Zainul Charbiwala rapidly shuffles through papers in his conference room on a Monday afternoon. The chief technology officer of Tricog Health Services Pvt. Ltd—one of the biggest Indian startups offering electrocardiogram, or ECG, services—has back-to-back meetings. Time is in short supply.
He glances every now and then at his Apple Watch—an action not without a tinge of irony for the co-founder of a portable-ECG company.
The latest model of the smartwatch has made waves around the world for a very specific feature: an ECG app that can monitor your heart rate and detect irregular rhythms. News reports abound of how the Apple Watch has “saved” iPhone users’ lives in the US and Germany since the ECG feature was launched in December. (In fact, in the last week of April, the US Food and Drug Administration (FDA) also cleared an iPhone accessory that can conduct more complex ECGs than the Apple Watch’s basic sensor.)
ECG tech—a fundamental diagnostic tool for cardiac care—has seen rapid evolution in recent years. From bulky hospital units to portable yet conventional devices to miniature patches and wearables to AI-enabled services.
In India in particular, the past five years or so have seen a slew of ECG startups mushroom across the country. All hoping to make a dent in an untapped market—while an ECG is a basic service for a large private hospital, most primary care facilities in India are not equipped with ECG machines on account of cost and complexity. At the same time, the country has one of the highest burdens of cardiac disease in the world.
In 2016, 5,681 in every 100,000 Indians suffered from cardiovascular disease—54.6 million in total, according to a study published in the Journal of the American College of Cardiology. The death rate jumped 34% between 1990 and 2016 to about 2.8 million deaths a year.
The likelihood of surviving a heart attack is over 80%, if action is taken within the first two hours. “However, the average time between symptoms and treatment in India is over six hours,” says Charit Bhograj, an interventional cardiologist and Tricog co-founder. Which is where access to ECGs comes into play—an electrocardiogram measures heart function and is the first step to diagnose cardiac conditions.
When companies like Tricog entered the market to solve the problem of access through remote diagnostic services, the assumption was they’d build a service network away from the traditional hospital system. With inexpensive portable devices, some training and intelligent algorithms, a caregiver in smaller towns could diagnose, cut costs and save millions of lives every year. The assumption was also that like fintech, which complements banking today, ECG as a service would meet the burgeoning demand and improve cardiac care quality at the same time.