AI stethoscopes in 2026: Eko CORE 500 review and what UK/US clinicians should know

Key takeaways

A February 2026 study in the European Heart Journal — Digital Health found that AI-augmented auscultation with an Eko digital stethoscope more than doubled the identification of moderate-to-severe valvular heart disease (VHD) in a primary care setting, compared to standard auscultation with a traditional stethoscope.
Separately, the TRICORDER study (published in The Lancet), which followed nearly 1,000 primary care clinicians over 12 months, reported that Eko AI users detected 2.3× more heart failure, 3.5× more atrial fibrillation, and 1.9× more VHD than baseline.
The Eko CORE 500 is the company's flagship device: a digital stethoscope with integrated 3-lead ECG, 40× sound amplification, active noise cancellation, a full-colour display, and FDA-cleared AI algorithms for murmur, AFib, and low ejection fraction detection. It costs $379 USD plus $119.99/year for the Eko+ AI membership.
Eko has 9 FDA clearances and has been clinically validated in 70+ publications, including collaborations with the Mayo Clinic. Over 700,000 Eko stethoscopes have been sold worldwide.
In the UK, there is no specific NICE guidance on AI-enhanced auscultation. Eko's AI features are available only in countries with regulatory approval, and UK clinicians should verify the device's MHRA status before relying on AI detection features in clinical practice.
For clinicians who want AI-powered clinical knowledge alongside their diagnostic tools — whether that tool is an Eko stethoscope, a traditional Littmann, or anything in between — iatroX provides free, guideline-grounded clinical reference and reasoning support accessible on any device.

The evidence: what the new studies actually show

The February 2026 EHJ — Digital Health study

The study, titled "Artificial-Intelligence-Enabled Digital Stethoscope Improves Point-of-Care Screening for Moderate-to-Severe Valvular Heart Disease", was published on 5 February 2026 in the European Heart Journal — Digital Health. It was a single-arm, single-blinded, prospective study conducted in primary care settings in the United States.

Design: 357 patients aged 50 or over, with risk factors for heart disease, were assessed using both a traditional (analogue) stethoscope and an AI-enabled Eko digital stethoscope during the same clinical encounter. The ground truth reference standard was echocardiography. Clinicians performed standard-of-care (SOC) auscultation first, documented their findings, and then repeated the exam using the AI-augmented device.

Key finding: AI-augmented auscultation more than doubled the identification of moderate-to-severe VHD compared to SOC auscultation alone. The AI device flagged structural murmurs that primary care clinicians had missed with the traditional stethoscope.

Nuance: The study authors noted a minor reduction in specificity with the AI-augmented device, which could potentially increase false positives and unnecessary referrals. They characterised this as an acceptable trade-off given the clinical value of earlier detection, but acknowledged that further research across broader clinical environments and more diverse populations is needed.

Why it matters clinically: VHD can affect more than one in two adults over 65, yet remains substantially underdiagnosed due to the well-documented limitations of traditional auscultation. Earlier research has shown that cardiac auscultation by general practitioners has poor sensitivity for detecting VHD — a finding that has been replicated across multiple studies. If AI can close this diagnostic gap at the point of care, the downstream benefits (earlier valve intervention, reduced heart failure hospitalisations, fewer emergency presentations) could be significant.

The TRICORDER study (The Lancet)

The TRICORDER study (Triple Cardiovascular Disease Detection Using an Artificial Intelligence Stethoscope) is the most significant real-world evidence for Eko to date. Published in The Lancet, it evaluated outcomes from nearly 1,000 primary care clinicians who used Eko's AI-enabled digital stethoscopes during routine clinical care over a 12-month period.

Key findings:

Clinicians using Eko AI detected 2.3× more heart failure
3.5× more atrial fibrillation
1.9× more valvular heart disease

This is not a controlled trial environment — it is real-world, routine clinical care. The magnitude of the detection uplift, particularly for AFib (3.5×), is striking and suggests that a substantial proportion of cardiac disease is currently being missed in standard primary care examinations.

The Mayo Clinic collaboration

Eko's AI algorithms were developed in part through a long-standing research collaboration with the Mayo Clinic. The partnership has produced work on using ECG data and heart sounds to detect reduced left ventricular ejection fraction (LVEF ≤ 40%) — effectively screening for heart failure with a stethoscope exam. A study published in The Lancet Digital Health demonstrated that the AI tool could identify individuals with reduced LVEF using single-lead ECG inputs, achieving clinically meaningful accuracy in a validation cohort of over 1,000 patients undergoing transthoracic echocardiogram.

The practical implication: a device that started as a better stethoscope is increasingly functioning as a point-of-care cardiac screening platform — detecting murmurs (VHD), rhythm abnormalities (AFib), and pump function impairment (low EF) in a single clinical encounter.

The Eko CORE 500: a detailed look at the hardware

The CORE 500, launched as Eko's flagship device, replaces the earlier CORE and DUO models. Here is what it offers:

Audio and auscultation

40× sound amplification with 7 volume settings
Active noise cancellation (TrueSound™ technology) — designed to reduce background noise and artefact, which is particularly relevant in noisy clinical environments such as emergency departments, ambulances, and busy wards
Three audio filters: Cardio (optimised for heart sounds), Pulmonary (optimised for lung sounds), and Wide (balanced, similar to a traditional stethoscope)
In-ear speakers rather than a hollow tube — sound is delivered digitally, which eliminates the tube-length limitations and ambient noise leakage of analogue stethoscopes
Eko claims an 8× improvement in sound quality compared to a typical analogue stethoscope

ECG

Integrated 3-lead ECG — the stethoscope's chestpiece contains electrodes that allow a 3-lead ECG to be captured during the standard chest examination
1-lead ECG display shown on the device's full-colour screen in real time
The ECG data is used both for visual inspection by the clinician and as an input to Eko's AI algorithms

AI detection (requires Eko+ membership)

The AI capabilities are the headline feature and are accessed via the Eko+ subscription ($119.99/year after a 14-day free trial with purchase):

Structural murmur detection: The EFAST algorithm processes heart sound and ECG data in real time to flag the presence of structural murmurs associated with valvular heart disease. This is the algorithm validated in the February 2026 EHJ — Digital Health study.
Atrial fibrillation detection: Flags suspected AFib from ECG data during the exam.
Low ejection fraction detection: Flags suspected reduced LVEF (≤ 40%), the heart failure screening capability developed with Mayo Clinic. (This feature uses the SENSORA™ platform and may have separate access requirements.)
Tachycardia and bradycardia alerts: Basic heart rate abnormality detection.

The AI produces screening alerts, not diagnoses. Eko is explicit about this: the findings are intended to aid clinicians in reaching an accurate diagnosis, not to replace clinical judgement. A positive AI alert should prompt further investigation (echocardiography for suspected VHD, 12-lead ECG or Holter for suspected AFib, echocardiography for suspected low EF).

Recording and sharing

Exam recordings can be saved to the Eko App (requires Eko+ for unlimited recording)
Recordings can be shared with colleagues for second opinions or teaching purposes
EMR/EHR integration is available for health system deployments

Build and battery

Scratch and splash resistant
Battery life: up to 60 hours of regular clinical use (approximately 300 minutes of continuous use)
1-year warranty and 30-day risk-free trial
Available in multiple colours (Silver, Matte Black, Champagne, Amethyst, Wintergreen, Sapphire, and others)

Pricing: what does it actually cost?

Component	Cost
Eko CORE 500 device	From $379 USD (~£300 / AU$600)
Eko+ membership (AI features, recording, sharing)	$119.99 USD/year (~£95 / AU$190) after 14-day free trial
Protective case	$25 USD
Year 1 total cost	~$499 USD (~£395 / AU$790)
Ongoing annual cost (Eko+ only)	$119.99 USD/year

For comparison, a Littmann Cardiology IV (the most popular premium analogue stethoscope) retails for approximately $175–$220 USD. The Littmann CORE (Eko's digitally enhanced Littmann collaboration model) starts from approximately $349 USD.

The CORE 500 is therefore roughly 2× the cost of a premium analogue stethoscope, plus an ongoing annual subscription for the AI features. The device is reimbursement-eligible via HSA/FSA in the US, and some employers and institutions may cover CME funds.

The critical question: Is the AI subscription worth $120/year? For a clinician who examines 10+ patients per day and has access to echocardiography for confirmatory testing, the cost is modest — equivalent to roughly 50 pence per working day. For a medical student or trainee who wants enhanced audio and learning but may not yet benefit from AI screening, the device without Eko+ (which still offers amplification, noise cancellation, ECG, and real-time visualisation) may be sufficient.

What this means for UK clinicians

This is where the analysis becomes more complex, because the UK clinical and regulatory environment is substantively different from the US.

NICE and AI-enhanced auscultation

As of March 2026, there is no specific NICE guidance on AI-enhanced auscultation or AI-enabled stethoscopes. NICE's existing cardiovascular guidelines — including those for hypertension, chronic heart failure, and valvular heart disease — recommend echocardiography as the definitive diagnostic tool for suspected VHD and heart failure. Auscultation is mentioned as part of the clinical examination but without specific reference to AI-enhanced devices.

This creates a paradox. The evidence for AI-augmented auscultation improving VHD detection is now strong (doubled detection in a prospective study, 1.9× in a 12-month real-world study). But the UK pathway — from GP consultation to echocardiography — is already well-established. The question is whether AI-enhanced auscultation would meaningfully change the referral threshold or simply add a step to a pathway that already exists.

The case for: In UK primary care, many patients with mild-to-moderate VHD are currently not referred for echocardiography because the murmur is not heard (or not heard with confidence) during auscultation. A tool that doubles detection could identify patients who are currently falling through the gap, leading to earlier intervention — particularly for aortic stenosis, where timely valve replacement is life-saving.

The case against: NHS echocardiography services are already under significant pressure. Doubling the rate of murmur detection in primary care would increase referrals substantially, and the health system benefit depends on whether those additional referrals represent genuine pathology or an increase in false positives. The EHJ study itself noted a minor reduction in specificity. Without NICE endorsement and a health economic analysis demonstrating cost-effectiveness within the NHS, widespread adoption in UK primary care is unlikely in the short term.

MHRA and regulatory status

Eko's AI features are described as available "in countries where Eko Health has regulatory approval." UK clinicians should verify whether:

The Eko CORE 500 device itself is available for sale in the UK (the hardware is a general-purpose stethoscope with added digital features, which may not require specific MHRA registration for the non-AI functions).
The Eko+ AI algorithms (murmur detection, AFib detection, low EF detection) have received the necessary regulatory clearance for use in Great Britain. AI algorithms that screen for cardiac disease are likely to fall within the scope of the Medical Devices Regulations 2002 and would require MHRA registration and appropriate classification.

Until both the device and the AI software are confirmed as available and registered in the UK, clinicians should be cautious about relying on the AI detection features in clinical practice. The stethoscope's enhanced audio (amplification, noise cancellation, ECG) functions independently of the AI and may be available regardless.

The broader NHS digital health context

The NHS is actively embracing AI in clinical workflows — from ambient AI scribes to clinical decision support tools to AI in medical education. But the adoption path for AI-enhanced diagnostic hardware is different from AI software. It requires procurement, device management, training, and integration with existing referral pathways — challenges that go beyond simply downloading an app.

For NHS Trusts and GP practices considering AI stethoscopes, the evaluation framework should mirror the approach used for any clinical AI tool:

Does it have the required DTAC and MHRA assurance?
What is the evidence base? (In Eko's case, this is now substantial — 70+ publications, the TRICORDER study, the EHJ-DH study.)
What is the downstream pathway? If the AI flags a murmur, is there capacity for timely echocardiography?
What is the health economic case? Earlier VHD detection should reduce emergency presentations and hospitalisations, but this needs modelling in the NHS context.
What is the training requirement? Clinicians need to understand what the AI is doing, how to interpret its outputs, and when to act (or not act) on its alerts.

What this means for US, Canadian, and Australian clinicians

United States

The US is the most favourable market for Eko. The device has 9 FDA clearances, the AI algorithms are approved for clinical use, and the health system's fee-for-service model means that identifying more pathology (and referring for more echocardiograms) aligns with economic incentives. The January 2026 FDA guidance further clarified that clinical decision support software that clinicians can independently review falls outside medical device regulation — which may benefit Eko's AI positioning.

For US primary care physicians, family medicine doctors, internists, and nurse practitioners, the CORE 500 is a straightforward adoption: buy the device, subscribe to Eko+, and start using AI-augmented auscultation in routine exams. The evidence supports it, the regulatory pathway is clear, and the cost is modest relative to US healthcare spending.

US clinicians preparing for boards — USMLE Step 2 CK, ABIM, or ABFM — should also note that cardiac auscultation and VHD screening are commonly tested topics. Understanding what AI-augmented auscultation can (and cannot) do is likely to become increasingly relevant to clinical practice questions on board exams.

Canada

Canadian clinicians should verify Health Canada clearance for the AI features. The hardware stethoscope is likely available, but the AI algorithms may have a separate regulatory pathway. For MCCQE preparation and clinical practice, the principles of AI-augmented cardiac screening are relevant and worth understanding.

Australia

Similarly, Australian clinicians should check TGA (Therapeutic Goods Administration) clearance for the AI software. The CORE 500 hardware may be available through general medical device channels, but the AI detection features require regulatory approval.

Limitations and what the evidence does not yet show

The evidence for AI-enhanced auscultation is strong and growing. But intellectual honesty requires acknowledging what we do not yet know:

No randomised controlled trial (RCT): The EHJ-DH study was single-arm and single-blinded. The TRICORDER study was observational. Neither is an RCT comparing patient outcomes (morbidity, mortality, hospitalisations) between AI-augmented and standard auscultation. This is the level of evidence that would typically be required for a NICE recommendation.
Population diversity: The published studies are predominantly US-based. We do not yet have data from UK, Canadian, or Australian primary care populations, whose demographics, disease prevalence, and referral pathways differ from the US.
Downstream outcomes: Detecting more VHD is only beneficial if the health system can act on those detections. If echocardiography wait times are already long (as they are in many NHS Trusts), increasing referrals without increasing capacity may shift the bottleneck without improving outcomes.
Specificity trade-off: The EHJ-DH study noted a minor reduction in specificity. In a screening context, this means more false positives — patients referred for echocardiography who turn out not to have significant VHD. The clinical and economic impact of this in a resource-constrained system like the NHS is not yet quantified.
Operator dependence: AI-augmented auscultation still requires the clinician to place the stethoscope correctly on the chest. Placement technique, patient body habitus, and clinical environment all affect audio quality and AI performance. The AI assists the clinician; it does not replace the need for proper examination technique.
Long-term outcomes: We do not yet have data showing that AI-augmented auscultation leads to improved patient survival, reduced heart failure hospitalisations, or better quality of life. These are the outcomes that matter most, and they will take longer-term studies to demonstrate.

Where iatroX fits: clinical knowledge at the point of care

An AI stethoscope can tell you that a murmur is present. It cannot tell you the latest NICE guidance on managing the patient with newly detected VHD, the appropriate referral pathway, the drug interactions to consider if you start medical management, or the differential diagnosis for the patient's presenting complaint.

That is where iatroX comes in.

Whether you are a GP using an Eko CORE 500 who has just received an AI alert for a suspected structural murmur, a junior doctor on a ward round trying to remember the echocardiographic criteria for severe aortic stenosis, or a medical student revising cardiac auscultation for an OSCE or UKMLA exam, iatroX provides:

Ask iatroX: Rapid, evidence-based answers to clinical questions, grounded in NICE, CKS, SIGN, BNF, and other trusted UK guidelines.
Brainstorm: AI-assisted differential diagnosis and clinical reasoning, contextualised to UK practice.
iatroX Knowledge Centre: A curated front door to authoritative UK clinical guidelines, reducing the time from question to answer.
iatroX Quiz: Adaptive, curriculum-mapped question banks for MRCP, MRCGP AKT, USMLE, MCCQE, AMC, and more.

iatroX is free, MHRA-registered, and works on any device — no special hardware required. It is the clinical knowledge layer that complements whatever diagnostic tools you choose to use.

The AI stethoscope detects. iatroX helps you decide what to do next.

Our verdict

The Eko CORE 500 is the most clinically validated AI-enhanced stethoscope available today. The evidence — from the EHJ-DH study, the TRICORDER study, and the Mayo Clinic collaboration — is now substantial enough that US clinicians in primary care should seriously consider it as an upgrade from their traditional stethoscope.

For UK clinicians, the picture is more nuanced. The evidence is compelling, but the regulatory pathway (MHRA clearance for the AI features), the absence of NICE guidance, and the downstream capacity question (echocardiography access) mean that widespread NHS adoption is not imminent. Individual GPs and private practitioners who want to use the enhanced audio and ECG features — even without the AI screening — will find the CORE 500 a genuinely superior auscultation tool. But relying on the AI detection features in UK clinical practice should wait for confirmed regulatory clearance.

For Canadian and Australian clinicians, the same regulatory due diligence applies.

The bigger story is this: the stethoscope — the most iconic tool in medicine, largely unchanged for two centuries — is being reinvented. AI-enhanced auscultation is not a gimmick. It is a genuine step-change in what a routine physical examination can detect. Whether you adopt the Eko CORE 500 today or wait for the next generation of evidence and regulation, the direction of travel is clear. The physical tools of clinical practice are becoming intelligent — and clinicians who understand what these tools can and cannot do will be better equipped to serve their patients.

Summary comparison: Eko CORE 500 vs traditional stethoscope

Feature	Traditional stethoscope (e.g. Littmann Cardiology IV)	Eko CORE 500
Price	~$175–$220 USD	From $379 USD + $119.99/yr (AI)
Sound amplification	1× (passive acoustic)	Up to 40× (digital, active)
Noise cancellation	None	Active noise cancellation
ECG	None	Integrated 3-lead ECG
AI murmur detection	None	FDA-cleared (with Eko+)
AI AFib detection	None	FDA-cleared (with Eko+)
AI low EF detection	None	FDA-cleared (with Eko+)
Recording and sharing	None	Yes (with Eko+)
Display	None	Full-colour display
Battery	None required	Up to 60 hours
VHD detection rate	Baseline	2× baseline (EHJ-DH 2026)
Regulatory status	Universal	9 FDA clearances; UK MHRA TBC