Portable EKG Could Reduce Overutilization, ED Visits

Many years ago, an elderly close relative was discovered to have atrial fibrillation during a routine visit to his physician. While the initial evaluation and treatment was being instituted, he suffered a stroke that left him with significant disability… something that created enormous challenges for the family. 

Atrial fibrillation is the most common arrhythmia seen in cardiology and occurs in about 2% of our population. It can come on suddenly and can cause palpitations, shortness of breath, weakness, difficulty exercising, chest pain, dizziness or fainting, fatigue, confusion… or oftentimes no symptoms at all. Major risk factors include hypertension, coronary disease, heart failure, rheumatic heart disease, structural heart disease, as well as a host of other conditions. 

But, atrial fibrillation is not just a bothersome condition; as mentioned in the opening, it is a common cause of stroke. As the upper heart chambers (the atria) enter into this erratic heart beat pattern, blood flow does not follow a normal path through the heart and small clots can form which, when expelled, can lead to strokes. 

Physicians diagnose atrial fibrillation using an EKG machine. Most people reading this article have had or witnessed an EKG and understand that an EKG is basically just an electrical recording of your heart that use wires that are attached to your body with sticky conductive material called “leads”. But you do not actually have to attach leads to you with sticky material. Many gyms have EKG leads imbedded into the handles of treadmills and other exercise machines that measure heart electrical activity just by touching the leads. Although these machines do not typically display the actual EKG, they are none-the-less detecting your heartbeat and calculating your pulse.

There are numerous different forms of EKG depending on how many different leads are used and where those leads are attached. The traditional EKG uses a wire on each extremity and wires attached across your chest. This is called a “12 lead” EKG.  The different leads look at your heart from different directions and allow physicians to see a variety of pieces of data; some of which is specific to different parts of the heart based on the location of the lead picking up the data.

Atrial fibrillation can be diagnosed with just a rhythm strip with just two leads. Although treatments for all phases of atrial fibrillation exist, one of the largest challenges is that people had to go to a hospital or physician’s office for the diagnosis… and that challenge has increased as people delay or entirely avoid health care due to the enormous increase in out of pocket costs, particularly the deductible costs, common since the start of the ACA.

A Mountain View, California company, AliveCor, may have solved this with an innovative smart device accessory they call Kardia Mobile, which retails for just $99.  They have developed a small device about the size of a playing card and not much thicker, that contains the sensors to perform a basic single lead EKG.  It communicates with your smart device using Bluetooth technology.

The FDA-cleared device, with the help of the smart device, can capture a medical-grade EKG in just 30 seconds and provide instant EKG analysis.  The device itself can “diagnose” three different rhythms: “AFib”, “Normal” or “Unclassified” (or “Unreadable”). The three categories reflect FDA approval, not limitations of the device.

“Normal” means that your heart rate was between 50-100 beats per minute, there were no or very few abnormal beats, and the shape, timing and duration of each beat is considered normal. Since there is a wide range of “normal” variability among different individuals, the “Normal” designation has been designed to be conservative. 

Unclassified means that the detectors could not classify your EKG recording as Normal, Unreadable or AF. There could be many reasons why you received this message.  If this comes up, you can send it to your physician or for a small fee, AliveCor allows you to send it to their clinical review service to provide an almost instant reading… by a trained technician or physician.

The app also allows you to keep voice memos of palpitations, shortness of breath, dietary habits and exercise patterns.  It is compatible with IPhones 4 and above, I Pads, IPod Touch and a variety of android devices and uses a common “button” battery that has a battery life of about 200 hours; you can purchase replacements at any drug store.

Kardia Basic, which comes with the device and free app, allows users to record unlimited EKGs with voice memos, but only supports saving and sharing your most recent report.

AliveCor also offers a higher subscription-level service called Kardia Premium.  A subscription to Kardia Premium includes Kardia Basic plus personalized reports with insights and advice designed to help you care for your heart. The quality of this report improves as you share more of your activity through Apple Health and Google Fit.

The company reports that literally thousands of cardiologists have purchased AliveCor for their personal use and in fact this device has been used by one cardiologist to diagnose a heart attack while traveling on a plane!

I was delighted to be allowed by the company to demo a real Kardia device for a few weeks. It starts with opening the package and finding a small black device about half as wide and a bit shorter than a smartphone and about as thick as two coins.  It contains two silver electrodes that are used to record the EKG. 

You then download the app from the app store (takes about 5 minutes). Open an account with email address, age and a few other minor details and you are ready to record your first EKG.

You are told by the app to sit still with your arms on the table and basically hold the device with both hands with the fingers of each hand holding onto the corresponding electrode and… just sit. Amazingly, your EKG appears on the smart phone screen. The FDA requires a physician read the first recording.  The reading is available by the next day. After that, you can open the app and record a reading at any time. 

I found the recordings to be highly readable and amazingly accurate in their reading.  I tried it on my wife and after exercise and found it quite good. I plan to tell my cardiologist friends about it as it is so inexpensive and will help their patients with a variety of complaints provide “at the moment” EKG readings. 

AliveCor is truly an amazing product and is another more mature example of how digital technology is transforming healthcare!