AFib History is the smooth start to a massive Apple Health revolution

When Apple announced AFib History as part of watchOS 9, it seemed like some sort of useful feature to have, but not very relevant to most people. But quietly stated within the announcement it was something I think is going to be absolutely huge, as the watch gains the ability to detect multiple health conditions.

The Watch will play a vital role in helping you and your medical professionals identify the role lifestyle factors can play on your health …


Atrial fibrillation (AFib) detection came to Apple Watch with the launch of the Series 4. Apple gained FDA approval for the feature after a study that showed it was 98% accurate.

Since then, there have been a ton of reports that the AFib sensing feature has been credited with saving lives. Here are just a few examples:

“AFib load”

When doctors evaluate atrial fibrillation, it’s not just that it has occurred that matters – it’s also important to understand how long a patient’s heart spends in atrial fibrillation state, because this can have a significant impact on the level of risk. for health. The percentage of time someone spends in AFib is known as the “AFib burden”.

Over the past decade or so the term “burden” has been frequently encountered in manuscripts dealing with atrial fibrillation (AF). Electrophysiologists have generally used it to indicate the percentage of time a patient is in AF, calculated from the total time in AF divided by the total monitored time.

Conceptually, this burden can therefore be linked to some clinical outcome and / or therapeutic decision. For example, the TRENDS study examined whether there is a critical level of AT / AF burden that increases the risk of thromboembolic events regardless of other known risk factors.

The researchers found that the risk of thromboembolism doubled if the AT / AF burden was ≥ 5.5 hours on any given day during the previous 30 days.

Normally, atrial fibrillation load can only be measured during the (usually short) period that a patient is being monitored in the hospital.

History of AFib

This is why the AFib History feature introduced in watchOS9 is so important – it can measure the load of AFib over a long period of time. Here’s how Apple describes it:

Research suggests that the amount of time spent in atrial fibrillation can affect a person’s symptoms, overall quality of life, and risk of complications. Previously, there was no easy way to monitor the rate of atrial fibrillation over a long period of time or to manage lifestyle factors that can affect your condition. According to the American Heart Association, addressing modifiable lifestyle factors can reduce the amount of time spent in atrial fibrillation.

With watchOS 9, users diagnosed with atrial fibrillation can activate the FDA-approved Atrial Fibrillation History feature and access important information, including an estimate of how often a user’s heart rhythm shows signs of atrial fibrillation.

Correlation of health conditions with lifestyle factors

But AFib History goes beyond just passive measurement of time spent in AFib – it also correlates it with other health and lifestyle data. Again, Apple:

According to the American Heart Association, addressing modifiable lifestyle factors can reduce the amount of time spent in atrial fibrillation.

With watchOS 9, users diagnosed with atrial fibrillation can activate the FDA-approved Atrial Fibrillation History feature and access important information, including an estimate of how often a user’s heart rhythm shows signs of atrial fibrillation, providing information learn more about their condition. Users will also receive weekly notifications to understand frequency and view detailed history in the Health app, including lifestyle factors that can affect atrial fibrillation, such as sleep, alcohol consumption, and exercise.

Users can download a PDF with a detailed history of their atrial fibrillation and lifestyle factors, which can be easily shared with doctors and healthcare professionals for more informed conversations.

In other words, the Apple Watch can now provide physicians with data to assess whether there is a correlation between atrial fibrillation load and lifestyle factors, such as how much sleep you slept the night before and how much exercise you are getting. While correlation does not always imply causation, this type of data can be extremely useful in assessing risk factors.

Type 2 diabetes could be next

At this time, this ability to trace connections between medical conditions and lifestyle factors is limited to atrial fibrillation. But as the Apple Watch gains the ability to detect multiple conditions, it’s a capability that can revolutionize healthcare.

An obvious example is type 2 diabetes. There have been numerous reports that Apple is working to add non-invasive blood glucose monitoring in future Apple Watch models, with a Nature last year’s piece describing a potential technology the company could use to achieve this goal.

This document reports a highly sensitive non-invasive sensor for real-time blood glucose monitoring from interstitial fluid. The structure consists of a chipless tag sensor that can be attached to the patient’s skin and a reader, which can be incorporated into a smartwatch.

The tag sensor is excited through the electromagnetic coupling established between the tag and the reader and its frequency response is reflected on the spectrum of the reader in the same way. The tag sensor does not consume power as no active reading or communication circuit is needed on the side of the tag.

Pair that with things like food diary apps and metabolic tests, which all feed into the Apple Health app, and it’s not hard to see just how much a transformative role can be played across a whole range of medical conditions.

With a lot more conditions probably later on

The Apple Watch started with a simple heart rate sensor and that alone was enough to subsequently lead to FDA-approved ECGs, AFib detection, and, in the Apple Watch Series 6, oxygen saturation.

A study conducted last year found this to be a reliable form of measurement for patients with lung disease.

A new study published in Scientific report, an open access multidisciplinary online magazine from the editors of Natureshows that the Apple Watch Series 6 “is a reliable way to obtain heart rate and oxygen saturation (SpO2) in lung disease patients under controlled conditions.”

The study of University of Sao Paulo, one of the most prestigious educational institutions in Brazil and was conducted with 100 patients with chronic obstructive pulmonary disease and interstitial lung disease from a pulmonary clinic. He collected SpO2 and heart rate data with Apple Watch Series 6 and compared it with two commercial pulse oximeters.

The study noted “strong positive correlations between the Apple Watch device and commercial oximeters. He notes that “there was no statistical difference in the assessment of skin color, wrist circumference, wrist hair and nail polish for SpO2 and hearing rate measurements in Apple Watch or commercial oximeter devices.”

Imagine being able to correlate O2 levels with things like the number of steps taken, the flights of stairs traveled, the quantity and quality of sleep, and so on.

All this is possible from a single sensor. When we anticipate adding more sensors to future models, the potential of the Apple Watch to assist with a whole range of medical conditions is simply enormous!

What may seem like one of the less exciting features of the Apple Watch, over time, I think, will become one of the most exciting and life-changing.

Photo: National Cancer Institute / Unsplash

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