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"Eko detected atrial fibrillation with 99% sensitivity and 97% specificity and heart murmurs with 88% sensitivity and 88% specificity" (Medgadget, 2022).

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"Eko brings cardiopulmonary focus to the frontline of care with the next generation DUO" (Eko, 2021).

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Source Details: Medgadget - Eko DUO ECG + Stethoscope Interview and Review (June 8, 2022)

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Source Details: Medgadget - Eko DUO ECG + Stethoscope Interview and Review (June 8, 2022)

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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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Eko DUO Digital ECG + Stethoscope: Exclusive Interview and Review

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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.

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"The Eko DUO is the first FDA-cleared cardiac assessment tool that functions as an electrocardiogram (ECG) and digital stethoscope to detect early signs of heart disease and facilitate timely care and personalized disease management" (Eko, 2021). Clinicians are able to use this pocket-sized Eko DUO attachment to get immediate data regarding cardiovascular abnormalities (e.g., heart murmurs, atrial fibrillation, etc.) through a quick listen. The Eko DUO is able to amplify sounds 32x by converting acoustic sounds into electrical signals (Eko, 2021). This device was made for telemedicine and is capable of wireless listening and recording. Recordings can also be stored and shared with other clinicians (Eko, 2021; Medgadget, 2022). This technology helps clinicians be more confident in their recommendations for further interventions and treatments.

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Eko Health: Eko DUO Press Release (August 16, 2021)

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Eko Health: Eko DUO Press Release (August 16, 2021)

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Eko: Eko's Next Generation DUO

https://www.ekohealth.com/articles/eko-launches-next-generation-duo

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The Eko DUO is a pocket-sized cardiac examination system that helps clinicians of all types detect heart disease earlier.

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Eko DUO Stethoscope with ECG Capabilities

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Eko DUO Stethoscope with ECG Capabilities

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Alice (Achiever) - Alice would be a valuable addition to the team because of her qualities of being hard-working, having a strong work ethic, and the ability to lead others by example. These are all qualities that can be beneficial in increasing the teams productivity.
Angelica (Analytical) - Angelica would be able to help the team by using her logic and intellect to strategically think through all factors, which includes reason and causes, that could potentially affect a given situation. Her analytical skills would greatly contribute to the overall success of the team.
Carter (Communication) - Carter's charismatic personality along with his communication skills will help with networking and be very beneficial in sharing the team's data/results through conversation and presentations.
David (Deliberative) - Although David may come off as a little cautious and standoffish, his determination to carefully make well-informed decisions and choices will positively impact the success of the team. He is able to use his good judgment to anticipate any future obstacles, and his ability to plan for the unexpected will help the team overcome challenges.
Rachel (Restorative) - Rachel's skills of being a good problem solver allows her to troubleshoot through situations. She would be able to work closely with David to help the team overcome any challenges.

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August 16, 2021

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- Portable and able to detect common cardiac abnormalities and perform basic single-lead ECG readings with accuracy.
- Helps clinicians accurately diagnosis murmurs and atrial fibrillation immediately upon assessment.
- Amplified sounds can be recorded, transmitted to a computer/laptop, and shared with other clinicians.
- Noise reduction capabilities to reduce surrounding noises or distractions.
- Visual display (via smart phone or tablet) allows clinicians to see what they're listening to; also, can connect bluetooth device for wireless listening.
- Useful for clinicians who work in rural environments or outside of normal clinical/hospital settings that may need quick results without having to order and wait on expensive tests.

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- Expensive ($349+)
- Although the accuracy helps clinicians immediately diagnose abnormalities, it doesn't add to the clinicians skills.
- Requires higher maintenance since it is composed of multiple electrical components. Damages will likely occur and parts can be expensive to replace.
- The Eko DUO requires smart phone or tablet capabilities to maximize its capabilities (e.g., must download Eko Health App to visualize sounds being heard or see ECG).
- Although the Eko DUO has a reliable battery life and automatically turns off when not in use, it is still battery powered and clinicians must remember to charge the device when the battery is depleted.
- This device needs battery to operate.

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After researching the Eko DUO, I personally think that this device is a great medical innovation, and is very practical in a clinical setting. Some of the features that interest me is the device's ability to  amplify sounds at least 32x, ability to visualize and record sounds heard upon auscultation, along with its noise reduction features, which can be very helpful in a typical busy healthcare setting. Although there are many great features, I do not think that this is a necessary purchase for all healthcare professionals. Advanced Practice Nurses (APRN) and possibly other advance practice providers may find this device useful in their practice, especially those who have difficulty hearing from regular stethoscopes. Overall, this device appears to have features that can benefit clinicians and lead to improved patient outcomes.

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Individualization - With individualization being my strongest strength, this skill allows me to identify the unique qualities of each person, and determine how these people can work together as a team.
Strategic - Being strategic means that I am able to quickly identify any problems that arise, and determine alternative ways to resolve the issue.
Arranger - As an arranger, I can be very organized with my thoughts and plans, but also maintain flexibility throughout my planning. This allows me to utilize all my time and resources to be as productive as possible.
Connectedness - I don't really believe in coincidences, because I believe that everything has a reason. In other words, things don't just happen because of chance and there is a purpose for everything.
Relator - I enjoy forming close relationships with other people, especially with my friends and family. I believe that having a good relationship with my team is very important as well because this helps increase productivity, as well as maintaining a positive work environment.

The combination of these strengths and gifts have been integral in paving the path to my professional development as a leader in nursing and will help me lead a diverse and talented team of individuals.

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Eko. (2021). Eko's next generation duo. Eko. Retrieved September 17, 2022, from https://www.ekohealth.com/articles/eko-launches-next-generation-duo.

Ferng, A. (2022). Eko DUO Digital ECG + Stethoscope: Exclusive interview and review. Medgadget. Retrieved September 17, 2022, from https://www.medgadget.com/2022/06/eko-duo-digital-ecg-stethoscope-exclusive-interview-and-review.html.

Medgadget Editors (2019). Eko DUO Stethoscope with ECG built-in now available for purchase. Medgadget. Retrieved September 17, 2022, from https://www.medgadget.com/2019/03/eko-duo-stethoscope-with-ecg-built-in-now-available-for-purchase.html.