Grandma Got a Smart Watch

Matthew DeVane, DO FACC: [00:00:08] Hi, I'm Doctor Matt DeVane.

Carolyn Lacey, MD FACC: [00:00:09] And I'm Doctor Carolyn Lacey. We are cardiologists at John Muir Health and this is our podcast, Living Heart Smart.

Matthew DeVane, DO FACC: [00:00:16] Our physician partners and colleagues are going to help guide you through many different and important cardiovascular topics to help keep your heart happy and healthy.

Carolyn Lacey, MD FACC: [00:00:24] Thank you for listening and we hope you enjoy our show.

Matthew DeVane, DO FACC: [00:00:33] I knew my world had changed when one of my sweet old patients brought me in all the information from her smartwatch. I was like, wow, we're all in on technology these days. Health care really is going all in. Doctor Lacy and I wanted to bring back Doctor John Vu to talk about health care technology and wearable cardiac devices. Doctor Vu really loves this stuff, and I think when used in the right way, this type of data can really improve health care. From a cardiology standpoint. I kind of like it. I mean, it's given us maybe more data than we can sometimes want to deal with. But in general, I think it's helpful, and especially when we're trying to pick up stroke-inducing rhythms like atrial fibrillation, these have significant implications. So, um, John, can you tell me what what you've done a lot of research on this lately. And we've all dealing with patients that have this, these great devices. So of them all where are we. If we wanted to limit it to just a couple to talk about today, maybe smartwatches and the Kardia devices that you can buy almost anywhere including Amazon.

John Vu, MD: [00:01:36] Yeah. So you know these are consumer wearable devices, cardiac devices. Uh, they come from multiple, uh, consumer companies. Big ones are Apple obviously is a big player and uh, Google has their own. They bought Fitbit. Uh, Samsung has their own device. Uh, they started out as a niche for people that were sort of, uh, wanted to get in tune with their heart rate. And, uh, exercise patterns were like, and it evolved to more of a, um, a health device that actually can monitor your heart rate, your heart rate variability, and using, uh, sort of sophisticated algorithms, even detect dangerous rhythm, like, you were noting atrial fibrillation. And it would even send an alert saying, look, it looks like you got an irregular heart rhythm. It could be AFib. Uh, you should see your doctor and, and also alerts you if your heart rate's too low or too high. And I've only just, uh, touched the tip of the iceberg in terms of monitoring other things like pulse oximeter, uh, you know, temperatures on the rise, a potential, uh, in the future. And, um, you know, putting the symptoms the patient has with this data that they acquire, uh, by themselves is, is useful. I mean, clinically, there's no guidelines, but, uh, it certainly helps us to pinpoint, um, what we should be looking out for. And I think, more importantly, it empowers the patient. And this day and age, you know, I've got some 80, 90 year olds wearing these iwatches, and I have to spend at least five, ten minutes actually showing them how to, to get it so that, you know, we can get the data out. You know.

Carolyn Lacey, MD FACC: [00:03:24] Their children have brought it for them.

John Vu, MD: [00:03:25] Yes, exactly. They said, hey, this looks good. You need to go. You need one of these. Yeah.

Matthew DeVane, DO FACC: [00:03:30] I think it's been helpful. I mean, especially for people. The most common thing we see, uh, are these extra heartbeats called PVCs or PACs, premature beats that are benign for the most part, but they're annoying. And, um, those devices are pretty darn good at picking up those and telling you what it is. And so it's very helpful for us because, again, when symptoms are so intermittent, our monitoring and EKGs aren't always that helpful. So I think it's in addition to what we're looking at, as long as the patient is educated about a how to use it correctly and how, almost as importantly, is to ignore a lot of the bad data that is sometimes gives and just how to relax. I get people that get caught up with it, and then they get anxious when they're seeing these things. Oh, you have AFib or your heart's out of rhythm, or you had to which, you know, they're good, but they're not great and they're not perfect. So we'll see where we are five years from now, because I do think it's evolving quickly. But we also have to be ready to give people plenty of reassurance that you don't don't panic. Just bring the info to us. We'll take a look at it, we'll put it together and we'll see how it goes. So I think the watches are good. Um, the one I do like is that it's Kardia or Kardia, so it's a device. Well, you please explain it. You probably know more than I do. Yeah.

John Vu, MD: [00:04:46] So the Kardia was a, um. Actually, I think it came out before the Apple Watch. It was a small device that's about the size of a bigger, uh, stick of gum. And it had two, uh, places to put your finger on. And the interesting story was that, uh, the prototype was, uh, being carried by one of the esteemed, uh, cardiologists, um, on a plane, and he noticed somebody was having chest pain. He took out the device that was a prototype and said, hey, you know, we put your fingers on this thing. And he diagnosed an acute heart attack on the plane. They had to land the plane. And, uh, that's, uh, you know, a little story about how this device, uh, came to the forefront. So once the Apple Watch came out, this device became less common. Uh, we used. But it's still useful because it's something that you could just take out, measure your EKG. It's now able to do more than just 1 or 2 leads. It can do actually a whole six leads. And it's not something you have to wear all the time. So there's pluses and negatives about it. I'd say, uh, it's great when you have need to spot check, but if you wanted something to wear all the time, an Apple Watch is a is a more comprehensive. But the cost difference is is huge. These devices are now like less than 100. Apple Watches are around $300 or $400. So you have to make that kind of decision if that's something worth investing in. Yeah.

Matthew DeVane, DO FACC: [00:06:15] The more important thing I'd like to know is, Doctor Vu, why you compare everything to sticks of gum.

Carolyn Lacey, MD FACC: [00:06:21] Oh, that's an excellent question.

Carolyn Lacey, MD FACC: [00:06:24] Dentyne.

Carolyn Lacey, MD FACC: [00:06:26] Wrigley.

Matthew DeVane, DO FACC: [00:06:27] I think he's infatuated with it. Anyway,

John Vu, MD: [00:06:29] I like miniature things.

Matthew DeVane, DO FACC: [00:06:32] There you go. Perfect. Okay, so what else? Anything else on the horizon that you can think of or you think is important for your patients to know about when it comes to home health monitoring and smart devices?

John Vu, MD: [00:06:43] Well, I'd have to say that, you know, even though you may have a watch, you had to wear it, obviously. Right. And there is a time period if you wear an Apple Watch where you can't wear it because it needs to charge, uh, so it doesn't replace Zio Patch or one of those, uh, uh, prescribed heart monitors because those are much more comprehensive. The one thing I note is also that, uh, due to some medical legal issues, you cannot make any diagnosis other than AFib, uh, on the Apple Watch. It can't tell you that you're having a heart attack. It can't tell you if you're having other arrhythmias, but it might be doing that in the future. So there's a lot to be said about, uh, the future.

Matthew DeVane, DO FACC: [00:07:26] Yeah. No, I think, um, yeah. Understanding the device's limitations is key for both physicians and the patients wearing these devices, so. But, um, hopefully these things will, you know, 15, 20 years from now, all these will go away because it's all going to be implantable, and then your whole body then will be James Bond, then it's going to be James, you know, outpatient insertion of something up in the chest wall. And it's going to give you, uh, it might be.

John Vu, MD: [00:07:51] Part of your wedding ring. You might just. Yeah.

Matthew DeVane, DO FACC: [00:07:53] I mean, I don't know, a lot of cool things are coming, so I'm excited about it. Well, listen, we covered a lot of data. Uh, a lot of good information today. I really appreciate Doctor John Vu for being with us on our new podcast. You are our second official guest. So Doctor Lacy and I say thank you, thank you, thank you.

Carolyn Lacey, MD FACC: [00:08:11] Thank you. We're excited. John, I've been asked I'm going to start asking people, don't worry. I'm not going to make you tell a joke yet. That's the next time you're on.

Matthew DeVane, DO FACC: [00:08:22] I want to hear a joke. Now, Doctor John Vu.

John Vu, MD: [00:08:24] I'm not a joke tara.

Carolyn Lacey, MD FACC: [00:08:27] When you. You know, we all went into medicine for different reasons, of course, but when you now in your practice, what's sort of the thing in your practice that you find when you're dealing with patients that really brings you the most joy, feeling of success, like, oh, we did it kind of thing. Is there anything that you can think of that really helps make you get up and go to work again the next day?

John Vu, MD: [00:08:53] Yeah, I think it's the longevity of, uh, the relationship you have with certain patients, the ones you saw when they were really struggling in the emergency room. You got them through the hospital stay and you got them out of the hospital, and and, uh, that's extremely rewarding. I think, uh, when I started, I didn't realize that was going to be part of it. But now that 15 plus years in it, I think that's the part that gets me going and saying, oh, this is like this guy I saw, you know, he was near, you know, uh, deaths bed. And I'm bringing him back. And here he's, uh, you know, having a grandchild. It's quite exciting, you know, and, um, I think that's the part that really gets me going. And especially all this technology. uh, one of the reasons I chose cardiology is it's so gratifying that to be able to combine the science with, uh, you know, patient care, something, uh, other specialties don't quite have the opportunity.

Carolyn Lacey, MD FACC: [00:09:49] It's good. Thank you. Yeah. Excellent.

Matthew DeVane, DO FACC: [00:09:52] Thank you. All right, let's wrap this thing up. I'm good to go. We're good.

Carolyn Lacey, MD FACC: [00:09:56] To go.

Matthew DeVane, DO FACC: [00:09:58] Well, I can definitely say this. The future of medicine looks very bright. All of this information that patients are collecting ultimately is going to be very helpful for their care in the long term. Whether it be the number of steps you take, your heart rate, your pulse ox, your heart rate variability, your EKG or your heart rhythm. All of it adds up to better health care. I love the fact that people are really just taking more interest in their own health, I love it. Well, Doctor Vu, once again, thank you so much, Doctor Lacey, and I really appreciate you being here. And I know you have a real passion for this topic. We'd love to have you back. Because this field is changing rapidly. Thanks everybody. This is Doctor Matt DeVane and on behalf of my co-host, Doctor Carolyn Lacey and our partners at John Muir Health, we hope that you enjoyed this show and we really hope that you keep living heart smart.

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