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Technology

Apple Watch Data Could Unlock New Insights Into Patient Health

Authors:
Pauline Huynh; Bibin Varghese, MD; Francoise A. Marvel, MD; and Seth S. Martin, MD, MHS
Johns Hopkins Medicine, Baltimore, Maryland

Citation:
Huynh P, Varghese B, Marvel FA, Martin SS. Apple Watch data could unlock new insights into patient health [published online November 14, 2019]. Cardiology Consultant.

 

Recently, Apple announced that it was partnering with the American Heart Association (AHA), World Health Organization (WHO), and the National Institute of Environmental Health Services (NIEHS) to conduct studies in cardiovascular disease (impact of heart rate and mobility signals of physical activity on cardiovascular health), women’s health (screening and risk for polycystic ovary syndrome [PCOS], infertility, osteoporosis, pregnancy and menopausal transition), and audiology (examining environmental factors that impact hearing health).1

Given our experience using Apple’s ResearchKit and CareKit2 to develop Corrie Health®, a digital health platform to improve post-acute myocardial infarction recovery, and its version for the Apple Watch (Corrie Health® WatchiOS), we find Apple’s drive in medical research exciting. As the first team to use the CareKit, ResearchKit, and Apple Watches (first generation), we recognize the value in collating de-identified health data to discover important signals in health outcomes.1 We recognize these studies as an opportunity for democratizing medical research through collaboration between researchers and consumers.

Mobile Devices for Improving Cardiovascular Health

Today’s consumers—our patients—are becoming more engaged in their health and the health of their loved ones, as evidenced by the exponential growth in mobile health (“mHealth”) applications and wearable device usage. They are eager to share their health information with their clinicians, and these new initiatives provide a unique method for de-identified data collection on an unprecedented scale.

Given our experience in preventive cardiology and with Corrie Health®, we were interested in heart health and movement. As frontline clinicians, we try to help our patients achieve the AHA’s physical activity goal of “150 minutes of moderate aerobic activity a week.” However, it is difficult to assess whether patients meet this activity goal. Purely subjective assessment is prone to bias. Instead, we can ask patients to open the health app on their iPhone during clinic visits. A quick glance at their daily step count and distance walked gives an objective measure of routine activity. This information enables goal setting—something to strive for before the next visit. Yet how this step count relates to the 150 minutes of moderate aerobic activity in the guidelines is not clear. 

The discordance between current guideline recommendations and what wearables measure will need to be resolved. For now, 10,000 steps a day has popularly become the daily goal to strive for. Yet, for many patients, that may not be a realistic goal, or even a necessary one. A study in JAMA showed that, in older women (around age 72 years), as few at 4400 steps a day could help them live longer.3 More research is necessary to examine dose-response relationships between daily steps and good health in different populations and examine the importance of parameters like walking pace. We are therefore looking forward to the results of the AHA’s newly launched study.

Protecting Patient Data

Of course, privacy and confidentiality are common questions about health technology research. In our experience with the development of the Corrie Health® app, it was critical that patient information was secure and protected. Our team utilized iOS's encryption features to protect patient information in Corrie Health® during our Myocardial infarction COmbined-device, Recovery Enhancement (MiCORE) Study.4 We had a transparent agreement detailing how data would be stored and used.

As Apple is collaborating with leading medical institutions, we are confident that similarly robust efforts will be made to protect participant data. The findings from these groundbreaking studies will provide useful insights that may be generalizable and guide future research efforts. Beyond research, we are hopeful that these efforts will be translated back into clinical care. Indeed, the Apple watch and iPhone data have potential to encourage patients to be active participants in their health and provides clinicians like us population-level insights into preventive medicine.

References:

  1. Apple announces three groundbreaking health studies [press release]. Cupertino, CA: Apple; September 10, 2019. www.apple.com/newsroom/2019/09/apple-announces-three-groundbreaking-health-studies. Accessed November 13, 2019.
  2. ResearchKit and CareKit: Empowering medical researchers, doctors, and you. Apple. www.apple.com/researchkit. Accessed November 13, 2019.
  3. Lee IM, Shiroma EJ, Kamada M, Bassett DR, Matthews CE, Buring JE. Association of step volume and intensity with all-cause mortality in older women [published online May 29, 2019]. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2019.0899.
  4. Spaulding EM, Marvel FA, Lee MA, et al. Corrie Health digital platform for self-management in secondary prevention after acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2019;12(5):e005509. https://doi.org/10.1161/CIRCOUTCOMES.119.005509.