Rocky Mountain University of Health Professions (RMUoHP) faculty member within the Master of Physician Assistant Studies Program, Viet Le, MPAS PA-C, AACC, was a recent contributor and study author for a research project that dove into a new smart phone app that has the ability to effectively identify potentially fatal heart attacks with the near accuracy of a medical ECG.

Le’s research brings exciting news to those who have preexisting heart problems and those who may experience a heart attack. The smart phone app has the potential to lessen the time it takes from the first signs and symptoms of a heart attack to receiving treatments at a hospital. Le goes into further detail about heart attacks, the warming signs, current technology within the healthcare realm, the new smart phone app, and how it can seriously improve people’s chances in not only reducing the effects of a heart attack, but also saving lives.

During or following a heart attack, contact emergency medical services or go directly to an emergency room where you will receive an electrocardiogram (EKG), a physical examination of vital signs (blood pressure, temperature, heart rate, oxygen saturation), and blood draw for cardiac biomarkers (troponin).

What your medical providers are looking for are changes on EKG, body presentation, and blood that signal that you have a blockage. Time is of the essence if you are having a heart attack, the longer you wait for treatment (restoring blood flow), the more heart tissue is at risk of being unrecoverable leading to death of tissue and ultimately the person.

While a non-medically trained person in the community may have a hard time differentiating chest discomfort caused by stomach acid, musculoskeletal pain, or loss of blood flow to the heart and may also not have access to laboratory services within their home, they do have access to one of the most sophisticated and powerful machines available that can be carried in the palm of the hand, a smart device, such as your mobile phone.

Several companies have been working on the development of handheld diagnostic devices that leverage our mobile devices with apps that may or may not require an additional small hardware unit. AliveCor (Kardia) is one of those companies. They developed a direct-to-consumer arrhythmia (defined as any abnormal heart rhythm) detection device that pairs with a smart device and can provide a single EKG lead with an accompanying software algorithm to provide a first level assessment (see below). This device has been FDA-cleared for detection of atrial fibrillation, a specific type of arrhythmia originating in the top 2 chambers of the heart.

There are nearly 1 million cardiovascular related events that occur annually in the US and nearly ¾ or ~725,000 are first time heart attacks. Coronary heart disease accounts for close to 370,000 deaths a year in the US (Benjamin et al., 2018). Recognizing that increased time to treatment leads to increased risk, the U.S. government in partnership with national cardiovascular organizations (American Heart Association, American College of Cardiology, etc.), and healthcare systems, have developed and implemented over the past two decades guidelines to shorten the time from the first signs of a heart attack to the timey the receive emergency services to restore blood flow to the coronary arteries to 90 minutes.

Not all chest pain is indicative of a heart attack and not all heart attacks present with chest pain. Many are worried that they will arrive at the ER with chest pain only to be sent home s with acid reflux or some other non-life threatening illness. First, do not be embarrassed. While medical professionals are trained to discern what is life threatening and what is not, you are not.

While time-to-treatment has improved for those who have contacted EMS and/or come to the ER, individuals often wait to call or come in, causing significant pre-hospital delays.

We sought to determine whether diagnostic quality EKGs could be obtained with a smart device compared to a traditional 12 Lead EKG obtained in the ER. Leveraging the Duke University Cooperative Cardiology Society (DUCCS), we were able to recruit patients from five different sites (Intermountain Medical Center, Mayo, Erlanger, Integris, and Argentina) to test EKGs on patients who presented to the ER for chest pain as well as patients in which a STEMI (ST elevation myocardial infarction) protocol was activated. A little over 200 patients were included in the study, of which 112 were chest pain patients in the ER and 92 were patients where the STEMI protocol had been activated.

Patients were evaluated and assessed by standard medical practice and were approached for enrollment in the ER. The study gathered data using 12-Lead EKGs followed by an EKG using the smart device and hardware used to recreate each single lead EKG. A smartphone 12-lead was generated later.

Based on consensus of an EKG board of physicians, smart device and standard EKGs were read side-by-side, which showed good results in 166 subjects (87.4%), fair in 23 (12.0%), and poor in one (0.5%).Based on results the authors concluded that a 12-Lead equivalent EKG could be obtained using a smartphone coupled with a software and inexpensive two-wire attachment for identifying whether or not there was the presence of STEMI compared to a traditional 12-Lead EKG.

Similar to the impact of automated external defibrillators (AED) have had on out of hospital cardiac arrests, the ability for EKGs to be obtained by non-medical providers may help improve survival for those suffering a heart attack by shortening the time between symptoms and transport to a medical facility. Also, similar to AEDs, the app would have both step-by-step audio and video instructions in usage as well as recommendations and follow-up if there is no STEMI detected. However, unlike an AED, the smart device (when and where cell service or wi-fi is available) would have the capability of sending data to local EMS as well as an area hospital via cloud-based services.

In the scenario below one can envision chest pain with a STEMI EKG sent to both the local ED and EMS, EMS being directed via GPS to the location of the patient and directed to the ED where the care team is already alerted and perhaps the STEMI treatment team has already been activated. The patient may even bypass the ER and go straight to the catheterization lab to the awaiting STEMI team.

 

Benjamin, E. J., Virani, S. S., Callaway, C. W., Chamberlain, A. M., Chang, A. R., Cheng, S., . . . Muntner, P. (2018). Heart Disease and Stroke Statistics—2018 Update: A Report From the American Heart Association. Circulation, 137(12), e67.

Le, V., & Mulestein, J. B. (2018). Use of Wearable Technologies for Early Diagnosis and Management of Acute Coronary Syndromes and Arrhythmias. Current cardiovascular risk reports, 12(24). doi:https://doi.org/10.1007/s12170-018-0588-3