The skeptical cardiologist was quite enthusiastic about AliveCor’s Kardia Band for Apple Watch upon its release late in 2017.
I was able to easily make high fidelity, medical grade ECG recordings with it and its AI algorithm was highly accurate at identifying atrial fibrillation (see here). This accuracy was subsequently confirmed by research.
Many skepcard readers spent $200 dollars for the Kardia Band and had found it to be very helpful in the management of their atrial fibrillation.
However, in December of 2018 Apple added ECG recording to its Apple Watch 4, essentially building into the AW4 the features that Kardia Band had offered as an add on to earlier Apple Watch versions.
In my evaluation of the Apple Watch I found it to be “an amazingly easy, convenient and straightforward method for recording a single channel ECG” but its algorithm in comparison to AliveCor’s yielded more uncertain diagnoses.
Given it size, prominence and vast resources, Apple’s very publicized move into this area seemed likely to threaten the viability of AliveCor’s Kardia Band.
But then-interim CEO (and current COO) Ira Bahr later told MobiHealthNews that his company’s broader business wasn’t threatened by its new direct competitor.
“We’re not convinced that Apple’s excellent, engaging product is a competitor yet,” he said in February. “We believe that from a price perspective, this product is least accessible to the people who need it most. If you’re not an Apple user, you’ve got to buy an Apple Watch, you’ve got to buy an iPhone to make the system work. So their technology is excellent, but we think the platform is both complicated and expensive and certainly not, from a marketing perspective, targeting the patient populations we target.”
Indeed, AliveCor’s Mobile ECG device and its recently released 6 lead ECG are doing very well but the threat to the viability of KardiaBand was real and MobiHealth News announced Aug. 19 that AliveCor had officially ended sales of the Kardia Band.
An AliveCor representative told MobiHealthNews that the company “plans to continue supporting KardiaBand indefinitely” for those who have already purchased the device. The company’s decision was first highlighted by former MobiHealthNews Editor Brian Dolan in an Exits and Outcomes report.
Mr. Bahr has confirmed to me that AliveCor does plan to continue supporting KardiaBand indefinitely. This includes replacement of KardiaBand parts.
Did Apple Kill Smart Rhythm?
The informed reader who notified me of AliveCor’s decision also notes:
The official reason is that they could not keep up with the Apple Watch updates and therefore the Smart Rhythm feature did not work properly.
I think many of us knew from the beginning that smart rhythm was not very accurate But in spite of that the Kardia band provided a valuable convenience over their other products.
It does appear that Smart Rhythm is no more.
AliveCor’s website was updated 6 days ago to state that Smart Rhythm was discontinued:
” due to changes beyond our control in the Apple Watch operating system, which caused SmartRhythm to perform below our quality standards”
Likely, as my reader was told, the frequent AW4 updates plus the lack of a large KardiaBand user base made it unprofitable for AliveCor to continue to support Smart Rhythm.
Smart Rhythm, of course was AliveCor’s method for watch-based detection of atrial fibrillation. It clearly had limitations, including false positives but given AliveCor’s track record of dedication to high quality and accuracy I assumed it would improve over time..
Apple, on December 6, 2018 with the release of its watchOS 5.1.2 for AW4 announced its own version of Smart Rhythm at the same time it activated the ECG capability of AW4.
Apple called this feature “the irregular rhythm notification feature” and cited support for its accuracy from the widely ballyhooed Apple Heart Study (which I critiqued here.)
The irregular rhythm notification feature (TIRNF)was recently studied in the Apple Heart Study. With over 400,000 participants, the Apple Heart Study was the largest screening study on atrial fibrillation ever conducted, also making it one of the largest cardiovascular trials to date. A subset of the data from the Apple Heart Study was submitted to the FDA to support clearance of the irregular rhythm notification feature. In that sub-study, of the participants that received an irregular rhythm notification on their Apple Watch while simultaneously wearing an ECG patch, 80 percent showed AFib on the ECG patch and 98 percent showed AFib or other clinically relevant arrhythmias.
Despite widely publicized reports of lives being saved by TIRNF we still don’t know whether its benefits outweigh its harms. It is not clear what its sensitivity is for detecting atrial fibrillation and I have reported one patient who was in atrial fibrillation for 3 hours without her AW4 alerting her to its presence.
For AW4 users, absence of an alert should not provide reassurance that your rhythm is normal.
Thus is does appear that the Goliath Apple hath smote the David AliveCor in the watch-based afib battle. This does not bode well for consumers and patients as I think as competition in this area would make for better products and more accountability.
Per AliveCor the KardiaBand currently works with all all Apple Watches except the original one.
The Apple TIRNF per Apple:
is available for Apple Watch Series 1 and later and requires iPhone 5s or later on iOS 12.1.1 in the US, Puerto Rico, Guam and US Virgin Islands. The irregular rhythm notification feature does not detect a heart attack, blood clots, a stroke or other heart-related conditions including high blood pressure, congestive heart failure, high cholesterol or other forms of arrhythmia.
10 thoughts on “AliveCor's KardiaBand Will No Longer Be Sold And Smart Rhythm Is No More”
Doctor, have you compared the original (one lead) Kardia and 6L one in terms of their accuracy? Took two readings – several seconds apart, without any symptoms – one lead record is very clear, but the first lead on 6L is full of noise and artifacts. The body position is not changed that much, as was using a knee, not an ankle.
I haven’t had the opportunity to do this sytematically. My sense is that we are more likey to get a good stable recording with the single lead with slightly less fuss than the 6L
Has anyone evaluated the EMF from the application/hardware associated with this solution from Apple? Curious to know.
I purchased an Apple Watch 3 and Kardia band in December, 2017 after reading your posts. I was diagnosed with afib in July, 2015. At that time, I had not interpreted symptoms as being heart related. Since then, I am much more aware of ‘flutter’ likely being afib and not just gas. The watch and band have saved me several trips to ER as I’ve been able to email and/or speak with my cardiologist or one of his colleagues and have been able to achieve sinus rhythm with an antiarrhythmic drug. There are other apps for the watch that report heart rate, and I now use one regularly. The last afib episode I had was at home, and both my band and new Omron Intellisense bp monitor reported possible irregular heart rhythm. I am unlikely to detect a sudden increase in heart rate unless there are other symptoms, so I do monitor my heart rate often. I was recently diagnosed with moderate obstructive sleep apnea, a condition I’ve probably had for years and a (not ‘the’) likely cause of my heart issues.
Your reviews and articles have been most helpful and interesting.
I think the KB and AW<4 are a great combo for stylishlily and effortlessly monitoring AFIB.
Many of my afib patients have learned like you to recognize when they are in afib by correlating what their Kardia device or KB is telling them with how they feel.
Thanks for the kind words!
ACP does great work here: he and I have tangled in the past & will again, but this info/approach here is 1st rate! HRS, MD, FACC
Perhaps not as convenient as the watch, but have you seen information on the QardioCore ECG device? It’s currently awaiting FDA clearance.
As a matter of fact I have…..https://theskepticalcardiologist.com/2018/09/30/a-review-of-the-qardiocore-ecg-strap-from-a-patients-perspective/
I have used both the Alive Cor 1 lead ecg where you use two fingers on each hand which is more accurate than the Alive Cor band and is only $99 compared to $200. I now have an Apple watch 4 which gives just as good a reading as the Alive Cor –However the Apple Watch 4 does not give a timely AFIB warning it may be as much as 8 to 12 hours late, rendering it pretty much worthless for this purpose. That said when I go into AFIB I always know it right away, I don’t understand how anyone who goes into AFIB wouldn’t know with a pulse jump of 40+ BPM and the irregular HB and often PVCs That go with it. So in my experience, which is very extensive personally, paroxysmal for 5 yrs going from every 9 months down to every 3 weeks, so much so that I recently underwent a cryoablation, which is much better than RF as it takes a lot less skill and time to do a good ablation, the Apple watch is every bit as good at generating a 1 lead AFIB strip as anything Alive Cor has, but not dependable for early detection of AFIB.
thanks for your comments. Good to hear different experiences with these devices.
Re “when I go into AFIB I always know it right away, I don’t understand how anyone who goes into AFIB wouldn’t know with a pulse jump of 40+ BPM and the irregular HB and often PVCs That go with it”
I have many patients who are unaware of when they go into afib. Some of these are on medications such as beta blockers or diltiazem which prevent the jump in heart rate, others are just unaware even though the HR has increased dramatically. Both of these kinds are at risk for presenting with stroke or heart failure as first symtom.
Do you have direct experience to substantiate “However the Apple Watch 4 does not give a timely AFIB warning it may be as much as 8 to 12 hours late, rendering it pretty much worthless for this purpose.”?