- AliveCor Heart Monitor is an iPhone case and app that provides clinical quality, single channel, electrocardiography (ECG)a
- AliveCor Heart Monitor is available for iPhone 4, 4s and 5. It is not currently available for other phones
Development of the AliveCor Heart Monitor
The AliveCor Heart Monitor was developed by Dr David Albert, a cardiologist from Omaha, Nebraska. In 2008 he conceived the idea of harnessing the computing power of the iPhone to provide affordable medical care in his area of practice, and by 2010 had posted a video on YouTube showing a well-developed prototype of what he then called the iPhone ECG.
Over the following three years Dr Albert formed the AliveCor company and got the Food and Drug Administration (FDA) approval necessary for the iPhone ECG to be used a medical device. To satisfy FDA requirements he undertook two studies1,2, one comparing the single channel iPhone ECG to standard 12 lead ECGb, and the other demonstrating the device could be used by those with no medical training - an important step if it was to be prescribed for use by patients as an event recorder. The monitor was licensed in the US in 2012, including for use by patients as an event recorder, and this year was given CE approval and licensed in Europe, UK and Ireland. It was introduced to the UK during Heart Rhythm Week (3-9 June 2013) where it was demonstrated in 20 hospitals. The AliveCor Heart Monitor retails for $199 in the US, and is available in the UK from Amazon for £169. Here are direct links to Amazon to both the iPhone 4 & 4S version and the iPhone 5 version.
AliveCor Heart Monitor in Falls Prevention
The incidence of cardiovascular disease (CVD) increases with age, with 70% of men and women aged 60-79 years having CVD, rising to 83% of men and 87% and women over 80 years3. Within these headline data, 35% of men over 80 years have ischaemic heart disease, 80% of women over 80 years have hypertension and 10% of men and women over 80 years suffer from heart failure. What’s not always understood, is that all cardiovascular disease has the potential to affect postural stability – ranging from syncope and pre-syncope in ischaemic heart disease, and with several cardiac drugs, to slow de-conditioning from the fatigue that accompanies heart failure - and it’s for this reason that NICE Guideline 1614 makes clear that multifactorial falls risk assessment (MFFRA) must include assessment of the cardiovascular system (CVS).
Clinical assessment of the CVS includes assessing for cyanosis, taking the pulse to determine the heart rate and rhythm, assessing the jugular venous pressure, listening to the heart and lungs to check for abnormal sounds, inspecting the feet and legs for dependent oedema and measuring blood pressure with the patient sitting and standing. If the pulse is too fast, too slow or irregular – what’s known as rhythm disorder – the clinician may order an ECG to identify the type of disorder. Rhythm disorder is a quite common in later life with an estimated 9% of those over 80 years suffering from atrial fibrillation (AF) alone5. Prior to the development of the AliveCor Heart Monitor, the options for doing an ECG were to connect a patient to a heart monitor, to ask a cardiac technician or clinical physiologist do a standard 12 lead ECG, or to connect the patient to a portable recording machine (Holter Monitor) to be worn for 24 hours or more. All expensive and time-consuming activities.
Since the development of the AliveCor Heart Monitor, health care professionals and patients can get clinical quality single channel ECG in the time it takes to put a plastic case on the back of an iPhone and tap an icon on the screen – and in virtually any setting - thus significantly reducing the time and cost of the assessment. This includes reducing the personal cost to older people of long hospital appointments, which may involve them having to navigate their way to different clinical departments. But along with the benefits, the AliveCor Heart Monitor has some limitations, in that single channel ECG doesn’t provide the all information necessary for the assessment of ischemia6, nor can the monitor be used as an event recorder for all disorders of rhythm. So whilst the AliveCor Heart Monitor may replace the standard 12 lead ECG or the Holter Monitor in many instances, there will still be occasions when only these tests will do. However when combined with findings from other parts of the CVS assessment, single channel ECG can make a significant contribution to understanding patients’ falls risks.
Setting up and using the AliveCor Heart Monitor
There are three components to the AliveCor Heart Monitor – the case, the app and secure cloud-based storage. Once the app has been downloaded from iTunes, and the cloud account set-up, the case will work. Using the monitor is as simple as putting the case on the iPhone, tapping the Alive ECG icon, and asking the patient to hold the monitor in the way shown in the video below. The recording speed and duration can be set to meet the user’s requirements (24mm/s, 10mm/mV and 30 seconds is standard), and once the ECG is taken, it can be saved and uploaded it to the cloud. The saved ECG can be downloaded from any computer via username and password protected access, and printed as a .pdf.
Experiences of using the AliveCor Heart Monitor
I’ve been using the AliveCor Heart Monitor for about three months. I use it in my initial assessments and each time I review a patient. Once I’ve done an ECG, I upload it to the cloud and then later download and print it, file a copy in the patient’s notes, and send another to the patient’s GP with my clinic letter. As things stand, as well as excluding rhythm disorder, I seem to be mostly using the monitor to confirm that patients who are said to be in rate-controlled AF are in fact rate controlled. But as well as using it in clinic, I also take it with me when I go to see my patients in their strength and balance classes. I check their BP, SpO2 and ECG at rest, and then in middle of the class, and find it helps me better understand how their cardiovascular systems are performing under exercise conditions. And the equipment for all of this can be carried in my messenger bag and with room to spare.
About the author
Dr Hugh Chadderton RN MSc PhD is consultant nurse and specialist in falls prevention. Between 2003 to 2010 he set up and ran the falls clinic at Bronglais Hospital in Aberystwyth, and by the time he left the NHS in late 2010, was seeing 150 new and 150 review patients a year. He has since developed The Falls Clinic at Vale Healthcare. Full details can be found at www.thefallsclinic.co.uk
a Single channel shows the electrical impulses with each heartbeat in one electrical axis. When held, the AliveCor Heart Monitor shows Lead I ECG (right arm minus left arm).
b Standard !2 lead ECG shows electrical impulses with each heartbeat in 12 electrical axes via limb and chest leads.
1. Garabelli P, Albert D, Reynolds D (2012) Accuracy and novelty of an inexpensive iPhone-based event recorder. American Heart Rhythm Society. Annual Meeting, poster presentation SP23
2. Saxon A S, Smith A, Doshi S, Dinsdale J, Albert D (2012) iPhone rhythm strip – the implications of wireless and ubiquitous heart rate monitoring. Journal of the American College of Cardiology 59 (13s1) E726-E726.
3. American Heart Association (2013) Older Americans and Cardiovascular Disease .pdf.
4. National Institute for Clinical Excellence (2013) Falls: assessment and prevention of falls in older people. Clinical Guideline 161, NICE, London
5. Royal College of Physicians (2006) Atrial Fibrillation. National Clinical Guideline for management in primary and secondary care. RCP London
6. Misra S, and Husain I (2013) Physician review of the iPhone AliveCor ECG heart monitor, the clinical reality of the device.
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