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FAQs
Q: What is AUDICOR®?
Q: What is the technology behind AUDICOR®?
Q: What diagnostic data is available on the report?
Q: How do diseases like heart failure cause the heart to produce abnormal sound?
Q: What is the clinical relevance of the third heart sound in heart failure?
Q: Why is heart failure difficult to diagnose?
Q: How can AUDICOR® help emergency physicians diagnose heart failure?
Q: How can AUDICOR® help hospitals better manage higher risk cardiac patients including heart failure and acute coronary syndrome?
Q: How has this technology been validated?
Q: Why use AUDICOR® when physicians can perform auscultation with amplified stethoscopes to detect the third heart sound?
Q: How is AUDICOR® diagnostic utility different from phonocardiography?
Q: Does AUDICOR® replace biomarkers?
Q: What clinical studies have been conducted on AUDICOR®?
Q: Are there peer-reviewed publications on this technology?
Q: What is AUDICOR®?
AUDICOR® is the first non-invasive technology to accurately diagnose, quickly assess, and easily monitor higher risk cardiac conditions including heart failure and acute coronary syndrome (ACS). AUDICOR® is being used across the continuum of care – in the pre-hospital community, emergency departments, hospital inpatients, and physicians’ offices because of its easy to use interface, cost-effective nature, and valuable diagnostic results that are helping improve missed diagnosis rates, facilitating earlier treatments, and improving clinical outcomes of patients.
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Q: What is the technology behind AUDICOR®?
AUDICOR® uses a patented signal processing technology called correlated
single-channel electrocardiography input to simultaneously detect, interpret and document the electrical and acoustical (heart sounds) activities of the heart. Dual-function AUDICOR® sensors are placed on a patient’s chest to record the incoming signals
and two electrodes record a single-channel of electrocardiography. Analysis and interpretation takes only 10 seconds and results are documented on a single-page report.
Click here to visit Our Technology page to learn more.
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Q: What diagnostic data is available on the report?
The report provides a summary of heart sounds and electrocardiogram (ECG) findings, a representative beat of detected heart sounds (S1-S4) with the correlated QRS complex, and a 10 second heart sound rhythm trace. If a myocardial infarction is detected, a graphical depiction of the likely location of injury denotes acute and ‘age undetermined’ and a bar graph documents the evidence of left ventricular hypertrophy. Clinicians are able to quickly use this data in the clinical management of cardiac patients.
Click here to visit Our Technology page to learn more.
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Q: How do diseases like heart failure cause the heart to produce abnormal sound?
The heart produces both normal (“lub-dub”) and abnormal sounds as blood moves throughout the heart. Cardiac diseases including heart failure cause the heart muscle to stiffen, making it difficult for the heart to properly contract and relax as it pumps blood. The abnormal third heart sound is produced when fast moving blood is suddenly stopped because the stiffened heart wall is unable to stretch.
Click here to visit Learn About Heart Sounds page to learn more.
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Q: What is the clinical relevance of the third heart sound in heart failure?
The presence of a third heart sound has high prognostic and diagnostic value in adults over 40 years old who exhibit signs and symptoms associated with heart failure. A landmark study published in the New England Journal of Medicine indicated the presence of a third heart sound (S3) is 99% specific for heart failure and leads to increased morbidity and mortality. The absence of a third heart sound, however, is not sufficient to exclude ventricular dysfunction, so further diagnostic investigations should be considered.
Click here to visit Clinical Trials and Events pages to learn more.
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Q: Why is heart failure difficult to diagnose?
Heart failure patients frequently represent diagnostic challenges to physicians because shortness of breath, a key symptom of heart failure, may be a non-specific finding in many elderly or obese patients. Clinicians need to differentiate patients with heart failure from other diseases, such as pulmonary disease. A patient’s past history is helpful, but only 81% accurate; chest x-rays are also helpful, but only 75% accurate. Lab tests are good tools; however, studies indicate results are negatively deflated in obese patients, inflated in patients with chronic renal function and only have clinical utility at specific levels. AUDICOR® identifies the third heart sound, which studies confirm is a highly specific marker for ventricular dysfunction.
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Q: How can AUDICOR® help emergency physicians diagnose heart failure?
Eighty percent of heart failure admissions are diagnosed in the emergency departments, where the misdiagnosis rate for primary heart failure is between 10-20%. In one study, AUDICOR® helped correct approximately 34% of the missed diagnosed patients. These missed patients had 3x the incidence of pulmonary disease, less history of heart failure, and lab BNP results under the 500 pg/ml cut-off, and longer lengths of hospital stays. AUDICOR® is helping reduce the missed diagnosis rate and shorten lengths of hospital stays by providing actionable diagnostic data at the patient’s bedside.
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Q: How can AUDICOR® help hospitals better manage higher risk cardiac patients including heart failure and acute coronary syndrome?
Many hospitals are benefiting from AUDICOR® in their facilities through reductions in under or missed diagnoses, earlier initiation of treatment, shorter lengths of hospital stays, and improvements on their core measure performance, which is tracked by the Center for Medicare Services (CMS) and Joint Commission on Accreditation of Healthcare Organizations (JCAHO). These core measures are a hospitals’ quality scorecard and new federal laws will begin impacting the economics of the hospital based on their performance. Studies indicate AUDICOR® used upfront in the earliest part of the emergency department evaluation can help eliminate missed diagnoses and assist the heart failure team to undertake the key core measure activities.
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Q: How has this technology been validated?
The propriety electrocardiography and sound interpretation algorithms were created in collaboration with top experts and validated against state-of-the-art cardiovascular diagnostic equipment including cardiac catheterization, transthoracic echocardiography, physician auscultation and phonocardiography tracings.
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Q: Why use AUDICOR® when physicians can perform auscultation with amplified stethoscopes to detect the third heart sound?
Auscultation is difficult. Overcrowded emergency departments and noisy clinical environments negatively impact clinicians’ abilities to accurately detect these low-frequency sounds. Since amplified stethoscopes just make all the heart’s sounds louder, in an already noisy clinical environment, these offer little diagnostic value to identify specific sounds including the third and fourth heart sounds. Studies indicate one-out-of-five third heart sounds are missed on auscultation. AUDICOR® proved to be more accurate in detecting S3s compared to attending physicians, fellows, residents, and interns. The experience and skill of the auscultator plus the patient’s physical characteristics can greatly impact the practioner’s performance. AUDICOR® delivers consistent, accurate results.
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Q: How is the diagnostic utility of AUDICOR® different from phonocardiography?
The diagnostic utility of AUDICOR® reaches well beyond the limits of a “sound only” recording obtained from time-consuming phonocardiography sessions. AUDICOR® performs beat-by-beat signal processing correlating electrical and sound activity based on multiple parameters including signal timing, frequency, and amplitude throughout the entire cardiac cycle. This technological analysis produces more accurate detection, interpretation and documentation of the heart’s status and mechanical function in an easy-to-use bedside test.
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Q: Does AUDICOR® replace biomarkers?
AUDICOR® does not replace biomarkers as a diagnostic tool for heart failure. Biomarkers have relatively high sensitivity yet low specificity; in contrast, AUDICOR® has relatively low sensitivity and very high specificity. This means the combination of both tests helps improve diagnostic accuracy in the emergency department, particularly when a biomarker BNP is within the intermediate range.
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Q: What clinical studies have been conducted on AUDICOR®?
Since first being introduced in 2003, several clinical studies have been conducted investigating AUDICOR® technology. Topics of interest include the prevalence of abnormal heart sounds, the diagnostic and prognostic usefulness of heart sounds in heart failure and acute coronary syndrome, the effects of pharmacologic treatment on the presence or absence of the third heart sound, and the monitoring of cardiac function resulting from changes in synchronization therapy. The results of these studies have been presented at premier medical and scientific sessions and conferences including the American College of Cardiology, the Society of Emergency Medicine, The Heart Failure Society of America, and other medical/engineering conferences. The current multi-center study is called HEart failure and Audicor Technology for Rapid Diagnosis and Initial Treatment (HEARD-IT) Trial.
Click here to visit Clinical Trials and Events pages to learn more.
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Q: Are there peer-reviewed publications on this technology?
Yes. Several clinical papers have been published in leading scientific medical journals authored by experts in heart failure care including the Journal of the American Medical Association, Congestive Heart Failure, American Journal of Emergency Medicine, and the Archives of Internal Medicine (in press). Through these peer-reviewed publications, physicians are learning the clinical utility of AUDICOR® technology and helping them improve how they clinically manage heart failure patients.
Click here to visit Publications page to learn more.
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References:
Bebout ED. Summary Report. 2003. Inovise Medical, Inc.
Collins SP, Lindsell CJ, Storrow AB, Abraham WT. Prevalence of negative chest radiography results in the emergency department patient with decompensated heart failure. Ann Emerg Med. In press.
Collins SP, Lindsell CJ, Peacock WF, Hedger VD, Storrow AB. The effect of treatment on the presence of abnormal heart sounds in emergency department patients with heart failure. Amer J of Emerg Med. 2006
Collins S. Clinical utility of heart sounds in heart failure and acute coronary syndromes. In: Peacock WF, Tiffany, BR, eds. Cardiac Emergencies. New York, NY: McGraw-Hill Medical Publishing; 2005: 364-366.
Collins SP, Peacock FW. Diagnostic and prognostic usefulness of AUDICOR® in dyspneic patients. Submitted for publication.
Dao Q, Krishnaswamy P, Kazanegra R, Harrison A, Amirnovin R, Lenert L, et al. Utility of B-type natruretic peptide in the diagnosis of congestive heart failure in an urgent care setting. J Am Coll Cardiol. 2001;37(2):379-385.
Drazner MH, Rame JE, Phil M, Stevenson LW, Dries DL. Prognostic importance of elevated jugular venous pressure and a third heart sound in patients with heart failure. N Engl J Med. 2001;345(8):574-581.
Marcus GM, Gerber IL, McKeown BH, Vessey JC, Jordan MV, Huddleston M, et al. Association between phonocardiographic third and fourth heart sounds and objective measures of left ventricular function. JAMA. 2005;293(18):2238-2244.
McCullough PA, Nowak RM, McCord J, et al, for the BNP Multi-national Study Investigators. B-type naturetic peptide and clinical judgement in emergency diagnosis of heart failure. Analysis from Breathing Not Properly (BNP) multi-national study. Circulation. 2002;106:416-422.
Peacock WF, Emerman CL, Costanzo MR, Borkowitz RL, Cheng M. Early initiation of intravenous therapy improve heart failure outcomes: An analysis from the ADHERE registry database. Ann of Emerg Med. 2003;42(4),S26.
Storrow AB, Collins SP, Peacock WF, Lindsell CJ. Length of stay and charges are increased in patients with digitally detected third heart sounds [abstract]. Acad Emerg Med. 2005;12(5):96. Abstract 262.
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