Not only does heart diease account for a quarter of all deaths in the U.S. every year, according to the CDC, it's also the leading cause of death for both men and women. Even with all of the new technologies being implemented in healthcare, the ability to accurately diagnose and treat heart disease, and to continue monitoring when they're outside the doctor's office, remains a serious problem.
"The ability for us to do invasive diagnostic tests is incredible and the amount of data that we have inside the system for patients with cardiovascular disease is unparalleled but as we look at the peripheries of care, primary care of after a patient has been diagnosed, our knowledge about a patient’s heart function massively drops off, so much so that standard of care for heart failure patients is to monitor them with a bathroom scale," said Connor Landgraf, CEO of smart stethoscope company Eko.
"Basically, there is no non-invasive way to understand a patient’s heart function when they’re outside of the clinical system beyond metrics like blood pressure or heart rate or these kinds of relatively imprecise, non-targeted measurements."
That's why Eko is building devices that can help physicians and patients better understand heart function using data from heart sounds and EKG in combination, as well as machine learning to interpret that data and provide better insights.
"We’re focused on screening which is in the clinics, being able to identify disease at the point of care, in the office, at the bedside, and then monitoring. When we send the patient home how do we then provide follow-up and track their cardiac function so we can identify opportunities to intervene earlier or change care plans as the patient’s cardiac function changes," said Landgraf.
On Wednesday, the company announced that it raised $20 million in Series B funding led by ARTIS Ventures, along with new and returning investors including DigiTx Partners, NTT Venture Capital (NTTVC), 3M Ventures, Mayo Clinic, Seraph Group, and XTX Ventures. This brings its total funding raised to $28 million.
Founded in 2013, Eko sells two devices; the first is the CORE stethoscope, which amplifies sound up to 40X. It can also capture, save and share sounds and can be connected to a smart device via Bluetooth.
"Physicians have used auscultation, basically listening to heart sounds, lung sounds, body sounds, for the last 150 to 200 years as the first line step in the diagnostic process to try to identify the source of disease or the presence of disease. So, we know that there’s rich data in sound, but we’ve always used our hearing and our cognition to be able to process that," Landgraf explained.
The company also sells the DUO stethoscope, which can be used in the clinic or by patients at home; it's an ECG and digital stethoscope combined, and made to be handheld, easy to use, and very non-challenging so patients can use it.
"With Eko we’re using machine learning to be able to automate the analysis process of heart sounds and to be able to identify disease for clinicians. The goal would be that we can make every single physician, whether they’re a nurse assistant or a clinical staff member, as accurate with the stethoscope as the best cardiologist at Mayo Clinic or Johns Hopkins. We want to democratize access to high quality cardiac screening."
Eko sells devices to individual clinicians, hospitals, departments and health systems. Its products are being used by tens of thousands of clinicians, representing over 4,000 hospitals, health systems, providers, urgent care clinics and others provider system in the US and Europe, which are the company's primary markets right now. Eko's devices have screened millions of patients physical exams.
Even though the manufactures devices that are designed to be used by the patient in their home, the company does not sell direct to consumer; Eko devices have to be prescribed by a doctor.
"The reason we’ve done that is we are focused on being able to close the loop with the care team. From our perspective, without being able to respond to an alert from our products to be able to change a care plan, there’s not much clinical value and we make to be able to make sure that the patients who use our product are able to close the loop with the care team," said Landgraf.
The new funding that Eko has just raised will be used, in part, for continued clinical studies for its machine learning algorithm technology, which has not yet been approved by the FDA; currently it’s just the hardware and software that are on the market, so the machine learning is currently only being used in clinical studies. The company is hoping to have that FDA clearance before the end of the year, though.
"When it’s approved, we anticipate that the devices will continue to be used just as they have been before, the software will continue to be used just as it had been before, but instead of having to only rely on their hearing to be able to identify disease that they get another decision support tool to assess whether this patient likely has a murmur or cardiovascular disease," said Landgraf.
Combining all three of those aspects, the hardware, the software and the machine learning algorithms, is what sets Eko apart of other companies, which are only focused on one of those aspects.
"We think it’s very important to have a unified workflow and product experience versus having three or four different companies build different parts of it; one company builds the hardware, one company builds the software, one company builds the algorithms. We don’t think that creates a very cohesive experience for patients or clinicians," he said.
The company will also use the funding for continued product development, including expanding beyond only cardiovascular, and into new areas of the body, with its stethoscopes.
"One of the incredible things about our product is that the stethoscope is such a ubiquitous tool, it’s used for cardiac, it’s used for pulmonary, and it’s used as a diagnostic tool for a myriad of conditions of those body systems, so there’s tremendous opportunity for us to extend the technology as we improve the algorithm performance," said Landgraf.
Ultimately, Eko's real goal is to use its devices to help supplement the doctors, and to enhance their ability to diagnose patients early, giving those patients a better shot at a better life.
"We view the physical exam stethoscope, the first line screening, as one of the best places to apply machine learning because it can really help change the course of treatment for many of these patients. We hear of so many cases where a primary care physician doesn’t appropriately identify that there’s cardiovascular disease present," Landgraf said.
When that happens, a patient then becomes symptomatic and it takes the healthcare system a long time to be able to identify what's actually causing their disease. And, during that process, there’s a bunch of specialist referrals that actually delay treatment and make it less likely that the patient is going to have a good outcome. Avoid that from happening, Eko eventually wants to be so ubiquitous as to be viewed as the standard of care, and to be so good at detecting disease that it's actually illegal not to use its devices.
"Our goal is to get to the point where it’s malpractice not to use our product because it’s so much better than just using our senses to be able to identify disease."