A new study underway at Toronto’s University Health Network (UHN), a group of working research hospitals in the city, could shift our approach to treatment in an area of growing concern in human health. The study, led by Dr. Heather Ross, will investigate whether the Apple Watch can provide early warnings about potentially worsening health for patients following incidents of heart failure.
The study, which is aiming to eventually span around 200 patients, and which already has a number of participants enrolled spanning ages from 25 to 90, and various demographics, will use the Apple Watch Series 6 and its onboard sensors to monitor signals including heart rate, blood oxygen, general activity levels, overall performance during a six minute walk test and more. Researchers led by Ross will compare this data to measurements taken from the more formal clinical tests currently used by physicians to monitor the recovery of heart failure patients during routine, periodic check-ups.
The hope is that Ross and her team will be able to identify correlations between signs they’re seeing from the Apple Watch data, and the information gathered from the proven medical diagnostic and monitoring equipment. If they can verify that the Apple Watch accurately reflects what’s happening with a heart failure patient’s health, it has tremendous potential for treatment and care.
“In the US, there are about six-and-a-half million adults with heart failure,” Ross told me in an interview. “About one in five people in North America over the age of 40 will develop heart failure. And the average life expectancy [following heart failure] is still measured at around 2.1 years, at a tremendous impact to quality of life.”
The stats point to heart failure as a “growing epidemic,” says Ross, at a cost of some “$30 billion a year at present in the U.S.” to the healthcare system. A significant portion of that cost can come from the care required when conditions worsen due to preventable causes – ones that can be avoided by changes in patient behavior, if only implemented at the right time. Ross told me that currently, the paradigm of care for heat failure patients is “episodic” – meaning it happens in three- or six-month intervals, when patients go into a physician’s office or clinic for a bevy of tests using expensive equipment that must be monitored by a trained professional, like a nurse practitioner.
“If you think about the paradigm to a certain degree, we’ve kind of got it backwards,” Ross said. “So in our thinking, the idea really is how do we provide a continuous style monitoring of patients in a relatively unobtrusive way that will allow us to detect a change in a patient status before they end up actually coming into hospital. So this is where the opportunity with Apple is tremendous.”
Ross said that current estimates suggest nearly 50% of hospitalizations could be avoided altogether through steps taken by patients including better self-care, like adhering to prescribed medicinal regimens, accurate symptom monitoring, monitoring dietary intake and more. Apple Vice President of Health Dr. Sumbul Desai echoed the sentiment that proactivity is one of the key ingredients to better standards of care, and better long-term outcomes.
“A lot of health, in the world of medicine, has been focused on reactive responses to situations,” she said in an interview. “The idea to get a little more proactive in the way we think about our own health is really empowering and we’re really excited about where that could take us. We think starting with these studies to really ground us in the science is critical but, really, the potential for it is something that we look forward to tackling.”
Desai, has led Apple’s Health initiatives for just under four years, and also spent much of her career prior to that at Stanford (where she remains an associate professor) working on both the academic and clinical side. She knows first-hand the value of continuous care, and said that this study is representative of the potential the company sees in Apple Watch’s role in the daily health of individuals.
“The ability to have that snapshot of an individual as they’re living their everyday life is extremely useful,” she said. “As a physician, part of your conversation is ‘tell me what’s going on when you’re not in the clinic.’ To be able to have some of that data at your fingertips and have that part of your conversation really enhances your engagement with your patients as well. We believe that can provide insight in ways that has not been done before and we’re really excited to see what more we’re learning in this specific realm but we already hearing from both users and physicians how valuable that is.”
Both Ross and Desai highlighted the value of Apple Watch as a consumer-friendly device that’s easy to set up and learn, and that serves a number of different purposes beyond health and fitness, as being key ingredients to its potential in a continuous care paradigm.
“We really believe that people should be able to play a more active role in managing their well-being and Apple Watch in particular, we find to be — and are really proud of — a powerful health and wellness tool because the same device that you can connect with loved ones and check messages also supports safety, motivates you to stay healthy by moving more and provides important information on your overall wellness,” Desai said.
“This is a powerful health care tool bundled into a device that people just love for all the reasons Sumbul has said,” Ross added. “But this is a powerful diagnostic tool, too. So it is that consumer platform that I think will make this potentially an unstoppable tool, if we can evaluate it properly, which we’re doing in this partnership.”
The study, which is targeting 200 participants as mentioned, and enrolling more every day, will span three months of active monitoring, followed by a two-year follow up to investigate the data collected relative to patient outcomes. All data collected is stored in a fully encrypted form (Ross pointed to Apple’s privacy track record as another benefit of having it as a partner) and anyone taking part can opt-out at any point during the course of the research.
Even once the results are in, it’ll just be the first step in a larger process of validation, but Ross said that the hope is to ultimately “to improve access and equitable care,” by changing the fundamental approach to how we think about heart failure and treatment.