
I Now Have a Cardiologist - Aaronn
https://joecieplinski.com/blog/2019/03/28/i-now-have-a-cardiologist/
======
dheera
I have had a couple instances of ventricular fibrillation. I have an implant
which brings me back to life when that happens; I would be dead without it.
However, I do go unconscious for a few seconds until I get shocked back to
life.

Although my case is infrequent enough that it is not thought of as a risk by
the medical community, for peace of mind what I would really like to have is a
link between a watch of some sort and a car capable of self driving. Should I
be driving when I go unconscious, all the car would need to do is
automatically kick in autopilot mode while gradually slowing down, until a
heart rhythm is detected again.

The risk is small, if you consider the percentage of time I'm behind the
wheel, but it would be good for peace of mind. It would also be helpful for
others who do not _yet_ know they have a heart condition, or those who are
having a stroke or epileptic attack while at the wheel. There are others with
worse conditions than mine who are basically advised not to drive, so it would
help them as well.

If falling asleep can be detected by any biological signals, that would also
be a useful autopilot trigger while waking the driver up, for the general
population.

Currently most cars require manually activating the autopilot mode; what I'm
proposing is a vital sign monitor to automatically _begin_ self-driving if the
human is incapacitated.

If the human doesn't wake up within a half a minute or so, the car could also
self-drive itself to a hospital. I think we're far enough with self-driving
tech that that saved life would far outweigh the risks of the self-driving
system having any issues en route.

~~~
dreamcompiler
> the car could also self-drive itself to a hospital

I think you're onto a good idea, except for the above quote. It would be a
much better idea to have the car automatically pull over to the shoulder,
stop, engage the flashers, and call 911. Paramedics can keep you alive en
route to the hospital with drugs, cardioversion, and CPR. Your car cannot.

~~~
tapland
The problem is response time. If you are currently on the road it's probably
faster to head to the hospital than to wait for an ambulance.

~~~
dreamcompiler
Which hospital is nearest? Which can be reached within the self-driving
capabilities of the car? Which has Advanced Cardiac Life Support staff and
equipment? Which is still open? Which is not already handling another cardiac
emergency? Which route has the least traffic?

Paramedics and EMTs can work these questions quickly and they have lights and
sirens to get through traffic. Your car will probably google "hospitals" and
(slowly) take you to the nearest one, which might be a closed methadone
clinic.

In most cities, an ambulance is going to get to your car much quicker than
your car would get you to an appropriate hospital. A modern ACLS rescue unit
is effectively a heart hospital on wheels. So calling 911 brings the hospital
to you, without putting anybody else on the road in danger from your car's
not-yet-quite-ready-for-unsupervised-operation autopilot software.

~~~
JaumeGreen
So what it is needed is that the car communicates with 911 and an automated
system will tell it to wait for help, go to a destination where help will go
to, or go to a help center (hospital or similar) where help will be waiting.

It could even work if you are at home and have an emergency. Call 911 and if
they decide you should go to a health center on your own it will send where to
go to your car.

Of course at first wait for help should be the default, but when automated
driving improves, and the processing of emergencies improves too, an automated
response system should be the norm for most of the time.

~~~
dreamcompiler
Agreed. Technology could help. There are significant elements of assessment,
planning, and optimization that now are done manually by emergency responders
that probably could be automated.

------
laurencei
If you put a popular device, with a medical detection tool into the wider
population, it would be logical that the device would pick up on patients who
would other not notice the symptoms (at least initially, if any).

So then the question becomes what other daily device(s) could be made to do
automatic health checks of certain specific indicators, which would give an
early indication to the possible condition, thus improving life expectancy and
quality of life, while lowering associated medical costs.

i.e. toothbrushes that detect cavities, sunglasses that check your pupils for
certain symptoms, hats that monitor your EEG. These are obviously extreme
examples, but you get the idea...

~~~
dwhit
A toilet that monitored urine and stool samples would be a major lifesaver.

~~~
peteretep
This strikes me as an exceptionally difficult problem to solve. I'll be
impressed if someone brings a workable solution to market in any reasonable
time-frame. I guess if you can retrain people in how they use their toilet,
you might be able to simplify some of the challenges, but many people use
their toilet as a generalized soft/liquid garbage can.

~~~
paul7986
Well that’s just it the UX of using a toilet would remain the same and the
smart toilet wpuld collect the sample(as a toilet does now)/analyze it and
send the data if it detects irregularities to your doctor. He/she then
analyzes it and schedules a follow up appointment if needed.

~~~
peteretep
Keeping the user experience the same — I suspect — will be excessively
difficult

~~~
paul7986
How so you use the toilet as you always would and everything is done
automatically by the smart toilet.

~~~
peteretep
Right, I also want a machine that magically makes me lose weight while I
sleep, while not affecting my sleep and costing $5 ... that doesn’t mean it’s
mechanically or physically possible with current technology though.

------
morganw
from the article: "Did my Apple Watch save my life? I think in my case, that’s
a bit of an overstatement."

Thanks to an Apple Watch w/ ECG, I now have a cardiologist, too. My A-fib
burden is only 4% and at my age without diabetes my increased stroke risk is
minimal, so my Dr. basically asked why I was bothering to wear this thing if
it was just worrying me unnecessarily.

I mostly agree. It _is_ nice to finally know what's going on because I've been
having irregular heartbeat when exercising for over 5 years & a stress test
(ECG on a treadmill) didn't show anything. Now I've had 2 weeks of monitoring
with an iRhythm Zio & an echocardiogram so I know I'm reasonably safe to
continue exercising.

Is it worth the $$$ insurance paid for all of it? I'm really not sure about
that. I kind of wish the Dr. had told me "lose some weight or you'll drop
dead" because I would have listened. I'm also not sure what I would have done
if I hadn't been able to figure out what was happening. Probably just continue
to keep my rate under 150 as it's a high rate that usually correlates with
irregular beats.

~~~
azinman2
So you’re cardiologist is saying it’s not a big deal to be in afib (unless
you’re on blood thinners)? I don’t understand how that could be a reasonable
thought.

~~~
morganw
My cardiologist is saying that it's not a big deal for _me_ to be in afib 4%
of the time with the longest lasting 3 hours 10 mins over a 2 week period. I
haven't had a stroke or transient ischemic attack previously, don't have
diabetes, hypertension or congestive heart failure. I'm male and 51 years old.
Thus, my CHADS₂ and CHA₂DS₂-VASc scores are zero.

~~~
azinman2
If you come out of it reliably on your own within a few hours, that makes
sense.

------
tasty_freeze
It is odd to me how he keeps describing his $500/month insurance as being
useless: he is generally in excellent health and his yearly expenditures are
low enough that he is always paying down the deductible.

Does he feel car insurance and home insurance are useless since he didn't
total his car last year and his house didn't burn down?

He knows this (as he mentions it obliquely) that he could lower his deductible
but his costs would go up. Is he complaining that he is on the wrong part of
that tradeoff curve? Or does he expect low-cost insurance with a low
deductible that covers all of his routine medical expenses?

~~~
usaphp
Imagine a regular sized family of 4, you have to shell out more than $20K/year
for the most basic health insurance for your family if you are self employed,
$20,000! and you still have to pay for EVERY doctor visit for your kids and
regular checkups, and your family deductible is around $10-12K. And every year
they send you a new increased quote by 10-15%. There should be some kind of a
discount for families, like when you have multiple cars under your insurance
your rate barely goes up when you add another one.

~~~
cbsks
In my expensive area of CA, a gold insurance plan for a family of 4 costs
$20,400 per year. That’s an insurance plan with a $0 deductible and $30 co-pay
per doctor visit. That is far from the most basic health plan. A plan with a
$12k deductible is $13,500 per year.

Even so, a $20k a year is peanuts compared to the out-of-pocket expenses of a
serious medical emergency. Don’t fall into the trap of thinking insurance is
not with it just because you haven’t had to use it yet.

~~~
usaphp
> $20k a year is peanuts compared to the out-of-pocket expenses of a serious
> medical emergency.

And that’s the most annoying part. The fact that $20,000 is considered peanuts
in a medical condition is already outrageous. My friend’s wife had a c-section
child delivery and was billed $38,000...for a 3 days stay at the hospital. No
complications just a planned c-section. I understand that’s the reason why the
insurance is so high

~~~
mbreese
> No complications just a planned c-section

There was a lot of effort, planning, and training that goes into making sure
that there aren't any complications. Not to mention the fact that even routine
procedures can have unexpected complications that have to be planned for and
addressed. I think that $38k for a surgical procedure with post-operative care
for the mother and child isn't necessarily that outrageous. Just imagine the
people, training, facilities, etc...

EDIT: Now that I'm thinking about it -- was the $38k bill with or without
insurance? Meaning, was this their out of pocket costs with insurance? If so,
that does seem rather unreasonable. If that was the billed rate for the
insurance company and your friend's out of pocket costs were lower, that would
make more sense.

~~~
baq
I have 3 kids delivered by c-section. Total paid - €0. Performed by trained
professionals in a nice hospital, not by villagers in a shed.

~~~
mbreese
Given that you are quoting the price in Euros, I suspect the funding mechanism
for your hospital is very different than the hospital costs the parent was
talking about.

I know nothing about how the financial side of European hospitals work
though... but I assume they still have internal costs that are tracked and
tallied. Your kids' deliveries may not have cost you, but there was a total
cost somewhere in the system. It probably wasn't anywhere near $38k, but even
that isn't a fair comparison due to the substantial differences between the
medical systems and the way indirect costs could be covered.

(I'm not trying to defend one system or the other, just pointing out that the
systems are different so direct comparisons like $38k vs €0 aren't that
straightforward. It gets even less straightforward when you factor in the US
medical insurance system.)

~~~
yoz-y
In France a 1 day stand in hospital is billed around 1000€, of course it is
almost entirely covered by insurance. You have to pay a fee of 17€ a day if
you have some standard insurance package. If you 'stay' at the hospital then
all costs are bundled in this price, if you only follow exams they can
actually get more expensive in total (usually they offer you to stay the night
if you have exams that would cost more than a "full-pension")

This was a few years ago so the prices may have changed.

~~~
mbreese
Thanks for the insight into how things work in France. Like I said -- I don't
know much about how non-US healthcare systems are funded.

But, I think the main question I was trying to get at is -- how much are the
French (or Japanese from a different thread) hospitals subsidized by the
government. I expect for there to be indirect costs that might have to be
covered by direct billing in one country, but not another. For example,
electricity bills (or the cost of the building, etc)... is this covered by the
1000€ bill, or is is paid for by some other means? I recognize that US
hospitals also get some level of subsidy, but there are hidden costs that
aren't always apparent.

This is what I was trying to get at... that direct comparisons of costs aren't
always that straightforward when comparing different systems. A 2000€ or $2000
bill might represent only a fraction of the actual cost of treatment. And
given the opaque nature of heathcare billing, it's very hard to know.

~~~
ABCLAW
> Like I said -- I don't know much about how non-US healthcare systems are
> funded.

Then shouldn't you read up on that before expounding upon how a 38k price tag
for a scheduled routine procedure is reasonable? Healthcare billing isn't that
shocking when you travel outside of the states.

------
itissid
While this is great for Afib detection it's its very rare CDC says 2.7-6
Million people[1]. Still great for those people! I still think we need to do
much better. High BP and hypertension is way more important to measure since
they can be diagnostic in a larger percentage.

My dad is a triple bypass heart patient. ECG and stress tests did diddly squat
to detect it, until it was too late and it was diagnosed by a CT Angiogram. I
now get CT Angiogram with contrasts every few years just to be safe because of
family history.

[1][https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atr...](https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_atrial_fibrillation.htm)

~~~
milemi
Do you know how many sieverts you get each time? I had one of those and I
think I got one year's worth of background radiation in those few seconds that
it lasted.

~~~
mlindner
People worry too much about radiation. A year's worth of background radiation
is not that much radiation.

~~~
milemi
I wouldn't know what's too much or not, but here's a link with the numbers
[https://www.radiologyinfo.org/en/info.cfm?pg=safety-
xray](https://www.radiologyinfo.org/en/info.cfm?pg=safety-xray)

------
faitswulff
This is the 2nd or 3rd story I've heard like this about the Apple Watch's new
ECG feature. I wasn't interested in smartwatches before, but now I am
considering getting an Apple Watch, even if it's just for my parents.

~~~
haukilup
Edit: Still not in Canada, though it seems to be in more countries. Very
frustrating!

Original: I don't think they enable the ECG feature for anyone outside the US.
It's locked based on the point of sale last I checked. Very frustrating to buy
something so expensive to find out it's been region-locked!

~~~
mr_toad
It counts as a medical device, which means it has to go through extensive
certification. Different countries have different procedures.

~~~
haukilup
Correct! The frustrating part (for me) is Apple’s lack of transparency in the
extended delay in the release of this feature. It was heavily promoted, yet to
find out that the ECG feature wasn’t available prior to purchase you had to
dig through their support documents to find the list of countries it is
available in - which at the time of my purchase, was between 1-4.

But I only found that out after spending 3 days income on the device - because
who would expect that a heavily promoted feature WASN’T available?

I understand Apple’s choices of communication from their perspective as a for-
profit business, which only makes me unhappier.

------
Waterluvian
A friend of mine in his early twenties drowned a few months back due to a
cardiac event related to atrial fibrillation. He was otherwise in phenomenal
shape and living life to the fullest.

~~~
kbos87
I’m really sorry that happened to your friend and to you. I think the best
outcome of tech like this is that it makes what seems like maybe small and
maybe seemingly mundane improvements that reduce the frequency that things
like this happen.

------
maxgee
> resting heart rate being in the 113-120 bpm

That seems insanely high

~~~
Tharkun
It's not "insanely" high. And blanket statements like this can cause undue
alarm.

If you're worried about an elevated resting heart rate, go get an ECG done.
Don't let random people on the internet talk you into health anxiety.

~~~
notacoward
As even the tiniest bit of research will show, that _is_ insanely high. Well
over 99th percentile for that age group, according to US CDC. While it might
be counterproductive to get anxious about minor symptoms, when one of the most
critical indicators of overall health is off the charts I think "you should be
worried" (with "go see a doctor" as the express or implied followup) is the
humane response. "Meh" or denying the statistical reality is IMO
irresponsible.

------
underwater
> It’s also worth noting at this point in the story that Atrial Fibrillation
> is extremely rare in men my age. Less than two percent of people in my
> demographic have it. Go figure. When I do something, I go big I guess.

This is looking at it backwards. How many serious health problems have similar
rates of affliction? If there are 50 different potential health problems then
he has a 2 in 3 chance of having at least _one_ of those.

~~~
Gibbon1
This reminds me of Lupus and Guillain-Barre syndrome both rare diseases. But I
know half a dosen people with lupus and four people that had Guillain-Barre
and suffer lingering effects.

So if you're a doctor it's really unlikely that you patient has either of
those. But start adding up all of those rare syndromes and it starts getting
scary.

------
sneak
> _" I continue to pay for my insurance because thanks to the Affordable Care
> Act, I have to. It’s the law. And I’m okay with that. Because I know paying
> into the system helps others who make less money than me have access to
> care._"

One had better be okay with it, because if you don't consent, they'll take the
money from you by force.

------
DoreenMichele
I saw some variation of this story around the time it came out:

 _Grandfather discovers heart condition thanks to children’s museum exhibit_

[https://kdvr.com/2019/02/21/grandfather-discovers-heart-
cond...](https://kdvr.com/2019/02/21/grandfather-discovers-heart-condition-
thanks-to-childrens-museum-exhibit/)

I don't think I submitted it to HN. I felt it would be viewed as fluff.

But we have incredible and constantly increasing opportunities to casually
check biometrics that previously required serious medical exams and lab work,
etc. It's absolutely changing things.

------
Waterluvian
Are there any quality alternatives for literally just monitoring your heart? I
don't like the watch but I want that feature pretty badly.

~~~
atomical
Go to a doctor for a physical every year.

~~~
Waterluvian
So I do. But nothing he does touches on this subject, at least I think. Maybe
I'm not in the right age group for him to bother. He listens to my heart and
checks blood pressure. My sense is that this is just so unlikely given what he
does know about my health that he doesn't explore further.

------
antirez
Here in Italy in order to subscribe to a gym you need to bring your ECG (not
mandatory by law but a number of gyms will ask for it), and every year you
need to make a new one, so I would say that the percentage of "active"
population that is not regularly checked is small. How is this matter in the
rest of the world?

~~~
inglor
Israel used to be this way and it used to be a requirement by the government
(not an ECG but a doctor note). Like a lot of other regulation it made it less
likely for people to work out.

Now it's a questionnaire instead. I think the new system works better here
since it's one less hurdle to get over before you can sign up for a gym and
work out.

~~~
antirez
I would say yes and not: yes it may become a barrier, but no, here most gyms
organized that they have a doctor inside and for 40 euros they do the doctor
checkup + ECG.

~~~
inglor
Oh, in Israel getting a doctor checkup or an ECG is free and most gyms don't
have doctors or even a nurse (all gym instructors must get CPR certification
though).

------
Topolomancer
I love the matter-of-factness of this article. Not only is it a great example
of how technology can have unexpected positive outcomes for users, the author
also manages to sneak in some extremely relaxed observations about the ACA and
having to subsidise healthcare of others. I am impressed!

------
simonebrunozzi
> "Since I don’t have a “job job,” I pay roughly $500 a month for “health
> insurance” out of my own pocket"

Tangential question, related to the above: I am currently paying for COBRA,
and the amount paid is outragerous. Anyone has suggestions for a cheaper, good
enough alternative?

------
raverbashing
> (a direct result of my resting heart rate being in the 113-120 bpm range)

Yeah that should have been a red flag in itself

Also remember that while it will give "true positive" results, there will be a
lot of borderline or non-worrying alarms that will need to be checked.

------
skizm
One thing to note: portable ECGs are <$100 on amazon. Not as feature rich as
the apple watch, sure, but the watch only measures from one location, normally
you want to measure from a few, usually at least 3: leg, arm, and chest.

~~~
mach5
the watch measures from two locations actually, through the wrist and through
a finger on the crown. you're still right that 3 (and more) is better.

~~~
skizm
For each of the three locations I mentioned, you also need to contact the
portable ECG with your finger. The finger is being used to create a closed
loop. It is not a measurement site.

------
intrasight
My health and my retirement depend upon Apple getting this right :)

------
BasicObject
I wonder when there will be tech like this for epilepsy.

------
dis-sys
from the article

> resting heart rate being in the 113-120 bpm range

with such readings, I guess one would just go to see a doc?

------
rsync
I also have a cardiologist.

It takes the form of a combination of very high output training (BJJ) coupled
with regular, sustained aerobic training at a high percentage of my aerobic
capacity (running and plyometrics).

It sounds like I'm being flip, or worse, self-satisfied - but I am quite
serious.

If my heart started behaving strangely, or weakened in some way, _I would
notice immediately_. It would be quite marked. Things that I partake in, and
think about, _and feel_ , would suddenly be off.

Or to put it more technically, I am running my body at a much lower set of
tolerances where defects are immediately identifiable.[1]

I have a suspicion that _my cardiologist_ is actually better than the apple
one, since I could _feel_ some differences that might not yet manifest
themselves in some kind of measurable heart output.

The downside to all of this, in the faraway future (I am currently 42 years
old) is that "heart trouble" might manifest itself _during exercise_ in a
sudden and acute fashion that leaves me dead. On the other hand, the exercise
makes that, statistically, less likely.

I also enjoy it very much, so there's that.

[1]
[https://www.keyence.com/ss/products/measure/measurement_libr...](https://www.keyence.com/ss/products/measure/measurement_library/basic/tolerance/)

~~~
gotocake
_The downside to all of this, in the faraway future (I am currently 42 years
old) is that "heart trouble" might manifest itself during exercise in a sudden
and acute fashion that leaves me dead. On the other hand, the exercise makes
that, statistically, less likely._

Actually depending on your condition and your activities, it’s entirely
possible that the first warning you’d have is dropping dead. I’m also not
being flip or self-satisfied, and I also have an anecdote to share. A good
friend of mine who was a serious tennis players, and later an equally serious
swimmer and runner got his “warning” about two years ago. He was at a
conference and complained of feeling a bit ill. Then he experienced sudden
cardiac arrest and despite an AED on premises he died.

He wasn’t much older than you, was in perfect shape and ate well his whole
life, saw his doctor and had good lab numbers. The “far future” you imagine is
hopefully just that, far in the future, but it might not be. Like a lawyer as
their own client, don’t be a fool and pretend to be your own cardiologist.

~~~
rsync
"Actually depending on your condition and your activities, it’s entirely
possible that the first warning you’d have is dropping dead."

Yes, that's exactly what I said.

~~~
gotocake
You placed that possibility in, and I quote, “the faraway future” and all in
the context of your fitness regime being an early warning system better than a
cardiologist. Even taking your post with a generous helping of charitable
interpretation, it seems Ill-conceived.

------
chirau
If the Apple Watch can be credited for new detections, can we also blame it
for non-detections?

Just asking... Because if the value prop is that they can detect, then they
should have some accountability for non-detected positives, no?

~~~
mr_toad
> they should have some accountability for non-detected positives

The device has been given a class II clearance by the FDA, which means it has
to “ provide reasonable assurance of safety and effectiveness “.

False negative rates are definitely one of the things that are considered in
getting this. That doesn’t mean false negatives aren’t possible.

------
est31
IDK about this. I find it kinda creepy to have my heart beat monitored & sent
to a server far away and not under my control. I mean, ad companies already
have so much data about me, do they also need to know how my heartbeat reacts
to an ad? Does my insurer need to know it? I wonder whether it can detect sex
and be used to e.g. track infidelity.

On the other hand, of course it's great to save lives and help you detect
possibly harmful conditions. The thing that makes me uneasy is not the idea of
a heart tracker watch per se, but the possibility that maybe one day the
facebook app wants access or chrome because of WebHeartBeat API or whatever.
This trend of constantly increasing amounts of data sources sent to the cloud
is sick.

~~~
saagarjha
> I find it kinda creepy to have my heart beat monitored & sent to a server
> far away and not under my control.

Heart rate information, like all health information gathered by Apple Watch,
stays on your device unless you choose to back it up to iCloud. In this case
it is end-to-end encrypted.

~~~
Tepix
Data backed up to iCloud is not yet encrypted in a way that Apple cannot
access it.

~~~
saagarjha
Health data is encrypted with a key that Apple does not have access to. It’s
true “end-to-end” encryption.

