technology

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

Huan Wang, PhD

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.”
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The Robotic Technology in Interventional Cardiology

Lina Ya'qoub, MD

The past few years have witnessed amazing advances in the robotic technology leading to its widespread utilization in both research and clinical aspects across multiple fields, including the cardiovascular field! I have recently attended a few conferences and the footprint of the robotic technology has been remarkable in each of them, emphasizing the great interest in the progress and utility of technology in our field. I decided to talk about robotic technology in interventional cardiology, the advantages and limitations of its use, and how I see it impacting the future of interventional cardiology.

  • How long have we used robotic technology in the cath lab?

Robotic technology has been used in surgical specialties and radiation therapy since the mid-1990s. Then, robotics systems for endovascular interventions were developed and have been utilized for different percutaneous interventions, including simple and complex coronary and peripheral interventions, as well as other structural heart disease procedures, including atrial septal defect closure.

  • Do we have scientific evidence-based trials assessing the robotic technology in interventional cardiology?

There are many prospective trials looking at robotic technology in both coronary and peripheral interventions. The two major studies are:

  1. PRECISE (Percutaneous Robotically Enhanced Coronary Interventions) trial: 164 patients with relatively simple lesions (>87% ACC/AHA type A/B; lesion length 12.2 6 4.8 mm), the investigators reported clinical success of 97.6%, technical success of 98.8% and > 95% median operator radiation reduction. Based on the results of this study, in 2012, the FDA approved the CorPath 200 System as the first robotic system for PCI.
  2. The RAPID (Robotic-Assisted Peripheral Interventions for Peripheral Artery Disease) trial, a prospective single-center, safety and feasibility study demonstrated the utility of the CorPath 200 system for robotic peripheral interventions. The study demonstrated 100% device technical and clinical success. No significant adverse events related to the device were reported, and based on this study, the CorPath 200 system received FDA approval for peripheral interventions.
  • Advantages
  • One of the main advantages of the robotic system in the cath lab is the reduction of radiation exposure for both the operators. The hazards of radiation are well-known and studies have demonstrated that the use of robots led to a reduction in radiation exposure [1]. Operators using the robotic system can either be in the cath lab several feet away from the radiation source or even in a separate room, where they can control the joystick and use the control pad to adjust the robot movements to control wires, the guide catheters and other devices (balloon, stents, etc..).
  • Robots also help avoid wearing heavy lead aprons and thus decrease the orthopedic problems that many operators suffer from in the long run, including back pain and arthritis.
  • Moreover, studies have also shown that robotic system use is associated with good precision and outcomes [1].
  • Robots have been increasingly utilized with around 100 hospitals in the US currently using robots in the cath lab. This quick and widespread utilization of this new technology demonstrates not only how safe and successful the robotic system is, but also how easy and user-friendly it is.

 

  • Limitations

In my opinion, this tool was developed to help operators, but not to replace them. Like any tool, the machine can potentially stop working, for a technical reason or other reasons, and at the end of the day, it is the physician’s responsibility to deal with the situation and solve the problem. In addition, the use of robotic system is limited in the following:

  • The use of robotics in STEMI or bifurcation lesions has not been well-established yet, although reports and smaller studies have shown it can be performed safely.
  • There are technical limitations of the robotic system, and if a lesion could not be treated, manual conversion is recommended.
  • Limited devices used by the current generation of robotic technology: use of over-the-wire balloons, intra-vascular imaging catheter, or mechanical circulatory support is not available with the current generation of robotics.
  • How will robots change the future of interventional cardiology?

The robotic technology has been increasingly utilized in multiple hospitals across the world. With more experience with robotic technology utilization, more knowledge and future upgrade of robotic systems, I think this tool will be increasingly utilized and updated to conform to the needs of patients, operators and different kinds of procedures and interventions; in fact, the robotic system is being studied in the utility of transcatheter aortic valve replacement (TAVR) procedures! Moreover, the utility of the robotic technology could potentially enable experienced operators to remotely perform complex interventional procedures in patients in different hospitals in rural or urban areas, different states, different countries or even different continents!

With the rapid progress in technology in all fields of our life, I think it is very important to establish and encourage more collaborations between technology and medical sciences, especially in procedural specialties, where precision and safety can be provided by these advanced robotics systems for optimal outcomes. I look forward to seeing how these technologies will evolve and transform our practice in the future!!

 

I would like to thank my colleague and friend, Dr. Jeff Hsu, for his help on this blog and for being an awesome senior buddy!!

References

  • Mahmud et al: Robotic technology in interventional cardiology: Current status and future perspectives. Catheter Cardiovasc Interv.2017 Nov 15;90(6):956-962.

https://onlinelibrary.wiley.com/doi/abs/10.1002/ccd.27209

“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.”