The lifestylisation of unnecessary medical testing: Apple Watch Electrocardiogram and the direct-to-consumer detection for atrial fibrillation

Patti Shih

Background: The Apple Watch electrocardiogram (ECG) offers direct-to-consumer detection for atrial fibrillation (AFib), a heart arrhythmia that can lead to stroke that is often asymptomatic. Unlike point-of-care screening targeting higher-risk populations, the ECG recording is self-performed by healthy consumers with low-risk of AFib, and operated within a multipurpose platform alongside fitness tracking and other everyday telecommunication functions.

Aims: While clinicians are primarily concerned about the potential harm of misdiagnosis and overdiagnosis of people who test positive, this study focuses on the practices and implications for the majority of users who will consistently test negative. We draw on concepts of commercial and technological drivers of medicalization to examine the expansion of unnecessary medical testing among healthy individuals.

Methods: Qualitative interviews were conducted with 19 purposively sampled Apple Watch ECG users from the United States, Canada, United Kingdom and Germany between August 2019 and April 2020.

Results: Product marketing raised a new awareness of AFib risk, albeit minimal among healthy consumers who sought to use the ECG feature to affirm health. This was frequently integrated into pre-existing fitness monitoring and other daily routines, and at times for fun and amusement. With little expectation to detect disease, the meaning and practice of a medical test is redefined.

Conclusions: The discursive and material assemblage of wellness management and disease detection facilitates the conceptual and practical ambiguity between health and medicine. The promotion of an innovative health technology in this case results in introducing a medical test with limited benefits into the everyday lives of healthy people.