Corporate Monopoly / Antitrust / Health Tech

The Heart App Which Apple Broke to Protect Its Own Watch

EvilCorporations.com • Ninth Circuit Court of Appeals, No. 24-1392 • 29 min read

Apple deliberately killed a third-party app that detected life-threatening heart arrhythmias. A federal court just said that was legal. Here is everything the ruling admits and everything it cannot undo.

What the Court Cannot Price: Living Without a Warning System

Atrial fibrillation does not announce itself. That is the entire problem. It flickers in and out. It can last less than a minute. It does not always feel like anything except maybe a slight flutter, maybe a moment of dizziness that you chalk up to standing up too fast. By the time your doctor schedules an appointment, there is almost nothing to show for it. The clinical name for this is “paroxysmal” Afib, and what it means in plain English is that the most dangerous heart condition many people will ever have can be completely invisible in a traditional medical setting.

AliveCor built something that addressed this exact gap. SmartRhythm ran in the background of your Apple Watch during workouts. It continuously watched your heart rate data and looked for the telltale pattern of an Afib episode. When it found one, it told you to take an ECG using KardiaBand. That ECG could be shared with your doctor. That information could be the difference between a diagnosis and another missed episode, between early intervention and a stroke.

This was not a novelty app. SmartRhythm’s effectiveness in detecting Afib episodes in people with a documented history of the condition was published in a peer-reviewed medical journal. It had real clinical standing. It worked for the population most at risk: people who already knew they had Afib and needed continuous monitoring outside of a clinical setting.

Then Apple changed an algorithm. A quiet update. watchOS rolled out in September 2018, and the heart rate data that SmartRhythm depended on was replaced with data from a different algorithm. SmartRhythm could no longer accurately recognize Afib episodes. AliveCor’s engineers tried to fix it. They failed. In 2019, AliveCor pulled both SmartRhythm and KardiaBand entirely.

People who had been using SmartRhythm to monitor a known, dangerous heart condition lost that monitoring. They did not lose a convenience feature. They did not lose a fitness tracker. They lost a system that was watching for one of the leading causes of stroke in the United States. What replaced it, Apple’s own Irregular Rhythm Notification feature, was explicitly cleared by the FDA only for adults without a history of Afib. Apple’s own warnings tell users that IRN is not intended for people who have already been diagnosed with the condition. The exact population SmartRhythm was designed to protect was the exact population Apple’s replacement was declared unsuitable for.

No lawsuit can put a dollar value on the monitoring that stopped. No court opinion addresses how many people may have had an undetected episode in the months or years after SmartRhythm disappeared. The Ninth Circuit’s ruling is a legal document, not a health outcome study. What it records is that Apple gained 100% of a market and paid nothing for it. What it cannot record is what happened to the people who used to have a warning system and now do not.

What the Court Documents Actually Say

The Ninth Circuit opinion is a legal ruling that goes out of its way to avoid calling Apple’s conduct malicious. Read the underlying facts it relies on and the company’s own internal record tells a different story.

“AliveCor relied on internal Apple documents suggesting that Apple could benefit from exclusively owning both the Watch and the heart-monitoring software that operates on the Watch because Apple could potentially sell that combination to future healthcare partners.” Ninth Circuit Opinion, AliveCor v. Apple, No. 24-1392 (filed Jan. 8, 2026)

“AliveCor also pointed to evidence of internal Apple discussions recognizing that changes to HRPO could harm Apple’s competitors’ features.” Ninth Circuit Opinion, AliveCor v. Apple, No. 24-1392 (filed Jan. 8, 2026)

“According to AliveCor, Apple removed third-party app developers’ access to HRPO data to ‘break’ software that would compete with IRN, such as AliveCor’s SmartRhythm and Cardiogram’s similar nascent feature.” Ninth Circuit Opinion, AliveCor v. Apple, No. 24-1392 (filed Jan. 8, 2026)

“Apple does not dispute that it has monopoly power in the relevant market for heart rhythm analysis apps on the Apple Watch.” Ninth Circuit Opinion, AliveCor v. Apple, No. 24-1392 (filed Jan. 8, 2026)

“IRN was cleared by the FDA to detect irregular heart rhythms suggestive of Afib only in adults without a history of Afib, and Apple accordingly warns users that IRN is not intended for people diagnosed with Afib.” Ninth Circuit Opinion, AliveCor v. Apple, No. 24-1392 (filed Jan. 8, 2026)

What Apple Said This Was vs. What the Documents Show It Was

Apple’s legal team argued the algorithm switch was a straightforward product improvement. Here is how that argument compares to what the court record actually contains.

The Damage Beyond the Courtroom

Public Health: Monitoring Withdrawn From the People Who Needed It Most

The health consequences of this case flow directly from who SmartRhythm served and who IRN was designed to exclude.

• SmartRhythm provided continuous, passive monitoring for patients with a documented history of Afib, the group most likely to suffer strokes and life-threatening complications from undetected episodes. When Apple killed HRPO access, that monitoring ended for every user who depended on it.
• Paroxysmal Afib, the type SmartRhythm was specifically designed to catch, can resolve within seconds or minutes. Without passive background monitoring, patients return to the standard clinical model where Afib episodes must coincidentally occur during a doctor’s examination to be detected. This is the exact diagnostic gap SmartRhythm was built to close.
• Apple’s replacement feature, IRN, carries an explicit FDA-mandated warning that it is not intended for people who have already been diagnosed with Afib. The highest-risk population SmartRhythm served was the first population Apple warned away from IRN. No equivalent passive monitoring tool for diagnosed Afib patients on the Apple Watch platform has emerged since SmartRhythm’s discontinuation in 2019.
• Cardiogram was developing a comparable feature that would also have competed in this space. Its development work was neutralized by the same algorithm change that ended SmartRhythm. Two potential monitoring tools were removed from the development pipeline simultaneously, leaving the highest-risk cardiac patients with fewer options, not more.
• AliveCor’s KardiaBand, which provided FDA-approved ECG capability through a Watch band replacement, was also discontinued as a result of SmartRhythm’s collapse. This removed a hardware tool that allowed patients to take clinical-grade ECG readings on demand and share them directly with their physicians.

Economic Inequality: Who Pays When a Platform Company Becomes the Only Vendor

The economic harm in this case follows the structure of platform monopolies: the costs are distributed across users and competitors, while the gains concentrate at the top.

• Apple Watch owners who purchased the device partly for its health monitoring capabilities paid for hardware that third-party developers had expanded into a genuine cardiac monitoring tool. When Apple revoked access to the data those tools depended on, those users’ hardware lost functionality they had relied on, with no refund and no notice from Apple that the capability would disappear.
• AliveCor invested in years of engineering, clinical validation, and FDA approval processes to build a medically credible product on Apple’s platform. That investment was rendered worthless when Apple changed the underlying data access rules. Small and mid-sized medical technology companies cannot absorb losses of this scale the way a trillion-dollar corporation can absorb the legal costs of defending them.
• The court’s ruling, while legally correct under current doctrine, establishes that any company building health tools on the Apple Watch does so at Apple’s discretion. Apple can unilaterally revoke the data access those tools require, at any time, for any business reason, as long as it frames the change as a product update. This effectively makes clinical-grade third-party health development on the Watch economically non-viable at scale.
• The “future healthcare partners” Apple’s internal documents reference would presumably pay Apple directly for exclusive access to the health monitoring layer on the Watch. The economic benefit of that arrangement accrues entirely to Apple. The cost, paid in eliminated competition and reduced options for patients, is distributed across millions of Watch users and the medical technology companies that tried to serve them.
• Patients in lower-income brackets who cannot afford repeated clinical visits or continuous professional cardiac monitoring are disproportionately dependent on consumer-grade passive monitoring tools like SmartRhythm. The destruction of that tool is not a neutral economic event. It maps most heavily onto the people who had the fewest alternatives.

The “Cost of a Life” Metric

What Now: Where to Apply Pressure

The Ninth Circuit’s ruling is the end of this particular lawsuit. It is the beginning of a broader policy conversation about whether antitrust law built for a pre-platform era can adequately address how technology monopolies operate today.

Decision-Makers Named in the Record

• Apple Inc.’s leadership and board of directors control the platform policies that determine which third-party developers get data access and which do not. No individual executives are named in the court record; Apple’s policies are institutional, which means pressure on the institution is where accountability lives.
• Apple’s Developer Relations team administers the API licensing agreements that gave AliveCor access to HRPO data and can revoke equivalent access to any developer at any time. The terms of those agreements are not public.
• Gibson Dunn & Crutcher LLP represented Apple in this case. Thomas G. Hungar argued the appeal. These are the legal architects of the argument that killing a cardiac monitoring app is legally protected conduct.

Regulatory Watchlist

• The Federal Trade Commission (FTC) has authority to investigate unfair methods of competition under Section 5 of the FTC Act. Apple’s platform data practices, particularly selective API access that benefits Apple’s own competing products, fall within the FTC’s statutory scope.
• The Department of Justice (DOJ) Antitrust Division has been increasingly active on platform monopoly cases. The legal theory that failed in this case under private plaintiff standing may find different footing in a government enforcement action, which carries different legal tools and evidentiary access.
• The Food and Drug Administration (FDA) cleared both SmartRhythm’s predecessor technology and IRN under different indications. The gap between what IRN is approved to do and the population it replaced SmartRhythm for is a public health policy question the FDA has not publicly addressed.
• Congress, specifically the Senate Judiciary Subcommittee on Competition Policy, Antitrust, and Consumer Rights, has ongoing oversight over whether existing antitrust statutes are adequate for platform economy conduct. This case is a concrete, fully adjudicated example of the gap that proposed platform competition legislation is designed to close.
• State attorneys general in California, New York, and other states that have more aggressive platform competition laws than federal doctrine currently permits are potential venues for enforcement actions that the Sherman Act, as interpreted here, cannot reach.

What You Can Do Now

• If you are an Apple Watch user with a diagnosed cardiac condition, document the absence of passive continuous Afib monitoring on your device and share that documentation with your cardiologist, your state health department, and your congressional representative. Patient testimony is primary source material for regulatory action.
• Support AliveCor’s remaining products. The Kardia app still operates on Apple devices for on-demand ECG recording and analysis. Using and funding the company that fought this legal battle is a direct form of resistance against the monopoly that beat them.
• Contact the FTC and DOJ Antitrust Division directly. Both agencies have public comment and complaint mechanisms. A single ruling in favor of Apple is not the final word; it is the opening argument for legislative and regulatory reform.
• Support medical technology advocacy organizations and patient groups focused on cardiac health technology access. The Medical Device Manufacturers Association and patient advocacy groups like StopAfib.org are organizations working in this specific space that need public backing and political visibility.
• Push your elected representatives to support platform interoperability legislation. Bills that would require dominant platforms to provide non-discriminatory data access to third-party developers operating in health and safety-adjacent markets address the exact mechanism Apple used in this case. Ask your representatives by name where they stand on this legislation.