Apple Watch 4's ECG feature could save lives – but is your heart compatible?

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Image credit: Apple

Apple has upgraded its Watch range to check for irregular heart beats in more countries around the world – but I can’t use one of the best features.

If you weren't already aware, the Apple Watch 4 can now conduct an electrocardiogram (ECG) test from your wrist in the UK and Europe (the features was rolled out in the US last year), and all models in the Watch series can detect signs of atrial fibrillation (AF), where the two chambers of your heart are beating out of sync.

Having this little monitor on my wrist, constantly checking whether I’m at risk of a stroke (the AF Association states that 500,000 people in the UK alone could have undiagnosed AF) seems like a useful thing that requires no effort – and given that I’m constantly running around and pushing my heart hard, anything that monitors possible negative effects offers some peace of mind.

Our recent ECG reading. (Image credit: TechRadar)

Our recent ECG reading. (Image credit: TechRadar)

(Image: © TechRadar)

However, running the ECG a few times (when you’re sitting comfortably, with your arms relaxed) came back with the notification that ‘This ECG was not checked for AF because your heart rate was under 50BPM.’

Looking into things further, Apple advises that “Training to be an elite athlete can also lead to a low heart rate”, which is the reason I’m not getting any AF tracking.

I mean, thanks Apple – but I’m not sure that I’m really elite though. I probably run about five hours or so a week in a passionately poor attempt to get better at marathon running, so I’m a bit despondent that I can’t access one of the best features of this device, and make sure that my heart is bopping nicely in the background.

So… why?

So that leads me to a bigger question: who is this for? Apple has been marketing the Apple Watch at the more active user for a while now, and while there are a large number of people out there with undiagnosed AF conditions, they’re largely the older segment of the population rather than the young upstarts that are increasingly buying the Apple Watch.

If you look at the wider feature set though, it’s clear that Apple wants to appeal to this older generation – another feature is fall detection, which can alert someone should an at-risk wearer take a tumble, and cellular connectivity means you don’t need to be connected to your phone to contact someone in the event you’ve fallen and no one has been alerted.

Add that to AF tracking and the Apple Watch 4 – which also has a larger, more legible display – becomes an attractive device for those who might feel vulnerable or who are struggling with poor eyesight.

An extra burden?

One might wonder why there’s even a question over why Apple would do this – after all, what’s the issue with more data?

Well, there’s the issue of false positives: people getting a notification that they’re in AF, and heading to the hospital to have what turns out to be a benign condition checked out. 

Even though I’ve not been getting any notifications suggesting there’s anything wrong with my heart, after being told I had a heart rate that was akin to that of an elite athlete in training (something I read while eating chocolate, FYI) I looked into whether my low heart rate was anything to worry about.

It turns out that it’s probably fine – that an enlarged, more efficient heart is the result of years of just trying to get faster and stronger, to run for longer. But it could also mask another condition, so I want to go and get that checked out now, where before I wouldn’t have worried for a second.

The fact is that we’re heading towards a world where wearables are going to give us more health insights than we’ve ever had before, and medical systems are going to need to evolve to cope. 

That could well be an incredibly positive move. When enough of the population has connected sensors that can notify both the user and the doctor of an issue, it could be normal to have a five-minute appointment via video call, rather than traipsing to the surgery and spending ages in a waiting room.

Yes, there might be ‘it’s nothing to worry about’ moments, but if those are outweighed by lives being saved, and it doesn't cause a huge amount of extra stress on health systems, then surely it's worth it?

Perhaps it could go further. A meaningless notification of a health issue could lead to further tests, and invasive surgery to investigate – and that comes with risks. But on the other hand we’ve already had one situation where the Apple Watch has likely prevented a stroke, so there clearly is some benefit to having wearables monitor your health.

Image credit: Apple

Image credit: Apple

(Image: © Apple)

Personally, I’m not too fussed that my heart isn’t being monitored – I run partly to keep it healthy. I’d love to know if I’m in danger before I collapse, but ultimately there’s enough in life to worry about without adding more.

What I would like to see is the ECG capability of the Apple Watch being developed for fitness applications. I’ve used Omegawave in the past, which uses an ECG (among other equipment) to test for deep fatigue in athletes, to let them know when they’re ready to push harder and when they need to rest.

The Apple Watch can’t do that yet, but the ECG addition could be a step towards deeper fitness monitoring from a daily wearable.

So while the recent upgrade to the Watch range isn’t going to have a huge effect on most wearers, and won’t be able to monitor certain conditions in those training harder, this could be the start of something bigger and better.