With your activity tracker, you can monitor your daily steps, calories consumed, heart rate and even your sleep patterns.
That’s all valuable health information although your doctor may not want to be bombarded with reams of detail that may or may not be related to your medical conditions.
If you have any heart problems, particularly an arrhythmia such as atrial fibrillation, you should be excited about one of the most recent advancements — a device that will give you a medically approved EKG (electrocardiogram) on your smartphone. It’s a one-lead EKG (compared to the 12-lead one you will get in your doctor’s office), but the device has been proven accurate and approved by the FDA.
Jerry learned about Kardia Mobile from the MyAfibExperience website. Other persons there were enthusiastic about the device, and the price ($100) was reasonable, so he quickly ordered one.
Jerry has what is known as paroxysmal atrial fibrillation. His episodes of arrhythmia come and go. Unlike some patients, who end up in the emergency room with a racing, pounding heart when arrhythmia strikes, Jerry has no symptoms. And that fact worries rather than reassures him.
Patients with afib are at high risk of developing blood clots that often lead to stroke. He is taking warfarin, an anticoagulant, to reduce that risk of a stroke, and his doctor has assured him that he can follow a regular lifestyle, including vigorous exercise. But that still didn’t ease Jerry’s mind, until he discovered Kardia Mobile. Now he can take his own EKG before and after a workout ... or any time.
Kardia Mobile is about half the size of a credit card — small enough to carry in a shirt pocket. And it is easy to use.
With an app downloaded to his phone, Jerry can place his fingers on two small electrodes, press the “record now” button and see his EKG flash across the screen. Within 30 seconds, the app will tell him if his heart rhythm is normal, shows possible atrial fibrillation or is “unclassified” (abnormal but not in afib).
There are other hand-held devices that can provide an instant EKG, such as MyDiagnostick and Zenicor EKG, but they cost significantly more than the Kardia Mobile device sold by AliveCor. All of these devices claim near 100 percent sensitivity and specificity greater than 90 percent for identifying atrial fibrillation. For diagnosing or monitoring a patient, a doctor might ask the patient to use the smartphone device in the same way that cardiac event monitors and Holter monitors are used.
A small battery-powered device, the Holter monitor records the heart’s activity continuously for 24 or 48 hours ... or longer. An event monitor records the heart’s rhythm only when it is activated by the user, when he or she suspects an abnormal rhythm.
The continuous monitoring is something the smartphone devices cannot provide. And that is often important, such as noting brief periods of arrhythmia or identifying what triggers an attack. Only continuous monitoring can show what happens to the heart’s rhythm during exercise of various intensities or during sleep.
An offshoot of Kardia Mobile, the Kardia Band for the Apple Watch, offers some of these features. Suspecting an arrhythmic episode, the user can simply press a button on the watch to get a quick response. The Kardia band is awaiting approval from the FDA and not yet available for purchase.
Some have suggested a useful role for these devices in widespread screening for atrial fibrillation. From 25 to 40 percent of patients have what is known as silent afib — never experiencing symptoms. In many cases, the arrhythmia is discovered during a routine examination. Too often, the first indication is a life threatening stroke. Detecting afib early in such patients could presumably save lives.
The most recent management guidelines of the European Society of Cardiology encourages screening for silent afib, particularly for patients age 75 and older and those with other risks for stroke. The U.S. Preventive Services Task Force does not recommend routine screening, in part because of the cost and the fact that it might increase the use of invasive procedures.
Smartphone screening is inexpensive but feeling the patient’s pulse is even less costly as an initial screening tool.
For atrial fibrillation patients who do experience symptoms, a smartphone EKG might seem extraneous. But there is often the need to confirm that afib is really the reason for the symptoms. The device might also be useful for patients who have undergone cardioversion or catheter ablation to monitor whether the arrhythmia has returned.
The state of the art equipment will continue to grow for cardiac patients with the opening of the new hospital as well. Patients will have access to the latest stress testing, external counter pulsation (ECP), telemetry monitoring systems, treadmills and bikes on the market. The future for heart patients is electrifying with no pun intended. Patients will be able to monitor their EKG with the push of a button. For more information about Cardiopulmonary Rehabilitation Services and the new hospital construction, visit bamc.org.
Dianne Menor is a cardiopulmonary rehab nurse at Bay Area Medical Center, an Aurora Health Care Affiliate.