Advances in heart monitoring technology pose new challenges

Technology is changing the way we live at a dizzying pace, and that includes advances in heart health monitoring. The point of all the new technology being developed is to be able to diagnose problems sooner so that they can be corrected, either with medication or procedures.

Five technologies currently in the early stages of development include:

• Soft wearable EKG monitors that don’t require batteries.
• Paper test strips that can measure blood serum and give readings on three known markers of heart failure.
• Soft dissolvable implants to monitor various aspects of heart health.
• Implantable smart stents that can provide data about how well the stent is holding up.
• Blood biomarkers to assess a person’s brain health after a cardiac event.

Cardiologist Lawrence McAuliffe, MD, FACC at Cape Cod Healthcare Cardiovascular Center in Hyannis, said that while all of these advances are going to be theoretically possible in the future, some of them are more likely to be here sooner than others. For example, EKG monitoring is already available with Apple watches and KardiaMobile devices that can detect atrial fibrillation.

“They are able to streamline the diagnosis of cardiac irregularities as well as, importantly, exclude a cardiac cause for a patient’s symptoms,” he said.

If a patient is frequently lightheaded and experiences heart palpitations, for instance, they can use those devices and a home blood pressure machine to monitor their heart rate, heart rhythm and blood pressure as the incident occurs. Quite frequently their cardiovascular status is fine and something else, like COPD or blood sugar issues, are to blame.

“Conversely, there are a lot of cardiac conditions that we want to know exist because they require treatment and intervention and you want to do that as timely as possible,” Dr. McAuliffe said.

Years ago, people wore a cumbersome 24-hour Holt monitor to detect cardiac irregularities, but if their symptoms occurred only a couple of times a month, a condition might go unnoticed. To correct that problem, Mobile Cardiac Outpatient Telemetry was developed to give doctors a 30-day window of the heart. But with symptoms that are infrequent, conditions could still be missed.

“Now we have implantable loop recorders that are the size of a pencil eraser that we can put underneath the skin,” Dr. McAuliffe said. “That has a battery, and we can monitor your heart rate and rhythm remotely for three years. So, that is the default monitoring modality that we use now for someone who has a very infrequent symptom or event, but we need to know what it is.”

Even though the soft battery-less wearable EKG monitors exist, they are not yet in mainstream cardiology, he said. The same is true of the other new technologies.

The Upsides and Downsides

The fact that these things might be part of the future of medicine raises a few issues that concern Dr. McAuliffe. While some of them hold promise for better healthcare, they also include some downsides.

One of the promises is the fact that patients can participate more fully in their own healthcare monitoring and decisions.

“It creates a new partnership between the physician and patient where the patient is not only participating in transmitting health data, but as part of the team in terms of trying to sort out a given symptom or issue,” he said.

The wearable devices also help speed up the timeline for at-risk patients to be diagnosed and therefore treated more quickly.

But not all patients are good candidates for self-monitoring, he said. There are the “worried well” who become anxious over every little change. This already happens with people who monitor their blood pressure too often, which then causes their blood pressure to actually go up from the stress of constant monitoring.

All of the new technology also brings up several tricky questions and issues, Dr. McAuliffe said, including:

• Continuous monitoring creates tons of new data, but who analyzes it?
• All of this technology is expensive and not everyone will be able to afford it. For example, the Apple watch with A-Fib detector costs about $300.
• Socioeconomic challenges also mean that some people don’t have access to the internet, which is necessary to transmit the data.
• Some patients aren’t tech savvy and would have difficulty navigating the new technology.
• If technology changes the paradigm of how we deliver medicine, do patients even need to come to the office anymore?
• How will healthcare professionals be reimbursed for their time if they don’t actually physically see the patient in the office?

“Even though you have the holy grail that the body can tell you everything that you need to know, the challenge is how to extract that data effectively and equitably,” he said. “There is amazing stuff out there. How we are going to apply it to healthcare is the unanswered question. It will potentially turn the traditional model of healthcare on its head.”