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My Healthy Self
Digital Health and Fitness
Eko DUO Digital ECG + Stethoscope: Exclusive Interview and Review

In the latest advancements of AI and med tech, the Eko DUO stands out as a smart and reliable product with FDA-cleared artificial intelligence (AI) algorithms being used to detect leading indicators of heart disease. More significantly, this is a smart stethoscope that boasts point-of-care ECG capabilities to detect signs of heart disease such as murmurs and arrhythmias, making it truly unique in its class and one of the first of its kind being used in the clinic.

The DUO is similar to Eko’s 3M Littmann CORE Digital Stethoscope in that it features enhanced acoustics that enable clinicians to amplify sounds to better check for murmurs, and the Eko App allows for AI-aided murmur detection. However, the CORE Digital stethoscope utilizes the classic diaphragm and bell everyone associates with this hardware, while the DUO takes a different form factor.

Arriving in two sleek product boxes with the earpiece attachment in one, and the rechargeable ECG+stethoscope unit in the other, the first questions that came to mind were: how will this device compare to the classic Litmann stethoscope everyone is used to? And will the ability to hear be impacted? In short, it’s very comparable and while there are minor differences initially, after getting used to the settings and understanding how to position the product on a patient, the enhanced features definitely outweigh some of the perceived differences. These advanced features can aid in a quicker diagnosis or faster capture of an ECG or auscultation sounds that can be immediately analyzed, uploaded to an electronic medical record, or shared.

The core stethoscope unit is very light and compact (4.7 in L x 1.9 in W x 0.6 in D), weighing in at just 3.6 ounces (102 grams) with a nice matte finish on the topside that is soft to the touch. The DUO features wireless charging via a charging pad, making it fast and easy to set down and recharge when not in use. There’s also automatic power off after four minutes of inactivity. However, one downside is that the DUO cannot be used when the batteries run on.

Without needing to be paired to the app, the DUO can turned on by pressing the center button and used immediately as a stethoscope by screwing in the provided earpiece attachment. While the initialization light sequence is fun to observe, another downside is that without the app, the user may have a hard time understanding which audio filter has been selected, since there are no labels (for filters diaphragm (cardiac), bell, mid-range (pulmonary), and “extended”). With practice, this becomes a non-issue. since the user would remember what modes and features exist. In terms of aesthetic design, it does look better without labels, however on-the-go functionality is partially impacted in the absence of familiarity.

What makes the DUO really special here is wireless listening and its use as a telemedicine device—what the DUO was designed for. The DUO can be used without the earpiece attachment altogether when paired with a mobile device.

Pairing the DUO Eko app on a mobile device was a seamless experience, and setting up an account to get going was similarly a fast process. The device is ready to use immediately at this point, and whatever headphones are paired to your phone or mobile device become the earpiece, which in turn makes the DUO completely wireless and easy to maneuver. Volume can be toggled from the buttons on the side and sounds can be heard clearly with up to 32x amplification.

What makes the DUO first-in-class, though, are the ECG capabilities that it boasts. Toggling to the ECG function within the Eko app immediately unlocks this feature, and the app will notify you when proper positioning of this single-lead ECG has been achieved, as a ECG trace will begin to show. A spot check will be analyzed in just 15 seconds, and the DUO currently supports automated checking for heart murmurs, AFib, tachycardia, and bradycardia. The recorded single-lead ECG traces are comparable to other single-lead ECG devices.

In fact, in clinical studies, Eko detected atrial fibrillation with 99% sensitivity and 97% specificity and heart murmurs with 88% sensitivity and 88% specificity.

Both stethoscope sounds and ECGs can be immediately visualized on the Eko app, recorded, and linked to an electronic medical record (EMR), or shared with a clinician for review.

Another associated favorite Eko product of ours was their “Eko Academy App,” which is a free resource for anyone to refresh their knowledge of auscultation, electrocardiograms, phonocardiograms, and cardiopulmonary conditions. We love that Eko makes an effort to educate on top of their product innovations.

Finally, we had the pleasure to interview Eko’s CEO, Conner Landgraf.

Alice Ferng, Medgadget: Great to meet you, Connor! Can you tell our Medgadget audience about yourself, your background, and what led you to founding Eko?

Mr. Connor Landgraf (Co-founder and CEO of Eko): My background is in biomedical engineering, and as an engineer I like to understand how things work. I got the chance to learn about how physicians used the stethoscope in their practice, and I was surprised to learn that the majority don’t trust their ears when using the stethoscope.  The stethoscope is the world’s most common medical device and is one of the most common medical exams done on the planet, yet it’s accuracy is highly variable and few clinicians feel confident in using it to diagnose cardiac and pulmonary conditions. Eko was founded to give clinicians more capability in using the stethoscope in their daily practice – we wanted to keep the workflow the same but transform what clinicians can do with their stethoscope.

Medgadget: Where do you currently see the largest gaps in telehealth and med tech? Where is there room for innovation?

Mr. Landgraf: Telehealth is between innings. We’ve seen tremendous growth in direct-to-consumer care, but there’s still substantial work to do to change high acuity care and chronic disease care. We’re not going to be able to meaningfully address cost unless telehealth can prevent costly admissions or reduce length of stay. To make that happen, we need better models of virtual care – video visits are not going to be successful for chronic disease management. Telehealth needs a more holistic picture of patient health, including vital signs to make that possible.

Medgadget: Eko DUO really offers some leading-edge technology and developments not yet seen in other products – what were some of the challenges in getting to this latest release?

Mr. Landgraf: We’ve introduced automated analysis of heart sounds and ECG to front-line providers for the first time. We use machine learning tools to provide accurate interpretation of heart murmurs and arrhythmias and make this accessible to providers in any location. With any new technology, there’s a large burden to prove that the technology is effective and gain provider’s trust.  As a company, we’ve put a tremendous focus on generating clinical evidence to show the impact on patient care.

Medgadget: How is Eko leading the charge in digital cardiac care, and what’s ahead? Any future visions you can share?

Mr. Landgraf: We’re built one of the largest networks of connected medical devices used in the clinic and we’re continuing to see providers develop innovative ways to use the devices in their practice.  We’re focused on extending the capability of the acoustic and ECG machine learning algorithms to new clinical indications and providing these capabilities to large health systems and IDN’s.

Medgadget: What are some of the major risks you have had to consider with your product and pushing it out for wider adoption?

Mr. Landgraf: Understanding how providers want to use technology in their practice and how to build their trust has been an important learning for us. Our goal is to aid clinicians in their decision making, but we are not meant to be diagnostic or to add a digital distraction to their patient encounter.  We also pay attention to demographics in our machine learning training and validation datasets. It’s crucial to know that the technology works effectively on every patient – regardless of their sex, race, or age, and that requires attention when conducting clinical research. 

Medgadget: Anything else you’d like to share with our audience?

Mr. Landgraf: Getting to build this company has been one of the most rewarding experiences for me. I feel deeply lucky to be able to build products for healthcare providers and give them better tools which they can use daily. The stethoscope is such a symbolic tool and we’re excited to breathe new life into it for the next 100 years. Our heart and lung sounds contain incredible information about our health and we’re focused on using machine learning to unlock those hidden insights – we’re just getting started.

Link: Eko DUO product page…

Flashbacks: Eko’s AI-Powered Stethoscopes Detect AFib, Heart Murmurs; Eko Releases New CORE Digital Stethoscope Offerings; Eko’s AI-Powered Stethoscopes Detect AFib, Heart Murmurs;

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