Apple is developing an advanced heart-monitoring feature for future versions of its smartwatch, part of a broader push by the company to turn what was once a luxury fashion accessory into a serious medical device, according to people familiar with the plan.
A version being tested requires users to squeeze the frame of the Apple Watch with two fingers from the hand that’s not wearing the device, one of the people said. It then passes an imperceptible current across the person’s chest to track electrical signals in the heart and detect any abnormalities like irregular heart rates. Such conditions can increase the risk of strokes and heart failure and develop in about one-quarter of people over 40, according to the Centers for Disease Control and Prevention.
These medical tests, known as electrocardiograms or EKGs and ECGs, are common in doctors’ offices, hospitals and ambulances. But they only monitor the heart’s activity for short periods, limiting their ability to spot potential abnormalities. There are wearable versions, too, such as the Holter monitor, but these usually track the heart continuously for a few days at most.
Apple’s current Watch has a more basic heart rate monitor, but the company is increasingly trying to use advanced sensors to predict future afflictions rather than simply collect historical data about the body. An EKG would make it easier to establish the health of a user’s heart, and potentially spot some cardiac problems early.
The development process is ongoing, and Apple may still decide not to include the technology in future products, the people said. They asked not to be identified talking about private plans. Apple spokeswoman Amy Bessette declined to comment.
"I can see a role for wearable ECGs as a mechanism to diagnose arrhythmia as an adjunct to what is currently available," said Ethan Weiss, a cardiologist at the University of California, San Francisco.
Apple announced a research initiative into irregular heart rhythms in November with Stanford Medicine, where Apple’s head of special health projects Michael O’Reilly also serves as a professor of anesthesiology. Participants download an app that uses the Apple Watch’s existing heart rate monitor to identify potential irregularities. The current system uses LEDs and light sensors on the underside of the Watch to track changes in blood flow from the pumping heart. If any abnormalities are spotted, the user is offered a free video consultation with a doctor from telehealth provider American Well. Data from the research may help Apple develop artificial intelligence-based tools that can spot abnormalities more easily and support the EKG project.
When it was first released in 2015, the Apple Watch was largely marketed as a high-end fashion piece. As the second and third generations went on sale, the focus shifted to health and fitness, with Apple adding alerts for abnormal heart rate spikes. While multiple Apple executives have repeatedly highlighted the healthcare sector as a target for innovation, the field is of particular interest to Chief Operating Officer Jeff Williams.
“There’s tremendous potential to do on-device computing, to do cloud computing as well and to take that learning, and through machine learning, deep learning and ultimately artificial intelligence, to change the way health care is delivered,” Williams told an audience at a conference in October. “We can’t think of anything more significant than this.”
The health industry’s size has made it attractive for tech giants seeking new growth markets. U.S. health spending is forecast to grow from almost $3.5 trillion in 2016 to $5.5 trillion by 2025, according to data compiled by Bloomberg. Google parent Alphabet has two healthcare divisions, while Amazon.com has for almost two decades been looking at ways to get into the pharmaceutical industry.
“ECGs are so cheap to manufacture that I have to believe they’ll become ubiquitous," said Brandon Ballinger, co-founder of Cardiogram, which makes an app that uses heart-rate data from the Apple Watch. "The purposes we use ECGs for will likely also expand.”
One hurdle to tech companies such as Apple entering the medical-device market has been the stringent testing requirements imposed by the Food and Drug Administration. The agency outlined proposals in July to use more computer testing to speed up approvals, potentially helping new entrants.
Apple Watch users can already buy an EKG made by AliveCor that is built into the watch’s strap. The startup’s device and its algorithm have received FDA approval. Portable EKGs from the likes of Medtronic that work with smartphones have been available for several years.