ECG Getting Smarter

Patients are being empowered to track and manage their own health, and healthcare is becoming more personalized through interventions tailored to individual patients.

Cardiovascular disorders (CVDs) are a major concern worldwide, causing 30 percent of deaths globally. The increase in cardiovascular diseases has a direct impact on demand for ECG devices. The opportunity and concerns lie in the estimate made by WHO that 23.3 million people may die from CVDs by the end of 2030. This forecast is expected to be a major propelling factor in the cardiac assist devices market, in the coming years. India, which has high geriatric population, is expected to show a major increase in demand with the geriatric population being more susceptible to cardiac diseases. In addition, technological advancements of ECG devices such as their portability, novel electrodes and sensors, and smart phone integration is expected to contribute to market growth. Emergence of novel ECG devices such as handheld ECG devices and ECG devices integrated with artificial intelligence systems will be key drivers.

Indian market
The ECG market has seen a major increase, and that too more in the high-end models. While the single channel, 3-channel, and 6- channel are seeing an increase in demand, it is the high-end models, which are earning the brands margins. Prices remained more or less constant. Philips, Schiller, BPL, and GE continue to be the popular brands. Edan, Mindray, Nihon Kohden, Nasan, Bionet, Silverline Meditech, Krishna Medi, Nidek, Skanray, Maestros, and RMS too have presence in the market. Building a strong and equitable healthcare system is an important landmark in a developing country’s journey. That can happen only if quality healthcare is provided to large segments of the population, which today is not the case in India. In 2016, heart diseases were the biggest killer, accounting for 28.1 percent of all deaths in India, according to the Indian Council of Medical Research, the Public Health Foundation of India, and the Institute for Health Metrics and Evaluation. While heart attacks can be detected by a quick ECG test, the country continues to be a victim of two critical issues, that is, most primary care clinics are not equipped with ECG machines and absence of sufficient training.

According to DRG’s Ambulatory ECG Monitoring Devices report, the revenue earned by monitoring companies was over a billion dollars in the United States of America in 2016 and growing in double digits for the next few years. While in India, the market (although smaller) is expected to grow at an even higher rate. Healthcare startups are mushrooming in this high-growth space and are trying to deploy solutions that will transform the market. However, one of the main challenges is making quality cardiac solutions available in rural areas. New, portable ECG devices, which run on mobile technology, can help change things for the better.

Various kinds of ECG recorders are available in the market manufactured by reputed organizations, but till date there are very few devices available which can record the ECG signals and transmit them to a remote database server on cloud.

Agatsa’s SanketLife is a credit card-sized, mobile-based leadless ECG machine. Placing both thumbs on the slots on the device gives a reading comparable to a single-lead ECG with 98 percent accuracy. Not only is SanketLife able to perform a single-lead ECG reading for emergency purposes, like AliveCor’s popular Kardia Mobile ECG monitor, but also has built-in provision to take 12-lead readings just as a conventional ECG machine, which makes it a complete 12-lead ECG solution that is remote, easy-to-handle, cost-effective, without any lead or wire, and accurate. The technology allows it to measure electrical activity of the heart through sensors and to transfer the data to a mobile phone using low-energy Bluetooth technology that can be shared with anyone for consultation over the cloud network

A tele-ECG machine prototype developed by Bhabha Atomic Research Centre (BARC) is being adopted by firms to offer healthcare solutions even for remote areas. Scientists at BARC recently developed the handheld 12-channel tele-ECG device that promises cardiac care at just a click. The prototype is developed to record all the 12-leads of ECG simultaneously and displays the same on mobile screens. The generated report can be immediately shared with experts via mobile phones’ Multimedia Messaging Service (MMS) or any other file sharing apps, thus saving on the time it takes to transport patients from their location to the nearest available cardiac units.

Uber Diagnostics’ Cardiotrack is a handheld ECG monitor that is easy to use, provides clinical grade output, and performs predictive diagnosis to start intervention immediately, thus reducing the need for invasive intervention. It is a network-connected device, wherein a patient’s ECG scan can be instantaneously transmitted to a cardiologist anywhere in the world. Cardiotrack allows doctors to take a 12-point ECG from a patient. It can then be transferred to a smartphone or tablet via Bluetooth and, from there, can be uploaded to the cloud. It also raises an alarm if it detects an irregularity during the test.

Tricog, a Bangalore-based start-up, has partnered with GE Healthcare to develop cloud-connected ECG devices that are placed at under-served locations to help doctors detect heart complications. Within minutes of an ECG test, cardiologists at Tricog’s center complete the diagnosis and share the interpretation with both the patient and the local doctor in real time. The system is designed to additionally enable continuity of care at a tertiary center through timely referral. Patients can also see their records and show them to doctors in future. Another firm, Cardiac Design Labs, has also built a similar product like Tricog, which is a low-cost, wearable cardiac monitor, Mircam. The product aids in initial diagnosis and sends alerts to doctors.

A clutch of global tech companies are also demonstrating how designing products specifically for India can help crack the Indian market – and make innovative products for the world. Medical device manufacturing giants such as Johnson & Johnson, GE, and Philips have designed and developed Made in India MedTech products best suited for local Indian market needs. It is no surprise that GE wants to set up its largest digital hub in India. The company has also introduced an electrocardiogram (EKG) system that is priced 80 percent lower than a similar imported product available in India. Companies including AliveCor, available in India through the Apollo Group of Hospitals, and Kito+, a smartphone case run by San Francisco-based company Azio, which also works as a fitness tracker and can even conduct an ECG, can also be seen in the Indian market.

Outlook
Due to the growing complexity of cardiovascular diseases with multiple problems in the heart, the method of diagnosis is also changing. Demand for predictive, personalized healthcare can be met not only through remote patient monitoring or mobile cardiac telemetry, but by integrating products and services with hospitals’ electronic health record systems. Using cloud interfaces for data sharing or predictive analytics can help patients and physicians detect cardiovascular risks, ultimately reducing complications, healthcare costs, and mortality. Companies are integrating event and Holter monitoring into a single device.

Innovations in nano- and micro-electromechanical systems and wireless communication have helped diagnostic devices become smaller, easily implantable, and more comfortable to wear. Patients are becoming empowered to track and manage their own health, and healthcare is becoming more personalized through interventions tailored to individual patients.