Heart of the matter

Place both the thumbs on the glass slots and just wait for the readings on the mobile app,” says Rahul Rastogi, demonstrating the credit-card sized device Sanket. In 15 minutes, the phone displays crests and troughs on a red graph — the ECG, thankfully, is normal. “We have been found to be 98% accurate when tested against digital ECG machines,” he says. 

Sanket 1.0 as Rastogi calls it doesn’t stop at producing an ECG. It also calculates stress levels. “In the next version, you will be able to send it to our doctor for a quick review. We will also be able to predict diseases by observing user patterns, and caution users about 17 diseases,” says the co-founder of Agatsa Software, which has developed the device. 

There is little doubt that heart disease is on the rise in India. But it was his father’s own heart condition that prompted Rastogi to build Sanket. Diagnosed with a heart condition in 2012, he couldn’t be operated on because he was diabetic. “Someone had to be around him all the time,” recalls Rastogi. 

Ideally, a patient with a possible heart issue should get an ECG done in an hour. “That’s the golden window but in India it takes 6-8 hours. About 4 crore people die each year because they don’t reach the hospital,” he says. When Rastogi and his wife looked for a solution that could detect heart trouble in time, that’s what they experienced. “We couldn’t find any device that produced ECG in time and conveniently,” says Neha Rastogi, co-founder, Agatsa. Even in hospitals, the process is cumbersome. Moreover, she adds, 70% Indians live in rural areas, away from diagnostic centres or hospitals.  

That’s when the couple, both engineers from Aligarh Muslim University, decided to build Sanket by putting their experience across companies such as LG, Samsung, Hewitt and CSC India to use. But the challenge was to bring down the cost. A conventional digital ECG machine costs anywhere between Rs.40,000 and Rs.200,000. Sanket, on the other hand, is priced at Rs.9,999. “Conventional machines are hardware heavy. The innovation on our part was that we were able to transfer the intelligence built in the hardware to the software. For us, the hardware is only required for the voltage flow/regulation,” says Rastogi. 

Frugal start
It was, however, difficult to find investors who understood the vision, say the duo. “We thus followed a frugal approach, didn’t spend too much money initially. In fact, for our initial prototypes we used cardboard and even matchboxes to give the doctors an idea of the product,” recalls Rastogi. 

The bootstrapped start-up though assimilated a lot of what the doctors had to say. What they wanted was a device based on the conventional 12-lead ECG. At that point, some Chinese devices were available that worked on single lead, which were expensive. In the conventional 12-lead ECG, ten electrodes are attached to obtain results from 12 different angles. So that’s what Sanket did. Besides the thumb slots, users have to place the device at conventional ECG points to get accurate results. 

The more Sanket got this part right, the more recognition came its way. Its office has poster size cheques won from start-up contests, including the Anjani Mashelkar award in 2015. The recognition, in turn, brought investors like Tata Trusts and the Biotech Industry Research Assistance Council (BIRAC). “We work closely with Tata Trusts and Sanket has been utilised in their projects,” shares Rastogi. The company has also been working with Reliance Venture Hub and is exploring how Sanket can be integrated with Reliance Jio. 

Gradually, Agatsa has changed its frugal approach. “We bootstrapped initially but now we raise funds a year in advance,” says Rastogi. The team has also grown from four members to 15 now. Neha adds, “We could have hired a doctor if we had raised money initially. But it was good that we didn’t because that meant talking to hundreds of doctors on the ground. That helped make the product better.” Dr Kamal Ahmad, MD, Indraprastha Apollo Hospitals in Delhi was one of the doctors that helped them. Ahmad was treating one of Rastogi’s family members for cardiac ailment. “Even then Rahul was curious about the possibilities of manufacturing an ECG device. I would brief them on its applications, how it helps detect heart problems and the technicalities that go into reading an ECG.”

Doctor at hand
While Sanket was commercially launched in March 2016 on Amazon, Agatsa has already sold 250 devices. “A product like this is the need of the hour given that India is the capital of heart disease. There is nothing like Sanket in the market today,” says Jitender Singh Minhas, CEO, STEP business incubator, who is an investor.  

Ahmad adds, “The best thing about Sanket is that it is user-friendly and can be used in distant towns where you don’t have a cardiologist. Where long-term monitoring is required, it can be done by patients themselves and post-surgery follow-ups can be done by sharing the report on the mobile — there is no need for patients to travel long distances to see the doctor.”

A for-profit company, Rastogi says he wants to be like Apple and not Samsung. “We don’t want to be only a product company, we want to be a data company,” he says. While he doesn’t reveal the start-up’s revenue, Rastogi says Agatsa might turn profitable by end-2017. “We are for profit, but we are not guided by that,” says the co-founder. He, however, counts Anil Gupta, vice chairman, National Innovation Foundation and Dr Raghunath Mashelkar as mentors. “We got inputs on market connect, product focus and business modeling, which are crucial. Earlier, we had plans to add more sensors such as the one for measuring blood pressure. But our mentors asked us to focus only on one niche, the cardiac space,” says Rastogi. 

While, as of now, the revenue comes by selling devices, the long-term plan is to tap the vast amount of data collected. Rastogi says the company can suggest lifestyle changes by analysing the data. Minhas, however, has a different point to make. “You can do a lot with that data. Probably, a stage can come when you can give the device for free and data from their ECGs can be utilised by life, health insurance companies and companies in preventive healthcare,” he says.  

For its next version, Rastogi is targeting a wearable with the capability of detecting 17 diseases such as diabetes, epilepsy, obesity, anxiety, neuropathy etc. “For example, for a person regularly using the wearable, we will be able to caution him/her about the likelihood of a disease months in advance,” claims Rastogi. 

But isn’t there a direct challenge from wearable giants like Fitbit and others? Rastogi doesn’t feel so. “Fitbit is only based on the heartbeat and is single-lead based. That doesn’t tell the entire story of your heart. You can’t foresee any heart disease with that data. Fitbit gives you details about heartbeat, steps, calories burnt and sleep duration etc, but Sanket is a more diagnostic and cardiac care device.”

Nevertheless, Agatsa will have to win over doctors. Rastogi understands that. “Making a product is only 10% of the job. One has to find a market for it,” he says. The start-up has thus already tied up with distributors. It is also working on getting approval from the Indian Council of Medical Research (ICMR), which works closely with doctors from AIIMS, a process that is underway. The medical body is likely to test the product on a large sample size over the next few months to check Sanket’s accuracy. But Rastogi is ready to wait. “We have also applied to the FDA in the US. An approval by ICMR will help us there,” he adds.

While it doesn’t need these approvals, the company believes it is a way to fast track its progress and add credibility. “There are only seven devices, all to be placed inside body, whose sale requires government approval. Sanket can be sold like a thermometer,” says the co-founder.

Already, Sanket is being sold in countries like Singapore, South Africa and Australia as and when the orders come. The long-term plan for Agatsa though is to operate through licensees in foreign countries. The company is also shifting its manufacturing base from China to India next month. It hopes to get at least 50 million people to use the product in the next couple of years. If it does, it might just become a leading player in cardiac care.