“App for That” The Transformative Potential of Mobile Diagnostic Applications

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CP61rkFUwAERPYe.jpg - @EricTopol: Echocardiogram of my heart thru my smartphone
@EricTopol: Echocardiogram of my heart thru my smartphone.....eureka!
Source: https://twitter.com/erictopol/status/648155158476525569

Today’s mobile applications provide a bevy of useful data for cardiovascular patients and physicians alike. These diagnostic apps show great promise to revolutionize healthcare delivery, especially with real-time heart monitoring and visualization, but they also pose important questions. 

In cardiology, it is hard to overestimate the importance of timely care for a patient’s outcome. During a heart attack or stroke, the clock is ticking, encouraging clinicians and industry to seize new opportunities to speed up healthcare delivery whenever possible. So, when a technology comes along that shows promise to reduce delays from symptom to diagnosis, it is not surprising when many in the specialty take notice. Such has been the case with mobile diagnostic apps for smart devices.

Once a novelty item, smartphones have become nearly ubiquitous, with a 2015 Pew Research Center (PRC) report indicating that 64 percent of Americans own a smartphone of some kind, up nearly twofold from 35 percent in 2011. As of January 2014, 42 percent of Americans owned a tablet computer, the PRC found. 

Having such powerful devices within arm’s reach has opened up a world of opportunities for patient care, and the cardiology community has taken advantage by developing apps that provide real-time heart monitoring and visualization.

“Right now, we see patients based on when they are not doing well, and what we would like to do is move toward a more value-based system where we’re improving patients’ health and not just managing disease,” says Zubin J. Eapen, MD, MHS, medical director of Duke Same-Day Access Heart Failure Clinic, Durham, N.C. “We need continuous streams of data to understand a patient’s state of wellness in the home, and these technologies have the potential to provide that.”

ECG on the go

One of the smartphone technologies that clinicians have begun to implement in practice is a mobile electrocardiograph (ECG; AliveCor). The FDA-cleared device provides real-time ECG recordings that can detect whether a patient is having atrial fibrillation (AF or afib) via its mobile phone-based heart monitor. Results can then be confirmed with a U.S. board-certified cardiologist or personal physician. The device costs $74.99 and the app is free, according to the manufacturer.

Jordan Safirstein, MD, director of radial intervention for the cardiac cath lab at Morristown Medical Center, Morristown, N.J., has already seen the impact of the mobile ECG device on his patients and practice. “I’ve had patients show up in my office and say, ‘I went into afib,’” Safirstein notes. “Normally the way that conversation goes is they say they felt an irregular heartbeat and aren’t sure whether it was afib. So, the usual recommendation would be to have them put on a monitor for seven days. That is a very inefficient and expensive way to assess for afib because it’s not dependent on the patient’s symptoms.”

Although the financial impact of mobile ECG to the healthcare system is unknown, results from the SEARCH-AF (Screening Education And Recognition in Community pHarmacies of Atrial Fibrillation) trial suggest it may be cost effective.

In a population of 1,000 screened pharmacy customers (mean age, 76 ± 7 years; 56 percent women), of whom 1.5 percent had newly identified AF, researchers found that the incremental cost-effectiveness ratio of extending the smartphone ECG screening into the community (based on 55 percent warfarin prescription adherence) was $4,066 per quality-adjusted life year gained and $20,695 for preventing one stroke. The device also demonstrated a 98.5 percent sensitivity for AF detection and 91.4 percent specificity (Thromb Haemost 2014;111:1167-1176).

Kevin Campbell, MD, assistant professor of medicine at the University of North Carolina, Chapel Hill, cautioned that while there are good data showing this technology is safe and effective and detects silent AF, there are not a lot of data available comparing it with different heart rhythm–measuring devices on the market.

Other novel applications

Not only can smart device technology monitor the electrical activity of the heart, but it can provide visualization. By downloading an app and connecting a transducer, a tablet can become a portable ultrasound system, allowing physicians to meet patients at the point of care.

According to a press release, the ultrasound system (Lumify, Philips) is available with a monthly subscription—which includes the transducer, app, access to an online portal, warranty