Kardia. An alternate way to use it.

[mjames1]

I think Kardia is a great home device and own four of their models. However, from experience and after reading many posts here, it seems that how you use Kardia can often be the difference between it being helpful device that helps diagnose and manage arrhythmia's, and a device that causes more stress than it should.

I think the main problem is that many confuse the Kardia ekg itself with Kardia's written analysis which Kardia calls "determinations". A determination, depending on whether or not you have their paid monthly plan could include "afib", "possible afib", "tachycardia", "bradycardia", "Wide QRS", etc,

Kardia's ekg is medical grade and when taken properly about as accurate as a Holter or single lead at your doctor's.  

The determinations on the other hand, while also very accurate, sometimes can be wrong or confusing. A common example is when Kardia says "possible afib" but when in reality it's just a normal rhythm with multiple ectopic beats.

In this example, Kardia can be wrong, but the ekg itself is most probably not and if the Kardia ekg is sent to a good ep (electrophysiologist) you will get a proper determination. And this is not just a Kardia issue, the same thing can happen with the AI analysis at the 12-lead ekg at your doctor's office and that's why a good ep doesn't look at the determinations, but simply reads the ekg based on their training. 

It's almost too bad that user's aren't given the choice between how the Kardia currently reports and what I would call a simplified model which might cause less anxiety for some. 

In the hypothetical simplified model, there would only be two Kardia readings. Either "Normal" or "Possible arrhythmia, show to your doctor". This would take Kardia's determinations out of the picture and make the analysis ep dependent, where in the final analysis it should be anyway, especially if you are planning on making a treatment decision based on that determination.

So perhaps those that find Kardia confusing or a cause of anxiety can construct their own simplified way to use it. And that would be to ignore the determinations and simply send any ekg other than "Normal Sinus Rhythm" to their ep (electrophysiologist) for a more definitive analysis, if that is feasible. Another option is to study up a little on how to read ekg's, which many including myself have done. And while I'm confident I can usually tell the difference between say ectopics and afib, often better than Kardia, I always forward the more complex ekg's to my ep for analysis.

Jim

[Jalia]

That's all well and good but to send every reading, other than NSR , to your EP for analysis would , at least in the UK be taking the proverbial P.

Educating oneself is the way forward.

I've paid to have anything which was concerning me to be analysed in the past. However my arrhythmia nurse has instructed me to send anything bothering me to her now.

[mjames1 in reply to Jalia]

Jalia: However my arrhythmia nurse has instructed me to send anything bothering me to her now.

I think that's what I'm basically saying, just more long winded😄And yes, educating yourself, if so inclined, is a big plus and for me a lot of that education was from ep's looking at my Kardia tracings and giving me feedback, so the second or third time I got the same kind of ekg, I could pretty much analyze it myself.

Jim

[Auriculaire in reply to Jalia]

There are many afib sufferers in the UK who have neither EPs nor arrythmia nurses and who struggle to get appointments with bog standard cardiologists .As you point out Jim's suggestions are fantasy land for users of the NHS -and indeed for afibbers in the US who don't have insurance.

[Speed in reply to Auriculaire]

I have direct line to Arrhythmia Nurse who can consult with my EP. Is this not the standard model now in the UK? I have previously (rarely though as I do not want to unnecessarily take up EP time), sent ECG reading from my Kardia to the nurse who has then got back to me quickly with a determination by the EP. I can’t fault the service and support.

[Auriculaire in reply to Speed]

How long did it take you to get a first appointment with an EP and was this recently?

[Speed in reply to Auriculaire]

First arrhythmia diagnosis was back in 2019 so pre-pandemic and referral time from GP to Cardiolist was about 8 weeks from memory. Turned out to be Flutter. I was however already in the system when I was later diagnosed with PAF and liaising with my Arrhythmia Nurse.

[Desanthony in reply to Speed]

Yes if concerned I can send my Kardia reading to the secretary at the Cardio nurses office at my local hospital. I can also do this prior to an appointment. So far, I have seen nothing too concerning. I also wear a fit bit so keep track of my heart rate on that - so if anything concerns me there I use the Kardia and would then decide whether or not to send on.

[LaceyLady in reply to Jalia]

How do you get an arrhythmia nurse? I have had no NHS checks in all the years I’ve had SVT & PAF. We’ve had private health cover via husbands job. The trouble is, there isn’t nurses or assistants to give regular check ups. Recently had an ablation via private. I had got referred to the cardiology of the local hospital and told I’d have to wait 3 months for an ablation, well that was before Christmas 🤷🏼‍♀️ I have no contact at GP surgery for heart checks etc, I believe there isn’t anyone at the surgery who is proficient in doing ECG’s ! I had a bad fall beginning of June on holiday and hoping it hasn’t ruined the op. 🙏🏻

[Jalia in reply to LaceyLady]

Well I discovered mine at my local hospital by chance. I had heard of Arrhythmia Nurses and decided to phone hospital to see if they had one! Luckily they had just appointed one.

I have stayed under the care of cardiology for the best part of 31 years and had yearly check ups for a long time and then more frequent ones, sometimes every 3 months.

I've found the aforesaid nurse extremely helpful when I've had problems between cardio appts and indeed have sent her readings from my Kardia which she was able to relay to my EP.

My local surgery therefore don't do heart checks as such as they know I have regular cardiology appts. ( Actually I know far more about AF than they do anyhow........)

[Hidden]

My experience with my Apple Watch is similar to what you describe with your Kardia: I can often read the ecg better than the algorithm, and when in doubt, I send it to my cardiologist or EP NP.

My Watch tends to say “Afib” when what I see are one or two PAC couplets. My cardiologist has verified and validated my reading of my readings. She said the Watch bases its interpretations on ventricular activity and often can’t tell the difference between atrial and ventricular activity. PAC’s, atrial activity, are not to worry about. My ventricles are in great shape.

I wonder how many Watch wearers get unnecessarily alarmed by inaccurate readings. It takes time to learn how to interpret and find useful the information from Kardia and Apple Watches.

[Debjimmay in reply to Hidden]

I have an Apple Watch and when I get a reading of Afib, I usually panic because the watch doesn’t give me Afib readings that often. I had appointment with the EP nurse practitioner and I brought a copy of this EKG to her and she said it wasn’t Afib and that it was PACs and PVCs. it can be quite confusing not knowing what you really have. And you are right, it can be very alarming and worrisome.

[bean_counter27]

What would happen if we all started sending ECG's from our smart devices (why stop at Kardias) to our EP/cardiologist every time we have a "possible arrythmia" outcome?

Besides, the wait for a determination can be just as agonising for a worrier like me or even more so than the eventual actual determination.

Each to their own. I certainly don't want my Kardia "dumbed down" to just "Normal" or "Possible arrhythmia". If that's all it did then I wouldn't have bothered buying it.

[mjames1 in reply to bean_counter27]

I certainly don't want my Kardia "dumbed down" to just "Normal" or "Possible arrhythmia". If that's all it did then I wouldn't have bothered buying it.

I wouldn't want my Kardia "dumbed down" either, because I welcome multiple opinions, even Kardias. 😄

However, for those stressed by sometimes inconclusive results and who also have access to ep evaluation, it might be a viable option.

In fact, at least in the US, specially programmed Kardias are sometimes given out after an ablation with instructions to take an EKG every week and/or if symptoms are felt. The patient never sees the determinations as they go directly to the EP who then does the analysis and takes action if needed.

Jim

[bean_counter27 in reply to mjames1]

"However, for those stressed by sometimes inconclusive results and who also have access to ep evaluation, it might be a viable option."

Isn't your suggested "Possible arrhythmia" classification just another inconclusive result?

I'm a worrier and I hate waiting to find out results of medical tests. I worry about what it could be until I know what it actually is. YMMV but I'd rather have an indicative result straight away than wait days for a final determination. If I want to, I can have both.

[mjames1 in reply to bean_counter27]

YMMV but I'd rather have an indicative result straight away than wait days for a final determination.

Yes, I am the same, but as you suggest the mileage may vary with others. That's why I propose it as an option not as a default.

Jim

[bean_counter27 in reply to mjames1]

We'll have to agree to disagree. You might think you're a worrier but I don't think you're a chronic worrier like me otherwise you wouldn't be suggesting a change that creates more uncertainty and potentially delays an outcome.

No doubt your suggestion is well intentioned but I don't think you truly understand the psyche of a worrier - the people your proposal is primarily targeting.

[Tellingfibs]

A very clear explanation Jim. I have the advanced determination but as you say, because payment is involved, it feels somehow that it must be more accurate. When it says ‘Afib’, you feel that it must be so, it’s so definite. It’s almost better to get a ‘possible Afib’ result, and you can tell yourself …’ it’s possibly not’ 😄

Annie

[Sixtyslidogirl]

Agree that it’s a good idea to learn how to read your own ecg. I did that with help of my cardiologist and also some internet resources. No reason why we need to abandon our brains. Knowledge is power as various people on here often say.

[Ppiman]

It is an excellent device in many ways but it is limited. NICE in the UK recommend it as being more likely than a Holter monitor to pick up AF since it can be used at the point symptoms are felt, which a much more expensive to maintain Holter cannot. The trace from fingertips contacts cannot compare with a Holter, however, which uses chest electrodes.

All other home ECG devices would be equally good as the Kardia in this "diagnostic" respect, i.e. at picking up AF when it is infrequent and maybe short lived and might be missed by a Holter. Those that use chest electrodes, naturally produce a far cleaner trace than those that rely on fingertips, creating graphs that define the "P" wave, for example, far more clearly and usefully.

The cost per month for the Kardia's "Advanced Determinations", in the UK at least, offers a poor return and this does seem to put many off - as it did me. There are a surprising number of negative reviews online about this and other aspects. The review site called "TrustPilot" has many such; it took me by surprise when I saw this as, on the Amazon website, the reviews are much more positive. The difference is stark and one is brought to wonder why this can be.

Also, if the user has any kind of "Wide QRS", the Kardia limits the determinations to, in my experience, a frustratingly unhelpful "NSR with Wide QRS".

As for the fear induced by these devices, that is real as a few posts here tell but it must be a personal thing as, for me, the opposite is the case. I would wholeheartedly recommend people to buy a Kardia or similar and take a trace along to their consultations each time. I have found it highly productive at extending the conversation usefully.

Steve

[ainslie in reply to Ppiman]

Steve

Can I ask you what to search under in trust pilot to see those reviews please

[Ppiman in reply to ainslie]

Hi Ainslie. It’s listed as “Kardiamobile”.

I’ll say now that the reviews surprised me but there we are. I would recommend the device to anyone myself and during the time I owned one I found the company responsive and helpful (my first one had a battery problem).

Its strengths are its simplicity in use, its accuracy, its marvellous design and small size. Also, although I’m not sure what this means, in practice, its FDA and NHS approved.

Its weaknesses are, to me, the lack of an onboard screen (so you need a mobile phone to see the trace); the optional need for ongoing monthly payments if you choose to have the KardiaCare package - and the relatively few arrhythmias this extra cost enables it to report.

The Apple Watch is more convenient, but expensive. It is just as accurate in use for the arrhythmias it detects, and vastly more useful as a general device.

The Wellue, Emay and Contec brands (this last one with 6-lead option now, too) both offer a lower price, a good onboard screen and free AI based determinations. The Wellue allows for the possible use of chest electrodes, too, for noise free traces.

Steve

[ainslie in reply to Ppiman]

Thanks Steve, I will have a look👍

[philologus]

I've used my Kardia on and off as needed for about seven years now. ( It has only needed two new batteries in that time).

It is proving to be useful at the minute because I felt really unwell last week and just about managed not to pass out. My GP thinks my heart is playing up again but I'm convinced that it's more to do with the amount of stress I have currently affecting my reflux/ulcer.

My wife is 79 and has Dementia (FTD 15 years) and has recently been diagnosed with bowel cancer. Her Hb is below 80. She doesn't fully understand it all and refused to have the op.

The op to remove the tumour is arranged for 4th July and we were persuading her to have the op by minimising and simplifying everything, And then a nurse blew it all by telling her in detail what would happen when she had a colonoscopy - and a few other stupid things that had nothing to do with her but were upsetting. My wife was upset and very agitated and stressed. The nurse had got it wrong. The surgeon had agreed to do the op without a prior colonoscopy as this would have caused too much stress. The scan results were enough to work from. By the time I realised that things had gone wrong it was too late to rescue the situation and so I got my wife out of there and took her home.

We have to start again now but with my wife less trusting and still upset I'm not sure whether we can do it. We have to try, but it is a stressful time.

GP asked me to take my blood pressure, heart rate and Oxygen saturation two or three times a day for a week and she has arranged a blood test and an ECG for 8th July. I told her that I had a Kardia and she said check that a few times a day as well.

I use it as a lead 1 and, by putting one side of it on my left knee, as a lead 2.

I found a website that offers some good information and I have learnt a lot from it.

geekymedics.com/how-to-read...

George

[BobsBeat]

All valid points here. After 3 years of researching and using my Kardia, I've become adept at using my device and interpreting the readings. I do have the single lead and not sure if the newer 6 lead is better or easier to use.

Many times I've sent various readings to different providers. I'll get runs of ectopics both PACS and PVCS, sometimes together, sometimes separate, sometimes infrequent or a couple per hour, sometimes frequent in a bigeminal pattern. Usually my Kardia shows as "Undetermined" if the ectopics are heavy enough and NSR if more infrequent.

When my Kardia shows Possible AFib I trust it because I can determine the difference on the reading between AFib and many PVCs or PACS. The ECG is erratic and there is no P wave in AFib.

A downside to the Kardia (I'm not sure if paying for the subscription would help) is when I'm in AFlutter. This only happens (so far anyway) in conjuction with AFib. They both alternate back and forth. The Kardia will show NSR when I'm actually in AFlutter. I know it's not true NSR because my rate will be steady but higher than normal (i.e. 80 bpm vs 60 bpm when in 3:1 Flutter). The ECG reading also has a fairly flat P wave, so I know it's not true NSR and I just don't feel right. I did try an experiment last time for flutter where the single lead Kardia is flipped with one pad on your knee and the other pad on the opposite thumb. This supposedly gives you VII readings and will show flutter waves.

So far I'm pleased with my Kardia, but I think a lot of the reason is that I've had 3 years of trial and error along with various provider feedback to get proficient at it. I also think it's a good device for the fact that every doctor I've sent readings to took it seriously and responded as from a medical device.

[Tplongy]

very informative Jim