These devices allow you to take detailed heart readings at home—but should you?
From fitness tracker apps to new devices, keeping an eye on heart health has never been easier
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Most people know that cardiac health is one of the most important components of overall wellbeing—and maintaining it through diet, exercise, and stress management can help prevent strokes, heart failure, and other cardiac-related health issues. But those who require closer attention to heart health may need frequent electrocardiogram (ECG or EKG) readings, which, until recently, could only be accessed by visiting a medical provider. But now, at-home devices—from smartwatches and fitness trackers to standalone gadgets like AliveCor and HealthyU (which debuted at CES this year)—allow people to take these readings on their own at home. If you’re thinking about getting one, here’s what to know and what to look for.
What is an electrocardiogram?
An electrocardiogram (ECG or EKG) records the electrical signals of the heart to detect arrhythmia or other irregularities. In most cases, ECG machines in doctor’s offices or hospitals have 12 leads, or points of contact with the body, and get readings from electrodes placed on the chest, arms, and calves. At-home ECGs usually use the fingertips and have fewer leads. Wearables like the Fitbit Sense, Samsung Galaxy Watch 3 and Active 2, and Apple Watch Series 4, Series 5, and Series 6 have FDA approval for their ECG apps, which take readings from a user holding their finger somewhere on the device. Standalone ECG devices, such as AliveCor’s KardiaMobile, and Omron Complete work by placing four fingers on designated areas.
All at-home devices classify the reading as Sinus rhythm (meaning the heart rate is normal) or atrial fibrillation (AFib, or an irregular heart rate, which increases the chance of stroke and heart attacks). Then they either create a PDF to send to a healthcare provider automatically (if you’ve provided an email address) or give you the option to save and send it yourself. Most, especially apps on wearable devices, will caution that they are not to be used to detect heart attacks and to contact a physician if you aren’t sure what to make of the reading.
Some newer gadgets also promise to provide additional insight. One yet-to-be released device, HealthyU from HealthyMedical, provides an ECG reading by putting four fingers on designated spots and holding it against the chest—which gives it seven points of contact (more than the wearables’ single point but not as many as the 12 of a hospital ECG). It also claims to check the level of oxygen in the blood, or pulse oximetry, heart sounds with murmur, lung sounds, temperature, respiratory rate, and blood pressure trend. HealthyU is currently in clinical trials and awaiting FDA approval, but once it enters the market (estimated for later this year), it may help people with heart issues safely monitor their health from home with oversight from a doctor.
Can you trust your own ECG readings?
Moving from 12 ECG leads to one or even seven may seem iffy in terms of the reliability of at-home readings. In fact, a study on the accuracy of Apple Watch 4’s ECGs done at the Cleveland Clinic last year found that the watch display identified just 41% instances of AFib in patients—however, the downloadable PDF identified 98% of instances of AFib in patients when interpreted by a physician. What does this mean? Having access to these PDFs and a medical professional to review them is vital.
“There’s a difference between informational ECG readings and ones with diagnostic intent,” says Dr. Regina Druz, chair of the American College of Cardiology Innovation Council. “That’s what consumers need to be aware of, that some of the readings are essentially information only and the discretion of the consumer if they wish to share it with their doctor. If you don’t share, there isn’t going to be any way for a physician to access it.”
In the future, you’re probably going to see a lot of medical devices that, like HealthyU, provide users and their healthcare providers with data. Another new at-home gadget, Omron VitalSight, is described as a “remote patient monitoring device.” It uses a blood pressure monitor with a cuff, a bodyweight scale, digital medication tracker, and a data tracking hub to send blood pressure readings to doctors in real time. If the readings are OK, it stores them; if something is irregular, it triggers an alert for the physician. Omron claims this can identify warning signs of heart attacks and strokes.
Demand for such instruments probably has something to do with the ongoing coronavirus pandemic, which made a lot of people wary about entering medical spaces when they aren’t sure if they require medical attention. But it also represents a larger trend in healthcare that had started before the pandemic, according to Druz. “I think these devices are popular not just because of the specific information they provide but because they reflect the tendency that patients and consumers want healthcare to be accessible, easy to use, and cheap,” she says. “What we’re seeing is the commoditization of what used to be the type of interventions and diagnostics that would only be available in a physician’s office.”
This doesn’t mean at-home devices will replace medical providers. In fact, Druz says that one of the most important things to know when you have an at-home ECG device is when to seek professional help. But it can help patients get familiar with the numbers that only their doctors could see and understand before.
What to look for in an at-home ECGs
ECGs are not must-have devices for every household. If you’re getting one, chances are good that it’s on the recommendation of a doctor based on an existing heart condition or prior cardiac episodes. If so, start by asking your doctor what they recommend. It’s also helpful to have some idea of what your readings mean and why the ECG reader is necessary for you.
“[Patients] need to understand the reason why they’re getting the device,” Druz says. “Is it mostly for information, or is it for diagnostic evaluation?”
If it’s mainly to stay informed, any device with FDA approval should work. If it’s for diagnostic purposes, look for one that highlights sending information as one of its main purposes—all devices should have the ability to save and share PDFs of the readings, but one that sends it directly to a healthcare provider without too much effort from the user may be the right call.
In addition to physician instruction, Druz recommends considering a few things when purchasing an ECG reader. “Ease of use is number one,” she says. This includes how easy it is to save and share the recordings and, if it’s a standalone device, it is paired with an app that’s relatively simple to understand.
No matter what kind you get, you can use it as a tool to enhance your medical experience and level of care you receive—and, as the devices continue to innovate, the healthcare you receive should get better.