It was a shift that began long before the pandemic: Tech companies, health providers, and patients alike were increasingly looking to remote devices like miniature electrocardiograms and blood pressure cuffs connected to the internet that let clinicians keep tabs on care from afar.
Now, with virtual care emerging as a safer alternative to in-person care, remote heart monitoring tools may be having a breakout moment.
The devices could prove useful during the pandemic for a range of reasons, from their ability to catch undiagnosed heart abnormalities in patients missing routine medical appointments, to their usefulness in gauging Covid-19 patients’ responses to experimental medications that impact the heart.
Nearly every heart-focused health tech company — from startups like AliveCor and iRhythm to medical device giants like Medtronic — has moved recently to make its heart monitoring EKG devices more broadly available for cardiac patients to use at home and for clinicians to use on Covid-19 patients. Their goal is twofold: keep tabs on at-risk patients while minimizing exposure to staff and other patients.
Those moves are happening at a time when big tech companies are also deepening their own cardiac ambitions. Both Apple and Alphabet spinout Verily have watches equipped with EKGs that detect the heart abnormality atrial fibrillation, or A-fib. Apple and Amazon have recently hired prominent cardiologists to fill their ranks, while Facebook is hiring for a team overseen by Freddy Abnousi, a cardiologist and the social network’s new head of health technology. Among the new roles: an expert in the same type of technology used to monitor the heart in Fitbits and Apple Watches.
“These [devices] are definitely boosters,” said Eric Topol, a cardiologist, the director of the Scripps Research Translational Institute, and one of the researchers involved in the Covid-19 tracking project. “And they’ll help more and more as people start to figure out that they can get answers to their symptoms without an appointment.”
Wearables like the kind made by Apple and Fitbit are already being tested as early warning systems to detect Covid-19 using data from the heart as well as insights on sleep and activity levels, all of which have been previously found to be helpful in predicting clusters of the flu.
But Apple Watches still aren’t sensitive enough to flag some kinds of potential cardiac harms, such as the effects of a drug being used to treat Covid-19. Other heart monitoring devices like those created by AliveCor and iRhythm’s, however, are already being deployed in the clinic. Executives from both companies said they had seen a sizable uptick in the use of their technology by patients and clinicians since the coronavirus lockdowns began in March.
iRhythm’s Zio device — a Band-Aid-sized, water-resistant EKG patch that sticks to the chest and can be worn for up to two weeks — is commonly used by patients with existing heart issues whose doctor has prescribed the tool. It’s also increasingly popular with clinicians treating Covid-19 patients, many of whom are seeking alternatives to contact-heavy traditional EKGs. Staff from the cardiac division of Montefiore Hospital in New York, for example, reached out to iRhythm to request more Zio patches for Covid-19 patients who need remote monitoring and cardiac patients who they want to keep out of the hospital amid the pandemic.
“This was a twofold idea: monitor patients and minimize exposure to our staff and to patients,” said Kevin Ferrick, professor of medicine and director of the EKG department and cardiology training program at Montefiore.
Experts said that moves like Montefiore’s are a sign of what’s to come in cardiology, where the use of remote tools rises as the need for traditional, in-person visits falls.
“The point of care has moved directly to the patient’s home,” said Judith Lenane, executive vice president and chief clinical officer of iRhythm.
Health tech startup AliveCor, which makes a handheld, miniature EKG that does not require a doctor’s prescription, also moved to make its devices easier to access for at-home use in April when it realized that heart patients were less likely to visit their clinicians during the pandemic. Demand for its devices has risen considerably since the lockdown started, said Ira Bahr, AliveCor’s chief commercial officer.
“People are rightfully cautious about visiting hospitals right now, so being able to get any readings from patients while they’re in their home is an advantage,” Bahr said.
There remains a question over whether the change in thinking around remote heart monitoring will stick after the pandemic subsides.
“The changes being made now have opened people’s minds to how they can deploy technology in a way that was different from what they thought of, even when we get back to a level of normalcy,” said Rob Kowal, chief medical officer of Medtronic, which has also seen a noticeable uptick in demand for its remote heart monitoring devices.
Remote wearable devices could also be used to monitor blood oxygen levels, which are affected by diseases that impact the lungs. In January, Fitbit rolled out a feature that allows for blood oxygen monitoring on some of its devices, beating Apple, who had also been working on the technology, called oximetry, to the rollout. The company aims to win clearance from the Food and Drug Administration to use the tech to flag sleep apnea, but has yet to do so.
“Tens of millions of people wear a smartwatch these days. That’s a freebie that you could just activate on their watch, instead of advocating that people go out and buy an oximeter,” said Topol, the Scripps director.
If virtual care — including remote heart monitoring — can give patients and clinicians a clearer picture of heart health in real time, experts project their use could become far more widespread in the coming months and years.
“I’d wager that over the next few years virtually all the heart-monitoring technology will be patches, or an Apple Watch, for example,” Ferrick, the Montefiore clinician, said.