Satish Misra MD is a Cardiology Fellow at the Johns Hopkins School of Medicine
Recently, AliveCor made a major addition to its Heart Monitor and announced the launch of AliveInsights.
This service provides interpretations of the single-lead tracings captured by their elegantly designed smartphone case that contains a single-lead ECG device.
Earlier this year, we did an in-depth review of the AliveCor Heart Monitor from a clinical perspective.
Overall, while we were very impressed with the simplicity and usability of the device itself, we found ourselves searching for broad clinical scenarios in which it would have a large positive impact.
We also raised concerns about inappropriate uses of the device leading to over-testing or giving false reassurance.
Through AliveInsights, a patient can obtain a preliminary review of their tracing from a cardiac technician within thirty minutes for $5. For $12, they can get a review from a cardiologist within 24 hours. The question, then, is whether they should.
The interpretation of these tracings appears to be outsourced to two firms–eCardio and CompuMed. eCardio provides more traditional cardiac monitoring services while CompuMed additionally provides a cardiologist 12-lead ECG remote overread service. In the examples on the AliveCor website, the interpretations are fairly detailed. The cardiologist interpretations also include recommendations for follow up such as advice to call your doctor or go to the ER.
There are some scenarios where this may be useful such as low risk patients being evaluated for palpitations or patients with a known arrhythmia like a paroxysmal AVNRT who are being followed. There are also bound to be some anecdotes of patients who have a paroxysmal high grade heart block or even symptomatic NSVT identified using this service, though if that is the concern, then a wearable continuous monitor would probably be more appropriate.
There are also some risks and it will be important to provide patients with clear guidance on how to use this service. For example, acute onset chest pain would not be the right time to rely on a single lead ECG tracing for reassurance. While the cardiologist interpretation and recommendation does incorporate clinical details provided by the patient, the technician interpretation does not appear to do that.
One scenario where a clinician may want to consider prescribing the AliveCor Heart Monitor over traditional wearable monitors is for patients with high deductible/copay insurance plans or uninsured patients with sufficient disposable income to pay for this device and service.
In the right clinical context, the AliveCor Heart Monitor may be a more affordable and equally efficacious approach to evaluation–for example, a young patient with a high copay/deductible plan with intermittent palpitations. There will also be patients out there who will view this service as an empowerment tool to help them manage their health. For this highly health literate group, there may be an additional benefit in getting this type of immediate feedback as well.
That the device is so portable, unobtrusive, and easy to use gives it potential advantages that are unmatched by other cardiac monitoring tools. The addition of AliveInsights certainly seems to be part of the natural progression of the device, helping it match similar services offered for traditional cardiac monitors.
However, as we pointed out in our review, there are still many unanswered questions around how the AliveCor Heart Monitor can be used in real world clinical practice to improve the quality of patient care. That AliveCor is currently undertaking numerous studies of their Heart Monitor in various clinical scenarios suggests they share these questions and are seeking out answers to guide thoughtful implementations of their device — we certainly applaud them for that.
Share your thoughts with us in the comments section below, especially if you have ideas about clinical situations where this type of device could be used to improve the quality of care