Apple and German Heart Foundation team up around using Apple Watch for dilated cardiomyopathy

Apple's HealthKit

Dilated Cardiomyopathy (DCM) is a heart condition that affects mostly men in their middle ages. The five-year survival rate is about 50% for this impacted with this condition. DCM is a condition where the heart becomes enlarged and cannot pump blood effectively.

Most diagnosis for DCM is performed using ECG, X-rays, and echocardiogram. A large component of the treatment focuses on lifestyle changes along with medications or via using implantable cardioverter-defibrillator.

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Enter Apple in 2020…

And it sort of becomes clear why Apple has been spearheading several key changes in its Healthkit. In particular, Apple makes additions to tracking comprehensive symptoms along with key mobility metrics in iOS 14 and watchOS 7. Apple Watch bio sensing for dilated cardiomyopathy

In April 2020, Apple and the University hospital of Heidelberg partnered up with the German Heart Foundation and German Cardiac society to launch a clinical trial focussed on improving outcomes for patients with DCM guided by longitudinal biosensing with the Apple watch.

The influence of an individualized sports program on dilated cardiomyopathy patients will be investigated in a randomized, prospective intervention study. The study includes 300 patients with dilated cardiomyopathy. And the trial runs over a period of 13 months.

Dilated cardiomyopathy study details

The primary objective of the study is the change in maximum oxygen intake.

In addition, the trial evaluates the safety along with the efficacy of the personalized sports program.

The study provides all participating patients with an Apple Watch S4 and requires each participant to perform the following:

  1. Heidelberg University Hospital designed an app for this study that all participants access during the study’s course.
  2. This app collects important information about the physical activity and symptoms of the patient (including pulse rate, duration of the training, the number of floors, number of steps, and ECGs). 
  3. Participants will use their Apple Watch to monitor notifications about their training status and to remind them of their training.

The participants present themselves 4-6 weeks after recruitment in the department of sports medicine to perform a spiroergometry and a sports medical evaluation.

The study team creates a personalized sports program (depending on the severity of the disease) for the subjects in each of the intervention groups, which consists of strength and endurance training.

The sports program runs for a period of 12 months.

iOS 14 HealthKit advanced health symptoms checker

Now, compare the activities and associated metrics for the study with what we learned from iOS 14 HealthKit changes.

The comprehensive Symptoms checker (30 symptoms) available via HealthKit includes shortness of breath, tiredness or fatigue, and fainting. All of these symptoms are commonly associated with dilated cardiomyopathy.

More importantly, the new set of mobility metrics introduced in iOS 14/WatchOS 7 not only includes the commonly used 6MWT (Six-minute walk test distance) for accessing aerobic capacity and endurance but also includes assessment around stair ascent and descent speed.

Since the Apple Watch is already able to pass on detailed wave-form ECG data via the new HKElectrocardiogramQuery object, App developers in studies such as these will be able to easily incorporate the readings into their assessment and feedback.

This new Apple Watch study started in June 2020 with an estimated primary completion date of June 2022.

Disease management during the study

As patients enroll in new customized training and exercise programs aiding their disease management, study doctors periodically check each participant with standard lab tests. Based on those results, the study teams introduce changes to the exercise programs as needed.

Apple Watch remote health monitoring

The Apple Watch with HealthKit will end up becoming a powerful platform that helps facilitate remote monitoring of these patients as they engage in different activities and exercises.

Christina Farr from CNBC recently did a superb piece where she spoke with leading physicians and influencers around this emerging topic. 

We noted recently that Apple took an active stance by partnering with many hospitals and universities in order to focus on rehabilitative and recovery options that offer tremendous value in personal disease management.

The company also now says it can monitor ‘functional capacity’.

However, there is a lot of room for improvement around carefully introducing more sophisticated monitoring. As per Christina’s assessment,

“Still, not every doctor said they’re blown away by the update. Some say that Apple needs to do a lot more for the medical community, and focus less on wellness features. They note that there are other ways of tracking movement, which are good enough for their purposes, but that Apple should focus on more sophisticated medical monitoring.”

As the baby boomer generation moves into an active retirement, health care options that integrate remote monitoring via wearables play an important role.  Particularly, Apple has positioned itself as a key player in this $ 600 billion dollar emerging healthcare space. And companies such as Teladoc are already gaining momentum.

Wrap up

As an Apple Watch user, what are some of the new features that you would like to see when it comes to health and wellness with the new Apple Watch when it is released later this year?

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