CONFERENCE UPDATE : ESC2020
Digital health provides opportunities to cardiologists and brings benefits to the healthcare system
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.”
AI-created digital twins of vertebra predict the vertebral fracture risk IN SM patients
It is projected that there will be 1.9 million new cancer diagnoses and over 600,000 cancer deaths in 2022 in the United States alone.1 Spine is the most common site for bone metastasis; up to 70% of cancer patients could experience spinal metastasis (SM) and about 20% of them become symptomatic, causing considerable pain and morbidity.2 Most common regions for SM are dorsal (45%), lumbar (17%), cervical (14%), and dorsolumbar (10%).3 Vertebral fractures (VFs) are the common complications of SM, with an estimation of 30% of patients developing VFs that mostly require surgery.4 Tumor lesions and some treatments for cancer can lead to loss of bone tissue, thus increasing the risk of VFs.5 Hence, it is imperative to predict the VF risk in SM patients, so that well-informed interventions can be designed.5 Factors influencing VFs include both the macro- and micro-structure of the vertebra, especially of the trabecula.5 In-vitro methods are used to study the biomechanical forces that alter the vertebral shape, but they cannot accurately measure in-vivo stresses that damage its microstructure.5 The development of computational modeling has made it a compelling tool for measuring these in-vivo stressors.5 A recent study by Ahmadian et al was to assess the feasibility of the artificial intelligence (AI)-assisted framework to create ‘digital twins’ of the human vertebra, termed ReconGAN, to predict the VF risk in both osteolytic and osteoblastic metastatic tumors.5
Influenza vaccines in HF patients reduce pneumonia and hospitalizationsa
In the American College of Cardiology (ACC) 2022 Scientific Session, Professor Mark Loeb from McMaster University, Canada, discussed his randomized controlled trial of influenza vaccines in heart failure (HF) patients to reduce adverse vascular events.1 The risk of cardiovascular (CV) events and de
Pharmacotherapy for HFrEF: A comprehensive network meta-analysis
Globally, approximately 26 million people suffer from heart failure, and an estimated 50% of those cases are heart failure with reduced ejection fraction (HFrEF).1,2 HFrEF patients have seen improvement in the mortality rate, in light of the evolving pharmacological treatment options.3 The utilization of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs), and sodium-glucose cotransporter 2 inhibitors (SGLT2is) have readily been employed.1,3-5 Despite the advancements and the availability of a variety of treatments, the mortality rate of individuals with HFrEF remains high.3,6 Therefore, it is necessary to ascertain optimal pharmacological therapy combinations supported by up-to-date global data, with the aim of further reducing HFrEF cases.2 Recent findings by Tromp J and colleagues published in the Journal of the American College of Cardiology: Heart Failure estimated and compared which treatment options are the most advantageous for HFrEF.4
AVATAR trial demonstrates early surgery benefits in asymptomatic patients with severe as
Aortic valve replacement (AVR) therapy is believed to improve symptoms, LV function and survival in symptomatic patients with severe aortic stenosis (AS).1 However, the indication for AVR in this group of patients remains a debate.1 And it is hypothesized that the strategy of early valve replacement in patients with severe AS in the absence of symptoms can be more beneficial than watchful waiting in carefully selected patients.1 Therefore, the Aortic Valve replAcemenT versus conservative treatment in Asymptomatic seveRe aortic stenosis (AVATAR) trial was conducted, by Professor Marko Banovic, Associate Professor of Cardiology at University Clinical Centre of Serbia and University of Belgrade Medical School, and his team to evaluate the safety and efficacy of early surgical AVR in asymptomatic patients with severe AS and normal LV function.1 This is a physician-initiated, prospective, multicentre, randomized, open-label, parallel group trial performed in 9 medical centres in 7 European Union (EU) countries to reach minimum of 35 prespecified events.1 The primary composite endpoints included all-cause death, myocardial infarction, stroke or unplanned hospitalization for heart failure.
Breaking the vicious cycle of cardiac, renal and metabolic risks in patients at risk of chronic kidney disease
Despite being associated with significant cardiorenal outcomes, many diabetic patients remain undiagnosed of chronic kidney diseases (CKD) or heart failure (HF) even when their diseases are at an advanced stage.1-3 In the recent Advances in Medicine 2021 held by the Department of Medicine and Therap
Hydroxychloroquine treatment poses no risk of heart failure in patients with rheumatoid arthritis
Despite the widespread clinical use of hydroxychloroquine (HCQ) as a disease-modifying antirheumatic drug for long-term rheumatoid arthritis (RA) treatment, only a limited data set consisting of case reports and case series is available to confirm the risk of HCQ cardiotoxicity, a rare but potentially life-threatening side effect.1