Remote Cardiac Monitoring

welcome to mayo clinic's ecg segment making waves continuing medical education podcasts join us every other week for a lively discussion on the latest and greatest in the field of electrocardiography we'll discuss some of the exciting and innovative work happening at mayo clinic and beyond with the most brilliant minds in the space and provide valuable insights that can be directly applied to your practice welcome to mayo clinic's ecg segment making waves we're so glad you could join us today we have an exciting episode planned for you as we discuss remote cardiac monitoring from the development to the practical implementation we'll be joined by not only a leader in this field but also someone who has invented and developed products available on the global market today and in flow disclosure to our audience mayo clinic and today's guest have an ongoing working relationship so let's get started technological advancements in software and hardware capabilities have revolutionized the way we monitor cardiac rhythms it has enabled instantaneous recording and continuous monitoring of a patient's heart health from the convenience of their home this form of remote cardiac monitoring has given us a glimpse into what the delivery of medical care could look like for our patients a patient can share cardiac rhythm recordings with their provider that might aid in their care in fact it appears that we may not be too far from this situation becoming a reality in this episode we will cover the role of personal and remote solutions in the current era of medical care how the pandemic has affected this field and the importance of fda clearance on new technologies in addition we'll learn how an idea can can be transformed into a reality that impacts the lives of so many we will discuss this with not only a pioneer in this field but someone we highly respect without further delay let me introduce you to today's guest dr david albert dr albert is a physician inventor and serial entrepreneur that's right a serial entrepreneur he's developed life-saving technologies and products turning a number of these innovations into tech startups today he's the founder of three technology companies uh innovative uh alarm and over alarm if i'm saying that correctly life tone technology and alive core his latest invention this alive course cardiac mobile personal ecg technology became a global sensation by means of a simple youtube video in january 2011 and it's become now featured on abc cbs cnn fox news and that's just naming a few dr albert has 72 issued u.s patents a large number of those are pending and several new secret inventions in development he has authored or co-authored more than 100 scientific abstracts and publications all mostly in the field of cardiology dr albert has lectured at the entrepreneurship programs at the mit sloan school and the university of oklahoma he graduated with honors from harvard college and from duke university medical school dr albert what a true honor to have you today thank you so much for taking time to join us well anthony thank you for inviting me and i'm always glad to work with my friends colleagues and collaborators at mayo clinic full disclosure mayo is is both a collaborator and an investor in my company alive core but uh it wouldn't be that way if i didn't believe i was working with the best so thank you for the introduction you're very kind no i i think we feel the same and it's been such a true pleasure to see all that's uh transpired over the years and before we get into kind of the personal remote solutions i think personally one of the most interesting thing is you know how you've come about in not only building these uh companies as a entrepreneur but bringing them to the market that are now used globally and namely let's kind of focus on a live core device that you know from a simple youtube video has become a sensation to many of us that we now have and can use in our home maybe you could tell a little tell us in our audience about you know where this idea originated from and then maybe a little bit of a journey from creating a company from initial idea to bring it to the marketplace well uh this idea actually dates back 25 years to the mid 1990s when i had another company called data critical that ultimately was sold to general electric and i i it was the beginning of the portable computing revolution so we had palm pilots and palm top computers uh they were far cry from our current smartphones which would have been a a super computer at the time and so i i saw that this wireless communication which was brand new these uh portable computing devices which were in their infancy could potentially be used to draw a straight line between a patient and a caregiver between a patient and a cardiologist and that you could send critical life information because you know the shortest distance between two points is a straight line so your cardiac rhythm could go from that patient who is in need directly to a doctor each of them on each side having a portable computing wireless device now that was an idea we we fooled around with it and the device we we built the solution we built was totally impractical it was a rube goldberg it had wires and cell phones and it was just a mess but it was an idea so fast forward to uh the advent of our current smartphones the original iphone you know basically the genius of steve jobs was to turn the phone into a software platform where there would be a lot of value added so today we have we order our transportation our food our banking everything through this device that is the portal uh through which we control our life it's really the remote control and so i saw that in the beginning and said this is going to be the platform that finally makes my idea a reality and after a couple of years we are able to to to build uh at first a smartphone case that was a personal single lead ecg device and that you know i made this video i thought i was sending it to three people and 24 hours later i had 250 000 views i had people all over the world calling me and i i became fast friends i had somebody who you probably have heard of a guy named dr eric topple called me up and said dave albert i've got to have one of these devices this is the future and i went well okay eric yeah great uh we were both mutual friends with another doctor you've heard of dr rob califf who've been the second author on my first paper at duke and i'd known rob for 40 years and he had been a big collaborator with eric's so that began again eric has no vested interest in my company has been has written about us in all of his books because he's a believer in the power of mobility and the power of empowering the patient his book the patient will see you now emphasizes that and so i was lucky enough to have people share in the excitement of this idea smartphones were very new in 2010 most people in fact i was told that if you're 65 or older you're not going to have a smartphone and those are the people that need heart monitoring and i was told by people who are very knowledgeable that one nobody over 65 is going to pay 99 for a device no doctor is going to interpret it unless they can get reimbursed and you don't have any of that dave so i'm sorry it's not going to work 2 million customers later 600 000 active users today 140 million ecgs later those people have admitted hey you were right well i had a little bit of rain wayne gretzky i didn't skate to the puck i skated to where the puck was going and and and where it is is we've mobilized our lives again the smartphones the the remote control for many things we do today i look at the pictures of my granddaughter including my new 10 10 day old granddaughter on my smartphone i get videos i get movies it really is our point of contact with much of what we do today in the modern world so i would tell you i was fortunate to be at the beginning of the tsunami of the mobilization of our lives of the smartphone enabling of our lives and i think that enabled venture capitals i'd already done it once i'd successfully started a medical device cardiovascular company i'd sold it to a major company and so i had a little bit of credibility but this device captured people's imagination like eric topple dr leslie saxon who was chief of cardiology at usc and others people at mayo clinic uh and and so when when the experts believe in it suddenly the money men believe in it so the venture capitalists came to me along with people like qualcomm uh a very ip high-tech company who was who's been an investor from the beginning in the live core and so you know i was able to raise a little bit of money after putting my money in in the beginning and uh and at first we didn't have fda clearance my video i had people the fda calling me at the consumer electronics show and i did the video saying uh dave you're not supposed to do that i go listen i had no idea i didn't even know what a viral video was viruses to me are bad things like omicron okay they they weren't good things they weren't things that were important so that was part of being an old entrepreneur at the time i was in my mid-50s i'm 67 now and um you know i wasn't a 25 year old uh geek uh i was a fairly savvy adult professional and and so i i had no idea the power of a viral idea and so it became a viral idea then it you know we started a company in the first year we sold to veterinarians because there's no regulatory burden we'll get into that for veterinarians and literally you could go on the internet today and see in a live court of ice being used on an eagle on a grizzly bear on a koala in addition to dogs cats horses all over the world and and so uh then we got our first fda clearance in 2013 and began selling to humans and uh to human doctors and since then you know we we we were a lone voice talking about personal ecg and then in 2018 [Music] maybe just the world's biggest most profitable most valuable company decided that personal ecg was important and of course the day they did that and came out i i thought well i'm dead and our lead investor a very famous venture capitalist named vinod khosla said it's the best thing that ever happened to you dave and we've only grown 700 since then so he was absolutely right they just made it they brought it into the mainstream and so today we have tb ads people see them all the time we've we uh we have a brand i didn't i'm a medical guy what's a brand that's something at procter and gamble but we have a brand that we've built and so we've we've come full circle bringing a real medical device with real clinical validation we have over 170 peer-reviewed papers a number with my collaborators at mayo clinic and so we have a lot of validation every major health system uses us mayo clinic maybe there's another clinic somewhere over in ohio mass general uh olive duke my alma mater cedar sinai ucsf basically every major medical center in our country in canada and europe recently we received what's called nice guidance which means the nhs said this is a valuable technology and we're going to pay for it and that took it's an overnight success only took eight years so i would tell you we're an overnight success 10 years in the making anthony and i feel very fortunate that that idea i had in 1995 that was impractical today is used by millions of people and that we uh attracted large competitors but that we were able to stake our claim and still thrive despite having maybe just the world's biggest companies competing against us what an amazing story i mean you're right it's from an idea that all these are even a struggle or but you know and you're a solution but still something that almost clung on to you and it hung on all through through those years that finally you know when the kind of the renaissance of all this technology stuff came to life and the iphone and all these uh capabilities and it's right the phone is with us everywhere we go you know i have mine beside me almost all day right it'll be interesting to see you know what are the effects of that long term but um it's amazing everywhere we go and it so it just makes sense that giving this personal solution and not only doing that you mentioned that straight line the shortest distance i mean that's as close as you can get and from there almost transmitting to the doctor it's it's incredible um so i mean applause to you because yeah we certainly love it it's been uh it's amazing you kind of gain that academic validation that it seems like it set off everything and i think that company if i may guess who you were talking to may be apple because i think you were ahead of them in this is that right well uh i would just say we were the pioneer problem with anthony about pioneers is the definition of a pioneer are people with arrows in their backs so i don't take off my shirt when i go swimming anymore because the scars are ugly yeah no amazing well you know the next thing you know thanks for sharing that story because i could stop there and say we had a great talk but let's talk about the medical care today and actually how do we bring this what do you see as the role of these personal these remote solutions in medical care today well i think um you know we've had two years of very unusual circumstances we've had a global pandemic and that pandemic has touched all parts of the world and the health care system you know my wife is a faculty at usc she's a rheumatologist my son was a front line internist at cedar sinai one of our biggest hospitals and so we've lived we've all lived covet for two years now and what did that do well certainly for 2020 it made medicine go remote it decreased significantly the people coming in for clinic visits and things of that nature that impacted mayo plant it impacted every physician every healthcare organization and so we just happened to be there and we were certainly a beneficiary because you're following somebody up who may have had an ablation may have had surgery and and you know they don't want to come in and you're not having them come in for a routine follow-up so they can have a cardiac device they can send you their rhythm you're not in atrial fibrillation you're in sinus rhythm that's great how's your medicine how are you feeling and so we all became used to telecare and telemedicine and remote care and while it's come down from the peak it's still going to be apart and now we have a hospital at home hospital at home mayo clinic's been a pioneer along with a number of others where we're going to move acute care not critical but acute care into the home and where we find it's both economical and very effective and i so i think the notion of remote medicine we're still going to have our hospitals we're still going to have our ors our icus we have to have those but we're also going to have a larger component of remote care and i think the pandemic simply accelerated that it accelerated the adoption of a live core but i'm i'm proud to say that 2021 was even better than 2020 2020 was a huge gain for us because people now are used to it it helped people get over maybe any anxiety they had about oh i'm going to take my ekg and send it to my doctor i i don't think anybody worries about that today and so that that was helpful to us but i think it's also really helpful to the patients they have an option you know mayo clinic in rochester minnesota is a mecca for people from all over the world but they go back home and so when they go back home to come up for a follow-up at six months nine months one year well you know probably that follow-up or a number of them can be handled remotely today they still get their mayo doctor they still get their mayo consultants they still get that male intellect and medical knowledge but it's handled remotely and so i think you know we're we're proud that we've helped enable that for in in some ways for cardiology yeah it's it's been clear the pandemic as you mentioned has accelerated that uptake in how we monitor our patients at home and as you mentioned here a lot of our patients at mayo end up going back home overseas and we need a way to kind of monitor them and it seems you answered the next question which i was going to ask do you think this will continue after the pandemic because we've seen that acceleration and i think from your answer it seems very clear you know i wonder what your thoughts are on how this is enhanced that doctor-patient relationship given that almost immediate access or uh way to connect and do you what do you think of its benefits more broadly to the healthcare system well it is first of all we you know it's always patience first i know at the mayo clinic that's a mantra it's a mantra in my life patience first and so if we can make their lives better uh if we can make them easier yet still take excellent care of them then we're doing the right thing whatever it is and i think um you know having routine follow-ups being able to do those remotely whether there's a pandemic or not is a convenience for the patient it does put the patients first and so you know we're all getting used to it we're on zoom right now we've all become uh expert zoom users i'm maybe not an expert but the point is we've all been significantly uh introduced to video and video conferencing uh so i would tell you i think it's it's not going to go away and we're going to find new uses for it i think things like emergency medicine uh first responders we will see more and more mobile remote care and i and i still believe you know let's take a specific example atrial fibrillation you come in you have a very successful procedure an afib ablation what we know is some certain number of those patients will have a recurrence of their afib when does that happen traditionally well we've done studies like a like a zio patch or a halter or whatever and we've done them at specific times snapshots but that recurrence can that recurrence can occur anytime and so the ability to monitor people both long term and on maybe even a daily basis becomes something valuable it helps us stay in tighter in touch with our patients and make sure that we're giving them the best care possible and so i i think you know it it is it it helps us live the words patients first no and you can see that not only from the reassurance side for the patient of you know are they doing okay and kind of calm their nerves but also you could see it used uh you know across seas and connecting but even in a preventative way of getting ahead of perhaps an alarming situation yeah go ahead well there's one other thing so we've had a great collaboration with dr mike ackerman one of the world's experts on on congenital heart problems and and mike we've been developing something that's going to be very exciting has already been used was used during the pandemic and that is to be able to monitor people's qt interval now your since this is an ecg podcast people will understand that but the ability to be able to monitor we've published several papers with mayo to be able to monitor that at home when people are taking drugs and quite frankly there are scores of medications that are very effective that are well needed yet present a risk to the patient and to be able to make sure that those patients are safe remotely without having them come in they may not be close is is going to be a huge benefit and we're excited i know mike is we're excited about the notion of qt becoming maybe another vital sign but certainly something that's used in all these patients that are that are taking medicines for instance people that are struggling with addiction methadone qt prolonger all the patients that are dealing with some severe psychiatric issues almost all their medications qt prolongers the people around the world who are dealing with drug resistant tuberculosis and malaria all the medicines for them qt prolongers and so we're excited along with our collaborators at mayo that we're going to be able to enhance patient safety in a remote you know mobile fashion and and that again puts patients first yeah now you could clearly see that i mean even we have some patients that are admitted for essentially drug or anti-rhythmic loading and monitoring them and sometimes you know they're taking up a bed that maybe is not necessary but we have to make sure they're safe you know again the patient coming first but you can imagine even those on antiarrhythmics but maybe now they uh need an antibiotic as you mentioned and you know having being able to prescribe something without having to admit them or do all these routine checks um is you could see the value in there and you're on that's right you're on solar law a drug that prolongs qt that we load in the hospital you're in your street clothes you're taking an oral medication and you're taking up a hospital bed that is a precious resource and and you know we're going to be able to keep those people safe and then by the way they're out at home and they develop a sinusitis and they go to a dock in the box and they're prescribed deserts from ice and zpac became famous during covet that's a qt prolonger but they're already on one the ability to make sure they're safe and give them the medicines they need is is going to be a powerful solution and we're just happy to collaborate with mayo on on delivering that uh here in the in the very near future yeah no it's a win-win for everyone uh in that situation and before we end i wonder if you could speak a little bit about the value of pursuing fda clearance really to fortify that relationship and the confidence of between the patient and provider in these remote monitoring devices well it's it's it's true uh you know people appreciate the fact that the fda is very diligent in evaluating new technologies be it something like ai be it something like a new mobile computing device uh i'll give you a prime example a live cord just about two weeks ago introduced a brand new remote ecg and here it is it's a credit card and it has a three year battery life and this device went through the fda went through clinical validation and that not only helps those consumers and by the way not every consumer is a patient but every patient is a consumer so they respond to the same things that people buying soap do and and that fda is that good housekeeping seal of approval it's also the good housekeeping seal of approval for the physicians like you like me it tells us that this is you know the fda has two mantras safety and efficacy that's what they regulate and so that tells the doctors as well as the patients that this is an efficacious effective device therapy solution and that it's safe and so you know it is that good housekeeping seal of approval it does give that confidence to those patients as well as to the doctors and i think you know we the rest of the world is adopting more like the fda so europe is going to something called medical device our mdr from mdd they're becoming stricter as are other places around the world india has never had any regulation they're developing regulations why because some places snake oil you know we may be in the 21st century but there's 21st century medical snake oil and so i think those countries care about their people uh and so they don't want uh snakewell sales people and and i think in the united states the fda makes sure we don't have that now i agree we're always on the side of the prescribing component in you know asking our patients to accept it but you can imagine us on the other side as a patient wanting to know what we're taking uh has the backup of evidence to support what's being assigned and we've seen it here firsthand what's what's new and so thank you for sharing us the new advice i mean again something personal just like uh some of the one on the phone that started with it and now right in your wallet remote cardiac monitoring is changing how we envision the delivery of health care to our patients instantaneous recording and continuous monitoring can provide updates on cardiac health and even alert us to emergencies that might be prevented while much works remains in how we deliver this these digital health solutions it's difficult to not be optimistic and excited about the possibilities that lie ahead dr albert what incredible work you have done and continue to do to advance the delivery of care to patients globally you are truly a pioneer in this field on behalf of our team thank you for taking the time out of your day to join us it's been a true pleasure well thank you thank you very much thank you for joining us today we invite you to share your thoughts and suggestions about the podcast at cveducation.mayo.edu be sure to subscribe to a mayo clinic cardiovascular cmd podcast on your favorite platform and tune in every other week to explore today's most pressing electrocardiography topics with your colleagues at mayo clinic [Music] you

2022-05-22 03:24

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