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Biomedicine

EKG to Go

A new handheld heart monitor and subscription service may assuage heart-attack fears – for people who can afford it.

Chest pain, shortness of breath, indigestion, backache, nausea: they could be symptoms of a myocardial infarction – or they could mean you have the flu. Many people are reluctant to wake their doctor at 1:00 a.m. over a case of indigestion – but if they’re really in the throes of a heart attack, waiting it out is the worst possible thing to do.

Enter EKGuard, a portable gadget and subscription service now available for the first time in the United States. EKGuard provides clients with a handheld electrocardiogram (EKG) monitor and a 24-hour call center staffed by cardiac specialists. Their goal: to drastically reduce the time between the onset of a heart attack and a patient’s arrival at the hospital.

“The biggest problem when it comes to heart disease is that people aren’t acting fast enough,” says Jay Lichtenstein, EKGuard’s president and CEO. “Typically, there’s about four to six hours between when people feel symptoms and when they seek help. But after two hours, a person’s chances of dying double – her heart muscle suffers permanent damage because it’s not getting oxygen.” And the greater the damage, the lower the chances of survival.

Currently, EKGuard is available only in New York, Connecticut, and New Jersey. All calls are channeled to a center in mid-town Manhattan, where the phones are answered by cardiac doctors, nurses, and EMTs. When a customer signs up for EKGuard, the company sends a handheld EKG monitor. They also take a customer’s medical history, contact his or her doctor and cardiologist, and explain how they should take a baseline EKG, for reference by cardiac specialists.

The portable monitor has three wires; placed in the right spots on the body, they record data from 12 different leads, like a standard hospital or ambulance EKG. When collected, the data build a picture of how efficiently electrical impulses are traveling through the heart. To transmit the EKG readings to the call center, the device translates the information into sound and plays it over a phone line to a computerized receiving station, where it is reconfigured into an EKG chart that can be analyzed for irregularities.

The technology itself isn’t new: The device EKGuard uses (manufactured by an Israeli company, Aerotel Medical Systems) was approved by the U.S. Food and Drug Administration in 2000. But legal and practical issues stalled the development of the call-center service for years. Most doctors, for instance, are licensed solely in the state where they practice, so the call center had to hire medical staff who could advise clients from each state where the company does business.

Now that the company is up and running stateside, Lichtenstein says, they plan to refine the technology. The next step: adding Bluetooth wireless capabilities to the device, so that it can communicate with a cell phone or a PDA.

Companies like EKGuard are already operating in Israel, England, Switzerland, Germany, Italy, and the Netherlands. More than 120,000 people in Israel alone are using a similar service, according to Lichtenstein, and a study by one company found that the technology helped its customers cut emergency-room visits by 30 percent. Even more telling, the average time it took for heart attack victims to call for help after their first symptoms appeared dropped from four hours to around 40 minutes.

In the United States, “as many as two-thirds of patients with heart attacks don’t arrive at the hospital for treatment until four of five hours after their symptoms started,” says cardiologist Mark Apfelbaum, chief of the Interventional Cardiology Network at New York’s Columbia University Medical Center and a member of EKGuard’s medical advisory board. “And any time you cut hours off time to treatment, fewer people are going to die.”

EKGuard encourages their subscribers to call at the first sign of trouble – as well they should, if they want to get their money’s worth. The service costs between $499 and $599 to start up (depending on the term of the contract), with subsequent monthly fees run $69-79.

“With this service available, I think patients will have much more of an inclination to call 10 or 15 minutes after their symptoms start,” says Apfelbaum. “We can see immediately on the EKG if it is, indeed, a heart attack. We call 911, we get the ambulance to the patient, call the closest hospital, have the [catheterization] lab ready and waiting, and can shave hours off treatment time in heart attack patients.”

The service will be most helpful for certain groups: those who’ve already been diagnosed with heart disease, who have had at least one heart attack already, who have had angioplasty, or who have other serious concerns about their cardiac health. But the company is also courting the “worried well” – people with high risk factors, such as hypertension and high cholesterol, but no history of the disease.

For that reason, among others, not everyone is buying what EKGuard has to sell. “Patients who are worried enough to call someone because they’re having chest symptoms really need to be seen by a physician, and been seen in an emergency room,” says Richard Stein, MD, a spokesperson for the American Heart Association (AHA) and a cardiologist at Beth Israel Medical Center in New York City.

Stein argues that a normal EKG doesn’t always carry enough information for a doctor to know whether there’s cause for concern. “Somewhere between 20 percent of men and 25 percent of women have symptoms during a heart attack that aren’t classic,” he says, adding that early EKGs don’t necessarily show telltale signs. Often, additional EKGs and blood tests are needed in order to rule out a heart attack, says Stein.

“I don’t think that the assurance EKGuard can give is one I would want my patients to have,” Stein says.

Lichtenstein, however, thinks that many of the people who might purchase his product and phone the call center are the type who might otherwise do nothing at all. “Research by the AHA has found that people just won’t call 911” during possible cardiac emergencies, Lichtenstein says. But he believes they will call EKGuard.

EKGuard will be available in five to eight more states within a year, and nationwide by 2010, Lichtenstein says.

Meanwhile, the medical community has yet to pass judgment on handheld EKG units. Stein and others would like to see the results of clinical trials before they give their endorsement; while many others seem optimistic, given the technology’s success in other countries.

If the service saves someone’s life, the steep startup cost will seem like a small price to pay, of course. On the other hand, if EKGuard creates a false sense of security for those who should instead be racing to an emergency room, cardiologists may not be quick to embrace it.

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