Tag Archives: Kardi pro

AliveCor’s Mobile ECG With Kardia Pro Is Eliminating Any Need For Short or Long Term Cadiac Monitors For Most of My Afib patients: A Tale of Four Cardioversions

I described in detail in March (see here) my early experience in utilizing AliveCor’s KardiaMobile ECG  device in conjunction with their Kardia Pro cloud service to monitor my patient’s with atrial fibrillation (afib). Since that post the majority of my new afib patients have acquired the Kardia device and use it regularly to help us monitor their afib.

This capability has revolutionized my management of atrial fibrillation. In those patients who choose to use AliveCor there is really no need for long-term monitors (Holter monitors, Zio patches, cardiac event monitors) and no need for patients to come to the office to get an ECG when they feel they have gone into afib.

When one of my Kardia Pro patients calls with symptoms or concern of afib, I quickly pull up their chart at Kardiapro.com and review their recordings to determine if they are in or out of rhythm. Most treatment decisions can then be handled over the phone without the need for ordering a monitor or an emergency room or office visit.

One 24 hour period will suffice to show how important KardiaPro is now to my management of my patients with afib

A Day In The Afib Life

Tuesdays I spend the day working in the heart station at my hospital. Typically, on these days I will supervise stress tests, read ECGs and echocardiograms, perform TEES and electrical cardioversions. On a recent Tuesday I had 3 patients scheduled for cardioversion of their atrial fibrillation.

The day before one of these patients called indicating that he suspected he had reverted back to normal rhythm (NSR) based on his Kardia readings. He had had a prior cardioversion after which we know (thanks to daily Kardia recordings) he reverted to afib in 5 days. Subsequently we had started him on flecainide, a drug for maintenance of NSR and scheduled him for the cardioversion.

Not uncommonly after starting flecainide patients will convert to NSR but if they don’t we  proceed to an electrical cardioversion.

I logged into KardiaPro and reviewed his dashboard and sure enough his last two ECGs showed sinus rhythm. I congratulated him on this and we canceled his cardioversion for the next day, saving the lab the time and expense of a cancellation the day of the procedure. The patient avoided much stress, time and inconvenience.

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ECG recordings showing the patient had transitioned from afib (bottom two panels) to NSR (top two panels) after starting flecainide.

It is important to note that in this patient there was no great jump in heart rate with afib compared to NSR. For many patients the rate is much higher with the development of afib and this is often detected by non ECG wearable monitors (like an Apple Watch.)  But for patients like this one, an ECG is the only way to know what the rhythm is.


A second patient with afib who had elected not to acquire an AliveCor ECG device showed up for his cardioversion on Tuesday and after evaluating his rhythm it was clear he had spontaneously reverted back to NSR.  Prior to my adoption of KardiaPro this was a common and scenario.


The third scheduled cardioversion of the day showed up in afib and we successfully cardioverted him back to NSR. I had not addressed utilizing AliveCor with him. Prior to the procedure he asked me about likely outcomes.

My standard response to this question is that we have a 99.9% success rate in converting patients back to NSR at the time of the cardioversion. However, I can’t predict how long you will stay in NSR after the cardioversion. NSR could last for 5 days or it could last for 5 years. Adding medications like flecainide or amiodarone can significantly reduce the risk of afib recurrence after cardioversion.

At this point he asked me “How do I know if I am in afib?” Whereas many afib patients immediately feel bad and are aware that they have gone out of rhythm, this man like many others was not aware.

Prior to AliveCor my answer would have been to check the pulse daily or look for evidence of high or irregular heart rates on BP monitors or fitness wearables. This scenario provided a wonderful opportunity to test the AliveCor’s accuracy at detecting AF in him. I pulled out my trusty AliveCor mobile ECG and prior to the cardioversion we made the recording below

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After the cardioversion we repeated the Alivecor recording and the rhythm (AliveCor’s interpretation) had changed from afib  to NSR.

Needless to say, this patient purchased a Kardia device the next day and since the cardioversion he’s made a daily recording which has confirmed NSR. I just logged into Kardia Pro and sure enough he made a recording last night and it showed NSR.


Later in the week I received a call from a patient I had electrically cardioverted a few days earlier. His Kardia device had detected that he had gone back into afib.

I logged into my Mac and saw his KardiaPro chart below.

Kardia Pro displays green dots corresponding to NSR and orange triangles corresponding to afib with 100% accuracy in this patient.

 

 

With perfect precision KardiaPro had verified NSR after the cardioversion lasting for 36 hours. For some reason after dinner the day after the cardioversion, the patient had  reverted back to afib. This knowledge greatly facilitates subsequent treatment and eliminates the need for in office ECGs and long term monitors.


Utilization of the Kardia device with the Kardia Pro monitoring service has proved for me to b a remarkable improvement in the management of patients with afib. Managing non Kardia afib patients feels like navigating a forest with a blindfold.

The improvement is so impressive that I find myself exclaiming to my assistant, Jenny, several times a week “How do other cardiologists intelligently care for afibbers without AliveCor?”

I have a few patients who balk at the 15$ per month charge for Kardia Pro and ask why the device and this monthly charge aren’t covered by insurance or Medicare. 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 patients.

antifibrillatorily Yours

-ACP

N.B. I realize this post appears to be an unmitigated enthusiastic endorsement of a commercial product which is quite uncharacteristic for the skeptical cardiologist.

One might wonder if the skepcard is somehow biased or compensated for his endorsement of Kardia.

In all honesty, this sprung from my love of the device’s improvement in my afib management and I have received no payment, monetary or otherwise from AliveCor and I own none of their stock (and I’m not even sure if it is on the stock market.)

The New Apple Watch 4: Cardiac Accuracy Unknown, “Game-Changing” Benefits Overblown

On February 10, 2014 AliveCor, Inc. announced that its heavily validated personal  mobile ECG monitor had received FDA over-the counter clearance. Previously the device, which allows recording of a single-lead ECG and, in conjunction with a free smart-phone app, can diagnose atrial fibrillation was only available by prescription.

Since 2013, I have been successfully using this device with my patients who have atrial fibrillation (and writing about it extensively)

Apple COO Jeff Williams standing in front of (presumably) an ECG obtained by Apple Watch 4. It’s OK quality (but smallish p waves). Is that the best they could do? Notice that it is making a diagnosis of sinus rhythm. This PDF can be mailed “to your doctor.”

I was shocked, therefore, to hear the COO of Apple, Jeff Williams, announce that Apple will be offering in its new Apple Watch 4  “the first ECG product offered over the counter directly to consumers.”

This seemed blatantly inaccurate as AliveCor’s device clearly preceded by 4 years Apple’s claim.

Furthermore, AliveCor’s Kardia Band which converts any Apple Watch into a single-lead ECG  (which I’ve written about here and here) has been available and providing the Apple Watch-based ECGs since November 30, 2017.

AliveCor has an outstanding website which documents in detail all the research studies done on their products (there are dozens and dozens of linked papers) and all of their press releases dating back to 2012. It also explains in detail how the product works.

The title of their November 30, 2017 release was  FDA Clears First Medical Device Accessory for Apple Watch®

AliveCor shortly thereafter (December 12, 2017) announced Smart Rhythm , an Apple Watch app that monitors your rhythm and alerts you if it thinks you are in atrial fibrillation. I’ve discussed Smart Rhythm here.

Apple’s Watch will tell you that you are not in atrial fibrillation. Given that we don’t know how accurate it is, should that be reassuring?

The new Apple Watch’s rhythm monitoring app sounds a lot like Smart Rhythm but without any of the documentation AliveCor has provided.

So, within 10 months of Alivecor providing the world with the first ever wearable ECG (and proven its accuracy in afib) Apple seems to have come out with a remarkably similar product.

The major difference between Apple and AliveCor is the total lack of any reviewable data on the accuracy of the Apple device. Yes, that’s right Apple has provided no studies and no data and we have no idea how accurate its ECG device is (or its monitoring algorithm).

For all we know, it could diagnose sinus rhythm with frequent APCS or PVCs consistently as atrial fibrillation, sending thousands of Watch 4 wearers into a panic and overloading the health care system with meaningless alerts.

Apple’s website claims

Apple Watch Series 4 is capable of generating an ECG similar to a single-lead electrocardiogram. It’s a momentous achievement for a wearable device that can provide critical real-time data for doctors and peace of mind for you.

Apple’s “momentous achievement” was actually achieved 10 months earlier by AliveCor and if its monitoring algorithm and ECG system are significantly worse than the proven AliveCor system they will be destroying the peace of mind of users.

Electrodes built into the Digital Crown and the sapphire back crystal allow sensing of cardiac electrical signals. Did Apple get this idea from AliveCor?

After describing the Apple Watch’s new health features, Jeff Williams introduced Ivor Benjamin, MD, the President of the American Heart Association. Benjamin proceeded to describe the new Apple Watch cardiac features as “game-changing”, noting that the AHA is committed to helping patients be “proactive.”

Does  Benjamin have access to the accuracy of the Apple Watch ECG sensor? If so, he and the AHA should immediately share it with the scientific community. If not, by endorsing this feature of the Watch he should be ashamed. Users need to know if he or the AHA was paid any money for this appearance. Also, we should demand to know if (as the prominent AHA logo suggested and news reports implied) the AHA is somehow endorsing the Apple Watch.

Frequent readers know I’m a huge Apple fan but this Apple Watch business makes me think something is rotten in the state of Apple.

Skeptically Yours,

-ACP