PIP for anticoagulation with Iphone app?

New phone app tracks heart rate
Prototype targeted at detecting atrial fibrillation

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UMass Memorial cardiologist Dr. David D. McManus demonstrates a smartphone app used to detect atrial fibrillation. (T&G Staff Photos/PAUL KAPTEYN)

By Karen Nugent TELEGRAM & GAZETTE STAFF
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The app works by holding an index finger over a smartphone camera for a minute or two while the camera's light source and lens detects small changes in skin color and underlying blood vessels.
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WORCESTER The little plastic clip to measure pulse and breathing rates that is immediately placed on ones finger upon entering just about any medical facility can be replicated from the comfort of your home or a coffee shop, ball game or just walking down the street with a new smartphone app developed by Worcester Polytechnic Institute and tested at UMass Memorial Medical Centers Memorial Campus.

The app, described as a prototype at this point, is targeted at detecting atrial fibrillation, a common irregular heartbeat associated with stroke, and an indicator of possible future stroke, according to Dr. David D. McManus, a cardiologist and lead clinician at UMass Memorial involved in the testing.

It works by simply holding an index finger over a smartphone camera for a minute or two while the cameras light source and lens detects small changes in skin color and underlying blood vessels.

Voil: a colored strip on the phone turns red if an abnormal rate is detected, or green if the rhythm is normal. A numeric heart rate is displayed, along with a verbal description of the rhythm, hopefully saying normal. Theres even a symptom recorder in which things like lightheaded can be typed in. Data can be emailed to a doctor or clinic, or kept as a record for future visits.

AFib is so common, but many people have no symptoms, or subtle symptoms like getting winded. This tool will be very helpful because AFib is so hard and expensive to diagnose, Dr. McManus said.

The app would also be extremely valuable, he said, in predicting future stroke risks for those who have only occasional episodes of irregular heartbeats.

The app, which was developed by Professor Ki Chon at WPI, will likely be on the market in three to six months. It is awaiting approval from the U.S. Food and Drug Administration. Dr. McManus said the agency is just beginning to formulate regulations on medical apps. It is unclear how the app would be marketed, he said, but it is hoped insurance companies would offer them in preventive health programs similar to fitness center memberships.

Mr. Chon developed an algorithm for the app while WPI researchers were looking for smartphone applications to record basic health information without the need of unwieldy external sensors requiring medical personnel.

Dr. McManus said 60 UMass patients with atrial fibrillation were tested, comparing the smartphone app readings to electrocardiograms done at the hospital. They all matched.

Donna Suter, a UMass nurse clinician who works at the AFib Treatment Program at the Memorial campus, said atrial fibrillation is the most common arrhythmia in the world, and effects more than 2.3 million in the United States. The number is expected to grow as the population ages, she said. Ms. Suter said it is a major cause of disability with complications such as heart failure, stroke even death.

Dr. McManus said the app is of particular interest in following those likely to suffer a stroke or heart failure because of family history, but have no symptoms.

Its a way to screen, he said.

In addition, Dr. McManus said it might be possible to use the technology to figure out why patients with no symptoms had strokes, with a watch band type device that would communicate data continuously.

The app, which would be downloaded like other apps, works by sampling 30 frames per second that produce readings of tiny color changes reflected in blood.

While it works on iPhones and most smartphones, it is not applicable to iPads, Dr. McManus said, because the light source is encased differently. He said the time required to hold ones finger down will likely be decreased in the final version of the app, perhaps to a minute or less.

The technology is different than EKGs, which translate the hearts electrical activity into tracings on paper.

Its not intended to replace EKGs or doctor visits, but its a valuable piece of information, Dr. McManus said.

Dr. Rishi Vohora, director of cardiovascular services at Clinton Hospital, believes the app has tremendous potential, especially for patients who need long-tem cardiac monitors, sometimes for up to 30 days.

The concept is fantastic, not just for AFib, but for patients that come in with (heart) palpitations that are hard to quantify, he said.

But like Dr. McManus, he described the app as a screening tool that would not replace an EKG or talking to a doctor.

Its a good starting point, Dr. Vohora said.

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