“The problem with heart disease is that the first symptom is often fatal.”
Michael Phelps, Olympic Athlete
The simple truth is that cardiovascular diseases are one of the most common problems patients in America face. Over 92 million Americans suffer from heart disease, according to a recent American Heart Association study. And over 14% of all annual health care costs are a result of cardiovascular conditions. The numbers are sobering and are projected to grow over the next ten years. Each February, the American Heart Association tries to raise awareness of the seriousness of heart disease during National Heart Month and Wear Red Day. Research has shown that digital technologies can help raise awareness around heart health and help to reduce adverse outcomes through monitoring and other digital tools.
Here are several technologies that can benefit clinicians and patients in helping to diagnose and manage heart disease.
Big Data, Analytics, Artificial Intelligence & Machine Learning
Two recent peer-to-peer reviewed academic articles have shown how big data can be used to prevent cardiovascular diseases and assist in generating early diagnoses. The first one, “System Framework for Cardiovascular Disease Prediction Based on Big Data Technology,” was published in the November 2017 issue of the journal Symmetry. The researchers looked at various factors that could be used to predict the likelihood that specific populations will develop cardiovascular diseases over time. As it turns out, big data models can predict the probability that a patient will develop a cardiovascular disease by looking at clinical, genomic, and lifestyle data through disease correlations, drug side effects, and genome research.
A second study, published in the May 2018 issue of the journal BioMed Research International, shows big data can correctly predict the likelihood of a person developing cardiovascular disease in 80% of cases. This article offers a comprehensive list of factors most likely to lead to cardiovascular diseases. These factors include gender, chest pain type, resting blood pressure, serum cholesterol, fasting blood sugar, ECG, maximum heart rate achieved, exercise-induced angina, old peak, slope, and the number of major blood vessels colored by fluoroscopy.
As artificial intelligence and machine learning applications advance, big data will become more available outside of a purely academic environment to widely available complex databases where a specific patient’s characteristics can be entered to obtain the likelihood of that patient developing cardiovascular disease with more than 80% confidence. According to an article in the Journal of the American College of Cardiology, artificial intelligence is poised to “provide a set of tools to augment and extend the effectiveness of the cardiologist.”
Voice enabled technology
Voice-enabled technology is already making impressive strides toward improving health outcomes for heart disease patients. Voice-enabled assistants like Amazon’s Alexa and Apple’s Siri are indispensable to cardiac patients. For example, a skill developed by the American Heart Association (AHA), asking Alexa to walk you through the steps of CPR, is as easy as ordering a pizza. AHA’s skills also help users recognize a heart attack and stroke symptoms. Medical device manufacturer Omron Healthcare built a new Alexa skill that allows patients who use their blood pressure monitoring devices to manage their condition using voice commands. All users must do is pair their Omron cuff to the company’s app and ask Alexa to read their latest blood pressure results and get alerts for anything that may be considered higher than usual.
But big tech companies aren’t the only ones developing these voice-enabled solutions for cardiac patients. Mayo Clinic is on the verge of proving that voice signal analysis can become a noninvasive diagnostic tool. While the vocal features that indicate heart disease are not perceived by the human ear alone, the Rochester-based medical center discovered that a voice-analyzing app could help detect coronary artery disease based on a patient’s tone and intensity. Another pilot study by The Journal of the Acoustical Society of America vouches for this technology’s efficiency in lowering healthcare costs and reducing mortality rates among patients with heart failure.
Gamification
An article published in the April 2018 issue of the journal Clinical Cardiology documents how mHealth technologies have been helping patients with cardiovascular diseases adhere to heart‐healthy recommendations designed to modify users’ cardiovascular risk‐factor profiles. The addition of mHealth technologies can increase patients’ physical activity levels to instill a positive impact on cardiovascular conditions. As the authors contend: “smartphone applications can impact PA [physical activity] include knowledge, social support, behavioral change support, decision support, and self‐efficacy.” These stimulating and gamified mobile apps have successfully motivated patients to improve their modifiable risk factors. As a result, they’ve been proven to reduce cardiovascular risk-factor profiles.
“I think it’s quite natural to a clinician to start in the cardiovascular space. It’s just so clear how supporting people with nutrition, physical activity, mental health, all of this, can directly benefit health outcomes. Within cardiovascular, we’ve been expanding into peripheral artery disease and a few others with our clients and partners.”
Dr. Tryggvi Thorgeirsson, CEO, Sidekick
“An estimated 50% of patients with chronic diseases do not follow the prescribed treatment. Gamified health tracking creates an environment that keeps the patient from straying from the appropriate therapy path.”
Bertalan Mesko, M.D., PhD
Healthcare providers who use gamification strategies in their applications will have a competitive edge over others who don’t. By 2027, GM Insights forecasted that the global market for healthcare gamification would reach $65 Billion and grow at a CAGR of 14.6%. It is due to the growing usage and adoption of technology and global digitization.
Digital sensors and wearables
Since 2008, Geisinger Health Plan (GHP) has implemented a telemonitoring program that specifically targets patients suffering from heart failure. In 2014, an article was published in Population Health Management titled: ‘Can Telemonitoring Reduce Hospitalization and Cost of Care? A Health Plan’s Experience in Managing Patients with Heart Failure.’ Data was collected over 5 years and compared against data from patients suffering from heart failure who did not enroll in the program. The results were eye-opening:
“The odds of experiencing a hospital admission in a given month was 23% lower when the members were enrolled in the telemonitoring program. The odds of experiencing a 30-day readmission was 44% lower, and the odds of experiencing a 90-day readmission was 38% lower. […] The implementation of the heart failure telemonitoring program was associated with approximately 11% cost savings during the study period.”
Population Health Management, 2014
I’ve written about the role next-generation wearables will create new opportunities in remote monitoring in a previous post. The evidence shows that patients suffering from cardiovascular diseases are significantly more likely to improve their condition over time when they benefit from digitally-connected solutions that help them manage their chronic conditions over time.
Telecardiology
As telehealth makes inroads into a broader range of medical specialties, cardiovascular care is among the fields offering more virtual visits. This branch of telemedicine, known as telecardiology, seeks to achieve real-time, remote diagnosis and treatment of heart disease — including congestive heart failure, cardiac arrest, and arrhythmia. One of those ways is raising compliance rates for cardiac rehab, a medically supervised program designed to improve cardiovascular health after a heart attack or other event requiring care. But only 25 percent of patients follow the prescribed regimen.
In 2016, the American Heart Association published a policy statement encouraging the use of telehealth applications to improve cardiovascular and stroke care.
“Remote monitoring of patients with implantable cardiac devices resulted in timely diagnosis and management of arrhythmias and heart failure symptoms, leading to better clinical outcomes. Also, using telestroke to evaluate patients with acute ischemic stroke eligible for thrombolysis provided access to acute stroke care in underserved areas and has been shown to be as safe and effective as usual care.”
Crystal Wong, MD
Telemedicine applications are exceptionally well-equipped to connect physicians with patients who live in remote areas of the country or to quickly offer a consultation to patients living with chronic cardiovascular diseases.
There are multiple benefits to both patients and clinicians in using Telecardiology in health care. Here is a partial list:
- Reduces Hospital Transfers
- Increases Access to Premium Healthcare Delivery for Cardiac Patients
- Creates Uniform Healthcare Accessibility to Larger Populations
- Encourages Effective Collaboration of Cardiologists Worldwide
- Makes Cardiac Healthcare More Affordable and Convenient
- Encourages Smooth Triage and Relieves the Burden on Healthcare Providers
- Increases Patient Satisfaction
Telecardiology is one of the fastest-growing fields in telemedicine. There is already a significant quantity of published clinical data, with some randomized multi-center trials to answer the most critical questions definitively. The contribution of telecardiology in some fields, such as emergency and chronic care, undoubtedly improves healthcare quality and helps contain rising costs.
Some closing thoughts – Digital technology does have the potential to overcome several barriers, such as geography and time. Hence, even with equivalent health outcomes to standard care, there are huge positives regarding reach from a public health perspective. Furthermore, digital health interventions should not be viewed as a stand-alone, one-size-fits-all solution but rather an addition to the current multifaceted health interventions that can be personalized to different patient populations. With the digital health revolution, we can consider these tools not only a way to achieve better patient health outcomes but also as innovative ways to reimagine the way we currently conduct clinical studies. These digital technologies can enable new models of virtual trials, potentially reducing the duration and costs of future research while increasing our ability to achieve meaningful results.