AliveCor IPhone ECG transforms heart rhythm monitoring

I’m sad. Gone is the novelty of having magic in my IPhone. For over a year, I was special. As a beta-tester, I could show you your heart rhythm on my IPhone.

Today, the AliveCor IPhone ECG passed muster with the FDA. It gained clearance to be sold to medical providers.

I first reported this story here on DrJohnM in January 2011.

In a paragraph, the AliveCor device enables an IPhone to record one’s actual cardiac rhythm. It is a one-lead rhythm strip done in real-time. The easiest way to record the rhythm is to lightly hold the electrodes on the case. A magic app on your phone displays the rhythm over a programmable length of time. It then stores the rhythm and allows it to be sent to a cloud, where it can be analyzed by a qualified person.

I’ll keep this post brief. Others have weighed in with more details.

Reed Miller covered the story on theHeart.org.

MobiHealthNews has this excellent recap.

Influential cardiologist Eric Topol discuss it in this video on theHeart.org.

Here are just two of my ‘beta’ stories:

I’m at a gathering of cyclists. A middle-aged guy comes up to me and says he hasn’t felt well in about a week. He has no power on the bike; his breathing is labored. Something is amiss, he says.

I think, hey, let’s check him with the IPhone.

Here it is:

Atrial fib on IPhone ECG

Amazing, I just made a diagnosis of atrial fibrillation with a dang phone! That, my friends, made me look really smart.

Another story: a staff member at the hospital has palpitations. The IPhone ECG comes through again. “Here,” I said, “hold my phone for a second.” The dx: benign-appearing PVCs. Based on my IPhone diagnosis, he went to his highly enlightened primary care doctor who recommended more rest, less ‘bad’ food and regular exercise. Voila…the pesky PVCs improved.

This is amazing technology. The AliveCor device allows an accurate diagnosis of a cardiac arrhythmia, or thinking optimistically, it might show a normal rhythm. It does so without a fuss. It empowers patients to have a beat on their heart rhythm, literally at their fingertips. The simplicity is shocking.

In my practice of AFib-ology, the situation of correlating what rhythm is going on at the time of symptoms comes up frequently. Right now, for monitoring of the cardiac rhythm, a patient has to drive to the doctor’s office, park, walk in, check in, fill out forms, sign forms, get a wristband, wait, wear wires for a day or a month, bring back the monitor, wait for it to be analyzed and then…what if during that time of monitoring the symptoms did not occur? (Is that a metaphor for US healthcare or what?)

With the nifty AliveCor device, a patient can easily use a smartphone to record their rhythm. Then, they could save it to review later, text it, or email it. And they can do so when they are feeling unwell or well.

Sure there are headwinds. Who’s going to pay for it—patients or insurance companies? How many patients will invest ‘their’ money for a medical device? That’s not the normal pattern. Medical stuff is supposed to be free. Plus, who will interpret the strips? We should not expect doctors to read these images and discuss with their patients for free.

New and disruptive technology always raises lots of questions.

Right now the AliveCor monitor won’t be available to patients. Only doctors will be able to buy it. The next step will probably be for patients to get access to the device with a prescription. And then, ultimately, it may become available at your local electronics store as a nifty IPhone case. (For the record, it’s a great case.)

This is progress.

Congrats to innovator Dr Dave Albert. (@DrDave01)

JMM

Comments

  1. Don L says

    Wow. Just four years ago my cardiologist hooked me up to a home monitor that communicated with his office via an acoustic coupler connection to my home phone. (i.e. dial a number on the phone, press a button on the monitor and listen to it whistle and wail for an hour or so. It reminded me of accessing the Internet back in the 1980s).

  2. Joe says

    This is great, and useful. I want one.

    Will patients ‘invest’ their own money in one? They will if they’re smart. Save one office visit and you come out ahead – for those of us who actually pay for our health care.

    I question the wisdom of not letting us regular folks buy them right off the bat.

    Patients can already buy a personal ECG device in the $200 range. They’re not as nifty, but they use a real computer instead of an iPhone (which constantly changes models). They are infinitely useful and cost effective for those of us with non-standard wiring :)

    Give a bit of understanding, a healthy dose of curiosity, and a bit of patience, anyone can get quite a bit of information from these devices. For example (from 2008, prices and lower and technology is better 4 years later)- http://www.ndsu.edu/pubweb/~grier/Comparison-handheld-ECG-EKG.html

    • says

      Interesting question you raise Joe! I completely agree that the intelligent, motivated, receptive and collaborative patient can potentially benefit tremendously from devices such as this one. That said – there is potential for a “double-edged sword” akin to the patient who checks their blood pressure too-numerous-to-count times daily – with resultant anxiety-producing over-focus on a number rather than attention to lifestyle alteration that probably matters much more. So while being as strong of a patient advocate as there can possibly be – I echo a word of caution for selection of which patients are good candidates for self-use of this new device.

      P.S. My above comment is NOT only directed at patients but also at physicians, who in years past at times overordered Holters – and who may also become prone to overuse of now ever-available rhythm monitoring. Knowing more isn’t always better … That said – development of the AliveCor monitoring device IS truly an exciting development that when used optimally holds promise of being a ground-breaking advance!

      • Joe says

        I’m glad we’ll always have a class of people like yourself who can decide for the little people out here who is worthy of additional knowledge about their own health.

        Sarcasm aside – this device is less invasive that a BP monitor! or even an oral thermometer!

        Affordable (less than the cost of an office visit) personal ECG devices have been available for years to the general public.

        Some people get worried about odd numbers on their exercise heart rate monitors – should those require a gatekeeper too? My guess is that those devices will have integrated 1-lead tracings in a few years too.

        If we’re going to get serious about having patients take responsibility for their own health, they’re going to need….gasp…..a bit of information so they can make decisions.

        People (even patients) will surprise you in a good way, if you let them. We might even bend that ‘ol cost curve in the process. :)

      • says

        @Joe- your sarcasm is not only misplaced but unjustified. I spent a 30-year career being as strong a patient-care advocate as you will ever find. The is NOT about what “can” be done- and the “cost” is NOT simply the cost of the device. Overdiagnosis is everywhere. Just because you can now monitor every heart beat each and every day in no way means that is a good thing. As one who has written chapters on Holter monitoring (and taught hundreds of students and clinicians the Hows and Whys of this test) – finding “arrhythmias” is not always good- does not always improve the way the patient feels and does not always improve outcome- and may sometimes be something you wish you didn’t find. The astute clinician in concert with the collaborative patient can arrive together at what the best monitoring (or not monitoring) plan is for that patient- with me always advocating final decision to be made by patient for what THEY want to do. For some patients I’d favor monitoring- but not for all – with me advocating joint decision making. Your sarcasm should not be directed at all physicians …

      • Joe says

        My sarcasm isn’t directed at _all_ physicians. It’s directed squarely (and only) at those who think they need to act as a gatekeeper to this kind of information.

        I’m not ignoring any of the problems you cite. I’m just saying ‘Have a little faith – people can be smarter and more capable of understanding nuance than you think’.

        The good will outweigh the bad – in a big way.

        From a practical perspective (ignoring the extra time and money wasted by both sides), there just aren’t enough ‘astute clinicians’ out there to maintain the kind of relationship you describe with all of us patients. I wish there were. And – these kinds of devices have been available and affordable for a few years now.

        In the mean time, we all make the best of the resources we do have and I think devices like this (without a gatekeeper) can really make a positive difference.

  3. says

    Hi there John,
    Informative article once again. I do not have an iPhone, but I do have the below device. I have a history of VT both sustained and non, as well as two SCAs, My sister died of an SCA before she was able to get an ICD. I am currently trying to get some episodes recorded since at the moment I do not have a prescribed Holter monitor, and have been having increasing symptoms within the past week. As a doctor, would you ever take a look at a report from a machine like this? The software (screencaps on webpage, scroll to view) cannot be altered and while only one lead, as with the AliveCor, it does show a variety of rhythms as well as a printout summary and graphs. I am hoping to have something to show the EP when I can finally get in to see one, as the wait here is months and I am trying to save for it. (I moved and no insurance, I had gotten somewhat started gathering evidence with a doctor friend in the past but he has since passed away and he had not given me the reports) Would I be better off going in and starting from scratch with a new doctor (the whole mess, holter, reports, ep study, etc) or would something like this perhaps be helpful to bring in? http://www.ebay.com/itm/New-CONTEC-CE-FDA-Wrist-Pulse-Oximeter-Wearable-Digital-Pulse-Oximeter-CMS-50F-/251055734872 I have 4 recordings so far of some pretty scary stuff which luckily resolved. As always thank you John for the news and information.

  4. says

    In the specific case of the medical subspecialty of Electrophysiology, there seems to be a spectrum of user training to interact with totally safe medical devices. In order:
    - Electrophysiology sub-specialist cardiologist
    - Cardiologist
    - Primary Care Physician
    - Licensesd Athletic Trainer
    - Unlicensed trainer
    - Patient
    Because heart rhythm monitors have been accessible for many years and seem to be used by exercise freaks and trainers as well as PCPs and more specialized physicians, it ought to be possible to get some actual evidence about the optimal degree of patient and community engagement in dealing with serious electrophysiology-related issues.

    Does anyone know of any actual evidence on this safety issue?

  5. says

    Disappointing. In the hands of doctors alone, the AliveCor iPhone ECG is nothing more than a fun little novelty device. Its disruptive power could only have been unleashed if it were to be sold as an over-the-counter consumer product. I wonder how much longer until we successfully rid medicine of its hindering age-old paternalism.

    • says

      Thanks HC. I’m with you.

      May I take an optimistic view?

      We must walk before running.

      Disruption in the medical world moves slowly. This is both good and bad. In the case of AliveCor, I believe we are going in the right direction.