AFib History is the quiet beginning of Apple’s huge health revolution

When Apple announced AFib History as part of watchOS 9, it sounded like a useful feature, but it doesn’t matter to most people. But speaking softly in the message was something that I think will be absolutely huge as the Watch gains the ability to detect more health conditions.

The watch will play a huge role in helping you and your healthcare professionals identify the role that lifestyle factors may play in your health …


The discovery of atrial fibrillation (AFib) came with the Apple Watch with the release of the Series 4. Apple received FDA approval for the feature after a study showed it was 98% accurate.

There have been many reports since then in which the AFib detection function has been attributed to saving lives. Here are just a few examples:

Afib weight

When doctors evaluate AFib, it’s not just the fact that it happened that matters: it’s also important to understand how much time a patient’s heart spends in an AFib state, because it can significantly affect the level of health risk. The percentage of time someone spends at AFib is known as the “burden of AFib”.

In the last decade or so, the term “burden” has been common in manuscripts discussing atrial fibrillation (AF). Electrophysiologists use it to denote in general the percentage of time the patient is in AF – calculated from the total time in AF divided by the total time observed.

Conceptually, this burden may be related to some clinical outcome and / or therapeutic decision. For example, the TRENDS study examined whether there was a critical level of AT / AF load that increased the risk of thromboembolic events, regardless of other known risk factors.

The researchers found that the risk of thromboembolism was doubled if the AT / AF load was ≥ 5.5 hours each day for the previous 30 days.

Usually, the AFib load can only be measured during the (usually short) time the patient is observed in hospital.

History of AFib

That’s why the AFib History feature introduced in watchOS9 is so important: it can measure AFib load over a long period of time. Here’s how Apple describes it:

Studies show that time spent on AFib can affect a person’s symptoms, overall quality of life and risk of complications. Previously, there was no easy way to track the frequency of AFib over an extended period of time or to manage lifestyle factors that could affect a person’s condition. According to the American Heart Association, tackling modifiable lifestyle factors can reduce the time spent at AFib.

With watchOS 9, users diagnosed with AFib can turn on the FDA-cleared AFib History feature and have access to important information, including an assessment of how often the user’s heart rate shows signs of AFib.

Correlation of health conditions with lifestyle factors

But AFib History goes beyond just passively measuring the time spent at AFib: it also correlates this with other data on health and lifestyle. Again, Apple:

According to the American Heart Association, tackling modifiable lifestyle factors can reduce the time spent at AFib.

With watchOS 9, users diagnosed with AFib can turn on the FDA-cleared AFib History feature and have access to important information, including an assessment of how often a user’s heart rate shows signs of AFib, providing a better idea of ​​their condition. Users will also receive weekly notifications to understand the frequency and view a detailed history in the Health app, including lifestyle factors that may affect AFib, such as sleep, alcohol consumption and exercise.

Users can download a PDF with a detailed history of their AFib and lifestyle factors that can be easily shared with doctors and care providers for more informed conversations.

In other words, the Apple Watch can now provide physicians with data to determine if there is any relationship between AFib workload and lifestyle factors such as how much sleep you slept the night before and how much exercise you do. Although correlation does not always suggest a causal relationship, this type of data can be extremely useful in assessing risk factors.

Type 2 diabetes may be next

Currently, this ability to link medical conditions and lifestyle factors is limited to AFib. But as the Apple Watch gains the ability to detect more states, it’s an ability that could revolutionize healthcare.

One obvious example is type 2 diabetes. There have been numerous reports that Apple is working to add non-invasive blood sugar monitoring to future Apple Watch models, with nature part of last year, describing a potential technology the company could use to achieve this.

This article reports on a highly sensitive, non-invasive real-time glucose monitoring sensor from interstitial fluid. The structure consists of a chip-free label sensor that can be glued to the patient’s skin and a reader that can be built into a smart watch.

The label sensor is powered by an established electromagnetic connection between the label and the reader and its frequency response is reflected in the spectrum of the reader in the same way. The label sensor consumes zero energy as there is no requirement for active reading or communication circuit on the label side.

Link this to things like food diary and metabolic testing apps, all powered by the Apple Health app, and it’s not hard to see how transformative it can play in a whole host of medical conditions.

With many more conditions probably later

The Apple Watch started with a simple heart rate sensor, and that was enough to later lead to FDA-approved ECGs, AFib detection and – in the Apple Watch Series 6 – oxygen saturation.

A study last year found that this is a reliable form of measurement for patients with lung disease.

New study published on scientific report an online multidisciplinary open source journal published by natureshows that the Apple Watch Series 6 “is a reliable way to obtain heart rate and oxygen saturation (SpO2) in patients with controlled lung disease.”

The study by University of Sao Paulo, one of the most prestigious educational institutions in Brazil and was conducted with 100 patients with chronic obstructive pulmonary disease and interstitial lung disease from an outpatient pneumological clinic. It collects SpO2 and heart rate data with the Apple Watch Series 6 and compares it to two commercial heart rate oximeters.

The study observed strong positive correlations between the Apple Watch and commercial oximeters. He notes that “there is no statistical difference in the assessment of skin color, wrist circumference, the presence of wrist hair and nail enamel for SpO2 and hearing frequency measurements in Apple Watch or commercial oximeter devices.

Imagine being able to compare O2 satts with things like the number of steps taken, the steps taken, the amount and quality of sleep, and so on.

All this is possible only from one sensor. When we plan to add more sensors to future models, the potential of the Apple Watch to help with a range of medical conditions is simply enormous!

What may have sounded like one of the least exciting features of the Apple Watch will eventually become one of the most exciting and life-changing.

Photo: National Cancer Institute / Unsplash

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