Apple Watch

Has anyone purchased the new Apple 4 watch which, apparently, alerts you if your heart rate goes above a certain rate? I am interested in it as my Afib always occurs at night. The hospital recommended that I have a Holter test but my GP ignored it. For all I know, I could be having Afib when asleep and not realising it. When I approached the GP he said that I should wait for the consultant to organise the Holter, but this seems to be a mistake. Surely it would be better to give the consultant the Holter result when I see him.

[CDreamer]

Hi Samazeuilh - you probably will need to wait for your consultant appointment, for several reasons, in my experience. GP surgeries not only need the equipment and some do and some don’t have that - but they also need to have the expertise to be able to interpret the readings and unless your GP has that, there would be little point. I know our surgery. - in their own words - ‘do not currently have GP who is competent in interpreting an ECG’. And working within their range of competence and training is important.

My experience is that the hospital will normally call you to arrange a Holter before your consultant appointment anyway and that’s the only reading they are interested in, maybe ring the consultant’s Secretary and ask. That seems to be the protocol at our hospital but all clinics will differ.

Thirdly - even if you are having AF at night unknown to you - nothing more will probably happen until you have seen the consultant anyway, so other than you knowing and probably worrying about whether or not you are having AF at night, how will it help you?

When you say ‘the hospital’. - who at the hospital? Cardiologh? A&E? When you say your GP ‘ignored’ that - for what reason?

And have you been diagnosed with AF or is this chasing a diagnosis? And finally - what is your concern about maybe having AF at night?

If you have an AF diagnosis AND are anti-coagulated then any treatment would be purely for symptom control and QOL anyway and as you obviously are not symptomatic because you don’t know or feel it - what is your concern?

If you haven’t a diagnosis and/or are not anti-coagulated or have not been assessed for anti-coagulation then yes, push your GP as hard as you can, put everything in writing and ring the AFA and ask how you can progress this - they are really good at giving advice at what to say and do to get a diagnosis.

Hope this helps - best wishes - CD.

[CDreamer]

PS - your mistake is in thinking the NHS is one seamless organisation and that common sense applies.

GPs are self funded private practices who either chose to or not, take on NHS work and are paid for it. Every hospital is also very differently funded - some are directly funded, some through the CCG’s or whatever they are now called, and yet other’s are ‘Trust’s’ which means they are governed differently and therefore freer to make their own decisions on how and what to spend money on. These differences in how services are funded and accounted for is essential to understand and accounts for the term - ‘Postcode Lottery’ when it comes to explaining the differences in how things work.

Let us know how you get on.

[jennydog]

My GP surgery could not organise a Holter. The Cardiologist at the Regional Hospital arranges them. Mine picked up AF in the night on the 4th night that it was attached. I would never agree to have one attached for less than 7 days because of the nature of my episodes.

[DerekSenna1]

Don’t think the new Apple Watch is connected to the British system yet ?

[bigbearatthecave]

Hello

I have an Apple watch 3 - the same thing underneath, I use cardiogram app to keep track - or I did!

The one problem with Apple watch is that you look at it all the time and your AF or ticker rate goes mad as you get stressed over the readings.

I am much better with my old TAG

Doctors now are very intolerant of the " Walking well informed" they prefer "Thick ill people" . AF at night for me is caused by acid reflux, being too hot (anytime not just night) and sleeping on my right shoulder !! Solution a swig of gaviglug before bed and sleep on left and stay cool.

As long as you walk and talk and below 100 ish the doctors are not interested.

[Hidden in reply to bigbearatthecave]

You've obviously had some bad experiences with your GP surgery !!

You are of course correct in not sleeping on your right side if suffering from reflux

[bigbearatthecave in reply to Hidden]

I am in the North East of England and my Doctor said he refused to look at printouts or readings from the Apple watch and said I knew better than he did so I was wasting his time. So as Spike said on his grave stone "Told you I was ill" !!!

[CDreamer in reply to bigbearatthecave]

That’s the postcode lottery - absolutely no consistency in attitude, knowledge, treatments or perception, my doctor asks for my read outs.

[Hidden]

Sadly I see the new watch also requires an iPhone to go with it, so the total outlay would be somewhere north of mind boggling...

[Gezp]

I know a bit about the Apple Watch 4. It has some new features re heart monitoring. It can detect AF and alert you, also as you say if heart rate goes to high / too low. It also has an ECG function (by putting your finger on the button on side) that will produce a PDF report that you can print and send to a doctor. The ECG has been approved for use in US but not in UK yet though, so may be some months before available on the watch.

Still all very new and will take some time to see if results match the hype. Personally I am waiting to see when ECG is available and then will probably purchase as like the idea that can wear something that is permanently monitoring for signs of AF. You will need an iPhone (older one will do) to get full function as it needs the Apple Health and ECG apps.

[Spoiler in reply to Gezp]

I live in the US and my Apple watch 3, not the new 4 with better features, is amazing! My daughter who is a 11 year cardiac nurse purchased it for me because of my afib. Yes, the watch alerts you when it detects my heart rate at 120 or above. It does a very slight vibration on your wrist and has a automatic message telling you. Yes, you need the Iphone with a free app to read all rates with a graph, it stores by the year, day, hour by hour etc. on your iphone app. Every single time I have been to the Dr or ER this watch showing the rate has been correct. In addition, it had matched my pacemaker information on correct documentation of my crazy afib rates! My EP Dr in Cleveland #1 clinic in the US says it is a great device to have. I am planning on purchasing the new 4 with the ekg readings, but the 3 is also well worthy to have. I wish I had one long ago, I assumed my abnormal rhythm was just part of my pvc’s and bradycardia I have had since my 20’s, NOPE a new problem-Afib.

[Gezp in reply to Spoiler]

Sounds like the 3 works pretty well on the heart rate monitoring so optimistic the 4 will be even better. I know the trials Apple have run have had good results on the EKG and AF detection, but they were marking their own homework so I guess people like us will do the real life testing!

[bigbearatthecave in reply to Spoiler]

What app do you use ?

[Spoiler in reply to bigbearatthecave]

I just goggled it apple watch 3 app and it came up with a red heart on the app. It is great how it pairs to your phone with a graph to track times, rates etc.

[jwsonoma in reply to Spoiler]

I also have the 3 which is great and tracks your HR rate. I have only been alarmed once and I think it was when I put the watch on so it may have been an error. The 4 will do an ecg but the app to do that isn't ready. I was told at the Apple store it maybe this year. There is a 2 finger ecg called Kardia which is $99 in the US. I bought mine on Amazon. It works with your smart phone and will send the report to you or your Doc.

I would request the 14 day Zio monitor vs the 24 hr Holter.

It is a small patch and even if your AFib isn't proximal it will give a much better picture.

I recommend the Apple watch even if you don't need the HR monitor. It does a lot of fun stuff. The 4 will have the option to get its own phone number (and monthly billing) and not need to be with the i phone all the time. So you can get calls and GPS tracking.

good luck

[Hidden in reply to Gezp]

Basically, I am interested in a device that would wake me up if I had AF. My PAF seems always to be at night. I am still waiting for a Holter, so for all I know I could be having PAF every night and not realising it. I don’t *think* this is the case, but I cannot be sure. If my doctor complained that I was bothering him with Apple Watch readings I would be inclined to say that he should have followed the advice of the hospital and organised a Holter.

[Gezp in reply to Hidden]

The Apple watch will look for an irregular pulse, taking into account inherent noise due to the watch moving on the wrist or changing light conditions. If it detects a pattern of irregularity that matches AFib enough times, it will alert you /wake you up. It's an expensive option if that's all you need the watch for, but if all the other functions appeal then fine.

[Tracyrdh]

Zio XT by iRhythm is a 14 day patch for heart monitoring. It is very small and great cardiac monitoring device that you may request from your doctor to monitor your heart rate and check for arrthymias.

[Hidden in reply to Tracyrdh]

This is interesting. Could you say a bit more about the device? Can these be bought at a reasonable price if the GP surgery doesn’t have them?

[Tracyrdh in reply to Hidden]

Im in US my EP placed It. I mailed back after 14 days. Then went for an appt with my EP to know what was going on with my heart rhythms

[EngMac]

Look on Medscape for a couple of topics about the Apple Watch. Generally, they are not super positive. I have the Series 3 watch and its heart rate monitor graph is not perfect but is helpful. It does not read the heart rate accurately but accurate enough to show when your heart is/was beating irregularly. Apple will allow you to try the watch for a period of time during which you can determine if it is of any help to you.

If you feel your pulse in your neck or on your wrist, you will know if your heart is beating irregularly. If you feel missed beats, these are likely extra beats and these are not likely AF. If the beats are very irregular and you know that you have AF, then your heart is likely in AF. It could be in atrial flutter but likely AF if you have it. I have a three lead ECG device which I have used to verify this. Now I only use it every so often to see if anything has changed. The watch is likely not going to tell you much more than feeling your pulse. After years of paying attention to symptoms, I can usually tell when AF is happening and feeling my pulse just verifies that it is. If you wear the watch at night, Apple or other brands, that have a chart, you will know if your heart was misbehaving during the night. That is likely all the Holter will tell you once you already know that you have AF.

It is unfortunate that some doctors do not educate patients a bit more so patients are not overwhelmed by a new AF diagnosis.

For me, I know my heart is in AF or will go into AF by the distress in my neck and back. Now I can often stop it or prevent it from happening by stretching or moving my back to certain positions. If the feeling continues, then my heart will go into AF and if I don't stop it right away, I can only get it to stop by walking for a period of time. Or it stops on its own after a period of time. In my case, I have vagal AF and what I experience likely may only apply if you have vagal AF. Chiropractic adjustments will affect the occurrence of my AF.

[Gezp in reply to EngMac]

I think that's fine for people who have lots of knowledge about AF or know their own bodies well enough. For people who are at higher risk or like me who have a had only one episode, I would like some technology to back up with evidence - plus I have a great watch with lots of other exercise and health functions etc.

[Hidden in reply to EngMac]

My problem is that the PAF is at night, generally when I am asleep.

[Hidden]

I was diagnosed at an A& E visit in July and told to see my GP to organise a referral next day. Typically in my area (East Sussex) you are referred to a Specialist Community GP led service who organise tests - usually echo before appointment then Holter after with a further follow up appointment. This didn’t make sense to me either & I didn’t want to wait 8 weeks feeling as Ill as I did, so I spoke to a Consultant Cardiologist privately who ordered the echo & Holter which were done within days and a consultant appointment within 10 days.

I was fortunate to be able to afford this with the help of my lovely Brother who paid for the tests (approx £300 each test) 2 appointments cost a further £200 each including ECG each time, so you need deep pockets. I’m now firmly back in NHS but feeling so much better.

I don’t know if I would recommend this route unless you already have a firm diagnosis.

You can get a BP monitor which alerts you to arrhythmia.