hidden

What Do We Know About the Future? The Digital Health Era

What do we know about the future? Although millions of possibilities come into mind, one thing is certain. One way or another, our lives are more and more dependent on computers and social media networks. How many of you check on your smartwatch or social media feeds more than once a day? I, for instance, am occasionally obsessed with my heart rate measurements and sleep patterns and constantly try to get a better understanding on how to optimize my own health. It’s very easy to get lost in trying to find the right kind of research from scientific journals. Most of the time people turn to social media to get ideas to make a healthcare decision. Study shows that 80% of internet users are looking specifically for health information1.

In today’s American Heart Association Scientific Sessions, a group of pioneers shares their insights in novel technologies for arrhythmia detection2 using big data to manage patient care systems. Dr. Leslie Saxon, of the University of Southern California Center for Body Computing, discussed the advancements of digital health, such as increased diversity of computer monitoring devices, increased data accessibility via the cloud, and novel digital biomarker identification. Particularly, using remote device follow-up improved 30-40% survival rate of patients after cardiac defibrillator implantation, according to a published clinical study (the ALTITUTE survival study)3. Another highlight from Dr. Leslie’s research, CORA, is a patient-facing, manufacturer-agnostic mobile application. CORA can help improve communications between patients and caregivers, visualize complex data in a simple way, and educate patients and caregivers about their health conditions.

Other advances in finding software solutions driven by big data collection are also critical in this digital era. An ongoing clinical study to determine if the Apple Watch and a heart health program can improve heart health outcomes, HEARTLINE, are recently launched in Feb 2020 with a collaboration between Johnson& Johnson and Apple (Clinical Trial NCT04276441).

Dr. Marco V. Perez from Stanford University talked out the recent developments of patient-acquired wearable technology, such as devices to monitor blood oxygen levels, glucose levels, and sleep rhythm. One of the challenges is potential data overload. Dr. Perez’s team implemented a machine learning algorism using a convolutional neural network to investigate 1.5 million ECG graphs from 500,000 patients collected from wearable devices. This artificial intelligence approach opens a new window with many possibilities in the health care systems and address novel research problems. Dr. Khaldoun G. Tarakji from Cleveland Clinic discussed how to use wearable devices to detect atrial fibrillation from a clinical practice perspective. He presented several case studies on using Apple watch to help diagnose and manage atrial fibrillation. In the field of telemedicine, Dr. Tarakji mentioned the advantages of using wearable devices to conduct virtual visits to improve patient care outcomes.

Figure 1: New technologies for the detection of atrial fibrillation 2

Despite apparent advantages of the application of wearable devices in the health care system, Dr. Paul D. Varosy from the University of Colorado discussed the challenges of using wearable devices regarding clinical, legal, cybersecurity, and ethical implications. The main questions are: How to fit data management into busy clinical practice? How to maintain financial sustainability? How to improve cybersecurity vulnerability? How to handle potential oversight? And who owns the data? These questions require continuing efforts from policy workers, researchers, doctors, and patients to work together to find solutions.

The new kid on the block: social media in the health care system. Dr. Janet K. Han from UCLA talked about the possibility of using social media to transform arrhythmia health care. Social media can make health information more accessible, engage patients better, provide valuable social and emotional supports4. Combining social media with big data with artificial intelligence and machine learning provides faster diagnosis and management5.

Wearable devices in combination with big data analyses in healthcare practices have a promising future. They are more accessible, engaging, and high payoff. Despite potential challenges, the era of digital health presents many possibilities and advantages in patients’ healthcare outcomes.

Reference

  1. Fox S. Profiles of Health Information Seekers. Pew Internet & American Life Project. 2011.
  2. Zungsontiporn N, Link MS. Newer technologies for detection of atrial fibrillation. BMJ (Online). 2018.
  3. Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, Meyer TE, Jones PW, Boehmer JP. Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: The ALTITUDE survival study. Circulation. 2010.
  4. Hawkins CM, DeLaO AJ, Hung C. Social Media and the Patient Experience. Journal of the American College of Radiology. 2016.
  5. Simonsen L, Gog JR, Olson D, Viboud C. Infectious disease surveillance in the big data era: Towards faster and locally relevant systems. Journal of Infectious Diseases. 2016.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

hidden

Can Fish Oil Supplements Help Your Heart? Consumer Discretion is Advised

The health benefits of fish oil, particularly omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) have been studied for decades. The key discoveries regarding the beneficial effects of n-3 LC-PUFAs include anti-inflammation, lowering blood lipid levels, anti-thrombotic effects, and possibly anti-arrhythmia (Mason, Libby, and Bhatt 2020). The market size of fish oil supplements expands rapidly in recent years and is estimated to reach USD 4.5 billion by 2027 (REPORTS AND DATA 2020). In many European nations, omega-3-acid ethyl esters have been prescribed to patients to reduce blood lipid levels for at least a decade and they also obtained US FDA approval in 2004 (Bays et al. 2008). However, not all news is encouraging. The findings of anti-arrhythmia effects of fish oil are mixed, with some trials demonstrating beneficial outcomes (Fig 1) and others finding no significant effects (Mozaffarian and Wu 2011; Reiffel and McDonald 2006).

Fig1. Physiological effects of n-3 PUFA that might influence cardiovascular risk.

The results of REDUCE-IT clinical trial published in 2019 promised a bright future for cardiovascular risk reduction using omega-3 fatty acids (Bhatt et al. 2019). In AHA 2020 late-breaking science session: “Fish Oil, Fancy Drugs, and Frustrations in Lipid Management”, Drs. A Michael Lincoff, Are Annesoenn Kalstad and Alberico Catapano presented compelling evidence on surprising neutral effects with omega-3 carboxylic acids supplement in two clinical trials. These controversial results provide an interesting argument on whether or not to take fish oil supplements for cardiovascular health protection.

Dr. Lincoff presented recent results about the effects of high-dose omega-3 fatty acids from the STRENGTH clinical trial (Nicholls et al. 2020). Despite moderate improvements in the blood lipid levels, patients with omega-3 supplementation have significantly increased risks of atrial fibrillation. The net outcome of omega-3 fatty acid supplementation is not beneficial. One of the possible explanations for this controversial result is using corn oil as a control condition instead of mineral oil–the control treatment in REDUCE-IT trial. Mineral oil treatment caused adverse effects, and corn oil had neutral effects on patients. Dr. Kalstad shared results from another clinical trial which showed similar findings (the OMEMI clinical trial) (Kalstad et al., n.d.). The overall effects of omega-3 fatty acids were neutral with an increased risk of atrial fibrillation. To bring together what we have learned, a summary was presented by Dr. Catapano to further evaluated the STRENGTH and OMEMI clinical trials. He thoughtfully discussed the discrepancies in REDUCE-IT, STRENGTH, and OMEMI trials, and provided several explanations such as the biochemical nature of DHA and EPA, different control conditions, and treatment dosage discrepancies.

Regardless of the discrepancies between STRENGTH and OMEMI trials, one thing is common, the increased risk of atrial fibrillation. So, if you are elderly with high cardiovascular risk, please think twice and monitor your response closely when taking fish oil as a dietary supplement. The frustrating results from STRENGTH and OMEMI trials don’t necessarily negate the beneficial effects in other aspects of the physiological benefits of fish oil (Fig 1) (Mozaffarian and Wu 2011). More research studies are needed in the future to better understand the effects and mechanisms of fish oil supplementation.

Reference

REPORTS AND DATA. 2020. Omega-3 Market To Reach USD 4.50 Billion By 2027 | CAGR: 7.2% | Reports And Data. Aug 10. https://www.prnewswire.com/news-releases/omega-3-market-to-reach-usd-4-50-billion-by-2027–cagr-7-2–reports-and-data-301109147.html.

Bays, Harold E., Ann P. Tighe, Richard Sadovsky, and Michael H. Davidson. 2008. “Prescription Omega-3 Fatty Acids and Their Lipid Effects: Physiologic Mechanisms of Action and Clinical Implications.” Expert Review of Cardiovascular Therapy. https://doi.org/10.1586/14779072.6.3.391.

Bhatt, Deepak L., P. Gabriel Steg, Michael Miller, Eliot A. Brinton, Terry A. Jacobson, Steven B. Ketchum, Ralph T. Doyle, et al. 2019. “Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa1812792.

Kalstad, Are Annesønn, Peder Langeland Myhre, Kristian Laake, Sjur Hansen Tveit, Erik Berg Schmidt, Pal Smith, Dennis Winston Trygve Nilsen, et al. n.d. “Effects of N-3 Fatty Acid Supplements in Elderly Patients after Myocardial Infarction: A Randomized Controlled Trial.” Circulation 0 (0). https://doi.org/10.1161/CIRCULATIONAHA.120.052209.

Mason, R. Preston, Peter Libby, and Deepak L. Bhatt. 2020. “Emerging Mechanisms of Cardiovascular Protection for the Omega-3 Fatty Acid Eicosapentaenoic Acid.” Arteriosclerosis, Thrombosis, and Vascular Biology. https://doi.org/10.1161/ATVBAHA.119.313286.

Mozaffarian, Dariush, and Jason H.Y. Wu. 2011. “Omega-3 Fatty Acids and Cardiovascular Disease: Effects on Risk Factors, Molecular Pathways, and Clinical Events.” Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2011.06.063.

Nicholls, Stephen J, A Michael Lincoff, Michelle Garcia, Dianna Bash, Christie M Ballantyne, Philip J Barter, Michael H Davidson, et al. 2020. “Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial.” JAMA, November. https://doi.org/10.1001/jama.2020.22258.

Reiffel, James A., and Arline McDonald. 2006. “Antiarrhythmic Effects of Omega-3 Fatty Acids.” American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2005.12.027.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”