Dr Debabrata Dash, MD (Medicine), DM (Cardiology), FICC, FCCP, FAPSC, FSCAI, FACC, FSCAI, FESC, FACC is a consultant interventional cardiologist at Aster Hospital, Dubai. Earlier in his career, he worked at Veterans General Hospital (Taipei, Taiwan), Toyohashi Heart Center (Toyohashi, Japan) and Guangdong Provincial Hospital (Guangzhou, China). He set up the interventional cardiology department and worked as a Director of Cath Lab and Consultant Interventional Cardiologist in S.L Raheja (A Fortis Associate) hospital (Mumbai, India) and Sai Bhavani Super Specialty Hospital (Hyderabad, India). He has accumulated vast experience over 20 years in interventional cardiology. He had served as a vice chairperson of interventional cardiology in the Asia Pacific region for 2 years. He represented India as invited as international faculty in China, Korea, Japan, Latin America, Vietnam, USA, Malaysia, & Singapore to present the latest developments in interventional cardiology.
Cardiovascular diseases account for approximately 32% all global death every year. Smoking, excess alcohol intake, an unhealthy diet or sedentary lifestyle can lead to hypertension, diabetes, obesity– all of which will eventually manifest as heart attacks, heart failure or strokes.
Early detection would be the key to prevention through constant monitoring which has been so challenging until the appearance of pocket-sized, user-friendly digital technologies. Fitness trackers, health sensors and wearables measure physical activity, provide personalized dietary recommendations, help medication adherence, optimize sleep, as well as monitor various parameters of the heart. Clinical studies have demonstrated that digitally enabled cardiovascular interventions can improve patient outcomes and have led to a 23% reduction in hospital re-admissions. Some emerging cardiac technologies include artificial intelligence (AI), big data, blockchain, Alexa skills, and chatbots.
AI is an innovative technology that allows massive amounts of data to be fed into the algorithms which can then help the doctors in making the best decisions about the health of their patients. New generation cardiac ultrasound systems have started incorporating AI to automatically identify the anatomy, segment, label it, identify the optimal echo views and perform automatic measurements before the cardiologist begins to read the case. Currently, AI-automated calcium scoring software for cardiac CT scans, creates the report quantification information in seconds and color coding the calcium by vessel segment on the dataset slices. AI algorithms are being used to automatically detect arrythmias and send alerts to patients using wearables or smartphone-based apps that record ECG. It has been demonstrated that coupled with an Apple Watch, the Kardia was able to detect atrial fibrillation with very high sensitivity. Moreover, another research has shown that when paired with AI technology, it was able to detect high potassium levels in the blood non-invasively, which could signal diabetes or heart failure. Examples of this technology are the Apple Watch and the Kardia Alivecor device. AI is likely witnessing its biggest steps forward in cardiology for point-of-care triage with apps and wearables cardiac monitoring technologies. This is likely to augment the process of getting high risk patients examined by a human cardiology specialist and aid in earlier detection of cardiovascular diseases. The EKO Core products are the most well-known digital stethoscopes on the market. Small, simple, smart, and portable medical devices enable the doctors to measure heart rate and record heart and lung sounds, saving it automatically to the app. Combining infra-red technology with Bluetooth connectivity, it is possible to stream the measurements to a clinician remotely, storing them for comparisons later. A wide range of digital health products including stethoscopes use AI to support the diagnosis. A Skeeper is a pocket cardiologist developed by a South Korean company. It listens to heartbeat with the level of the accuracy of a stethoscope, analyzes beats per minute and heartbeat consistency. VitalConnect’s patch is an example of digital tattoos which is a biosensor monitoring many physiological measurements simultaneously including heart rate, heart rate variability or respiratory rate, while also functioning as single lead ECG. Wiwe is another smart sensor using a unique, AI algorithm that evaluates the properties of the ECG wave to calculate if there is a risk of atrial fibrillation related stroke and sudden cardiac arrest. It not only gives accurate data about ECG, blood oxygen level or different physical activities but the use of the pedometer function helps reduce the risks related to heart disease. Cardioexplorer is the first evidence-based AI powered test which detects plaques, fatty deposits in coronary arteries with higher accuracy. It may predict the potential risk of heart attack. I believe that in the future, patients would monitor their heart health anywhere, and the AI powered gadgets will only notify them and their physicians in case of abnormal health events.
Big data is another technology that can be used to detect and predict cardiovascular diseases. In the near future, doctors will have access to complex databases where a specific patient’s characteristics can be entered to get the likelihood of that patient developing a cardiovascular disease with more than 80% confidence. A comprehensive list of factors include gender, type of chest pain, resting blood pressure, serum cholesterol, fasting blood sugar, ECG, maximum heart rate achieved, exercise induced angina, old peak, slope, and number of major blood vessels colored by fluoroscopy.
Blockchain technology is slowly gaining momentum in the cardiovascular healthcare after proving its efficiency in various industries from banking to real estate and supply chain. Farasha, a startup has designed the first watch to analyze, alert, and prevent cardiovascular diseases in real-time using AI and blockchain smart contracts. Smart contracts are a computer protocol designed to make digital transactions faster and more secure. Smart contracts are also used to store patient records in a digital ledger. Health providers currently use multiple electronic health record (EHR) systems to record patient data. This often leads to medical errors, accounting for third leading cause of death after heart disease and cancer. Many deaths from heart attack and stroke and cancer could be prevented each year if these patients were in charge of their personal health information via an EHR system that is powered by blockchain technology. Blockchain technology also used to encourage healthy behaviors among patients with heart problems. By adopting a healthy lifestyle, patients can cut their risk of heart disease by 50%.
Amazon’s Alexa is a voice-enabled technology that is already making impressive strides towards improving health outcomes for heart disease patients. This tool with smart speakers could tell if the patient is having a cardiac arrest by listening to the breathing and it is accurate 97% of the time. Omron Healthcare has built a new Alexa skill that allows the patients who use their blood pressure monitoring devices to manage their condition using voice commands. The Rochester-based medical center discovered that a voice-analyzing app can help detect coronary artery disease based on a patient’s tone and intensity. We can vouch for this technology’s efficiency in reducing healthcare costs and mortality rates among heart failure patients.
Chatbots are AI messaging programs designed to elicit information from users and provide answers based on user input. Doctors should explore the chatbot options that can best be integrated with their existing technologies and use them to collect critical information for treating patients suffering from cardiovascular diseases. Gamified mobile apps are mobile health applications motivates patients to improve their modifiable risk factors and to reduce cardiovascular risk-factor profiles. Currently Telemedicine applications are well-equipped to connect physicians with patients living in remote areas to quickly offer a consultation to patients living with chronic cardiovascular diseases that impacts quality of care and patient outcomes. Robots in the catheterization labs allow remote control manipulation of catheters for angioplasty which takes the operator out of the radiation field. It will be more useful for the more complex and prolonged procedures.
The complexity of coronary artery disease is currently on the rise. Complex high-risk and indicated percutaneous coronary intervention (CHIP) is an evolving concept that usually involves left main PCI, calcium atherectomy, chronic total occlusions, and left ventricular support assisted percutaneous coronary intervention (PCI). With emerging techniques and technology, this concept avoids open heart surgery to a greater extent. Emerging tools like AI and machine learning might help physicians to unravel the best choice for patient outcomes in this scenario. For acute heart attack patients with 100% blockage with heavy clot burden, new devices such as the latest mechanical clot removal catheter “NeVa” assisted angioplasty have demonstrated excellent efficacy. The new-generation drug-eluting stents with thinner struts are associated with better outcomes. The latest advance in stenting technologies is the development of bioresorbable stent (BRS) that overcomes many of the limitations of current metal stents. BRS eventually breaks down and dissolve into the blood after implantation. This overcomes the need for long-term antiplatelet therapy, removing the risk of local hypersensitivity and chronic inflammation. This stent aims to leave a normal patent vessel with natural blood flow. Transcatheter aortic valve replacement (TAVR) has replaced surgical valve replacement in many situations and is being performed as a same-day outpatient procedure. With the success of TAVR, cardiologists’ attention has rapidly shifted toward transcatheter mitral valve repair and replacements (TMVR) and transcatheter tricuspid valve repair and replacements (TTVR). Several devices are underway to meet the need of TMVR and TTVR that would obviate the need for open heart surgery. Certainly, the potential emerging techniques and technologies would create a favorable impact on prevention, early diagnosis, and treatment of cardiovascular disease.