ECG Event Recorder – PMS Instruments

The economic case for the AliveCor Kardia Mobile ECG

The AliveCor Kardia Mobile ECG has swiftly become one of our more popular products. If you’ve not yet heard of it, the Kardia Mobile ECG is an incredibly handy and portable ECG monitor that is held in the patient’s hand. The only thing it needs is a smart phone with the Kardia app installed.

Using a single channel ECG monitor with automatic ECG evaluation, it can detect possible Atrial Fibrillation (AF). The smartphone application shows a real-time visualisation of the ECG recording, as well as historical data for comparisons.

The device has been popular for the home market, for those needing to track either their own or a relative’s health. However, there’s a serious economic case for the Kardia Mobile ECG to become a standard for surgeries. If surgeries have access to the mobile ECG, to be able to supply to patients, a lot of time can be saved.

Let’s first look at the current representative pathway for patients presenting with palpitations according to a case study from NHS Coastal West Sussex.

Patient present with palpitations > Sees GP > GP refers > Hospital receives letter > Consultant receives letter > Outpatients > 24hr ECG > Negative Test > Has 7-day ECG > Outpatients and decision > Has 7-day ECG > Outpatient and decision > Consider Implantable Loop Recorder (ILR) > Put on waiting list > Lost to system > Sees GP > GP writes letter > Hospital receives letter.

That’s quite a list, 18 steps in all. Goodness knows the time, resource and cost this entire process could be to the system.

Here’s a potential pathway with the Kardia:

Patient presents with palpitations > Sees GP > GP supplies Kardia Mobile ECG > Symptomatic trace > Sees GP > Advice and management.

Already, you can see where the Kardia Mobile ECG being part of your surgery’s strategy could save valuable time and money. The aforementioned case study does give some idea for the potential savings to be made.

The previously quoted pathway is costed up at £1305, nearly £6000 if the ILR (implantable loop recorder) is included. Whilst all of these steps and the costs suggested might not always be the case, it shows that it could be an expensive process. Taking into consideration that an estimated 2,000,000 people in the UK have Atrial Fibrillation, we simply must find a more sensible solution, the AliveCor Kardia Mobile ECG.

The same pathway, with the inclusion of the Kardia Mobile ECG being supplied comes in at just £172.50. That’s an incredible saving.

Across the country, that’s a potential saving of £2,265,000,000 (without ILR, £11,377,000,000 with ILR in every case) which is a staggering figure. This is no longer about whether surgeries should be supplying the Kardia Mobile ECG, it’s a case of when they start.

That time is now.

Kardia Mobile ECG. What’s in a name?

The AliveCor Mobile ECG is now Kardia Mobile by AliveCor and the AliveECG app is now the Kardia App.

Why change the name? Kardia is more than just a new brand. Users of Kardia and Kardia Mobile will benefit from new features including:

Support for voice memos to provide subjective context to EKG recordings

Integration with Apple’s Health app and Google Fit to fuel more robust, personal heart health reports in addition to EKG recordings
An optional subscription service (Kardia Premium) to provide personalized reports and a detailed ECG recording history via the Journal
All users will have access to a free Kardia Premium trial through September 30, 2016.In addition to these new features, the new Kardia Band for Apple Watch, will enable you to record your ECG and capture a voice memo discreetly from your wrist. Kardia Band is pending 510K clearance and CE mark, and will be available for purchase later in the year.

Kardia by AliveCor lets you take a proactive role in your heart’s health by giving you the ability to record medical-grade EKGs anytime, anywhere, easily. In just 30 seconds, Kardia shows you whether your heart rhythm is normal or if atrial fibrillation (a leading cause of stroke) is detected in your EKG. Kardia delivers accurate results, and makes it easy to share EKG data with your doctor for analysis and diagnosis. Works with Apple iOS and most Android smartphones and tablets. Requires download of the free Kardia app, available on the App Store and Google Play.

The Kardia by AliveCor can be purchased by visiting www.pmsinstruments.co.uk

Why You Should Use ECG Event Recorders in Primary Care.

The updated NICE clinical guideline CG180 (2014) was published in June 2014. It gives guidance on the management of atrial fibrillation and recommends an ECG should be performed on all patients where atrial fibrillation is suspected where an irregular pulse has been detected, whether symptomatic or not.

It recommends using ambulatory ECG recording in patients with suspected paroxysmal AF as follows:

A 24-hour Holter ECG monitor should be used in those with suspected asymptomatic episodes or symptomatic episodes less than 24 hours apart.
An event recorder ECG should be used in those with symptomatic episodes more than 24 hours apart.

The National Service Framework for Coronary Heart Disease chapter on cardiac arrhythmias lists three quality requirements relating to patient support, diagnosis and treatment and sudden cardiac death.

So why aren’t more GPs using Event Recorders in Primary Care?

There are two main types of ECG recorders worn by patients in an ambulatory setting away from the

Surgery. They are Holter ECG recorders like the Meditech CardioMera or Event Capture ECG recorders like the Meditech CardioBlue and DCBiomed InstantCheck.

They are generally used to investigate suspected symptoms of arrhythmia including palpitations, light-headedness or syncope (partial or complete loss of consciousness), which have not been detected during a shorter 12 lead, surgery based ECG.

Holter or event recorder

Continuous full disclosure Holter ECG monitors were first used in the 1970s and typically operate for 24-48 hours recording every single heartbeat during this period.

This can mean that upwards of 100,000 beats are recorded over a 24 hour period. They are especially useful if the wearer does not feel or is not aware of the ECG abnormality, and are typically more expensive than event recorders.

In most cases data is now stored digitally either on internal flash memory or on removable SD data cards.

Data is uploaded to a computer where software automatically analyses the recording classifying it by beat type, identifying and labelling specific arrhythmias and in some cases, providing a textual summary for the clinician.

Reports should be customisable and have the ability to be attached to the patient’s clinical notes electronically.

Most Holter analysis software can run on a desktop PC and a separate dedicated PC is not required. This makes the analysis of the recording much quicker.

Event ECG recorders are different and are designed for patients who experience symptoms very infrequently and require monitoring over several days or even weeks.

This type of recorder is usually patient activated by pushing a button, but some can be programmed to record automatically at pre-set intervals or will trigger automatically at the onset of certain arrhythmias.

Some event recorders record post event data only. Others operate in a ‘loop’ memory mode so the device records 30 seconds of pre event and 30 seconds post event data. This is useful should the patient lose consciousness and allows the clinician to view the ECG immediately leading up to the event.

Traditionally, post event recorders would have had an external lead with electrodes fitted to the patient’s chest or be held against the chest to record. Recent advances in technology have seen the development of new recorders, which have built in finger or wrist watch type electrodes, which permit long term monitoring without the discomfort or irritation of a patient lead.