The skeptical cardiologist has empowered many of his patients to self-monitor their diagnosed cardiac rhythm abnormalities and undiagnosed palpitations with personal ECG devices by AliveCor or Apple Watch.
If they have one of the three AliveCor Kardia devices (original single lead, 6-lead, or Kardiamobile Card ) along with a Kardiacare subscription I can review their recordings online when abnormalities or concerns arise.
But what do patients do who have made an Apple Watch or Kardia recording that comes back with an unclassified recording or a diagnosis of atrial fibrillation who aren’t connected to a cardiologist like me?
If they have a PCP or a cardiologist who is willing to review a PDF of their recordings they can upload to Epic or equivalent EMR or email a PDF. Unfortunately, most physicians seem unwilling to review this data thus many patients may be left in the dark.
AliveCor offers a potential solution for those not connected to a skeptical cardiologist or its equivalent: TeleConnect.
TeleConnect: Your 10-minute Consultation with a Cardiologist
AliveCor has for some time offered a service called Clinician Review. This allows a Kardia user to submit a single ECG recording for review by a board-certified cardiologist for a 25$ fee.
More recently AliveCor has quietly rolled out TeleConnect, a service that allows Kardia users to connect virtually with a board-certified cardiologist and receive a 10-minute “consultation” for $69.
It’s pretty easy to initiate the process from within the Kardia smartphone app (IOS or Android) either right after making a recording or by selecting a prior ECG for review by the consulting cardiologist
The service is activated from the Kardia smartphone app, the same one which makes the ECG recordings.
After pushing that green Consult button you are taken to this information screen
After selecting the ECG you want to focus on you are asked to select the state you are in. I selected Missouri as my location and was told “selected state doesn’t match your current location.” Somehow the app knows where you are as it accepted California, my real location.
Due to our country’s archaic system of individual state medical licenses, most states require doctors performing telehealth visits to have a state license corresponding to the state where the patient is located.
This means that if you are a patient utilizing this service and live in California you must be connected with a cardiologist who has a California license.
Alivecor is rolling this service out slowly to various states (as they gather, I presume, cardiologists on the reading team with appropriate state licenses) and the last time I checked the Alivecor website had made it available in 33 states.
The app asks you to enter in the reason for the consultation along with any questions or concerns you have for the cardiologist to review and any symptoms you have been experiencing. The cardiologist will review this information along with your ECG recording prior to starting the visit. This information is all the cardiologist has on your case before he/she starts speaking with you so be as detailed as possible.
You can choose telephone only or video visit and then the 10-minute timeslot and day you prefer.
Following your TeleConnect consultation, you’ll receive from within the app an after-visit summary report from the cardiologist which should include their recommended next steps.
The Value of the “Mini-Consult”
Obviously, a 10- minute consult even with the world’s greatest cardiologist is not optimal for patient care.
Alivecor’s FAQs on TeleConnect reveal some of those limitations:
- No medications can be prescribed
- Not covered by insurance
I haven’t found any reviews or articles on TeleConnect. Clearly, my patients don’t need this service so I haven’t heard any reports on users’ experience and satisfaction.
Hopefully, this will fill a gap for patients who have purchased one of the Kardia personal ECG devices but don’t have an immediately available physician to help them process the information obtained. The optimal outcome would be the appropriate triage of these cases.
Some Teleconnect cases will be reassured that their ECG findings are benign. For example, many “unclassified” recordings are normal but have considerable motion artifacts that the AliveCor algorithm has been confused by.
Some Teleconnect cases may desire rapid information on Kardia’s Advanced Determinations. These include premature ventricular contractions (PVCs) , premature supraventricular contractions or wide QRS. Many of these are likely also to be benign but upon first encounter can provoke anxiety and stress.
Some TeleConnect cases will have been diagnosed with “possible atrial fibrillation.” As the Alivecor algorithm is not 100% accurate, a fair number of these may actually be normal upon review by a cardiologist, and the consultee can be reassured that all is OK.
Some of these “possible atrial fibrillation” cases may be real atrial fibrillation in individuals without this as a prior diagnosis. Best practice in managing such a situation varies depending on many variables (many of which are not accessible to the TeleConnect consulting cardiologist.)
Patients with “possible atrial fibrillation” with significant symptoms (shortness of breath, dizziness, chest pain) or very rapid heart rates are best served by heading immediately to an ER (severity dictating whether by ambulance or personal car.) This is a tough call to make in a 10-minute consultation.
Patients with “possible atrial fibrillation” which upon review is real atrial fibrillation without significant symptoms or very rapid heart rate also present a challenge for a TeleConnect consulting cardiologist. Most of these can be handled as outpatients but a long educational discussion is required. In addition, patients at high risk for stroke should be started on anticoagulant therapy, something TeleConnect can’t do. Ideally, such patients are seen by a cardiologist or their PCP within a few days to go over stroke risk factors, continue the educational process, and decide on rhythm versus rate control strategies.
As I mentioned, TeleConnect has been slowly rolled out by AliveCor with little to no fanfare as far as I can tell. If you’ve noticed an advertisement please let me know.
If you have tried it out and want to share your experience by all means share it on the comments section below or in a direct email to me at firstname.lastname@example.org.
The low-key roll-out may allow AliveCor more time to assess the program for weaknesses or problems that weren’t initially anticipated. If you have encountered potential problems let AliveCor know, I’m sure they will welcome the feedback.