What is the best strategy for doctors and patients dealing with atrial fibrillation during the COVID-19 pandemic?
Clearly, at this time everyone needs to minimize visits to the doctor’s office, emergency room, urgent care center or hospital. But patients with paroxysmal atrial fibrillation by definition will have periodic spells during which their heart goes out of rhythm and many of these will occur during this period when we want to minimize contact with individuals outside the home.
In my practice, we are able to manage the majority of these episodes remotely by using a combination of personal ECG monitoring, online cloud ECG review capability, and home adjustment of medications.
Given the presence of coronavirus in the community and the potential for overload of acute care medical resources, outpatient/home management of atrial fibrillation is more important than ever.
I have described in detail in previous posts how we utilize Alivecor’s Kardia device in conjunction with the cloud-based KardiaPro subscription service to manage our afib patients remotely. (See here and here.) The Apple Watch ECG can also be utilized for this purpose but is more expensive than Kardia and has no online review service.
With this approach we are able to minimize ER visits and hospitalizations. In addition, use of long-term monitors (which also requires a visit to an outpatient center for hook-up) has been greatly reduced.
Given heightened anxiety during the pandemic we are also seeing many patients experiencing palpitations, which are not due to their atrial fibrillation. These can be due to benign premature ventricular contractions or premature atrial contractions.
If an afib patient calls with symptoms of palpitations or rapid heart beat and they have a Kardia device or Apple Watch ECG we can review the recorded ECG, and can quickly make a determination of the cause and best treatment. If they don’t have one of these devices we have no idea what the cause is or the best treatment.
General Advice For Afib Patients
Obviously, it would be great if patients don’t have episodes of afib during the pandemic.
Paying attention to the eight lifestyle factors which influence afib occurrence I’ve recently posted on is even more important during this stressful period. In particular, afib patients should be limiting the inclination to consume more alcohol and utilizing healthier ways to reduce stress.
Regular exercise has demonstrated benefits in reducing afib episodes and also reduces stress. Gyms are closed or closing, but with spring arriving, outside exercise is always possible. Even if you don’t have exercise equipment in your home there are many exercises you can do inside that provide cardio, strength, and flexibility training. Consider bodyweight exercises, jumping rope, hoping on to a small chair, or go find your old Richard Simmons exercise VHS tape. My wife and I have been enjoying the Seven app lately which takes us through a variety of exercises without the need for equipment. There are tens of thousands of exercise videos on YouTube.
Some afibbers find that meditation or relaxation apps or yoga helps with stress control.
Finally, make sure you have plenty of your prescription medications on hand and that you take them as prescribed without fail. Many pharmacies have home-delivery available for prescriptions.
Regarding medications, please note that good blood pressure control also reduces afib recurrence. Do not stop ACE inhibitors or ARBs as I discussed here.
A Call For More Self Monitoring
Given the importance of staying home right now, afib patients who do not have a method for self monitoring their heart rhythms should consider acquiring a Kardia device or Apple Watch.
N.B. As I’ve mentioned multiple times I have no connections, financial or otherwise to Apple or Alivecor.
KardiaMobile, the original single lead personal ECG is selling for $84 right now. It’s available also on Amazon.
In my opinion, there is no compelling reason to prefer the Kardia6l, which costs $149 over the single lead KardiaMobile.
Both of these devices work with a Google or iPhone app which is free. To store recorded ECGs on Alivecor’s cloud service requires a subscription fee.
When I enroll my patients into KardiaPro I send them an email invitation which allows them to purchase the KardiaMobile plus have one year of cloud storage and connection to my KardiaPro dashboard for $120. Thereafter the one year KardiaPro service is $60/year.
Apple Watch 5 starts at $399. ECGS are stored in the iPhone app. No cloud storage. ECGs can be emailed as PDF.
Patients with Apple 4 Watches or later can send a PDF of their ECG via email or fax to their cardiologist (https://support.apple.com/en-us/HT208955). Check with your cardiologist if they can view a PDF.
NOTE: Apple has closed all of their retail stores outside of Greater China until March 27. Online stores are open at www.apple.com, or you can download the Apple Store app on the App Store so you can still buy an Apple Watch or an iPhone too.
Cheaper personal ECG devices are available. I’ve reviewed several of these and don’t recommend them. (See here and here.)
Thanks to Mark Goldstein and Dan Field for review/editing of this post.
9 thoughts on “Atrial Fibrillation In The Time of Coronavirus: A Call For More Personal Remote ECG Monitoring”
I was looking for an appropriate place for a new topic amid all the COVID talk, this is as close as I could find. I searched the site and couldn’t find anything on bradycardia. Kardia can measure it, but really more suited for my Apple watch. I noticed it a year ago, turned off the alert due to medication I was taking at the time, but since being off the meds for over six months, my heart rate still regularly drops in the low 50’s, high 40’s, even while standing & moving about. I’m 57, not athletic, active, or particularly healthy, with a history of angina & palpitations and minor occlusion in LAD. Not looking for a diagnosis, just the SC’s view on bradycardia.
It is very hard to focus on anything but Covid talk these days.
Your message suggests I should devote a post to bradycardia so I’ll look at doing that at some point.
Briefly, bradycardia just means a heart rate less than 60 BPM. I’ve talked elsewhere on this site about the range of normal heart rates, mostly discussing that each individual has a different baseline normal.
Some individuals have a tendency to be less than 60, others >100 and they can do very well with these heart rates.
If you are free of any symptoms such as dizziness or weakness related to the bradycardia we consider it benign and nothing else needs to be done.
A slow heart rate actually is a good prognostic sign from a cardiovascular standpoint as it is related to better conditioning and higher parasympathetic tone.
I have dozens of patients whose heart rates routinely run in the 40s or 50s and they are doing very well.
Thanks for that, much appreciated, and I do look forward to a bradycardia article. I do experience symptoms related to bradycardia, so it’s been a greater concern for me as an “at-risk” factor if I contract a serious COVID infection. Similar issue with SpO2 hovering around 90 much of the time (at sea lvl), so it’s a matter of having multiple cardiac issues, no one on it’s own being of great concern, but added all together just causes me a greater degree of concern. I just always come back here for greater insight.
Hello Dr. & Chris,
Hello Chris, my heart rate varies in the range of high thirties to high forties. My local cardiologist (I live in the Caribbean and doctor is British trained and a consultant in our hospital system ) looked at my profile from a holter test and also an echo and concluded that I did not appear to be in need of a pacemaker. I do feel a bit of a flutter once in a while. Have no pains etc. Don’t feel dizzy normally either. When I exercise my heart rate goes up as expected and comes back down well after exercise. I was told by US doctors at a US hospital that I needed a pace maker urgently – just because of my heart rate. When I sought more rationale from them I got nothing. I did not put in the pacemaker.
I wanted to explore buying the Kardia but I saw that once one’s rate is under 50 it would give some feedback that the reading could not be validated. I thought this meant that it was not geared to giving accurate data for heart rates so low. Can you advise on use of the device in my case? I felt that its better for me to do some self monitoring to aid in my local cardiologist making diagnosis. I havent yet discussed this with him yet though. But the holter monitoring I used in the past never really captured the events (flutter) that prompted me to seek attention in the past as its intermittent and erratic.
I also have glaucoma and medication with beta blockers are not recommended and was advised to install the pacemaker if if interferes with the glaucoma eye drop treatments.
Your story is a typical one. It is pretty common in the US for pacemakers to be recommended and inserted inappropriately for the sole indication of a slow heart rate.
The slow heart rate must be causing symptoms for a pacemaker to be useful or appropriate.
The Kardia will do a fine job of calculating your heart rate below 50. It will display this as “bradycardia” .
In addition , you would be able to email the PDF of your recording to your cardiologist for his review and confirmation
Thanks for the response. I would invest in the device.
A very interesting post – thank you. We have had to put our gym memberships on hold – the Australian government has recommended social isolation and distancing for our high risk and age cohort. We will check out the Seven app – thanks for that referral.
I bought the original Kardia device when it was first released. I bought a thick plastic case for my iPhone.
I measured the outline of the Kardia onto the case, and cut out a hole. Checked the Kardia slipped into the cutout OK.
Attached the case, then glued the Kardia onto the iPhone case. The glue is very secure onto the metal case.
This setup has worked very effectively for years – discreet, and not bulky, and encourages quick checks.
Will see if the new 6L has similar opportunities. No compelling need to upgrade except SWMBO encourages my enchantment with the latest – she thinks it is very therapeutic for the old codger to let the little boy out to play with his latest toy.
Since retiring, I have returned to my woodworking hobby, and many older men report the therapeutic benefits of having a hobby and just pottering around.
Maybe TSC might consider the role of fun and hobbies as therapy for a future post? Plus the support of an understanding spouse.
I bought the Kardia mobile a couple weeks ago and so far all is normal. I was diagnosed with afib 5 years ago during a routine exam and then a holter monitor confirmed. I’ve never felt it so am curious if it’s gone away after I was put on meds 5 years ago. Seemed strange to me that cardiologist doesn’t do a follow up holter every couple years. But now I’m checking myself albeit only once or twice a day. My doc recommended the Kardia but doesn’t subscribe to the cloud service nor will they accept an email with apdf chart saying it’s not secure. But a fax would be ok. Really? Or I could mail them in if I get a bad reading.
Anyway, thanks for your insight.
The AliveCor is an excellent device. I recommend it.