High-Tech Hearts

By Paula Felps

New advancements in technology are changing cardiac care for both patients and doctors. 

John Napurano didn’t let a coronary artery bypass graft in 2013 slow him down; instead, he’s maintained an active lifestyle that has allowed him to continue pursuing his passion for rowing and sculling.

And that’s exactly what Napurano, a member of Mended Hearts Chapter 347 in Fort Lauderdale, Florida, was doing last year when he went into AFib. Even when he paused rowing, his heart rate stayed high and wouldn’t slow down. He was able to read his vitals and knew exactly what was happening, thanks to his participation in Stanford University’s Apple Heart Study, an eight-month research project that evaluated how well the Apple Series 4 smartwatch could correctly identify AFib incidents.

“The watch alerted Stanford and they called me the next day to make sure I had contacted my doctor,” he says. Based on the readings from his watch, Napurano called his doctor, who adjusted his heart medication and the problem was under control within three days.

“As with most people who have been through heart problems, every little ‘warning sign’ can give you pause,” Napurano says. “You can’t run to the doctor for every little thing, but this is a good way of quantifying what is going on.”

The Apple Smart Watch is just one example of how technology is changing cardiac care, both for patients and for doctors. A growing number of apps help monitor and record health metrics as well as reminding users to do everything from brush their teeth to drink more water. For people with heart disease, it provides more ways to measure and monitor cardiac activity and, most importantly, it gives users an extra level of confidence to go about their daily lives.

“There’s no question, I will embrace new technologies because it helps me stay grounded and knocks down a lot of the fears you get from living with heart issues,” Napurano says. “It’s a great tool, but doesn’t take the place of a good heart doctor.”

Tracking Tools Get More Sophisticated

The Apple Watch Series 4 has been one of the most widely publicized innovations of the past year. With a sensor capable of conducting an EKG and an app that analyzes pulse rates, one of its distinguishing features is its ability to warn users if they might possibly have AFib.

The heart-monitoring software runs through Apple’s Health app and, when users place a finger on the crown of the watch, it takes a reading in about 30 seconds. That reading then appears on the user’s iPhone.

In April, the FDA cleared Alivecor’s personal EKG device, KardiaMobile, for use in detecting bradycardia and tachycardia. The portable EKG reader, which uses a set of pads synced up to a smartphone to capture readings, was first cleared by the FDA in 2017 for detection of normal sinus rhythm and atrial fibrillation.

Designed to work with both Android and iOS products, the Kardia is also significant in that the company offers doctors a remote patient monitoring program that encourages patients to track their own health while at the same time allowing doctors to review a patient’s health data without requiring an office visit.

The ability to put such technology directly into consumers’ hands has generated both praise and criticism from the medical community. While it can help with early detection, Healthcare Weekly reported that many physicians have voiced concern over the Apple watch in particular, saying that AFib is difficult to diagnose and that using the device could lead to undue anxiety from users — and create an unnecessary stampede to doctors’ offices.

But supporters of the new technology are quick to point out that the app has been cleared by the FDA as a Class 2 medical device and is less invasive than such devices as a Holter monitor. It also could help increase consumer awareness about heart rhythm disturbances and AFib. That, in turn, could open the doors for greater patient education as well as giving doctors the opportunity to recommend specific exercise regimens and medications earlier in the progression of heart disease.

Just as in Napurano’s incident, when the Apple watch’s algorithms detect a potential AFib incident, the user is prompted to contact a telehealth professional through the app. Then, based on a video consultation, the user is either urged to seek immediate care or will be mailed an EKG patch that they’ll wear for up to seven days. At the end of seven days, the patient will talk to the telehealth physician again to discuss results and determine next steps.

At the American College of Cardiology Scientific Sessions in New Orleans in March, researchers from Stanford University revealed the results of their Apple Heart Study, which evaluated how well the smartwatch worked during the study, which had more than 400,000 participants. The ability of the watch to correctly identify AFib incidents showed what Marco Perez, M.D., Stanford associate professor of medicine, called “a solid foundation upon which further research in digital health can be conducted.”

The Future of Digital Health

It seems that everywhere you turn, there’s another example of how technology is transforming care for people with heart disease. There are more advanced screening tools, less invasive treatments that allow for faster recovery times and new innovations that provide doctors with more efficient ways to interact with patients. Together, these advancements continue raising the bar on what’s possible in the world of medicine.

“We view technology as the tool that’s able to help us, as physicians and nurses, take better care of our patients,” says Randolph Martin, M.D., chief medical officer of Bay Labs. Dr. Martin was one of the pioneers in the use of echocardiography in the U.S. and served as director of noninvasive cardiology at the Emory University School of Medicine and on the faculty of Mayo Medical School. He also is past president of the American Society of Echocardiography.

“I am a strong proponent of using developments in echocardiography to improve our care of patients. Echocardiography has become the gateway to diagnosis and management of cardiac diseases and conditions.”

Despite the many advancements in technology and greater knowledge about self-care and prevention, cardiovascular disease continues to be the top killer of people in the U.S. The country’s aging population, along with the prevalence of obesity and diabetes, are creating what Dr. Martin calls “a tsunami of problems” for the country.

“Two of the largest conditions that cause cardiac diseases are valve disease and heart failure,” he says. “Heart failure is the No. 1 reason for people over the age of 65 to be admitted into the hospital. And so those are the areas that most need to be looked at.”

Artificial Intelligence, Real Results

Further adding to the expanding options for diagnosing and treating cardiovascular disease is artificial intelligence, also known as deep learning and AI.

“AI can improve the access, quality and value of care,” says Dr. Martin, who became chief medical officer of the San Francisco-based company Bay Labs two years ago. In November, the company joined with Northwestern Medicine for a study in AI-enabled cardiology that will enroll approximately 1,200 patients. The study will evaluate the use of Bay Labs’ EchoGPS cardiac ultrasound guidance software to enable certified medical assistants (CMAs) as medical professionals with no prior scanning experience to capture high-quality echocardiograms.