Mental health coaching startup Ginger raises $50M



Ginger, a digital health startup that lets users chat with a mental health coach, raised $50 million in funding in a series D round. Advance Venture Partners and Bessemer Venture Partners led the funding round, with participation from Cigna Ventures, Kaiser Permanente Ventures, and LinkedIn Executive Chairman Jeff Weiner.

David ibnAle, a founding partner with Advance Venture Partners, and Steve Kraus, a partner with Bessemer Venture Partners, will both join Ginger’s board. To date, the company has raised $120 million.

The San Francisco-based startup connects users with coaches through a text-based chat. They can’t provide the same services as a therapist, but they can send users exercises and encourage them to pursue good sleeping habits and meditation, for example.

For patients who would benefit from more care, Ginger can connect them to a video chat with a healthcare provider. The company contracts with psychiatrists and therapists that then work with its coaches.

Like many telehealth startups, Ginger has seen a surge in visits since the start of the Covid-19 pandemic. In the first week of July, it saw a 125% increase in use of its coaching service compared to its averages before the pandemic.

“The goal of this system is to solve for the supply-demand imbalance that exists in mental health,” Ginger CEO Russell Glass said in a phone interview. “Even pre-Covid, there are far more people that have a need that can access it today. It can take weeks to months.”

The service is currently only available to users whose employer or health plan include Ginger as a covered benefit. The company says it has 200 clients, including Delta Air Lines, Sanofi and Chegg. Its insurance partnerships include Optum Behavioral Health, Anthem California and Aetna Resources for Living.

Ginger was initially created in 2011 by two MIT researchers, Anmol Madan and Karan Singh, who started off with the idea of using cell phone activity to predict users’ mental health. For example, if someone was depressed, they might not communicate with others like they normally do, or their daily patterns of going to the work, the gym or the grocery store might change. Novant Health, Kaiser Permanente and 20 other health systems partnered on this early concept.

Since then, the company has pivoted to focus more on providing health coaching and therapy services.  It still uses information “for proprietary analysis and development of personalized behavioral profiles,” according to its privacy policy.

Ginger is one of a number of startups providing mental health services using digital tools. Competitor Lyra Health raised $75 million  earlier this year, and struck a partnership with Starbucks. And UnitedHealth’s Optum subsidiary was reportedly planning to acquire mental health startup AbleTo for $470 million.

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Funding roundup: Billing automation startup Alpha Health raises $20M


Alpha Health, a startup looking to automate billing and reimbursement, raised $20 million in funding. The San Francisco-based company is developing revenue cycle management software to automate complex tasks, by capturing current workflows and then using that information to train machine learning models.

CEO and Co-Founder Malinka Walaliyadde, a former partner at Andreesen Horowitz, said the goal was to reduce financial complexity in reimbursement.

“Complexity in medical reimbursement drives up hidden costs that we all pay; both in terms of dollars spent, and in the erosion of trust by the American public that our healthcare system can serve them well,” he said in a news release. “Alpha Health will be a powerful force for restoring trust in healthcare, by bringing together the best of people, data and technology to address financial complexity in the U.S. healthcare system.”

The startup, founded two years ago, names Sacramento-based Sutter Health as one of its clients.

Andreessen Horowitz led the $20 million funding round, with participation by Costanoa Ventures and Jim Momtazee, former head of healthcare investing for KKR & Co. Andreesen Horowitz also led a previous, $5 million seed round in the company, bringing the total amount invested to $25 million.

Here are some other biopharma and healthcare technology startups that raised funding this week:


Cue Health

Amount: $100 million

Headquarters: San Diego

Cue Health, a company making a connected testing device, raised $100 million in funding. The San Diego-based startup received an Emergency Use Authorization from the FDA for its molecular point-of-care Covid-19 test. The company also plans to submit an at-home test for influenza A and B for FDA clearance. Decheng Capital, Foresite Capital, Madrone Capital Partners, Johnson & Johnson Innovation and ACME Capital participated in the series C round.


Amount: $60 million

Headquarters: Boston

PatientPing pulls in admissions, transfer and discharge data from 1,000 hospitals and more than 5,000 post-acute care facilities. The Boston-based company raised a $60 million series C round, led by Andreessen Horowitz, F-Prime Capital, GV and Transformation Capital. With the new funding, PatientPing plans to expand its network and its analytics capabilities.



Amount: $43.9 million

Headquarters: Boston

CereVasc is developing minimally invasive treatments for patients with hydrocephalus, or the buildup of fluid in cavities deep within the brain. The startup has developed a minimally invasive cerebrospinal fluid shunt, intended to avoid the invasive surgeries currently associated with treatment.

The startup raised $43.9 million in series A funding, led by the Perceptive Xontogeny Venture (PXV) Fund and ATON Partners, LLC. It plans to use the capital to support the first clinical trial of its system, which is expected to begin enrollment in the second half of 2020.



Amount: $30 million

Headquarters: Boston

Kyruus, a company that develops provider search and scheduling solutions, raised $30 million in funding from private equity firm Francisco Partners. The Boston-based startup plans to use the new investment to expand its platform to more health systems and providers. With the new investment, Francisco Partners Co-President Ezra Perlman will join Kyruus’ board of directors.


NFlection Therapeutics

Amount: $20 million

Headquarters: Wayne, Pennsylvania

NFlection Therapeutics began clinical trials of its lead project, a topically applied gel to mitigate Neurofibromatosis Type-1, a rare disease characterized by the growth of benign nerve tumors. There are currently no treatments available for this condition.

The study will evaluate three concentrations of this treatment, called NFX-179 Gel. NFlection will enroll 48 patients in the double-blind randomized, controlled trial.  The company raised a $20 million series A funding round with investment from venBio Partners and F-Prime Capital.

Amount: $13M

Headquarters: Tel Aviv

Tel Aviv-based startup says it can measure a number of vital signs just from viewing a person’s face, including heart rate, respiration levels and stress. The startup taps users’ smartphone cameras as a health monitoring tool.

Maverick Ventures Israel led a $13.5 million investment round into the company. Esplanade Ventures, Sompo International, GiTV and IAngels also participated in the funding round.


Conversa Heath

Amount: $12 million

Headquarters: Portland

Conversa Health’s chatbot not only helps triage patients, but it can also be used to monitor patients with chronic conditions or after they are discharged from the hospital. The startup raised a $12 million series B round led by Builders VC and Northwell Health. The company also named a new CEO in Murray Brozinsky, with co-founder West Shell III becoming executive chairman.



Amount: $9.5 million

Headquarters: Boston

CareAcademy, a startup that provides online training for home care and home health workers, raised $9.5 million in funding. More than 110,000 caregivers have already used its platform, and the startup hopes to train 1 million home care workers by 2023. The Impact America Fund led the $9.5 million funding round.

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Funding roundup: Mental health startup led by former Uber exec gets $100 million


Telehealth once again captured investors’ attention this week when Amwell raised a large funding round.

The Boston-based company raised $194 million from previous investor Allianz X and drugmaker Takeda.

Though Amwell had been talking to investors well before the Covid-19 pandemic started, the telehealth company and its competitors have seen a surge of visits as a result. For its part, Amwell said it had been seeing up to 5,000 visits per day since the pandemic started.

Other digital health companies have seen a boost as a result. Read more about the companies that raised funding this week:



Amount raised $100 million

Headquarters: Mountain View, Calif.

The Covid-19 pandemic has put behavioral health into the spotlight, as worries about health and job security have come to the forefront. Many digital health startups in this space focus on mindfulness and other general wellness goals, but Mindstrong has a bit of a different approach.

The company focuses on providing virtual care to people living with a serious mental illness, such as bipolar disorder or major depression. Through its app, it connects users to therapists, psychiatrists and care coordinators.

Mindstrong also said it is developing a technology that patients can use to monitor their symptoms based on their smartphone usage, such as how they type of scroll on their phone.  The company conducted a study with a ketamine clinic to determine which smartphone features would be the best predictors of a user’s mood. But, as noted by STAT, little data is available to the public.

Still, the company has a strong roster of backers. General Catalyst, ARCH Venture Partners, Foresite Capital, 8VC, Optum Ventures and What If Ventures participated in its series C round.

Mindstrong also recently named a new CEO, bringing in Uber’s former product head Daniel Graf to lead the company.

“Mindstrong has clinically demonstrated that it can deliver health assurance to people who suffer from serious mental illness in a cost-effective manner,” General Catalyst Managing Director Hemant Taneja said in a news release. “I am excited to see Daniel and team scale the Mindstrong service with this capital to make a meaningful difference for this significant yet underserved population in our society.”


Rapid Micro Biosystems

Amount raised: $120 million

Headquarters: Lowell, Massachusetts

While much of the attention may be on finding a treatment for Covid-19, in the background, dozens of companies are working to make sure drugs are produced in a safe and efficient manner. One of them is Rapid Micro Biosystems, a company working to automate quality control to ensure products aren’t contaminated with bacteria, mold or fungi during the manufacturing process.

The Massachusetts-based company raised $120 million in funding, led by Hong Kong-based Ally Bridge. Geneva-based Endeavour Vision, Bain Capital Life Sciences and Longitude Capital also participated in the funding round.

Rapid Micro Biosystems plans to use the funds to support its commercial expansion in the U.S., Europa and Asia. It will also invest some of the funds into product development, including a rapid sterility test for the final release of products that it has been developing with the U.S. Biomedical Advanced Research and Development Authority (BARDA).



Amount raised: $21.5 million

Headquarters: Singapore, New York City

Health data analytics company Holmusk raised $21.5 million in funding led by Optum Ventures and Health Catalyst Capital. The startup is building a behavioral health analytics platform. Holmusk said it is combining mental health data with chronic conditions to help support the best treatment decisions for patients.

“Our team is encouraged by Holmusk’s evidence-based approach to improving care for people suffering from behavioral health disorders, and we look forward to working closely with the Holmusk team to support the next phase of growth” Optum Ventures Senior Principal Dr. Vijay Barathan said in a news release.

The startup acquired behavioral health EHR MindLinc from Duke University School of Medicine in 2016, giving it more than 20 years of longitudinal health data. With the new funding, Holmusk plans to expand its offices in New York.

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Primary care startup One Medical delays some office openings due to Covid-19


Primary care startup One Medical is looking to shift more of its services online as a result of the Covid-19 pandemic. The company, which went public in January, saw the number of in-office visits drop in March and April as stay-at-home orders went into effect. Though the pandemic didn’t affect its first quarter earnings, it expects to take a hit in the second quarter.

“As Covid-19 started to emerge, we had immediately cut most discretionary spending,” One Medical CFO Bjorn Thaler said during a Wednesday earnings call.

He added that the company had stopped hiring for almost all nonclinical roles and was reviewing its clinical real estate footprint. This year, it plans to open 20 to 25 new offices, bumping back some planned openings into next year.

One Medical’s parent company, 1Life Healthcare,  just went public in January for $245 million. The direct primary care company had been growing quickly, adding new members, hiring more physicians and building more brick-and-mortar clinics. The company currently has more than 60 offices across the U.S.

But of course, all of those bring added cost.

During the first quarter of 2020, One Medical saw its membership and revenue grow past expectations. The company brought in revenues of $78.8 million, up 25% from last year. It also saw its membership grow to 455,000, a 25% increase year-over-year. But the company also saw its net loss balloon from $7 million in 2019 to $34.6 million in the first quarter.

Through its direct primary care model, One Medical brings in a portion of its revenue from services billed to insurance, and a portion from an annual $200 membership fee that it charges.

Thaler said the company didn’t see a significant increase in expenses as a result of the pandemic, but did see a reduction in revenue going into March. To offset this, the company launched telehealth visits in late March that have helped make up for some of the loss in patient volumes.

“Our in-office volumes continued to decline into early April before settling into a suppressed level. However, we launched billable remote visits in late March and have seen accelerating week-over-week adoption,” he said.

In April, the company saw about 55% of the patient volumes that it saw before the pandemic. Those levels have increased some in May. But even though insurers are reimbursing for remote visits, they’re still less profitable than in-person visits, as physicians can’t administer certain services or procedures.

Physician groups and primary care offices have been hit hard by the Covid-19 pandemic, and One Medical is no exception. But the startup hopes that by leaning into telehealth, it can recoup some of those costs.

“A positive outcome of launching remote visits and changing demand patterns for in-person care is that we have an opportunity to further optimize our office footprint and provider staffing model,” Thaler said. “Over time, we may increase the number of providers we staff per office with providers working some shifts in office and some shifts remotely.”

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Startup automating healthcare administration raises $51M


Decentralized clinical trial design

A startup building AI tools for health systems closed a $51 million funding round. Olive AI said it plans to use the new funding to further its growth; Olive’s AI assistant is already used at more than 500 hospitals across 41 states, including large systems such as Centura Health and OhioHealth.

Technology venture capital firm General Catalyst, which has backed Livongo and  Oscar Health, led the $51 million funding round.  Previous investors include Drive Capital, and Ascension Ventures and Oak HC/FT, which previously led a $32.8 million funding round in 2018.

In addition to the funding, Olive AI will gain a new board member in Ron Paulus, the former CEO of North Carolina-based Mission Health. Paulus currently serves as an executive-in-residence with General Catalyst. Part of the firm’s strategy is to partner software startups with experienced executives to grow their business.

Columbus, Ohio-based Olive Health uses AI to automate repetitive, error-prone tasks, such as insurance eligibility checks and code matching. For example, Connecticut-based health system Yale New Haven Health previously stated it was using the system to automate prior authorizations.

Olive Health describes its AI, called Olive, as a “digital employee” that is assigned tasks and can provide updates to a manager. It also says the system is EHR-agnostic.

CEO Sean Lane, a software entrepreneur and former Air Force intelligence officer, founded the company in 2012 after he noticed the technology systems used in healthcare were often disconnected from one another.

“The AI workforce is here, and the days of disconnected bots that don’t learn from each other are over,” Lane said in a news release. “The time is now and this investment enables us to accelerate our vision of the internet of healthcare – where when one Olive learns, all Olives learn.  We’re on a mission to radically change the way healthcare leverages and views an AI workforce.”

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Startup raises $15M to help prevent and treat opioid addiction


Opioid pills
A startup building tools to prevent opioid addiction closed a $15 million funding round. AxialHealthcare raised the new funds from previous investors, including Oak HC/FT, .406 Ventures, BlueCross BlueShield Venture Partners and the Sandbox Advantage Fund. The company plans to use the additional funds to build tools to support patients struggling with addiction and connect them with resources in their communities.

“It’s not one size fits all. We want to go really deep into communities and understand exactly how the epidemics affect the community, what providers are there and which providers offer quality care,” said Carter Paine, who became axialHealthcare’s CEO last year. “We plan to use the funding to support our expansion in terms of putting feet on the street in those communities that we serve.”

Nashville-based axialHealthcare originally started as an analytics company, which analyzed claims data to help providers identify patients at risk of addiction. For example, it can show how many other physicians have prescribed a patient opioids in the past, or if they had been admitted to the ER for an overdose. The company struck a partnership with Surescripts in 2018 to add prescription fill data to its platform.

Now, axialHealthcare is building out tools for patients and their families to help them navigate substance use disorder treatment and recovery. For example, it has a tool that directs patients to the top-performing pain care providers. It also helps them connect to community resources, such as transportation, housing or job assistance programs.

“It’s one of the hardest areas to navigate. Patients and families are often just going to Google, which is not enough info on where is there high-quality treatment in community and what is the right level of care for a patient as they deal with this disease,” Paine said.

The startup also has a separate app that directly engages patients, connecting them to a health coach that can support them in their treatment.

“We want to be that trusted support and advocate,” Paine said. “It’s a wickedly hard disease to conquer or to go into remission on. Anyone who has gone through this would tell you they had people they leaned on as they go through recovery.”

Oak HC/FT General Partner Nancy Brown, who joined axialHealthcare’s board in 2016 after her firm led a $16.5 million round in the startup, said the company broadening its tools across the entire spectrum from substance abuse to treatment would allow it to have a bigger impact.

“We have been focused on solutions associated with the opioid addiction crisis since our earlier investment in axial. It became clear that in order to have the substantial and sustained impact we hoped for we needed to broaden our tools to support the entire continuum from prevention to treatment,” she said in an emailed statement. “Carter Paine is an experienced leader who has proven ability to take a disconnected healthcare ecosystem and provide tech enabled services to drive improvement to clinical outcomes and costs at scale.”

Paine joined axialHealthcare last year from his previous startup, NaviHealth, a post-acute care company. AxialHealthcare’s former CEO, John Donahue, became executive chairman of the company last year.

Seven health plans currently use axialHealthcare services, covering a few million members. In addition to building out its platforms, the company plans to build out the number of clients it serves.

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Primary care startup Iora Health raises $126M


Money currency vector illustration. Various money bills dollar cash paper bank notes and gold coins. Collection of cash heap pile and currency stack vector set.

Iora Health, a startup that operates primary care clinics focused on Medicare patients, raised $126 million in a series F round. The new funds are in addition to the more than $220 million Iora has raised to date.

The Boston-based company currently has 48 practices across the U.S., a significant increase from the 24 practices it had in 2018, when it raised $100 million. Iora claims it can reduce patient hospitalizations through its model, where physicians charge a flat fee per patient visit rather than billing for every service provided. The company also gives its patients access to health coaches and has built its own software platform, which it uses to share records and visit information with patients.

Premji Invest, the billion-dollar investment group created by Wipro Chairman Azim Premji, led the $126 million funding round. The Bangalore-based family office has largely invested in tech companies, though it also participated in insurance startup Devote Health’s most recent funding round.

“At Premji Invest, we see the dire need – and ripe opportunity – for innovation in healthcare,” Dhiraj Malkani, a partner with Premji Invest, said in a news release. “The team at Iora is at the forefront of this transformation. The impact they have already made on the thousands of patients they serve is impressive and we’re most excited about the future development and growth that will lead to making even larger impact on both people and the bottom line.”

Previous investors Flare Capital Partners, Temasek F-Prime Capital, Cox Enterprises, Devonshire Investors, .406 Ventures, Polaris Partners and Khosla Ventures also participated in the round.

Iora Health said in plans to use the new funds to accelerate its growth and add new features to its technology platform, Chirp. The company also plans to certify its platform as Medicare electronic health record system, with new features to generate electronic patient information and share encrypted health information with non-Iora providers.

Iora Health CEO Dr. Rushika Fernandopulle said the funding round was a testament to Iora’s business model and progress, “and the industry’s — and especially our investors’ — confidence in the future impact Iora will make on the industry and more specifically on all of our patients’ lives.”

A physician at Massachusetts General Hospital, he co-founded the company in 2011.

As Iora Health raises funding, the competition is also heating up. Other companies are taking a closer look at Medicare, including CVS, which hired Iora’s former CMO to head up its walk-in clinics.

But Iora Health also has some significant partners. The company expanded an existing partnership with Humana in September to open 11 new clinics in Arizona, Georgia and Texas. Blue Cross and Blue Shield of North Carolina and Blue Cross Blue Shield of Massachusetts also include Iora Health in their networks.


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Samsung teams up with startup making vision-assistance headsets


A user wears one of IrisVision’s headsets in front of the Sydney Opera House. The company recently struck a partnership with Samsung,


Samsung launched a new partnership with IrisVision, a startup making wearable vision-assistance devices. The Pleasanton, California-based company makes virtual-reality headsets that allow users with low vision to see around them with a wide field of view.

“With this partnership, Samsung’s technology and support, along with its global channels and partner network, it will also enable the next generation of IrisVision products to diagnose and treat conditions remotely anywhere in the world,” IrisVision CEO and co-founder Ammad Khan said in a news release

The startup was founded in 2017 by Khan and Frank Werblin, a professor of neuroscience at the University of California, Berkeley. The company has since launched clinical trials with Johns Hopkins, Stanford and the University of Pittsburgh Medical Center. Its system is currently designed to help patients with macular degeneration, diabetic retinopathy, retinitis pigmentosa and other common eye conditions. IrisVision is registered as an FDA Class I medical device.

IrisVision currently uses Samsung’s hardware. That includes its smartphones, virtual reality headsets and mobile AI platform. Through the partnership with Samsung, IrisVision will work with its research and development teams to further expand its use of Samsung’s technologies.  Samsung will also help the company scale as it brings its technology to market.

“It is amazing to see what IrisVision is doing to enable the large and underserved low vision community to live more independently,” Edward Choi, Samsung Electronics’ corporate vice president of global strategic alliances, said in a news release. “We will help guide IrisVision on technology integration and market strategy to ultimately help every affected patient.”

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CommonSpirit Health taps startup to reduce administrative workload


Notable Health’s software helps providers with everything from patient intake to documentation.


Chicago-based nonprofit health giant CommonSpirit Health will implement a new software system to reduce administrative burdens for physicians and staff. It will run a pilot using software from Notable Health to help collect patient records and making its existing systems interoperable.

Rich Roth, senior vice president and chief strategic innovation officer of CommonSpirit Health, said the health system picked Notable as a partner for its ability to cover the full spectrum of administrative tasks on one platform. For example, Notable’s software allows patients to schedule appointments online and fill out paperwork ahead of their visit. Physicians can dictate notes through their Apple watch, and patients receive a summary of each visit through the system.

“The industry has developed more individual point solutions today. … We wanted to cover the full spectrum, instead of a separate product for filling out forms and a separate product for registration,” Roth said. “Ultimately, this will allow for more meaningful time with physicians and patients.”

Notable’s system is already live at some of CommonSpirit’s primary care clinics along the Central Coast of California, with plans to expand its footprint by next year.


“TurboTax for patients”

Notable CEO and Co-Founder Pranay Kapadia has a strong background in software. He previously served as head of product for Intuit’s consumer finance software, Mint. Kapadia created Notable in 2017 after talking to his wife, a physician, about the onslaught of paperwork she faced at work.

“She thought it was a disservice to her patients,” he said. “It’s taken away the joy from physicians.”

With six other physicians in his family, Kapadia dug into the issue. Sitting around the dinner table for the holidays, they talked about how they handled administrative tasks.

“They all had different workflows. If they weren’t the ones typing, there was still a massive staff around them helping them do that,” he said

As he dug more into health systems’ administrative backlog, Kapadia realized there were a lot of opportunities for human error. Between five and 25 people are involved with a patient’s chart, and with each step, new problems can be introduced. For example, an expired insurance card might be taken, or labs might be sent to the wrong place.

“It all comes down to poor patient experience,” he said. “The industry knows about the death-by-1000-clicks for physicians. They often forget about the realty for patients. They’re very intertwined.”

Administrative staff also struggle with the paperwork burden. In some cases, they might have to scan a patient’s ID into three different systems that are not interoperable, Kapadia said.

Plenty of other companies are already working on these individual problems, but most of them are point solutions. Tapping into his past experience with Intuit, Kapadia instead sought out to create the equivalent of TurboTax for patients.

Currently, Notable just offers its own solutions, but the company plans to open up its platform to other partners in the future. Kapadia said his solution results in more than 65 percent of patients engaging before they show up for their appointment, and saves medical administrative staff 35 percent of their time on average.

“What’s interesting about Notable is they’re focusing on an area of patient complexity and dissatisfaction that needs better innovation in health care,” Roth said. “These are operational problems and challenges that need to be solved every day. We hope to see more and more innovation arriving.”


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Startup says algorithm identifies new risk factor for heart disease but a doctor is skeptical


An Israeli biotech company recently said that a study has endorsed what it describes as a new risk factor for heart disease as analyzed by the company’s proprietary algorithm.

The predictive power of the factor – variation in heart rate – was borne out by a clinical study led by Dr. Ilan Goldenberg, director of clinical cardiovascular research at the University of Rochester Medical Center.

The algorithm was developed by Lev El Diagnostics of Heart Diseases, a biomedical company based in Jerusalem. Its product, HeartTrends, listens to heartbeats for 20 minutes through a wearable monitor connected to an app. The app sends data through the cloud back to Lev El for analysis of heart-rate variation. It can work on any monitor and does not require a baseline reading first.

The question, however, is whether variation in heart rate is more predictive than existing risk factors, such as age, family history and fitness levels, according to one cardiologist who was not involved in the study.

“I think this is true for any new test, whether it’s to detect heart disease or cancer or cognitive dysfunction,” the cardiologist, Dr. Richard Josephson, said in a phone interview. He is a professor at Case Western Reserve University School of Medicine and director of cardiovascular and pulmonary rehabilitation.

HeartTrends currently is not being used in the U.S., said Dov Rubin, CEO of Lev El Diagnostics. But the algorithm is FDA-cleared. It is currently being used in other countries by life insurers as a way to assess actuarial risk in younger, healthier people, Rubin said, noting it is more convenient and less costly than traditional stress tests, which typically involve measuring heart rate as a person walks on a treadmill or rides a stationary bike.

Rubin expects to gain a U.S foothold through life insurers but sees a bigger role in healthcare for the algorithm, which his company has been developing for nearly eight years.

“The vision is it should be part of your annual health exam,” Rubin said in a phone interview.

The company’s website pitches its test as ideal for healthy adults with at least one risk factor or who are unable to undergo a traditional stress test. It might be similar to the Apple Watch’s apparent ability to detect atrial fibrillation or an irregular heartbeat, Rubin said.

“We would like to follow in that because this is really a non-threatening type of test,” he said. “This is an early warning. This is not something that says we have to go to surgery tomorrow.”

A typical person’s heart rate varies but the variation declines when coronary arteries start to clog, a condition known as myocardial ischemia, Goldenberg said. The variation can start to decline even in people who appear healthy otherwise.

The results of the study, the third on the HeartTrends algorithm, were presented in mid-November at an American Heart Association scientific conference in Philadelphia and are slated for publication in the association’s journal. The study looked at 1,043 people who had no known coronary artery disease. Participants were enrolled in the study between 2015 and 2018 either through the Mayo Clinic or at Sheba Medical Center in Israel. The average age was 59, and 38% were women. Of the total, 6.3% were found to have myocardial ischemia. Goldenberg said his study showed the algorithm was more likely to predict myocardial ischemia than conventional stress tests.

As with any new test, however, the challenge lies in convincing clinicians to use it – and insurers to pay for it.

Josephson acknowledged that heart-rate variability may be a risk marker for coronary artery disease. But, he said, based on what he had seen of the study, it was unclear whether the algorithm truly added to the predictive powers of established risk factors, such as age, fitness and past tobacco use. He also noted that tests of otherwise-healthy people run the risk of generating a disproportionate share of false positives.

Goldenberg said his study of HeartTrends showed that heart-rate variability is an independent predictor of myocardial ischemia in healthy people even after adjusting for traditional risk factors and that it improves diagnostic results when added to those other factors.

Between 30% and 40% of those identified as at risk in the study turned out to be false positives. But taking the test twice should reduce the incidence, as is the case for other tests, he said in an email response to questions. The test, however, was 97% accurate in ruling out myocardial ischemia, he added.

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