EPI Life, first ever ECG mobile phone is an innovative idea – but is it worthy of all the hype?

EPI Life, the first ever ECG cell phone is bringing a huge amount of hype. The phone has been featured on CNET[credit picture] and Engadget, with both outlets hyping its life saving potential – but the exact method of how the integrated ECG unit in the mobile phone works is not clear. Chow U-Jin, medical director at Ephone International, which developed the EPI Life, has said the device records readings by having the user touch their fingers on the side of the phone – basically how it’s being held in the picture.

A trip over to the EPI Life website doesn’t yield many clues, except they do say it has an integrated “multi-lead ECG”. From the output shown in the pictures though and the limited data available – it appears to be useful for heart arrhythmias at best, where changes in the sequence of the ECG tracing may be enough to make the diagnosis.

Heart attacks and other more subtle cardiovascular pathologies require a more detailed scan, usually obtained with “12 lead ECG” where a dozen leads are arrayed in a specific pattern across the chest. When performed properly,  the portion of the heart that is affected can even be determined (for example, a lateral heart attack would be reflected on the V5-V6, 1 & aVL leads). Some types of heart attacks are not even reflected on the ECG and only discovered later by blood tests showing abnormally elevated cardiac enzymes.

Basically, if you think you’re having a heart attack, you should first be calling 911, and not performing a self administered ECG that provides limited data.

Then the question is, how well do portable “leadless” ECG monitors work for monitoring arrhythmias? I went through some literature to see if I could dig anything up.

I found only one recent study on this topic, “Prospective comparison of the diagnostic utility of a standard event monitor versus a “leadless” portable ECG monitor in the evaluation of patients with palpitations“, by Scherr, Dalal, Henrikson and colleagues (2008).

This prospective comparative study used a standard patient activated event monitor system and a “leadless” portable ECG monitor. There were 18 patients, and each patient spent 30 days with the standard monitor, and then 30 days with the leadless portable ECG monitor. The portable leadless ECG monitor used in the study was the Omron ECG monitor.

Note, compared to the EPI life ECG mobile phone, this portable monitor is actually placed on the chest and most closely approximates the vector for lead 1 of a 12 lead ECG. With the sensors in the EPI life phone though, I wouldn’t be surprised if you could use the phone in the same fashion as the picture shown above.

The conclusion of the study was that the leadless ECG monitor (Omron), had a high patient compliance rate and had high quality ECG recordings. The authors concluded that the diagnostic yield of this monitoring system is equivalent to a standard event monitor.

However, the study had several limitations. First, with only 18 patients, the study lacked the power to make definitive conclusions. Also, the study participants were not randomized by any means, rather all picked on a single day of clinic visits.

What does this all mean? There is hope that portable ECG monitors are just as effective as typical standard event monitors, but a more definitive study with a larger patient population needs to be undertaken.

As the mobile health movement continues to grow, these types of innovative technologies are critical towards advancing how patients and medical providers will interact – but at the same time, we need to have studies or data that show emerging mobile health technologies are at least as good as the technology we have at present.

Comments:

  • Chow U-Jin
    Thank you for the article. It's true that the various media reports may not have given the full picture.The EPI Life was conceptualized as a portable patient-triggered event monitoring device for detection of abnormal heart rhythms and early signs of cardiac events. The main objectives were to ensure that the device was portable and simple to use, ensuring maximum compliance. After all, it would be of no use sitting in your drawer when you are symptomatic.

    However, here's where the similarity ends with the Omron portable ECG. Riding on a mobile platform, the ECG reading taken on the EPI Life can be transmitted immediately (without having to be downloaded or bluetoothed) to a 24x7 call centre where cardiac technicians and doctors will interpret and reply by way of an SMS back to the phone, all within 10 minutes. This almost immediate feedback helps the user make an informed decision as to what next steps should be taken.

    The EPI Life is able to measure limb leads and all the chest leads (hence multi-lead) but being single channel, the leads will have to be taken sequentially. The EPI Life is not an ECG replacer and in the event of a suspected heart attack, call 911 immediately! However, if you are experiencing non-specific symptoms or if you are trying your darnest to catch that pesky tachycardia that your doctor has never managed to record using his clinic ECG, the EPI Life would be a good bet.

    Do email me at md at epi.com.sg should you need more clarifications. Thank you!
  • Marc-Emile
    Good post

    "we need to have studies or data that show emerging mobile health technologies are at least as good as the technology we have at present."

    This is really important, especially in this case. I wouldn't be surprised if the NNH is lower than the NNT for this gadget...
  • Iltifat Husain
    Marc-Emile

    You're right, trying to find the NNT for something like this appears to be a pipe dream. I can't even imagine trying to get funding for it. At the same time, with Canada approving ReolutionMD for docs, it would be great to see our federal bodies here in the States take a more active role in mobile health.

    At least provide some more information on the website though! There is a huge void of information on the EPI life ECG phone on their website. We need to know exactly how this thing works first...
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