Portable MCG technology could transform the treatment of heart disease across the US
Frank Peacock, MD, FACEP, FACC Professor, Associate Chair, and Research Director at Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine.

American Heart Month takes place every February. It raises the awareness of heart disease, the biggest killer for both men and women in the United States, and seeks to raise awareness on its prevention. Sadly, every year, one in three deaths are caused by heart disease. In fact, cardiovascular diseases (CVD) claim more lives each year than all forms of cancer and Chronic Lower Respiratory Disease combined.

According to the American Heart Association, between 2013 and 2016, 121.5 million American adults had some form of cardiovascular disease and in 2014-15, the direct and indirect costs of total cardiovascular diseases and stroke were $351.2 billion. CVD and stroke accounted for 14% of total health expenditures in 2014-2015, more than
any major diagnostic group. The direct medical costs for CVD are projected to increase to $749 billion by the year 2035.

This is a vast challenge which matters on a micro and macro level. Each statistic is a person who may spend up to 24 hours in an emergency department waiting to receive the appropriate treatment. What’s more, for every individual who is experiencing genuine cardiac related chest pain, there will be many more who present with chest pain but ultimately will not be experiencing a genuine cardiac issue. Sifting through the patients to identify those with a serious acute cardiac condition is the challenge that emergency departments face every day.

Presenting symptoms
It’s a highly complex area with a number of different problems that might cause chest pain such as severe stress, anxiety, or even indigestion. However, if the problem is acute cardiac related, it’s important to know quickly.

Each year, 8 to 10 million patients present to US emergency departments with chest pain. About a third of these are ultimately diagnosed with acute coronary syndromes (ACS) but staff are required to place the majority through the entire chest pain pathway before they can safely rule them out. This places a huge strain on clinicians’ time and hospital resources and has potential cost implications for the patient.

Life-saving technology
Innovative technology has always played a key role in helping us improve efficiency and patient care and in recent years, clinicians have been looking for new ways to solve this problem. They have found that one potential solution is a portable magnetocardiography (MCG) device to alleviate the issue of effective chest pain triage.

UK MedTech company Creavo Medical Technologies has initiated a study in the US to support using its next generation MCG device. The device detects extremely small magnetic fields generated by a patient’s heart, which produces a map indicating the difference between normal and abnormal cardiac behaviour. The technology uses a different area of physics compared to the technology that existed previously in super quantum SQUID devices, which are large and expensive. Having MCG technology available at a patient’s bedside could be a game changer. Using Creavo’s MCG device, the heart’s electromagnetic fluctuations can be measured and used to produce a trace, numerical data and a 2D visual magnetic field map of the heart to aid chest pain triage. Cells in the heart that lack oxygen or are dying (necrotic) distort the data points and parameters detected by the device, which can be seen in the resulting trace and magnetic field map.

Most importantly, the scan can be performed in five minutes, which means that ACS can potentially be ruled out quickly and accurately. Essentially, those that need urgent diagnosis can get it rapidly, and those that don’t can either be channelled to the appropriate care pathway for their needs or sent home. Crucially, this can be done without the need for specialist personnel – who would otherwise be required to conduct supplementary tests including CAT scans and stress tests for example – and can be done at any time of the day or night.

The device is in use for a study at five of the most respected research facilities in the United States (Baylor College of Medicine, Houston, TX; Indiana University, IN; University of Cincinnati, OH; Vanderbilt University, Nashville, TN; and Wake Forest University, Winston-Salem, NC). It is the largest study of its kind with approximately 720 patients being enrolled. It is scheduled to be completed by late 2019.

Overall, the device has received excellent feedback from both clinicians and patients alike at Baylor. The opportunity to aid the rule out of ACS within five minutes by a patient’s bedside, by-passing the current (often extensive) triage process, could have the potential to streamline the ‘rule-out’ process unreservedly.

Study results published later this year will help to indicate the accuracy of the device. If the device proves to be a high sensitivity test to exclude the presence of acute coronary syndrome in its current iteration, I believe we can expect the test to be run millions of times in the US each year.

Global potential
In my years as an emergency physician I have witnessed and explored many new technologies, but portable MCG has the hallmarks to be a significant one. It has never been possible to measure the heart’s magnetic field from a patient’s bedside before now. The technology could improve cardiac patient outcomes but could also create huge efficiencies within the broader healthcare system by freeing up resource required elsewhere. Similar challenges exist with chest pain triage across the world, and I believe that this new technology has the potential to be a big deal.