The reach of technological innovation in cardiac care is continuing to grow, and as it does, is changing how and where care can be delivered. This allows providers to stay connected with patients at all times.
The scope of these emerging technologies is amazing, says Dr. Mike Mathier, director of the heart failure and pulmonary hypertension section of the UPMC Heart Transplant Team. One of the major developments today is steady movement toward fundamentally changing heart structure through catheters, rather than surgery, he says.
“There’s been a revolution over the last five to 10 years, where we can increasingly fix people who have valve disease with catheter-based methods instead of having them go to the operating room, get their chest opened up and go through a standard old-fashioned surgery; [and this] appears to be markedly decreasing adverse events,” Mathier says. “It’s speeding recovery time. It’s also enabling things to be done in patients who, in the past, were considered too risky.”
One of these procedures is the trans-catheter aortic valve replacement. This procedure is a less invasive way to repair aortic stenosis — a blockage of the aortic valve — and avoids making an incision on the body. Dr. Stephen Bailey, a thoracic and cardiac surgeon and division director of cardiac surgery at Allegheny General Hospital, calls it a game-changer.
“We go in through a catheter in the leg and place the stent valve inside the knee of the aortic valve, and really dramatically improve patients’ symptoms such as shortness of breath, extra stress tolerance, heart failure symptoms, and extend their life quite dramatically by alleviating the aortic stenosis,” he says.
This new procedure has been rolled out cautiously, first to people who are very high risk for surgery, or who can’t be operated on at all, Bailey says. It was just approved for people who are at moderate risk. Allegheny General Hospital has begun a study looking at this procedure for low-risk patients.
Dr. Srinivas Murali, medical director of Allegheny Health Network’s Cardiovascular Institute, also sees tremendous progress made with respect to imaging.
“We are now able to image the heart in two dimensions,” he says. “3-D imaging is available, which allows us to get a better look at the heart in three dimensions. That allows us to improve our diagnostic capabilities and identify the problem much more precisely than we could in the past.”
Cardiac-care devices, such as pacemakers and defibrillators, are more advanced now than they’ve ever been, with most containing built-in electronic chips. The patient takes home a little box that’s put next to his or her bedside, and physicians can watch that pacemaker remotely for an indefinite period of time.
“In other words, you get a pacemaker placed and you go home,” says Dr. Jeffery M. Friedel, chief of cardiology for St. Clair Hospital.
“It used to be that every six months, the patient would come in and we’d check the device, and so forth. Whereas now, the patient takes the monitor home, and we can watch the heart rhythm and the heart vitals continually throughout the year.”
Due to this home-monitoring capability, cardiologists can now quickly detect heart rhythm problems. In addition, the devices are smaller and less invasive, and the batteries last longer, Friedel says. In his sub-specialty of interventional cardiology, heart catheterizations, angioplasties and stent procedures have seen significant advances in the past couple of years.
“There are some stents which actually partially dissolve in the body after they are placed,” he says. “There are also some newer stents that completely dissolve or are absorbed by the body. This has been a huge advancement for the specialty because it helps prevent inflammation inside the artery after the stent is placed. It makes it less likely for blood clots to form in the artery.”
Ultimately, these new breeds of stent will lead to less reliance on long-term blood thinners, Friedel says.
Another major development unfolding is greater integration between patients, doctors, caretakers and care facilities brought about by advances in information technology. As a result, doctors can keep a much closer eye on how their patients are doing on a day-to-day, or even hour-to-hour basis, if necessary.
Mathier says they are very optimistic this will result in improved outcomes and decrease the number of patients who need to be hospitalized, especially for conditions such as congestive heart failure.
According to Murali, there has been significant progress in recognizing and understanding the differences between heart disease among men and women. Women’s heart disease is now recognized as a distinct condition.
“The risk factors are different, and the way the disease behaves is different,” he says. “So the outcomes are different, and perhaps the testing used for diagnosis and the treatment options are also different. At Allegheny Health Network, we have a different heart center that focuses on this and is able to target these patients and really treat them in a very personalized focused way to allow for the best outcome.”
As he looks ahead, Mathier says the field of medicine in general is moving toward personalized medicine and personalized care.
“This idea that instead of making the assumption that everybody fits the same mold, we’re going to increasingly be able to understand very specific aspects of each individual’s care, and their own individual body, and its biology and how it functions,” he says.
Most of this will occur through genetic analysis, but other methods will be implemented, including the possibility of implanted monitors where physicians can follow cardiac function and vessel function in real time.
“I think we’ll move from an era where we approach every patient in a very similar way to one where we’ll be tailoring care for the individual,” Mathier says.
Bailey adds that it will be important to look at each patient holistically.
“It’s going to be incumbent on all of us in healthcare to really look more globally at the patient and not just take care of one little problem, but think about their whole self,” he says. “We need to do a better job of communicating amongst different specialties and different physicians to look at the whole patient experience and coordinate that care in a more efficient way. I think that is going to lead to much better outcomes and probably some cost savings too.”
