CARDIOLOGY 

December 2019 

2.0 

Sophisticated Technology in the Diagnosis and Treatment of Cardiovascular Diseases

By Partho Sengupta, Chief, Division of Cardiology,


WVU Heart and Vascular Institute,

J.W. Ruby Memorial Hospital.

There are currently two most important issues with respect to cardiovascular diseases, which need to be largely addressed. Firstly, the epidemic is increasing worldwide. There's an increase in the pool of patients who are getting older, which is associated with high prevalence of cardiovascular disease.


The other problem is that the number of medical professionals providing services is not increasing at the same rate. Hence, there's a disparity, and soon there will be a shortage of medical professionals. In fact, there's an evident shortage of medical professionals across the globe that is already projected.

These barriers have led to differ-ent consequences. Healthcare providers or professionals are beginning to consult more patients in a shorter period of time, which is adding further complexity to the above-mentioned issues. Also, the amount of information being recorded is drastically increasing. There is no one simple therapeutic solution. Multiple types of solutions are offered. The fact that there are more patients, fewer physicians and a labyrinth of complex information has led to a chaos as to how we can provide services and at the same time, be abreast of all the developments and yet, be able to deliver the right care for the right patients.


Leveraging Technology to Solve the Intricate Challenges

Fortunately, the processing speeds of computers have grown, because of which we are able to sort the issues effectively. We are seeing the emergence of more miniaturized technologies entering the scene. Devices that used to be bigger can now be in your pocket. A lot of the diagnostics or information sensing gadgets have now become miniaturized smartphones and devices that can register huge volumes of information. Another ability that is making it easier to treat patients is the imaging and robotic devices that hospitals use for surgical

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There are several m-health applications that are introduced. M-health has brought in both, a challenge and an opportunity for physicians. For example, when a patient connects with a doctor, he may no longer ask questions regarding how short of breath he is or what is happening to him. Instead, he could say that he has downloaded an app from the internet which records his pulse

and that there is a fluctuation and ask the doctor what it means. This is a challenge because the physician is not trained to consult patients in these ways; the doctor has to be able to interact with these new devices and try to make sense of what problem the patient is having. The opportunity is the fact that, he would almost not see the patients at all if he were to consult them this way.


Partho Sengupta, MD, WVU Heart and Vascular Institute Chief of Cardiology, demonstrates how mobile technology is revolutionizing diagnostic testing, and why this efficient method is beneficial to patients.

For advanced heart failures, there's no doubt that some of the new therapies and proto - cois will allow us to do even high-risk procedures, but the bigger question is: where should the investment go? Should it be into products and protocols which allow an advanced disease to be treated or toward protocols and procedures that help detect diseases early and reverse them at that stage so that they don't develop into advanced diseases? The latter is more important. All the technological evolution and all the resources should be in the direction of helping people when they are younger and more productive and when they have the ability to make choices. 


The biggest issue is that a majority of theelderly people never often know about this disease affecting them. They may have had a disease that they did not know about it for 15 years, and now they are suddenly told that this heart valve needs to be replaced in six months. If the patient knew before, he would do something about it, treat his risk cycle more aggressively, and take decisions on alternative therapies. There needs to be more emphasis on earlier detection and earlier intervention than late intervention to reduce the billions of dollars spent on diseases identified at a later stage. All the latest technologies are of great help, but the emphasis should be on early risk prediction and intervention so that we can reduce billions of dollars spent in late stages of the diseases.

   The Role of Newer Devices in Enhancing the Quality Of Life

In the earlier days, for heart issues, the doctors would have to touch the patients, examine how the heart moves, and try to understand the problem. But today, there is already enough information that the patient shares through device-based recordings and these need to be ingested in conjunction with the examinations. Providers do not need to feel for the heart on the chest, they can simply put a pocket ultrasound on the chest and see if the heart chambers and valves are working. There is no need for imagining the state of the heart; the imaging can provide more direct information. The doctor doesn't have to guess how the heart is beating. It can be recorded and viewed on app or a monitor; the ease and clarity enable a physician to make better and faster decisions right when they meet the patients for the first time. In the past, 60-70 percent of the time was spent in understanding what was going wrong and the remaining 30 percent in the actual treatment of the patients. Today, this ratio can be reversed. We can accelerate the understanding of the problem in the first 20-30 minutes and spend the rest of the time talking to the patients on the right strategy. We have also evolved ourselves with developments like healthcare kiosks where they could be an automated telemedicine portal. There is also a lot of emphasis on leveraging Artificial Intelligence (AI) and machine learning applied at the point of care.


With the sophisticated imaging abilities, a heart image produced can be taken and cloned into a computer, and the doctor will work on that cloned model of the heart, and if he sees a valve, he could try to treat the valve with a design of surgery or minimally invasive procedure and try to solve the issues and how well the outcome can be predicted. When the patients come in, a blueprint of the surgical or the non-surgical solution can be shown. This gives a more personalized approach to treating the patients. The newer type of imaging techniques, with AI and machine learning, can together help create more realistic solutions.

Partho Sengupta

"All the latest technologies are of great help, but the emphasis should be on early risk prediction and intervention so that we can reduce billions of dollars spent in late stages of the diseases."