Branislav Vajdic, PhD, is the CEO and Founder of HeartBeam, Inc., a company developing a 3D-vector ECG platform for heart attack detection.
The field of medicine sees a continual supply of new and updated technologies to help doctors better diagnose and treat a wide variety of conditions. However, one area that’s seen an outsized impact from a sudden surge of consumer-facing devices is cardiology.
The Changing Landscape In At-Home Heart Attack Detection
It’s no surprise that many cardiologists are struggling with how to address the influx of devices such as smartwatches with built-in ECG sensors. On one hand, such devices can provide invaluable patient data.
On the other, many cardiologists find themselves having to correct patient expectations surrounding such devices, which can lead to many false alarms and sometimes increased anxiety. As such, cardiologists might find it helpful to regularly survey the landscape of technology accessible by consumers.
A survey published in Nature Reviews Cardiology goes deep into the types of sensors available and how they work. However, some cardiologists might want to skip the engineering lesson and go straight to the practical knowledge, which is what I will try to do here.
Types Of Sensors In Use By Consumers
Smart wearable devices can generate a wide range of data via an array of various sensors. Activity sensors may be most common. They can provide cardiologists quantitative data on a patient’s actual level of physical activity so that they don’t have to rely on anecdotal statements from the patient.
At-home access to ECG sensors have exploded in recent years amid growing adoption of devices like the Apple Watch, Samsung Galaxy Watch, Fitbit Sense, and AliveCor KardiaMobile. However, many of these devices capture only single-lead ECGs.
Based on the limitations of single-lead ECGs, they might be adequate for measuring heart rate and detecting simple and common arrhythmias or irregular heartbeats like atrial fibrillation (AFib). Unfortunately, this also means they’re not capable of detecting heart attacks or diagnosing more complex arrhythmias.
Some consumer devices also incorporate a blood pressure sensor or blood oxygen level sensor, while others capture biochemical data like body fluid electrolytes. This last category remains an emerging branch without much empirical data on these sensors’ effectiveness or accuracy.
Next-Generation Devices
Given that 12-lead ECGs are the standard of care in cardiovascular disease detection, patients with known heart conditions could benefit from 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 ECG technologies such as smartwatches and other popular wearables could give some heart patients a false sense of security.
Cardiologists could and should play a big role in educating their patients about consumer-facing, commercially available heart-monitoring devices. When it comes to the standard of care, there are not many choices in 12-lead ECG devices specifically for patient use.
Philips introduced the first at-home, 12-lead ECG-integrated solution for decentralized clinical trials last year. Biocare also offers a portable 12-lead ECG machine. AliveCor makes a 12-lead device called the Kardia 12L, which is based on smartphone technology. HeartBeam’s AIMIGo device can be carried in the patient’s wallet (I am founder and CEO of HeartBeam) so that they always have it with them.
However, these patient-applied 12-lead ECG technologies require the patient to keep a pouch of electrodes and wires with them. Indeed, a key prerequisite for wide consumer adoption of 12-lead ECG solutions for use outside the medical setting is that these devices be easy to use and always with the patient.
Challenges With The Flood Of New Devices
With so many different kinds of heart-related devices, cardiologists may have a difficult time telling one from another. However, given the rapid growth of smartwatches and other wearables, it could make sense to learn the type of data captured by the most popular ones.
Cardiologists know the eventual medical outcome of a patient with 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. Thus, they might want to guide patients by providing their own shortlist of preferred at-home, comprehensive cardiac-monitoring devices capable of heart attack detection.
Another issue is data integration. Many patients don’t know how to upload their device’s data to their electronic medical records, so they end up showing it to their doctor on their smartphone. It will take time for data integration standards to be developed, so cardiology practices that start educating their patients on how to properly upload data from their mobile cardiac devices will be ahead of the curve.
Key Takeaway: Resetting Patient Expectations
Ultimately, cardiologists might find it helpful to stay on top of all the technology available to consumers so that they can correct patient expectations around such devices. One of the biggest myths circulated 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 the appointments triggered by an abnormal Apple Watch alarm may be false alarms. Another 2020 study found that such devices can increase patients’ anxiety, triggering even more false alarms.
Apple itself states clearly on its website that the Apple Watch does not detect heart attacks, but patients don’t 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 are not capable of detecting heart attacks. The role of a doctor is to educate their patients about that.
At the end of the day, cardiologists alike stand to benefit greatly from the influx of heart-related data from consumer devices. However, the key takeaways are the need to be aware of what the most popular ECG-equipped devices can and can’t do and a commission to teach patients what they need to know about those devices.
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