Stethoscope

Stethoscope is Dead, says Leading Cardiologists

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The role of the stethoscope, the ubiquitous tool of the medical profession for over 200 years, is at the center of debate in the US with a leading Indian- origin cardiologist declaring “the stethoscope is dead”.
In recent years, the sounds it transmits from the heart, lungs, blood vessels and bowels have been digitised, amplified, filtered and recorded.

Algorithms already exist that can analyze the clues picked up by a stethoscope and offer a possible diagnosis. But whether all this represents the rebirth of diagnostic possibility or the death rattle of an obsolete device is a subject of spirited discussion in cardiology, The Washington Postreported.

The widespread use of echocardiograms and the development of pocket-size ultrasound devices are raising questions about why doctors and others continue to sling earphones and rubber tubing around their necks.

“The stethoscope is dead,” said Jagat Narula, a cardiologist and associate dean for global health at the Icahn School of Medicine at Mount Sinai Hospital in New York. “The time for the stethoscope is gone,” Narula said.

Starting in 2012, Mount Sinai began giving its students hand-held ultrasound devices that are little bigger than a cellphone but can generate real-time images of the heart right at the bedside. Several other schools will join the experiment in the coming months, the report said.
Stethoscopes retain their value for listening to lungs and bowels for clues of disease, experts say. But for the cardiovascular system, “auscultation is superfluous. We are wasting [students’] time,” Narula said.

“Why should I not have an echocardiogram in my hand if it’s as small as the stethoscope?” Not so, counters W. Reid Thompson, an associate professor of pediatrics at Johns Hopkins University School of Medicine.

“We are not at the place, and probably won’t be for a very long time,” where listening to the body’s sounds is replaced by imaging. “It is valuable,” he said. One thing on which both sides agree, however, is that doctors are not very good at using stethoscopes and have not been for a long while, the report said.
In 1997, researchers examined how well 453 physicians in training and 88 medical students interpreted the information obtained via stethoscope. According to their study, “both internal medicine and family practice trainees had a disturbingly low identification rate for 12 important and commonly encountered cardiac events.”

19 years later, another team tried to determine when doctors stopped improving at “auscultation” the art of listening to the body to detect disease. The answer: after the third year of medical school.
French physician Rene Laennec had invented the stethoscope in 1816.

Take a deep breath, now check your smartphone.

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SMARTWAY TO HEART: Clockwise fromleft: The Eko Core handheld device that can be attached to a normal stethoscope; a doctor uses Eko Core stethoscope to check a young patient; the readings of heart sounds transmitted aswaveforms to a smartphone. EKO DEVICES

The stethoscope, that quintessential tool of doctors, has been upgraded several times since it was invented two centuries ago. Eko Devices, a startup led by three recent graduates of the University of California, Berkeley, is betting that it is time for another innovative overhaul.

The company received approval last Friday from the Food and Drug Administration to market its Eko Core, a digital device that attaches to a conventional stethoscope and allows it to record, amplify and wirelessly send audio and sound wave images to an iPhone application.

Its software meets federal standards for privacy and security, the founders say, and it can transmit its heart sounds and waveforms to the electronic health records used in hospitals and clinics. An Android app is scheduled to be released early next year. The Eko Core device went on sale two weeks ago, priced at $199. A complete stethoscope with the same capabilities will sell for $299.

Cardiologists at the Mayo Clinic, Stanford and the University of California, San Francisco, who have seen and sampled the Eko technology, are initially impressed.

“This is probably one of the most important innovations in the plain old stethoscope in recent years,” said Dr Charanjit S Rihal, chairman of the department of cardiovascular diseases at the Mayo Clinic.

The stethoscope was invented in 1816 by a French physician, Dr Rene Laennec. His first version was essentially a hollow wooden tube, and embarrassment, it seems, was the impetus for his invention. He was apparently uncomfortable putting his ear on women’s chests to hear their heartbeats.

The device’s materials and acoustics have improved steadily over the years, and digital stethoscopes have been available for about two decades. But the previous generation of digital models, cardiologists say, was often bulky and complicated to use and was not able to send recordings and data wirelessly to a smartphone.

The Eko technology, said Dr Robert Harrington, a cardiologist and chairman of the department of medicine at the Stanford School of Medicine, has “the potential to improve a physician’s diagnostic acumen” by enabling a doctor to hear and see the pattern of a patient’s heart rhythms in greater detail. He also identifies a benefit in the ability to store the heart sounds in a patient’s electronic record, so doctors can compare sounds from a recent visit with ones from a year or two earlier.

Harrington plans to use the Eko technology as a teaching tool at the Stanford medical centre with the next crop of physician residents, making use of the digital recording and wireless sharing capabilities. “They can hear while I listen and describe different heart sounds,” he explained.

The seed of the idea that became Eko was planted at a class that Connor Landgraf, a bioengineering major, attended in his senior year at Berkeley. A researcher from the University of California, San Francisco, spoke to the class about gaps in modern medical technology.

In particular, he pointed to the challenge of interpreting heart sounds and accurately detecting abnormalities, especially for most physicians, who do not spend years listening to heart rhythms, as cardiologists do.

Landgraf, now 25, who has experienced occasional heart palpitations, was intrigued. “It was the inspiration for this company,” he recalled. He persuaded two undergraduates – Jason Bellet, 23, a business major, and Tyler Crouch, 23, an engineering major and software developer – to join him. The pitch, Bellet recalled, was the opportunity to “bring the stethoscope into the 21st century.”

There are cardiologists who regard the stethoscope as a relic that should be jettisoned, given the scientific precision of ultrasound technology and echocardiograms.

At first, members of the Eko team thought that they would reimagine heart sound detection in a way that would be less costly than ultrasound but with a device that would look very different from a traditional stethoscope. An early prototype resembled a hockey puck, Landgraf recalled.

When they took their idea to doctors, they learned a lesson. “Physicians love their stethoscopes,” Landgraf said. “It was shocking to us, but really important.” After seven months, in early 2014, the Eko team had a prototype that resembled its current product.

Other ventures
Beyond its devices and mobile app, the company is developing a decision-support software algorithm that compares a patient’s heart rhythms with a cloud-based data library of he-art sounds. The smartphone app then classifies the patient’s result as normal or abnormal.

The University of California, San Francisco, medical school has begun enrolling patients for a clinical trial to test the diagnostic reliability of the Eko algorithm. In the trial, the predictions of the Eko algorithm will be compared with echocardiograms for the same patients.

The principal investigator in the clinical trial, Dr John Chorba, is the researcher who spoke to the Berkeley class and inspired Landgraf two years ago. “You have all this data collected by the device, but the question is whether the software can identify pathological heart sounds,” Chorba said.

“I’m not a big-data person or a computer scientist,” he said, “but as the device gets used, you get more data, and accuracy should improve.”

Chorba said the clinical trial would most likely take about a year. The decision-support software will undergo a separate review by the FDA. Chorba, Harrington and Rihal are all unpaid advisers to Eko Devices.

The Eko Core Is A Digital Upgrade For The Centuries-Old Stethoscope

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In a few months, the stethoscope will celebrate its 200th birthday. A medical breakthrough in 1816, it’s still a part of nearly every doctor’s visit today and a symbol of medicine itself.

Yet the stethoscope hasn’t changed much in the past 200 years. No different than in the 17th century, listening to a heartbeat has been a manual process that relies entirely on a doctor’s ear to detect irregularities.

That is, until today. And it’s all thanks to Eko Devices, a Berkeley-based startup that just became the youngest team to secure FDA clearance for a Class II medical device. Co-founders Connor Landgraf, Jason Bellet, and Tyler Crouch, all rather recent graduates of UC Berkeley, have added a digital dimension to the centuries-old tool.

Dubbed the Eko Core, their solution is an adapter that attaches to the typical stethoscope and streams the heartbeat data to the cloud, providing doctors with an entirely new layer of information to analyze.

“It’s incredibly challenging to hear a minute heart murmur, especially in patients with high heart rates,” says Landgraf. “Cardiologists say it’s almost like a musical ear, it’s something that you have to learn over five or ten years of practice.”

With the Eko Core, the physician can see the heartbeat in wave form on a mobile device as well as hear the sound at an amplified level. Both the visible and audible data can be recorded and easily shared between physicians and hospitals.

For doctors, this takes a lot of the guesswork out of detecting murmurs, valve problems, and blockages in the arteries.

And for the 70 percent of pediatric patients with suspected heart murmurs who are unnecessarily referred to a cardiologist, Eko will be able to save thousands of dollars in avoidable echocardiograms.

“Physicians don’t have confidence in their ability to use the stethoscope in a lot of situations so they frequently refer people to cardiologists when it’s not necessary,” Landgraf says.

Eko is running a pilot with Stanford Hospital, where all residents will be using the Eko Core device as a training tool. Today, the company is releasing the device to the public for $199 on its own, or $299 with a stethoscope included.

Over the next few months, the team will be continuing to develop an algorithm that analyzes the data collected by all Eko devices in order to match heartbeats to conditions in real-time. Kind of like the “Shazam for heartbeats,” as Landgraf says doctors like to call it.

“Connecting patients to physicians with noninvasive tools to understand what’s going on in peoples’ hearts is going to be really powerful,” Landgraf says. “Right now you can catheterize a patient to find out what the pressures are like inside of the heart, but it’s very invasive and inefficient.”

The condition-detecting feature is slated to launch in Q1 of next year, and Landgraf hints that Eko will eventually roll out additional products to give physicians a better understanding of the heart in a noninvasive manner.

Since Eko was founded in 2013, the company has raised $2.8 million from Stanford’s StartX Fund, FOUNDER.org founder Michael Baum, and the co-founders of Shazam, among others.