CONFERENCE UPDATE : ESC2020

Digital health provides opportunities to cardiologists and brings benefits to the healthcare system

30 Oct 2020

During COVID-19, digital health has become increasingly more prevalent over the world. Composed of information and communications technology, computer sciences, genomics, artificial intelligence (AI) and more, digital health helps collect patients’ information and analyze a large amount of data to support decision making in health-related fields.

 

One such application of digital health is to enable the remote monitoring of atrial fibrillation (AF) and improve the data collection and screening accuracy of detecting and predicting AF. In patients without ventricular dysfunction, those with a positive AI screen were at 4 times higher risk of developing future ventricular dysfunction when compared to those with a negative screen (HR=4.1; 95% CI: 3.3-5.0). The results showed that the application of digital health to electrocardiogram (ECG) can transform the data into a ubiquitous, inexpensive and powerful screening tool in asymptomatic individuals to accurately identify asymptomatic left ventricular dysfunctions (ALVD).1

 

Dr. Friedrich Koehler, Head of the Centre for Cardiovascular Telemedicine, Berlin, and other researchers from Germany carried out a study investigating the impact of remote patient management (RPM) on unplanned cardiovascular hospitalizations and mortality in heart failure (HF) patients. The TIM-HF2 trial is a prospective randomized controlled multicenter trial that have recruited 1,538 HF patients with a history of a HF hospitalization within 12 months prior to randomization. After 12-month follow-up under intervention and 12-month real-world extended follow-up, patients managed by a telemedicine center had a lower mortality rate, HF-admission rate and an improved quality of life.2 Dr. Koehler commented, “Remote monitoring can detect patient’s voice, sleeping behavior, activity, and results in better monitoring.”

 

In addition to applying AI for remote HF monitoring, digital health can also help detect AF cases. At the e-congress of ESC 2020, Dr. Emma Svennberg, Department of Cardiology at Danderyd's Hospital in Stockholm, Sweden, said, “Possibly, we can see that digital health can at least provide some links towards the solution, certainly by using artificial intelligence to identify population that are at risk of atrial fibrillation. We can use artificial intelligence from existing tools in the clinic to possibly predict who will get AF. The increased use of wearables in the society can aid and detect cases of asymptomatic AF.”

 

Despite its advantages, the use of AI has raised some ethical concerns in privacy and confidentiality such as how patient data is used, how decision-making algorithms are designed and operated, how healthcare professionals are interacting with technology, and who can access the collected data. In particular, there are concerns that the healthcare industry may become over-reliant on AI to the point where any company that utilizes digital health can become a healthcare provider. Medically, cardiologists have also expressed concerns that patients may begin to rely on digital devices and information found on the internet and hold incorrect medical ideas or practices. In this evolving patient-physician relationship, the traditional art of caring may be twisted into a science of measurement only with patients' life and feeling neglected.

 

That said, the appropriate integration of digital health to a cardiologist’s practices can provide efficient data analysis to improve the healthcare system as a whole. By removing regional barrier, cardiologists can utilize digital health to provide care to patients in remote areas. To ensure the transparency of digital health, regulations and legislation should be enforced to protect patients’ privacy and confidentiality before bringing digital health into clinical practice.

“We can use artificial intelligence from existing tools in the clinic to possibly predict who will get AF.”

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