In March of 2017 AliveCor introduced Kardia Pro, a cloud-based software platform that allows physicians to monitor patients who use the Kardia mobile ECG device.
I have been utilizing the Kardia mobile ECG device since 2013 with many of my atrial fibrillation (AF) patients and have found it be very useful as a personal intermittent long term cardiac monitor. (see here and here)
I signed up for the Kardia Pro service about 3 months ago and all of my patients who purchased Kardia devices prior to March of 2017 have been migrated automatically to Kardia Pro by AliveCor.
Now (post March 2017), patients who acquire a Kardia device must sign up for the Kardia Pro service at $15 per month to connect with a physician.
I think this is money well spent and I’ll demonstrate how the service works with a few examples.
Monitoring Patients With Atrial Fibrillation
I saw a 68 year old man with persistent atrial fibrillation that was first diagnosed at the time of pneumonia in late 2017.
He underwent a cardioversion after recovering from the pneumonia but quickly reverted back to AF. His prior cardiologist offered him the option of repeat cardioversion and long term flecainide therapy for maintenance of normal sinus rhythm (NSR) but he declined.
When I saw him for the first time in the office a month ago I listened to his heart and to my surprise, noted a regular rhythm: an AliveCor recording in the office confirmed he was in NSR. The patient had been unaware of when he was in or out of rhythm
We discussed methods for monitoring his rhythm at this point which include a 24 Holter monitor, a 7 to 14 day Long Term Monitor, a Cardiac Event Monitor and a Mobile Cardiac Outpatient Telemetry device. These devices are helpful and although expensive are often covered by insurance. They require wearing electrodes or a patch continuously and the results are not immediately available.
I also offered him the option of monitoring his AF using a Kardia device with the recordings connected to me by Kardia Pro.
He purchased the device on his own for $99, downloaded the app for his smartphone and began making recordings.
I enrolled him in my Kardia Pro account and he received an email invitation with a code that he entered which connected his account with mine, allowing me to view all of his recordings as they were made.
When I log into my Kardia Pro account I can now view a graphic display of the recordings he has made with color coding of whether they were considered normal or abnormal by Kardia.
The patient overview page also displays BP information if the patient is utilizing certain Omron devices which work with Kardia.
The display shows that after our office visit he maintained NSR for 3 days (green dots) and then intermittently had ECG recordings classified as AF (yellow dots) or unclassified (black).
The more he used the device and got feedback on when he was in or out of rhythm the more he was able to recognize symptoms that were caused by AF.
I can click on any of the dots and six second strips of the full recording are displayed. In the example below I clicked on 2/27 which has both an unclassified recording (which is atrial flutter) and an AF recording
Clicking on the ECG strips brings up the full 30 second recording on a page that also allows me to assign my formal interpretation. In the example below I added atrial flutter as the diagnosis, changing it from Kardia’s unclassified (Kardia’s algorithm calls anything it cannot clearly identify as AF that is over 100 BPM as unclassified.)
The ECG can then be archived or exported for entry into an EHR.
The benefits of this patient being connected
to me are obvious: we now have an instantaneous patient-controlled method for knowing what his cardiac rhythm is doing whether he is having symptoms or not.
This knowledge allows me to make more informed treatment decisions.
The Kardia Pro Dashboard
When I log into kardia pro I see this screen.
It contains buttons for searching for a specific patient or adding a new patient. Adding new patients is a quick and simple process requiring input of patient demographics including email and birthdate.
From the opening screen you can click on your triage tab. I have elected to have all non normal patient recorded ECGS go into the triage tab.
Other Examples
Another patient’s Kardia Pro page shows that he records an ECG nearly every day and most of the time Kardia documents NSR in the 60s. Overall, he has made 773 recordings and 677 of them were NSR, 28 unanalyzed (due to brevity) , 13 unclassified and 55 showing AF.
Monitoring Rate Control In Patients With AF and Reversion Post-Cardioversion
Another patient I saw for the first time recently has had long-standing persistent AF. His previous cardiologist performed an electrical cardioversion a year ago but the patient reverted back to AF in 40 hours. Before seeing me he had purchased a Kardia mobile ECG device and was using it to monitor his heart rate.
After he accepted my email invitation to connect via Kardia Pro I was able to see his rhythm and rate daily. The Kardia Pro chart belowshows his daily heart rate while in atrial fibrillation. We utilized this to guide titration of his rate controlling medications. Such precise remote monitoring of heart rate in AF (which is often difficult to accurately assess by standard heart rate devices) obviates the need for office visits for 12 lead ECGs or periodic Holter monitors.
I performed a second cardioversion on him after which he made daily recordings documenting maintenance of NSR. With this system we can determine exactly when AF returns, information which will be very helpful in determining future treatment options.
Kardia Pro Plus Kardia Mobile ECG Creates Personal Intermittent Long Term Rhythm Monitor
There are many potential applications of the Kardia ECG device beyond AF monitoring (assessing palpitations, PVCs, tachycardia, etc.) but they are all enhanced when the device is combined with a good cardiologist connected to the device by Kardia Pro.
I’ve gotten spoiled by the information I get from my AF patients who are on Kardia Pro now. When they call the office with palpitations or a sense of being out of rhythm I can determine within a minute what their rhythm is wherever I am (excluding tropical beaches and mountain tops) or wherever the patient is (for the most part.)
On the other hand patients who are not on Kardia Pro have to come into the office for 12-lead ECGs. When they call I feel like my diagnostic tools are limited. Such patients usually end up getting one of the standard Long Term Monitoring (LTM) Devices. If I am fortunate, after a few days to weeks , the results of the LTM will be faxed to my office.
I am optimistic based on this early experience with Kardia Pro that ultimately this service in conjunction with the Kardia Mobile ECG device (or similar products) will replace many of the more expensive and inconvenient long term monitoring devices that cardiologists currently use.
Skeptically Yours,
-ACP
Navigating Treatment Options For Atrial Fibrillation 
I’m getting a lot of false high heart rate readings with the Kardia app but understand it is the Apple watch that is at fault regardless of the app interpreting the reading (perhaps the watch is confusing electrical current with heart rate since some of my false readings occur when the watch is being recharged). Are these false alarms causing you and other Kardia Pro users difficulties? It is also annoying that the Kardia app does not cause my watch to vibrate when my heart rate is too high so am failing to take ECGs when I should; I am insensitive to high heart rate. The settings on the watch are as high as they will go, and the watch vibrates for other non-health apps. Perhaps you can persuade AliveCor’s techies to upgrade the software.
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I have been using my AiiveCor for about three years now because of the recommendation from Dr. Pearson. I have a difficult time recognizing when I am in Afib. I have learned when to do a reading now and send it to Dr. Pearson because I have gone into Afib. This device is helping me as well as Dr. Pearson determine my treatment. It has given me peace of mind to know Dr. Pearson can see my reading immediately.
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Is it possible to use Apple-based Health technology to achieve an integrated view of the key health factors eg diet, exercise, heart data, BP etc? And if so can DrP recommend how to do so? Thanks
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Possibly. But I haven’t figured out exactly how.
The Kardia/Apple Watch allows exercise/weight/heart data and BP (with Omron devices) to relatively seamlessly gather in an easily scanned format.
I don’t see any integration of diet or sleep which are arguably as important as the other data.
Readers feel free to offer your advice
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In your experience, how accurate are the “normal” readings?
I’m struggling to get consistent, good quality recordings (low voltage and/or high noise) and I’d like to know if I can more or less trust the algorithm. I’m completely unqualified but I don’t understand how it can differentiate between p wave or random noise etc.
I tried placing the recorder on the left side of my chest, but that mostly comes back as “unclassified” – even when taken a few times in a row, intermittently with multiple “normal” finger ECGs. The chest recordings have high voltage and low noise, but seem to lack detail.
I’m in my 20s and use the device hoping to catch the disturbing but probably benign moments of skipped beats and palpitations, not atrial fibrillation.
I could send more details via email if that’s of any interest.
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Normal reading is highly accurate.
Have you tried the left knee , right hand , lead II method?
You can send tracings to drp@theskepticalcardiologist.com
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I should add that “normal” means no atrial fibrillation and a rate between 60 and 100.
So when it says normal you are almost always in normal sinus rhythm but you could still have PVCs or APCs .
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