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New Apple research app could revolutionize heart, hearing, women’s health research
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Apple announced that it is launching three studies leveraging the Apple Watch’s capabilities to allow people to track their heart rate and movement, to allow women to track their menstrual cycles and to determine how routine sound exposure affects hearing.
For all three studies, participants will be able to enroll via Apple’s Research app, which will be made available later in 2019, according to a press release from the company.
“Using an app for study recruitment is certainly something that many of us having been discussing for a while, and it is terrific to see this being launched at a population level,” Cardiology Today Editorial Board Member Jagmeet P. Singh, MD, DPhil, associate chief of the cardiology division at Massachusetts General Hospital and professor of medicine at Harvard Medical School, told Healio. “This will significantly democratize how research is done and enable the generation of large data sets, and in turn will change the playing field (literally). It would be interesting to see how this will get integrated into electronic health records in the future, as that is what will truly determine the clinical value and utility. I do believe the future of clinical care will be sensor-aided, digitally enabled virtual care, powered by predictive analytics. And this seems to be another step in that direction.”
The studies are being conducted with Apple’s ResearchKit technology, which drove the Apple Heart Study that was published and presented in March and showed that the Apple Watch could detect people with suspected atrial fibrillation.
Heart and Movement Study
For the Apple Heart and Movement Study, conducted by Apple in collaboration with the American Heart Association and Brigham and Women’s Hospital, researchers will analyze how heart rate and mobility signals such as walking pace and climbing flights of stairs — collected from the Apple Watch — relate to CV health, hospitalizations, falls and quality of life.
“We are committed to educating and empowering people to be proactive in all areas of their heart health and general well-being,” Nancy Brown, CEO of the AHA, said in the release. “We believe that emerging technology solutions that seek to provide deeper health insights offer great potential in getting us there. We are collaborating with Apple and Brigham and Women's Hospital on the Apple Heart and Movement Study to explore the correlation between a broad range of physical activities and a persons overall heart health to ultimately understand risks and interventions to improve health.”
The study could provide valuable information to cardiologists, Singh said in an interview.
“Having wearables that are seamlessly integrated into daily living will enable behavioral modification that could be shown to positively influence disease states and outcomes,” he said. “Showing the impact of mobility and heart rate at a population level would be meaningful in many ways; in not only reducing costs through simpler strategies, but just promoting overall wellness.”
The study may also raise awareness about the importance of movement in maintaining CV health, Cardiology Today Editorial Board Member Matthew W. Martinez, MD, chair of the American College of Cardiology’s Sports and Exercise Council, told Healio.
“One of the exciting things about this study is that we are continuing the interest level in movement,” he said. “Studies that have been done with other mobile devices have not yielded the amount of information that we would hope this one will. We are looking at better understanding the types of exercise and their relationship with outcomes such as hospitalization, risk of falling and quality of life. We hope it correlates to other data suggesting that volume of exercise is related to improvement in cardiovascular health.”
Women’s Health Study
For the Apple Women’s Health Study , the company will partner with Harvard T.H. Chan School of Public Health and the NIH’s National Institute of Environmental Health Sciences to create the first long-term study on a large scale focused on menstrual cycles and gynecological conditions. The study will inform screening and risk assessment of conditions like polycystic ovary syndrome, infertility, osteoporosis, pregnancy and the menopausal transition.
“A disruption in menstrual cycle length, or skipping menses, is usually an indication of an underlying endocrine problem,” Andrea Dunaif, MD, professor of medicine and system chief of the division of endocrinology, diabetes and bone disease at the Icahn School of Medicine and Mount Sinai Health System, told Healio. “It is an indicator that needs to be further evaluated.”
In a study published in npj Digital Medicine in August, Jonathan R. Bull, PhD, of Natural Cycles Nordic AB in Stockholm, and colleagues assessed menstrual cycle characteristics observed from a database of more than 612,000 ovulatory cycles collected through the Natural Cycles app and investigated associations of menstrual cycle characteristics, such as menstruation, basal body temperature and luteinizing hormone, with cycle length, age and BMI. For a cohort of 124,648 users, mean cycle length was 29.3 days, mean follicular phase length was 16.9 days and the mean luteal phase length was 12.4 days. Mean cycle length decreased by 0.18 days and mean follicular phase length decreased by 0.19 days per year of age among women aged 25 to 45 years, according to the researchers, and the mean variation of cycle length per woman was 0.4 days or 14% higher in women with a BMI greater than 35 kg/m²relative to women with a BMI ranging from 18.5 kg/m² to 25 kg/m².
“The study demonstrated that a minority of women have 28-day menstrual cycles,” Dunaif said in an interview. “We talk about 28 days as being the gold standard. These researchers showed cycles can vary in length and that cycle length chnages with age and BMI. This information is transformative to the field. This is the beginning of a tidal wave of novel information about menstrual cycles and their substantial variability. Hopefully, it will allow women to seek care much sooner and to be interested in their reproductive health.”
Rebecca Thurston, PhD, professor of psychiatry, psychology and epidemiology at the University of Pittsburgh, said irregular or absent menses in a woman’s reproductive years can indicate a range of potential conditions that have implications for women’s health more broadly, including women’s bone, CV and brain health.
“In short, menstrual cycle information provides very important information about women’s health,” Thurston told Healio. “Assuming that the technology is reliable and has adequate protections for user privacy in place, this is a very important innovation in helping the research community further understand both the prevalence of menstrual disorders and the importance of these conditions to women’s health.”
Stephanie S . Faubion, MD, MBA, FACP, NCMP, IF, medical director of the North American Menopause Society and executive director and international medicine director of the office of women’s health at Mayo Clinic in Rochester, Minnesota, said big data gleaned from this type of study will help researchers identify associations that cannot be detected with smaller studies.
“Certainly, Apple has the capability to accomplish this ambitious goal,” Faubion told Healio. “I am hopeful that this will ultimately inform the clinical care of women beyond menstrual cycle tracking for fertility or menopause identification purposes.”
Hearing Study
The Apple Hearing Study, conducted with the University of Michigan, will use the Apple Watch to collect data on the extent to which everyday sound exposure affects hearing, according to the release. The data will be shared with WHO as part of its Make Listening Safe initiative.
“We are excited about this unique opportunity to partner with Apple to determine how everyday activities affect our hearing,” F. DuBois Bowman, PhD, dean of the University of Michigan School of Public Health, said in the release. “The information gleaned from this partnership will be critical for us to address the public health impact of various noise exposures on hearing loss in the United States.” – by Regina Schaffer and Erik Swain
Reference:
Bull JR, et al. NPJ Digit Med. 2019;doi:10.1038/s41746-019-0152-7.
For more information:
Andrea Dunaif, MD, can be reached at andrea.dunaif@mssm.edu.
Stephanie S. Faubion, MD, MBA, FACP, NCMP, IF, can be reached at faubion.stephanie@mayo.edu.
Matthew W. Martinez, MD, can be reached at matthew_w.martinez@lvhn.org.
Jagmeet P. Singh, MD, DPhil, can be reached at jsingh@mgh.harvard.edu; Twitter: @jagsinghmd.
Rebecca Thurston, PhD, can be reached at thurstonrc@upmc.edu.
Disclosures: Brown is an employee of the American Heart Association. Singh reports he consults for Abbott, Biotronik, Boston Scientific, Impulse Dynamics, LivaNova, Medtronic and Toray. Thurston reports she has consulted for MAS Innovations, Procter & Gamble and Pfizer. Bowman, Dunaif, Faubion and Martinez report no relevant financial disclosures.