Branislav Vajdic, PhD, is the CEO and founder of HeartBeam, Inc., a company developing a 3D vector ECG platform for the detection of heart attacks.
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In the medical field, there is a continuous supply of new and updated technologies to help physicians better diagnose and treat a wide variety of conditions. However, one area that has seen an outrageous impact from a sudden wave of consumer-facing devices is cardiology.
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The changing landscape in home heart attack detection
It’s no surprise that many cardiologists are grappling with the question of how to cope with the influx of devices such as smartwatches with built-in ECG sensors. On the one hand, such devices can provide valuable patient data.
On the other hand, many cardiologists find themselves having to adjust patients’ expectations about such devices, which can lead to many false alarms and sometimes more anxiety. As such, cardiologists may find it helpful to regularly survey the landscape of technology accessible to consumers.
A study published in Nature Reviews Cardiology goes deep into the types of sensors are available and how they work. However, some cardiologists may want to skip the tech class and go straight to the hands-on, which is what I’ll try to do here.
Types of sensors used by consumers
Smart wearable devices can generate a wide variety of data through a range of different sensors. Activity sensors are the most common. They can provide cardiologists with quantitative data about a patient’s actual level of physical activity, so they don’t have to rely on anecdotal statements from the patient.
Home access to ECG sensors have exploded in recent years amid the growing adoption of devices such as the Apple Watch, Samsung Galaxy Watch, Fitbit Sense, and AliveCor KardiaMobile. However, many of these devices only record single-lead ECGs.
Based on the limitations of single-lead ECGs, they may be suitable for measuring heart rate and detecting simple and common arrhythmias or irregular heartbeats such as atrial fibrillation (AFib). Unfortunately, this also means they can’t detect heart attacks or diagnose more complex arrhythmias.
Some consumer devices also contain a blood pressure or blood oxygen sensor, while others record biochemical data, such as body fluid electrolytes. This latter category remains an emerging branch without much empirical data on the effectiveness or accuracy of these sensors.
Next generation devices
Since 12-lead ECGs are the standard of care in the detection of cardiovascular disease, patients with known heart conditions may benefit from having access to a 12-lead device at home. This is especially true for heart attack patients. Unfortunately, a lack of understanding of the limitations of single-lead EKG technologies such as smartwatches and other popular wearables can give some heart patients a false sense of security.
Cardiologists can and should play a major role in educating their patients about consumer-oriented, commercially available cardiac monitoring devices. When it comes to the standard of care, there aren’t many choices in 12-lead ECG devices specifically for patient use.
Phillips introduced the first home, 12-lead ECG integrated solution for decentralized clinical trials last year. Biocare also offers a portable 12-lead ECG device. AliveCor makes a 12-lead device called the Kardia 12L based on smartphone technology. HeartBeam’s AIMIGo device can be carried in a patient’s wallet (I’m the founder and CEO of HeartBeam) so they always have it with them.
However, these patient-applied 12-lead ECG technologies require the patient to carry a bag of electrodes and wires. Indeed, an important condition for widespread consumer acceptance of 12-lead ECG solutions for use outside the medical setting is that these devices are easy to use and always with the patient.
Challenges with the deluge of new devices
With so many different types of heart-related devices, cardiologists can find it difficult to distinguish one from the other. However, given the rapid growth of smartwatches and other wearables, it might make sense to learn what type of data is captured by the most popular ones.
Cardiologists know that the ultimate medical outcome of a patient with a suspected heart attack is often determined by the amount of time that elapses between the onset of chest pain and other symptoms and the medical intervention. Therefore, they would like to guide patients by providing their own shortlist of preferred comprehensive home heart monitoring devices capable of detecting heart attacks.
Another problem is data integration. Many patients don’t know how to upload the data from their device to their electronic health records, so they end up showing it to their doctor on their smartphone. It will take time to develop data integration standards, so cardiology practices that are beginning to teach their patients how to properly upload data from their mobile heart devices are leading the way.
Key takeaway: resetting patient expectations
Ultimately, cardiologists may find it helpful to stay abreast of all the technology available to consumers so they can correct patients’ expectations about such devices. One of the biggest myths circulating widely among consumers is the belief that the Apple Watch and other smartwatches with ECG sensors can detect heart attacks.
As a result, when many consumers receive an alert that they are in AFib, they rush to the emergency room. However, a study published in September 2020 suggested as many as 90% of appointments triggered by an abnormal Apple Watch alarm can be false alarms. Another study from 2020 found that such devices can increase patients’ anxiety and cause even more false alarms.
Apple itself clearly states on its website that the Apple Watch does not detect heart attacks, but patients do not always read everything about their new device. Of course, most doctors are aware that single-lead devices like the Apple Watch can only detect heart rate and AFib and cannot detect heart attacks. A doctor’s role is to educate their patients about it.
At the end of the day, cardiologists will benefit greatly from the influx of heart-related data from consumer devices. The main points, however, are the need to be aware of what the most popular EKG-equipped devices can and cannot do and a committee to teach patients what they need to know about those devices.
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