Recent advances in cardiac care

Author: Dr Varsha Kiron , Consultant CardiApollo Hospitals, Jubilee Hills

India

healthysoch

New Delhi, September 27, 2022:

Cardiovascular diseases (CVDs) are a group of disorders involving the heart and blood vessels which, as per WHO result in over 30% of global mortality. Of these deaths, 85% result from a heart attack or a brain stroke. The prevalence of CVDs among middle aged individuals in India is about 30% making it a very important target for prevention and treatment. There are many recent advances in medical technology aimed at treating the burden on CVDs.

Wearable devices for monitoring:

Smart watches have become very common and most of them have features like step counting, sleep tracking, activity tracking and heart rate monitoring making them very viable clinical tools. More advanced smart watches like Apple watch (series 4 and above), Fitbit charge and Samsung Galaxy series 3 have an electrical heart sensor which enables them to take a single lead ECG. This makes remote diagnosis of dangerous heart rhythm abnormalities like Atrial Fibrillation very easy. Some of the newer features in these watches include fall detect alarm and automatic notification to emergency contacts which has documented many lives saved due to early identification of a problem.

Wearable blood pressure (BP) monitors like Omron Heart Guide and Platinum offer wireless connectivity to the phone, and also have additional features like activity tracking and colour coded feedback on the measurements. Wearable biosensors in the form of self-adhesive patch by Philips Biosensor BX100 measures vital signs like temperature, pulse rate and respiratory rate. Additionally, the patch would also measure posture changes, activity level and ambulation, which made a remarkable contribution towards management of COVID19 patients during isolation.

Digital assisted therapy:

COVID19 pandemic paved a way for significant uptake of telemedicine in the form of online consultations and e-ICU setups. There have been numerous online consultation platforms like Apollo 24X7 which enabled doctor consultations and therapy in patients who were isolated at home. Availability of Biosensors patches made the idea of remote e-ICUs a reality wherein a wide variety of vital signs and continuous ECG is monitored remotely by a physician.

CureApp’s DTx app delivers personalised advise to the patients on diet, exercise, sleep and medication reminders based on the blood pressure trends. It also facilitates a remote consultation with the physician. The preliminary date from Japan not only showed a 10 mm Hg reduction in the systolic BP of its users, it also resulted in 10.7% reduction in CVDs over a follow up period of 6 months.

Digital stethoscope eliminates the need for direct physician contact with the patient for examination thereby bridging a huge gap in the field of telemedicine. TAAL device by MuseInc. is an indigenous digital stethoscope that can record the auscultatory sounds for remote transmission. They have also developed COSWARA audio detection tool which showed high specificity in the detection of COVID19 in symptomatic individuals based on lung auscultation. Littmann EKO and HD Steth are other examples of digital stethoscopes which enhance the physician’s ability to diagnose various cardiac conditions.

Remote cardiac monitoring:

Remote cardiac monitoring empowers the patients in managing their health and resulted in significant reduction in the need for emergency hospitalization by 65%. TIM-HF2 trial showed the importance of daily wireless transmission of body weight, BP, heart rhythm, oxygen saturation and self-rated health status in prevention of unplanned heart failure hospitalizations.

A major challenge to this remains the compliance to the measurements and their periodic transmission to the physician. Numerous algorithms exist with implantable devices like CRT and ICDs in measuring thoracic impedance, thereby extrapolating the fluid status. Major drawback of this technology is cost and the fact most patients with heart failure do not have an indication for these devices.

Another indigenous solution to such a problem is solved by Dozee device which is a contactless vitals monitoring system. Dozee uses Ballistocardiography (BCG) to record ultra-low-frequency vibrations of the heart during various phases of cardiac cycle and it records heart rate, respiratory rate and presence of any arrhythmias.

Dozee mat is placed under the matress over which patient sleeps and the above mentioned date is generated through various algorithms. Additional parameters such as no-contact BP measurement as well as left ventricular ejection fraction (heart’s blood pumping capacity) measurement is also possible through this platform. Such a solution brings revolutionary change in the field of remote monitoring even in critically ill patients.

Artificial intelligence and machine learning in cardiac care

Artificial intelligence (AI) refers to the machines’ ability to solve problems that would otherwise have required human effort. Machine learning (ML) is the ability of machines to learn independently and make necessary predictions and algorithms. Its application is broadly in automated image processing, data extraction from electronic health records and predictive analysis.

One of the most successful application on image processing is the ability of AI-ML algorithms to detect atrial fibrillation by a smart watch as proved by Apple and Huawei. Chest X-ray interpretation for prediction of COVID19(infections)/Cancer is an ever growing area of research.

EchoNet-Dynamic is a novel video based deep learning algorithm which estimates the left ventricular ejection fraction (heart’s pumping capacity) on 2D echocardiography. A recent study showed this algorithm out-performed trained cardiologist in accurately predicting the cardiac function. AI-ML has a huge potential for development in future and changing the way the most cardiac conditions are detected and treated.

healthsoch