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Cardiac Monitoring – Where Are We Headed?

Heart disease is one of the most common causes of mortality in India. Heart disease accounts for one in four deaths and has been the focus of extensive research for the prevention, diagnosing, and treatment. Every year multiple medications and devices for diagnosis and treatment of all aspects of cardiology are undergoing extensive research. In spite of all the advancements, an ECG remains the first test for screening and diagnosis of heart disease. Every day many lakhs of ECG’s are being performed across the world.

Market trends
In 2017, single channel and 3-channel machines accounted for almost 50 percent of all ECG machines. The ECG segment is growing not just in terms of volume, but with the improving technology and lower prices, the demand for higher end machines is bound to increase. With the advent of national health schemes leading to improved accessibility of healthcare, there will be an increased need for quality devices at affordable rates.

Technology trends
The past few years have seen a spurt of multiple startups’s in the cardio-diagnostics space looking at ECG monitoring and long term Holter monitoring. There are also some app’s that provide your heart rate by using the camera sensor of the phone.

An ECG has 2 major utilities-one is to diagnose a heart attack and the other is to diagnose abnormal heart rhythms. Sometimes detecting abnormal heart rhythms requires long term heart rate monitoring with a Holter monitor.

There are many Indian startups that are utilizing homegrown technology for doing ECGs. Some like Agasta are able to get an ECG by sequentially touching the device (smaller than a credit card) at different points on your chest and that is wirelessly transmitted onto the phone. Uber Diagnostics, Tricog, and Cardiac Design Labs are other similar startups that are coming up with new ways to acquire an ECG. An essential feature that most of these devices are utilizing is the ability to wirelessly send these ECGs to a doctor at a remote location. This is essential as an interpretation of ECG still remains a skillset of the few, especially in the remote locations.

It is important that the government and regulatory authorities enforce strict quality control before these devices are widely adopted – under or overdiagnosis can have far-reaching implications beyond just financial.
There is also a lot of innovation in the ambulatory continuous ECG monitoring. Per some reports, in the US the revenue earned by companies in this space was upwards of 1 billion dollars. One of the most notable developments in the past year has been the launch of the 4th generation Apple watch. The latest generation watch can provide a single lead ECG that can help detect irregular heart rhythms. Apple has partnered with Alive Cor (an established company in the ECG space) to refine their technology and help identify patients with irregular heart rate.

Their data was presented at a major international cardiology meeting and though it is promising, it is not yet perfect. Other major technology companies like Omron and Fitbit are also working on similar technology that in the next decade should complete transform or perhaps even replace the more traditional Holter monitoring.
However, for me as a doctor, the most important question is will technology improve quality and accessibility or will it also translate into clinical outcomes? As a busy cardiologist what is most interesting about this space is the data that is being collected. Recently, there was a report of 1.5 billion hours of heart rate data that was being analyzed and collected by Fitbit. Such massive amounts of data may help find early changes of heart diseases that can be used to prognosticate and even maybe even predict events.

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