Smartphone app more efficient in cardiac assessment

["Dave Farber" <farber () gmail com>]

http://wap.business-standard.com/article/news-ani/smartphone-app-more-efficient-in-cardiac-assessment-118040300320_1.html

Smartphone app more efficient in cardiac assessment
A new randomised clinical trial has found that smartphone application performs better than traditional exam in cardiac 
assessment.

According to a University of Ottawa Heart Institute-led research, a smartphone application using the phone's camera 
function performed better than traditional physical examination to assess blood flow in a wrist artery for patients 
undergoing coronary angiography.

These findings highlight the potential of smartphone applications to help physicians make decisions at the bedside. 
"Because of the widespread availability of smartphones, they are being used increasingly as point-of-care diagnostics 
in clinical settings with minimal or no cost," said researcher Benjamin Hibbert.

"For example, built-in cameras with dedicated software or photodiode sensors using infrared light-emitting diodes have 
the potential to render smartphones into functional plethysmographs [instruments that measure changes in blood flow]", 
continued researcher Hibbert.

The researchers compared the use of a heart-rate monitoring application (the Instant Heart Rate application version 
4.5.0 on an iPhone 4S) with the modified Allen test, which measures blood flow in the radial and ulnar arteries of the 
wrist, one of which is used to access the heart for coronary angiography.

A total of 438 participants were split into two groups; one group was assessed using the app and the other was assessed 
using a gold-standard traditional physical examination (known as the Allen test). The smartphone app had a diagnostic 
accuracy of 94 percent compared with 84 percent using the traditional method.

"The current report highlights that a smartphone application can outperform the current standard of care and provide 
incremental diagnostic yield in clinical practice," wrote Hibbert with colleagues.

"However, while they aren't designed as medical devices - when smartphones and apps begin to be used clinically - it is 
important that they are evaluated in the same rigorous manner by which we assess all therapies and diagnostic tests," 
said lead author, Pietro Di Santo.

"When we designed the iRadialstudy we wanted to hold the technology to the highest scientific standards to make sure 
the data supporting its use was as robust as possible."

"Although this application is not certified at present for use in health care by any regulatory body, our study 
highlights the potential for smartphone-based diagnostics to aid in clinical decision-making at the patient's bedside," 
concluded Hibbert.

The health care profession and regulatory agencies should proactively address the challenges associated with bringing 
mobile health (mHealth) solutions into practice to maximize their benefits, wrote researcher Kumanan Wilson in a 
related commentary.

The study appears in the CMAJ (Canadian Medical Association Journal).




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