ECG improvement recommendations from a heart patient

[SpO2]

Hi. I'm a heart patient. I've been having yearly professional 48-hour ECG's for 30 years now. I've had them all; from the big noisy tape recorders to the small memory recorders. I've even worn those emergency recording watches with a huge 9 volt battery, the ones where you had to play the recordings back to the hospital over a phone line.

Compared to that, the ECG in the Fitbit Sense is an amazing piece of technology. I've gotten my Fitbit Sense recently. The ECG was the sole reason for upgrading from Fitbit Versa.

I would like to make some recommendations as a user for whom the ECG is the most important feature.

1. ECG Report Accessibility

On a bad day I make 50 ECGs. This is what has to be done for each EGC:
Fitbit App > Discover > Scroll down > Assessments & reports > Heart Rhythm Assessment > View Results > [Report] > Scroll down > Export as PDF > Got it > "View" on notification > Download PDF

1a. Shortcut on home screen. Could you add an optional shortcut directly to the _View Results_ page from the Fitbit App dashboard and/or the Android home screen?
1b. Mark old reports. I don't know if I've added 7 or 11 report since last time I checked. Could you clearly mark which reports have already been seen/exported?
1c. Bulk download reports as PDF. Some option to download all unseen reports as PDF would be appreciated. Otherwise I have to do the described procedure 50 times. 👉 Feature suggestion here
1d. 🐛 Export reports with RECORD date, not EXPORT date. This is a bug that causes unique exported reports to overwrite each other. See this comment below. 👉 Feature suggestion here.

2. Cut of first second or two from ECG

Once you touch the corners and the ECG starts, there is a 30 second countdown. But the first second or two are noise and calibration. Consequently, every exported ECG PDF starts like a kid with a custom made differential amplifier, notch and low pass filter on a breadboard. It would be better if the ECG line would start without the countdown, and once the 'middle' is found (i.e. calibration is complete) _then_ the 30 second ECG starts. The exported PDF would show a perfect ECG.

If the watch itself is not smart enough to detect when the calibration is accurate, you can automatically wait 1 or 2 seconds before recording. If there is any case I'm not aware of where someone might want that first second, this calibration cut off could  be made optional.

3. Extrasystole Detection

3a. Detect extrasystoles. I have them often, I have them bad. When I'm fine, I get a "Normal sinus rhythm" report. When I clearly have repetitive extrasystoles and they're shown beautifully on the ECG, I get an "Inconclusive" report.

👉Feature suggestion here.

3b. Count extrasystoles❣️ The most important thing for patients like me is to know how much extrasystoles (VPB's) we have on a day, and what type. I personally don't need a warning about having them; I know that already. What I want to know is: Do I have 5,000 per day? 10,000? I have requested this repeatedly, and made a very detailed explanation a year or two ago.

👉Feature suggestion here.

We don't even need the new Fitbit Sense sensor. The Fitbit Versa could do it. I would do it myself if a developer could get low level hardware access. But this requires a Firmware update. Please focus on this. This is very important. My life is getting harder as I am getting older. I would like to have a report of average number of extrasystoles per day over say a six month period.

This can be rough. It can be calculated whenever the heart rate is measured. I guess you need a simplified fourier transform to get multiple periods. If only one is found, rhythm is normal. If two are found, divide the first by the second and you'll now what type of extrasystole (VPB-1, VPB-2 or VPB-3) and you can use that as the average amount of extrasystoles until the next measurement is done.

Please Fitbit. Please! Is there any way I can help you with that last one? I am a developer.

[SpO2]

Extrasystoles, or ventricular premature beats (VPBs), are faux heartbeats perceived by the patient as a skipped heartbeat followed by a heartbeat that throbs twice as hard. The bigger your heart is, the more uncomfortable it is.

Most people have some VPB's. They are innocent. Some unfortunate people have a lot of them. They can become dangerous.

A while ago I voted for this detect irregular heart beats feature suggestion. A solution was announced by @LizzyFitbit in the form of a whole new Fitbit Versa: the Fitbit Sense. Which I immediately purchased.

Turns out, the Fitbit Sense does not recognize my perfect textbook example VPBs, and whenever I have them, it will report my ECG as "Inconclusive". Whenever I feel fine, I get "Normal sinus rhythm".

So clearly the Fitbit Sense figured out my VPBs are not a "normal sinus rhythm". Is there someone from the Fitbit team I can work with to get these VPBs recognized?

See also point 3 from my more detailed Fitbit Sense recommendations.

Edit: Feature suggestion here. Please vote.

[SpO2]

I've made a more frustrating discovery today, after downloading a hundred or so ECG reports using the painfully verbose method described above in bullet point 1.

Turns out the PDF reports have the EXPORT date in the filename, not the RECORD date.

As a consequence, when manually exporting a whole bunch of reports one by one, and say you export 10 reports per minute using this method, all of those will have the same filename (ECGReport_15 Nov 2020_23-45.pdf), so every download exported in that minute will overwrite the previous. 😩

This is clearly a bug. What is the proper procedure to have someone look at this? Use the RECORD date, and not only will the filenames be more useful, it will also fix this problem.

I will add this as a bug 🐛 1d in the top comment.

What is the proper channel to do a bug report?

This on the Fitbit app version 3.32 on Android from the Google Play Store (last update oct 13 2020)

Edit: Bug report here, please vote.

[SpO2]

This is a workaround for that Report PDF export bug 🐛 mentioned above.

Simple workaround: The simple workaround that requires a lot of work: Use a separate file manager to rename the exported report after every export. Add a random number to the end before you export the next.

Advanced workaround: This can be simplified for people with advanced Linux skills. Not suitable for most users, but in case it will help someone else, here is what I do:

You can login to your phone over your ssh if you have Termux installed with an ssh daemon set up and storage configured. No root required.

Login to your phone from your laptop and navigate to your downloads folder; e.g. ~/storage/downloads

After every export from the Fitbit App, enter:

for F in SpO2_*; do mv "$F" "_${F%.*}-$RANDOM.pdf"; done

(Replace SpO2 with your app username or whatever your exported report file name starts with.)

For every new file that you export, press [UP] [Enter] to execute the same command. This way, after every export, a random number will be appended to the filename, and an underscore will be prepended. Now all the reports that were exported in the same number won't overwrite each other because you have moved the filename out of the way.

Then you can copy all PDF files to your laptop like so:

scp myphone:/data/data/com.termux/files/home/storage/downloads/_SpO2* .

Now you can safely remove the files from your phone storage using ssh or a file manager app.

[LizzyFitbit]

Hi @SpO2. Welcome to the Community Forums.

I'm glad that you've been taking advantage of your Sense and thanks for your through feedback about the ECG app. Our team constantly works on every product and feature to enhance your experience, and the comments shared in the forums help us to evaluate our procedures and make sure we're delivering what our users want and need. With that in mind, I'd recommend to post each of your ideas in the Feature Suggestions board so our developers can take them into consideration for new updates or product development. As a piece of advice, please try to only post one idea per suggestion, so we can keep the board organized, easily searchable and see which idea other members are voting for.

By the way, our web API and smartwatch SDK are open which means that the service you are wanting could eventually be integrated with Fitbit. Take a look to our existing API and SDK and resources such as the web dev API community. If you need anything else from me, don't hesitate to let me know.

See you around.

[DaughterofMaat]

It would be nice if it would recognize PACs as well!

[SpO2]

@DaughterofMaat good suggestion! Although PVC's are very clear on even a rudimentary reading, and PAC's are more subtle, if PAC's aren't detected, we should add them in!

What types of problems are actually detected? The "Detect Irregular Heartbeats" feature was released, but what does and what doesn't it detect? Apparently it missed two symptoms:

• :heavy_check_mark:Normal Sinus Rhythm
• :cross_mark:PVC (Inconclusive)
• :cross_mark:PAC (Inconclusive)

I know I have valuable data and wanted to join the test program for ECG development but in the signup process it rejected anyone who was not from the United States. So they have missed all kinds of heart problems.

I keep trying to make a "feature suggestion" like @LizzyFitbit recommended but then mods merge my suggestion with unrelated ones that use a few of the same keywords. I'll try again. I'll call it "Improve irregular heart beat detection"

Edit: Feature suggestion here. Please vote.

[CBV2]

Excellent stuff SpO2! I support everything you say and particularly the recommendation that the first few seconds be lopped, but I would suggest that the recording time be lengthened to 40 seconds and the first 10 seconds be lopped. To be sure to be sure.  I find the first few, maybe up to six or seven seconds can be distorted with noise and calibration, so lopping 10 should give a clean output.

[DrJWo]

I got a survey a couple of weeks ago from the Heart study and they asked me about other features I'd like to see.  I requested PVC's, PAC's and SVT.  

[SpO2]

Very good @DrJWo. I have received no such survey (Europe). Are you a U.S. resident?

[DrJWo]

Yes, I believe the heart study was based in the U.S. only.  I feel if they really want to compete in the e-health wearable market, that having these features in the sense are essential. 

[SunsetRunner]

I have owned a Sense for two weeks now, bought in Europe. ECG was the main reason why I bought Sense.

But my doctor finds the ECG signals too noisy, i.e., with too much high frequency background noise making it more difficult to identify some major relevant ECG events. My doctor is used to ECG's produced by Apple watches, which are, it seems , much more clean and devoided of these high frequency background noise..

Does everybody have the same experience?

Is this a (small) bug that can be corrected by future firmware/software upgrades? If so, please do it as soon as possible, Fitbit.

---

UPDATE July 8 2021:

Now I manage to get ECGs that are quite good, according to my doctor.

What was I doing wrong? I must be seated before starting the ECG; both arms, hands and both fingers touching the Sense's ring must be as quiet and relaxed as possible.

[SpO2]

I have to export a hundred or so reports again for my visit to the cardiologist, and I am extremely disappointed to find out that all issues, including easy-to-fix high impact bugs like all exports overwriting each other still persist. The Fitbit team is amazingly incompetent. Just read the interaction written in the linked report above. It's like trying to explain the problem to a snail. It's hard to believe that they managed to build such a product in the first place.

[Rich_Laue]

You might be able to assign a quick start function to start the ECG