Why The Apple Watch Comes Up Short In Heart Attack Detection… And Other Alternatives

Photo by Raagesh C on Unsplash

When the Apple Watch with its ECG capability was first released a few years ago, it wasn't long before news headlines proclaiming that the device had saved someone's life began to appear. However, many consumers don't realize that the Apple Watch isn't able to detect a heart attack at all, and their confusion may be understandable.

Apple (Nasdaq: AAPL) CEO Tim Cook said in an interview a couple of years ago that the company's greatest contribution will one day be "about health" rather than the iPhone. With the heart attack diagnostics market expected to be worth nearly $25 billion in 2030 after a compound annual growth rate of 8%, it’s easy to see why Apple wants a piece of the pie. 

However, there may be better places to invest in heart attack detection than via devices such as the Apple Watch.

Where the Apple Watch comes up short in heart attack detection

The Apple Watch does offer features designed to track the wearer's heart health, but the company states clearly on its website that it doesn't detect heart attacks. Instead, the smartwatch can alert the wearer that they have entered atrial fibrillation (AFib). It is an irregular and often very fast heart rhythm that can lead to blood clots in the heart or brain. Unlike heart attacks, AFib usually isn't immediately life-threatening.

Newer Apple Watch models also have an AFib history feature that tracks how often the wearer shows signs of AFib. The history feature also tracks lifestyle patterns that could contribute to the risk of developing AFib, like sleep and exercise. 

There’s no denying that the Apple Watch has saved some people’s lives by alerting them to a potential heart problem. However, patients with known heart conditions might need a device that provides more data.

All of the Apple Watch’s features rely on single-lead ECG components — meaning that the Apple Watch comes up far short of the standard of care in heart attack detection. The standard of care in heart attack detection is a 12-lead ECG, but smartwatches like the Apple Watch and other consumer-facing devices are not capable of recording a 12-lead ECG.

A single-lead ECG, which is all that many such devices are capable of recording, gathers data from only one position of the heart, so there simply isn’t enough data to determine whether someone is having a heart attack. On the other hand, a 12-lead ECG gathers data from 12 different electrical positions of the heart. Even though it’s called a 12-lead ECG, it only uses 10 electrodes

Some of those electrodes are part of two pairs, so they provide two leads. Using those 10 electrodes, a 12-lead ECG gathers data on the position of the heart as viewed from 12 different angles via their different placements on the body. As a result, 12-lead ECGs provide a more complete picture of the heart’s health because they enable physicians to view the heart from many different angles. 

On the other hand, the single-lead ECG device in the Apple Watch has built-in electrodes in the Digital Crown and the back of the watch to measure the electrical signals across the wearer’s heart when used with the ECG app. When the wearer places their finger on the Digital Crown, it closes the circuit between their heart and both arms, capturing the electrical impulses across their chest. 

Problems with single-lead ECG devices

Of course, there are advantages to having a smartwatch capable of detecting heart rate and AFib because it can lead patients to seek help with a previously undiscovered heart problem. However, a critical problem is that smartwatches often trigger false alarms because they aren't capable of capturing all the data necessary to detect heart problems.

Additionally, doctors usually aren't paid to review single-lead recordings like those captured by the Apple Watch because they are not medical devices and were not prescribed to begin with. Another key problem is that many consumers may feel like having a smartwatch is enough to help them monitor their heart problems.

However, the reality is that while millions of Americans do have AFib, the number who are at risk for a heart attack is more than three times higher. Since smartwatches like the Apple Watch can detect AFib, many consumers may have a false sense of security because they don't realize that they can't detect heart attacks.

More than 5 million people in the U.S. have AFib, while about 20 million people are at risk for a heart attack because they have coronary artery disease (CAD). Moreover, about 8 million people in the U.S. are at very high risk for a heart attack, as they already had at least one intervention for CAD, like having coronary bypass surgery or a stent placed.

Coronary artery disease is caused by a buildup of plaque in the arteries, which eventually results in a life-threatening closure of an artery. On the other hand, AFib can be a sign of a problem down the road that’s worth making a doctor’s appointment for, although it is usually not immediately life-threatening.

The power of a hospital-grade ECG in a patient’s pocket

While there can be some value in having a single-lead ECG always available, patients with known heart conditions need much better technology at their fingertips. Of course, they can't take a 12-lead ECG like the one on the cart at the hospital with them everywhere they go, but HeartBeam (Nasdaq: BEAT) will soon offer the same standard of care in a device the size of a credit card. 

HeartBeam’s synthesized 12-lead ECG device is based on 3D-vector imaging of the heart. AliveCor also makes a 12-lead device. The Kardia 12L is based on smartphone technology. Unlike HeartBeam's device which fits in a wallet, the Kardia 12L requires the patient to keep a pouch of electrodes and wires with them at all times, which makes it impractical for everyday use.

HeartBeam’s synthesized 12-lead ECG device is based on 3D-vector imaging of the heart. The literature has shown that heat-vector-based detection methods for detecting heart disease are generally equal to or better than the 12-lead ECG, which is the standard of care. HeartBeam is preparing to submit its credit-card-sized device for heart attack detection to the FDA for approval as a medical device.

The company touts its credit-card-sized device as being powerful as an ECG machine on a cart in a medical institution. In fact, those ECG machines carted around our hospitals haven’t seen any significant improvements in many decades. 

HeartBeam recently obtained a patent for the method it will use to pack the power of its 12-lead ECG device into a smartwatch. Unlike the Apple Watch, HeartBeam's smartwatch should qualify as a true medical device that places the standard-of-care 12-lead ECG directly on a patient's wrist. 

The company’s goal is to reduce the amount of time between the onset of chest pain and the patient’s arrival at the emergency room while cutting back on the number of unnecessary ER visits.

Investing in heart attack detection

When it comes to heart attack detection, patients are often presented with two extremes. On one hand, there is the single-lead Apple Watch, which detects AFib but not heart attacks. At the other end of the spectrum is Abbott Laboratories’ (NYSE: ABT) RX Implantable Cardiac monitor, released in 2019, which may be overkill for many patients. 

Thus, between the single-lead Apple Watch and Abbott’s implantable device lie some interesting opportunities for investors in the form of investable, groundbreaking technology that will change heart attack detection forever.

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Disclosure: Heartbeam (Nasdaq: Beat) is a client of Quantum Media Group, LLC

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Andrew Armstrong 1 year ago Member's comment

Good article, thanks.

Paul McGee 1 year ago Member's comment

Reads well for beat and it’s 12-lead. As noted in the article.

Ari Zoldan 1 year ago Contributor's comment

Thanks Paul!