The skeptical cardiologist proclaimed in 2018 that “AliveCor’s Mobile ECG With Kardia Pro Is Eliminating Any Need For Short or Long Term Cardiac Monitors For Most of My Afib patients“. At the time I naively presumed the rest of the cardiologists in the country would follow the pathway I had blazed for them through the bewildering, expensive and depressing morass of long-term cardiac monitors.
This clearly didn’t happen and I rarely encounter a patient outside my practice who is being monitored by a consumer-level personal ECG device like KardiaMobile or Apple Watch.
Perhaps, other cardiologists require published literature rather than my anecdotal evidence. Although, I must say, that the anecdotal evidence I witness every day is powerful and has convinced this skeptic of the value of such remote monitoring beyond a shadow of a doubt.
Early in the COVID-19 pandemic, I wrote “Atrial fibrillation in the time of Coronavirus: a call for more personal remote ECG monitoring” and as the pandemic persists so does the need to utilize more frequently remote telehealth visits as well as mobile ECG (mECG) monitoring.
I’m happy to report, therefore, that a paper entitled “Usefulness of Mobile Electrocardiographic Devices to Reduce Urgent Healthcare Visits” was published recently which confirms exactly what I observed in 2018.
The author’s premise was that due to mECGs quick, accurate, and remote personal diagnosis of different arrhythmias their use should improve triage of patients reporting symptomatic episodes and therefore cut down on in-person visits for evaluation.
They performed a retrospective review of the EHR records and KardiaPro database for patients who had records for about 1 year prior to purchasing a KardiaMobile device.
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.
The authors identified 128 patients and prospectively followed them for one year tracking metrics of monitor usage and health care visits.
Patients were less likely to have cardiac monitors ordered (30 vs 6; p <0.01), outpatient office visits (525 vs 382; p <0.01), cardiac-specific ED visits (51 vs 30; p <0.01), arrhythmia-related ED visits (45 vs 20; p <0.01), and unplanned arrhythmia admissions (34 vs 11; p <0.01) in the year after obtaining a KardiaMobile device compared to the year prior to obtaining the device.
Clearly, this study has serious limitations as it is a before and after observational study without a control group, however, since it was published in a peer-reviewed medical journal perhaps it can tip the cardiologic scales more than my personal observations of the same phonomena.
Another study from 2020 found that “Smartphone ECG Monitoring System Helps Lower Emergency Room and Clinic Visits in Post–Atrial Fibrillation Ablation Patients.“
This study used a device I’m not familiar with, the ECG check
The ECG Check device (Cardiac Designs Inc, San Francisco, CA) is an over-the-counter smartphone-based ECG monitor that is FDA 510k cleared (K170506) and is CE Marked (0086). The device uses 2 metal pads which measure a single-lead electrical tracing and wirelessly transmits this transmission to the paired smart device via the Bluetooth protocol
The ECG Check study was a retrospective look at post-ablation AF patients, comparing those who were utilizing the device versus those who weren’t whereas the KardiaMobile study was 3/4 AF patients with a smattering of different arrhythmias making up the other quarter.
Its design and methods and are so weak it doesn’t add to the scientific literature at all. It was published in a journal I have never heard of “Clinical Medicine Insights: Cardiology” which I suspect as being predatory and “pay to publish” in nature.
The people at ECG check have no supporting scientific literature listed on their website whereas AliveCor has about 180 papers using KardiaMobile.
Given the dramatic reduction that I have noticed in my use of long-term monitors as well as office and ER visits in this population, CMS and third-party insurers would be wise to explore Kardia monitoring as a more cost-effective way of monitoring afib and other cardiac arrhythmia patients. However, payors, as far as I know, are still not reimbursing for Kardia or Apple Watch.
Despite that, I encourage my fellow cardiologists to embrace this patient empowering technology. Although it doesn’t put a lot of dollars in your pockets it keeps your patients out of EDs.
Monitoring Rhythmically Yours,