter (jointly known AF), irregular heart rhythms, which can significantly increase the risk of stroke and heart failure. About 700,000 people do not know that they have AF.

Especially the cardiologists are interested in this second group. If product like Apple can detect undiagnosed arrhythmias in large populations and force flag users to take adequate preventive action? It could save life.

But here it is, even if Apple Watch marks the unconditioned AF (large if), use this screen to a large number of asymptomatic people is not necessarily a good idea.

Screening with risks: Middynamics. Excess tests. Overtreatment. "These are the real problems that need to be distributed," says Cardiologist Mintoou Turrharia, a study literature and director of the Stanford digital health center. That's why he and his team will observe what is happening to Apple Watch customers: they should follow the healthcare provider, and not the diagnosis and treatment. "We are interested in a patient's journey, but we also want to see how important it is to pay attention," says Dhurghia.

The biggest unknown surrounding AF screening is a simple one: its benefits outweigh its costs? "Today's evidence is not enough to say that there is one way or another," said Seth Lanfef, chairman of the Department of Medicine of Birmingham University and a member of the US Preventive Service Working Group, an independent, volunteer group of experts. The absence of such evidence is why the USPSTF recommends against the asymptomatic adults screening.

Apple's research does not directly refer to the biggest problem of USPSTF. "Millions of dollars that we really need to answer are people who are less likely to use screen screens longer than long in the long run than those who are not," says Landefeld. This research is primarily designed to see how AF's findings are identical to the loyal fan and not the people who receive the AF warnings. For this you need to repeat your participants over a long period of time (Strokestop Research's main advantage). Random control groups do not hurt either.

The turquoise disagrees. But he notes that AF's thinking has expanded on stroke. "Even if you have AF, the worst thing is the stroke," she says, "but, moreover, we learn that, like hypertension, it is the general labeling of cardiovascular risk and many other conditions associated with fatigue and respiration Heart failure and cardiomyopathy. "

Of course, Apple and Stanford can address these questions for further studies. But there is a smooth inconsistency in Apple's plan that studies heart saving technology, and it will become the most popular clock on earth. According to the paper described in the design of Apple Heart Heart design, Turgahia and his colleagues write that Apple's ultimate goal of studying the arrhythmia potential is "the scope of such technology." But Apple plans to release the irregular rhythm notification and ECG features for the public at the end of 2018. The results of Stanford's research are not finalized until 2019. So, Apple puts the cart before the horse?

It is worth mentioning. On the one hand, the investigation, such as the Apple Heart Study, would not have been the company's decision to involve medical technologies in Apple Watch. On the other hand, technology is defined, not a program. I asked him, if he thinks Apple thinks of himself in the course of his study. "I can say that we were not involved in the regulatory process in Stanford," says Torkia. "So I can not comment."

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