AliveCor’s Heart Monitor: A Possible Game Changer for Rural Health

It’s a busy office day, and Mrs. J is seated calmly in my exam room. She has a history of an intermittent heart rhythm disturbance. She says she feels well, but that she gets a little dizzy at times and feels her heart skip once in a while. The nurse who took the vitals typed “pulse irregular” on the electronic chart. The last few times she was in the office, the vitals were similar, and an ECG was usually obtained, showing only a minor abnormality.

I’d like to know if anything has changed, but it takes a couple of minutes to order the ECG, have the patient disrobe, attach 16 leads of the machine, and then record the rhythm – and I’m already a little behind.

Instead, I pull out my smartphone and ask Mrs. J to hold it gently in her hands for 15 seconds. In a matter of seconds, there is Mrs. J’s heart rhythm on its display (and immediately uploaded wirelessly to a secured server) showing no significant change.

I am a technophile: I’m the one at the office to whom colleagues frequently come for app advice. My latest acquisition connects my personal interest to my professional work. It’s my iPhone 4 case, which happens to be an incredibly powerful device, the first of many in the mobile realm that could significantly change health care.

The case looks like your generic thin, plastic smartphone case, with small holes for your camera, speakers, and charger. Yet, there are two metal plates on the back that set the case apart. These plates are the electrodes for a miniaturized ECG machine built into the case. It has its own power source, so that it doesn’t drain precious battery power from the iPhone, and works in conjunction with a free app that is downloaded from the App Store (The app was developed by AliveCor as a heart monitoring device). The case was approved by the FDA in December as a medical device, and currently works with iPhone 4 and iPhone 4S.

Aside from usage at the office, others have used it to diagnose heart attack at 35,000 feet in an airliner, or on a group bike ride to diagnose atrial fibrillation in another rider who was experiencing fatigue. One of the most amazing aspects of this case is how fast it wirelessly (via cellular or WiFi) uploads the ECG into the secured central server. This capability is critical to a provider serving a rural population, like me – a physician based in Vermont. Imagine receiving that kind of data from a far away patient and being able to quickly access it. That’s a game changer.

The case is only available to health professionals now, but its low cost and ease of use make it ideal for patient use. I can see a near future in which you receive a prescription for a smartphone case as a follow-up after your heart rhythm procedure. You are feeling a few skipped heartbeats while out on the soccer field watching your child’s game. You pull out your phone, open the app, and hold it steady for a few seconds. You then text your cardiologist to check your rhythm on the server. In a minute, your smartphone vibrates, and on the screen you see, “Everything is good!”

That’s the kind of future I look forward to.

Prospero B. Gogo, MD, is Director of the Cardiac Catheterization Laboratory at Fletcher Allen Health Care and Interventional Cardiologist. He is an Associate Professor at the University of Vermont College of Medicine.