The Big Kardia Review and the Evolution of Digital Health

Kardia was the very first health sensor I have ever used, and I was fortunate enough to follow its evolution. Now, the company, AliveCor sent me their latest version of the Kardia Mobile heart health monitor. Check out my review below!

The progress of a health sensor

Alivecor has a special meaning to me, since it produced the first digital health device, which I have ever seen and used. I believe it was four years ago. As I held the little gadget in my hand, the potentials of the technology and the fact amazed me that with this simple smartphone-connected device, I could do an ECG analysis. As a medical student, approximately a decade ago I had to use a big device on a cart and as the result, I got the ECG on paper. Alivecor proved that digital health was about to boom.

Since then, I’ve been following the company and their development path closely. For me, the way their ECG device has changed, clearly shows the evolution of digital health. Gadgets have become smaller, more comfortable and more efficient. For example, the first version of their FDA-approved, medical-grade ECG recorder only works on the iPhone 5; as the device itself was built into the iPhone 5 case. The next generation was already thinner and more universal, meaning it works with all smartphones, while the app got better too.

Now, the company was kind enough to send me the newest generation, Kardia. Even thinner, more elegant and with a swarm of new features built in the app. So, let’s see what it looks like and how it performs!

An ECG machine to put in your pocket

The latest version of Kardia Mobile consists of the hardware and the corresponding Kardia Mobile app. The former is only a little bit thicker than your credit card and fits perfectly into your purse or pocket. It has a simple, streamlined design and it is very easy to use. You do not need any wires, patches or gels (as for example in the case of the old ECG machines).

When you download the app, you will see that it is also very user-friendly and straight-forward in giving you the necessary information. You turn on the app, push the ‘record now’ button, place your fingers on the electrodes (the two grey button-like formations) as indicated on a little drawing and you’ll get your medical-grade ECG results within seconds.

The default option for the heart monitor is to take a 30 second recording. Yet you have the possibility to record the functioning of your heart for one, two, three, four or five minutes. It is up to you what you choose, but in my opinion it is usually enough to make a 30 seconds long analysis.

The device provides you with a proper one-channel ECG recording, which was my expected result from AliveCor from my previous experiences. What I found exceptional was the battery time of the device, which embraces 200 hours altogether! I never met any gadget lasting so long.

Kardia Mobile gives you instant analysis

One of the most annoying things I experienced with digital health gadgets was when they provided values without clear explanations. So my advice for developers has always been: give users explanations. And Kardia does. After it detects your heart rate, it immediately tells you whether it is normal, whether you possibly have atrial fibrillation or whether you might experience some “unclassified” risks. Let me explain the latter two.

The most common arrhythmia or heart rhythm disorder is Atrial Fibrillation (AF). When a person has AF, electrical signals in the atria are fired in a very fast and uncontrolled manner. These signals arrive in the ventricles in a completely uneven fashion, so the heart beat is completely irregular. AF is a leading cause of AF-related strokes. Thus, it is a very serious condition, which needs regular monitoring. If you are an “afibber”, you should definitely get the Kardia Mobile, and check the health of your heart with it regularly!

If you experienced any disturbance during your recording, you might get an “unclassified” reporting on your phone/tablet. However, you might also receive such a notification, if you have any other arrhythmia than AF. For example PACs or PVCs. The former, premature atrial contractions (PACs) are beats which are initiated in the atria or upper chambers of the heart, prematurely, which cause the SA node (the natural pacemaker of the heart) to be interrupted. Together with premature ventricular contractions (PVCs), they are the two most common heart rhythm abnormalities, which are frequently benign and require no treatment. However, in some cases they may be so frequent (over 15-20/minute) that they may cause the heart to beat inefficiently enough to cause symptoms which may need to be addressed. Thus, in these cases, it is also recommended to regularly monitor them.

Beyond the “basic” analysis on your smartphone screen, Kardia Mobile also offers a premium service. If you subscribe to it, you can have your ECG recordings analysed for $9 (technician-only analysis) or $19 (cardiologist analysis and recommendation).

AliveCor lets you measure your blood pressure and tracks your weight

As a premium user, you will also be able to track your blood pressure with the compatible Omron device. AliveCor partnered with Omron in September 2016. Their stated aim is to allow you to regularly check your heart rate and blood pressure (and having a history of both stored on your Kardia app). And as a result, you can track trends and spot any potential heart issues sooner than later. The idea is to have a more complete picture of your heart health over a period of time.

Moreover, the new Kardia goes even further. It also allows you to record your weight and medication. The overall idea is the more data you provide about your health, the better you can track trends over time and make adjustments. For example, if your weight goes up, you may discover higher blood pressure levels. If you discover this trend, you can change your lifestyle to lose weight and lower your blood pressure - perhaps with another digital health device. For constant monitoring, you obviously need stored data, and fortunately, you can have that with Kardia. It gives you a historical view of your heart health data, which can be important for your physician to decide over any treatment plan. In order to have this overview, AliveCor also provides you with unlimited storage options regarding your heart data.

AliveCor has big plans for the Apple Watch, too. At the moment, its Kardia Band is waiting for FDA approval, but once it will receive regulatory endorsement, you’ll be able to have an ECG recording simply by putting your finger on the band! Very promising innovation!

On the other hand, as a medical professional myself, I would also suggest to add the chance to use electrodes for a multi-channel - usually 12-lead - ECG, which records information from different views of the heart; and provides a complete picture of electrical activity. It would mean further benefits for the medical community as well as for patients.

The medical community recognizes Kardia’s merits

I already mentioned that the Kardia Mobile is FDA-approved, which is a great achievement in itself and shows appreciation for the innovative device from the regulator’s side. However, also many clinical studies backed its use, and most importantly, it is popular among physicians as well as patients.

To date, they have made 13.6 million ECG recordings and have hundreds of thousands of users worldwide. It is present throughout the whole world with such key markets as the US, UK, Ireland, Germany, Spain, France, Italy, Australia or Canada and recently announced a $30 million round of funding.

David E. Albert, MD, the Founder and Chief Medical Officer of AliveCor says that 15 peer-reviewed published papers on different clinical applications of the device. He mentioned that it is used by Cleveland Clinic, which is the world's leading heart center as well as by many other leading groups (like the Brompton in London).

A few dark spots

All in all, I have a very positive image on AliveCor’s product in my mind, however, as everything, it also has some shortcomings. I believe that the device has a fair price of $99, however the analysis service is slightly overpriced. Up until recently, there were three ECG analysis options and the cheapest one was only $2. There are only two options now. The cheapest one is $9 and the other one is a whopping $19. On the other hand, it has a one-year warranty and offers 30-days money back guarantee option, which gives confidence to the users.

Aside from the financial issues, I find it less appealing that the company does not ship to many countries and thus the app is not available everywhere. I understand the regulatory hurdles, but digital health needs to be accessible everywhere.

As an avid Android user, I don't understand why the Kardia Band will only work with the Apple Watch. I only hope they will collaborate with other producers on the market as well, such as Fitbit or Garmin.

All in all, if you need a clinical quality ECG device that you can use with your smartphone, Kardia is the top choice. This is the essence of digital health. Bringing data to the hands of patients and their caregivers in a quality, reliable and comfortable way. Making healthcare and the practice of medicine faster, more efficient and cheaper. Making the patient to become the point-of-care.

Dr. Bertalan Mesko, PhD is The Medical Futurist analyzing how science fiction technologies can become reality in medicine and healthcare. As a geek physician with a PhD in genomics, he is a keynote speaker and also an Amazon Top 100 author.

Subscribe here for The Medical Futurist newsletter to get exclusive details about digital health!