I Now Have a Cardiologist

With Apple’s release of watchOS 5.2, I see the ECG feature is now more widely available throughout Europe and other regions. That’s great news.

I want to encourage those of you with Apple Watch devices in those supported regions to go grab the update and try out the ECG. Not just because it’s extremely cool tech. But because, well, let me put it this way:

I now have a cardiologist.

That isn’t a statement I was planning to make in my forties. But there it is. And it’s only true because of Apple Watch.

Let me back up.

Last fall, when the ECG feature was finally released, I couldn’t wait to try it out. I’m a total geek for this sort of thing, and I believe health is the next big thing as far as technology is concerned.

I wasn’t expecting to see anything other than good old-fashioned Sinus Rhythm. I didn’t know what a good heart rhythm was supposed to look like as it was being recorded, really. So I was just enjoying the cool animations, not noticing the strange pattern. Then the recording finished:

Signs of Atrial Fibrillation.

Hmm. That has to be a bug, right? Experimental new feature. Maybe I was shaking or moving my wrist a bit. So I try it again:

Signs of Atrial Fibrillation.

This time, I read the rest of the text more carefully. I didn’t write down the exact wording, but it read something like: “If this is a surprise, you should contact your doctor and talk about it.”^[1]

Now is a good point in the story to point out that at the time, I didn’t have a doctor. I’m an indie software consultant in his mid-forties, living in the US, the world’s worst industrialized country for health care. Since I don’t have a “job job,” I pay roughly $500 a month for “health insurance” out of my own pocket. But for most things, this insurance is essentially useless. My deductible is so high that pretty much any doctor visits I make are out of pocket.

I continue to pay for my insurance because thanks to the Affordable Care Act, I have to. It’s the law. And I’m okay with that. Because I know paying into the system helps others who make less money than me have access to care.^[2]

It’s worth noting that having this insurance also protects me against very serious costs from various serious illnesses, or accidents, etc. If I had cancer, I’d eat through my deductible pretty quick. But that’s the thing. I’ve never really had any serious health issues.

That’s actually an understatement. With the exception of appendicitis when I was about 13, I haven’t been to the hospital since I was born. I’ve never had any drugs prescribed to me for more than a few weeks. I barely take aspirin when I get the occasional headache.

This year, I had my first common cold in fifteen years. This is how not prone to health issues I am.

I had no need to go to a doctor beyond the occasional physical, is what I’m saying. Until now.

It’s also worth noting at this point in the story that Atrial Fibrillation is extremely rare in men my age. Less than two percent of people in my demographic have it.

Go figure. When I do something, I go big I guess.

So I found a primary care physician and set up an appointment for a routine physical. It had been a while, anyway. I asked him to take an ECG (an official one, with all the wires and stuff). That was going to cost me extra, as it’s not part of a routine physical, but I told him about the watch readings, and he agreed I should take a look.

The results? While admitting he was no heart specialist, the primary care doc said my ECG results were definitely a bit of a concern. “Your heart is a little fast, and little irregular.” He was trying not to scare me. I wasn’t going to drop dead that day, but something was definitely up. My watch wasn’t lying to me.

So then he sent me to the cardiologist.

When the cardiologist asked why I came in for a visit, I told him about my Apple Watch ECG. “I know, this is new tech. And maybe it’s not scientifically as accurate as the real thing, but it told me I should come in. And I thought I’d better not take a chance.”

The doctor didn’t scoff. Quite the opposite, in fact.

“Oh yeah? Can I see how it works?”

He was fascinated. I started up a new ECG reading, and within seconds, he said “Yep. That’s AFib.”

Persistent AFib, in my case. Over the course of the next month or so, as the doc prescribed some beta blockers and instructed me to continue monitoring my condition, I continued to take readings. No doubt about it. I was in a constant state of AFib. The doctor is still at a loss as to why. (I have none of the genetic indicators and no habits that would increase my chances of this happening.^[3] I just have a heart that wants to beat in odd time, as I’ve gotten into the habit of saying.)^[4]

More alarmingly, I had very few symptoms that I could easily identify. I felt a bit more sluggish than usual (a direct result of my resting heart rate being in the 113-120 bpm range). But I’m not in the best shape, so sluggish isn’t exactly strange for me. I had the occasional discomfort in my chest. And even more occasionally, I’d feel my heart fluttering a bit, as if I had just watched a scene in a scary movie. But it would pass in seconds.

It was enough to tell me that something was off, but probably not enough for me to go to a doctor. Seeing the watch reading definitely gave me the push I needed to investigate.

In trying to figure out when this condition may have started, the best we could conclude was sometime during the previous summer. It was post-WWDC; I was running betas of iOS and watchOS, as I was developing a new app and wanted to utilize some of the new notification and Siri features. (ECG wasn’t part of the beta.) Once or twice, while sitting on the couch watching tv, I got a notification on my watch saying my heart rate had suddenly jumped into the hundreds, with no indication of a change in activity on my part. I wrote it off as a beta bug, of course. That was certainly more likely than me having a heart condition. And it only happened once or twice.

My cardiologist now thinks I was in AFib all the way back then. Almost six months before I made my first appointment. Maybe even earlier. That’s how subtle the symptoms were.

Anyway, fast forward to this January. I had an echocardiogram done. (Basically a sonogram for your heart.) Other than the weird rhythm, my heart was perfectly normal. The fast beating and strange rhythm hadn’t caused any muscle or tissue damage—yet.

The next step was to get me out of persistent AFib. This involved what’s called an electro cardioversion.^[5]

The issue with an electro cardioversion is that while it will zap the patient back into sinus rhythm in most cases, since we don’t know what caused the AFib, there’s every chance that it will come back in the future.

If it does come back, you can do the electro cardioversion again, but the next real step is something called a cardiac ablation, which involves sticking a probe up through your leg into your heart, and burning the areas where the incorrect electrical impulses are happening. When you hear the procedure described, it sounds super cool; then you realize it’s your heart they want to burn holes in. But hey, it does cure AFib permanently, with relatively low side-effect risk.

If it’s all the same to you, though, I’d prefer to avoid that.

So far, luckily, since my cardioversion in January, my heart has stayed in sinus rhythm. So I haven’t needed to go the ablation route yet. But that remains a possibility for the rest of my life.

In the meantime, I’m off all prescriptions, and I’m taking ECGs with my watch regularly.^[6]

All told, I’m several thousand dollars out of pocket, still not having hit my deductible, but my heart is doing what it’s supposed to, so I think I’ll call that a win. My useless insurance will become dramatically more expensive next year, while remaining just as useless.

But still. A win.

“You have all you need to monitor this on your own” the cardiologist told me, pointing to my wrist. “So we’ll know if and when this ever comes back.”

Did my Apple Watch save my life? I think in my case, that’s a bit of an overstatement. I’ve seen a lot of the stories about people whose lives really have been saved by technology. I'm not in their league. My Apple Watch did help me discover a condition that would likely have gone untreated for a long while.^[7] I wasn’t going to die that afternoon. But I might have had a stroke (the most likely result of leaving AFib untreated) a few years down the line. So I’m very grateful to the team at Apple who added this functionality. If any of you are going to be at WWDC in San Jose this June, get in touch. I’d love to buy you all a drink and thank you in person.^[8]

I’ve seen some news articles where certain doctors expressed concern that false positives from Apple Watches could lead to panic, with patients going to the emergency room needlessly, etc. To those doctors, I have two middle fingers I would happily like to extend. At no point did my watch give me any indication that I was in a true emergency. It just encouraged me to talk to a professional about what seemed to be abnormal heart rhythm. If I had gone to my doctor, and the official ECG had turned up completely normal, the worst thing I’d have to say is that I now had confirmation that my heart rhythm was normal. How could that be a bad thing?

The ECG function in Apple Watch represents the best value for money I’ve ever spent in technology. There may only be a few people like me who are helped out by this, versus the millions who will just run the ECG for fun and get confirmation of their normal heart rhythms. But helping those few is totally worth it. Trust me.

I can’t wait to see even more functions built into wearable technology that will help diagnose even more conditions for others.

Tim Cook believes Apple’s contributions to health will end up dwarfing everything else the company does, when looking back a hundred years from now.

I have good reason to believe him.