Last November, my Android phone died as I descended on a JetBlue flight into San Francisco. I took that trip as part of the CXOTALK series of conversations with technology executives and had six interviews lined up at a conference.
Fast forward about three months, and I'm enjoying life in the Apple ecosystem. The Apple Watch is frustrating at times, but the notifications work, it's waterproof, and the built-in heart rate sensor is accurate.
One frustration with the Apple Watch is limited functionality in the native Apple apps. For example, there is no sleep tracking, and Apple seems unaware of the concept of heart rate zones. Fortunately, third party apps fill some of the voids.
One of the third-party apps I installed is called HeartWatch, which gathers sensor data from the Apple Watch and presents a richer view than Apple's activity tracking software.
Several weeks ago, I started receiving odd alerts from HeartWatch, saying my heart rate was elevated at certain times.
Although I noticed the alerts, they seemed like anomalies, and I dismissed them as spurious readings from complicated software that I did not have time to learn properly. I incorrectly interpreted these elevated heart rate notifications as spam.
The accuracy question
Eventually, however, I started to notice that my resting heart rate seemed higher than normal. Because I regularly work out and track my overall heart activity, I have a general sense of what seems right for me.
Thus, I started paying closer attention to my pulse and became aware that mildly elevated rates were happening consistently. Not alarmingly high, but enough to pay special attention to readings from the heart rate sensor in the Apple Watch.
Then, while walking home from dinner out one night, I checked my pulse, and it was far too high, given my slow walking pace. I can tell you, watching that number rise was alarming.
At this point, the immediate question became, "Are the readings correct?" To verify, I pulled out my Polar M400 and its Bluetooth-enabled H7 heart sensor. Testing the Apple Watch against the Polar, I found the Apple Watch readings to be sufficiently reliable.
Isolating the problem
After ten days, it became clear that something was wrong. So, with a heavy heart (no pun intended), I went to see my doctor. She had me do the following:
Take an immediate EKG (which was normal)
Take a blood test to check for non-cardiac underlying causes such as thyroid problems
Wear a heart event monitor for two weeks. It's a portable device that captures an EKG while the patient is out in the world, tracking intermittent heart issues.
Get an echocardiogram
Within a few days, I picked up the heart event monitor (a King of Hearts Express, to be precise, that uses old acoustic coupling technology to transfer collected data back to the doctor for analysis). Almost at once, it showed sinus tachycardia, meaning a fast heart rate. And the blood test showed something going with my thyroid. And so, the doctor added a thyroid ultrasound and asked me to visit an endocrinologist.
In retrospect, the apparently "spurious" readings reported by HeartWatch were early indicators of a potentially serious problem. Aside from seeing the heart rate data, I felt nothing strange, despite having heart rates that were alarmingly high at times.
Along the way, I also bought a blood pressure monitor, because more information is helpful. I purchased the Omron Evolv, which has Bluetooth and an app that tracks readings over time.
The bottom line
Sensor data reported by HeartWatch made me aware of a potentially dangerous condition of which I was otherwise absolutely unaware. Based on the data, I'm now undergoing various tests and treatment.
Heart health: What's missing from the Apple Watch
You can find many reviews of the Apple Watch explaining what's good and bad. However, from a heart health-tracking perspective, the native watch software and associated apps are overly complicated and incomplete:
Heart reporting is minimal, at best. The Apple Watch is full of sensors, but you must actively start a "workout" to activate heart rate reporting in the Apple apps.
There is no native concept of heart rate zones, which is how virtually all other activity trackers report workout intensity.
Although the data is buried in HealthKit, Apple's apps do not let you easily see trends over time such as heart rate zone, and min / max heart rates. It reports average heart rate, but that is not enough.
There is no native sleep tracking app. Seriously?
What about correlating sleep and heart activity? Also missing.
How about mirroring a real-time heart rate from the watch to the iPhone, to monitor heart rate without continually to look at the watch?
A minor bug: if you try to measure heart rate while the watch is charging but connected to a Bluetooth heart rate strap, the watch gives an error and insists you put on the watch.
In summary, Apple should rethink the data presentation and reporting aspects of its health-tracking sensors.
Heart and sleep apps
If you want to track heart health, here are a list of apps I have tried during this whole experience.
Heart and sleep apps that work with the Apple Watch