Cardiovascular diseases remain the number one killer of people in the world, resulting in 31 percent of all global deaths (17.9 million per year), and are the most expensive condition to treat. However, AI and machine learning technologies are being developed to make care pathways, treatment and real-time visualization of cardiac anomalies and subsequent therapy more effective. Artificial intelligence (AI) and machine learning capabilities may provide numerous advantages over traditional analytics and clinical decision-making techniques, and cardiology is likely to benefit tremendously from these advancements as they mature.
Stuart Long
“As machine learning-based algorithms become more precise and accurate by interacting with data and programmed information, these technologies will allow care teams to gain unprecedented insights into diagnostics, care processes, treatment variability and patient outcomes, especially in regard to cardiac care,” said Stuart Long, CEO of InfoBionic, the leading digital health company that created the MoMe Kardia remote cardiac monitoring platform.
“AI algorithm-based cardiac devices can procure tremendous amounts of data, providing for the ability to match up what physicians are seeing to long-term patterns and possibly detect subtle improvements that can impact care,” noted Long.
Leveraging AI for clinical decision support, risk scoring and early alerting is one of the most promising areas of development for this revolutionary approach to data analysis. Powering new tools and systems can help make clinicians more aware of nuances, more efficient when delivering care, and more likely to curb a patient’s developing health problems.[1]
AI is ushering in new clinical quality and breakthroughs in patient care. For example, at the Cleveland Clinic[2], a customized algorithm developed by clinicians analyzes data, including blood pressure, heart rate and oxygen saturation levels, to flag the patients that are at highest risk of deterioration. The ultimate goal is to provide front-line clinicians notice of serious cardiac events before they happen. Moreover, the precision now possible with cardiovascular imaging, combined with “big data” from the electronic health record and pathology, is likely to lead to tremendous cases of cardiac disease management and personalized therapy[3].
Healthcare consulting firm, Frost & Sullivan, projects a 40 percent growth rate[4] for AI in healthcare between 2016 and 2021, and said AI has the potential to improve outcomes by as much as 40 percent, while reducing the costs of treatment by as much as 50 percent.
Sudden cardiac arrest (SCA) remains the leading cause of death in athletes, with recent studies showing the condition occurs more frequently than historical estimates.[1] Currently, there are more than 350,000 SCA-related deaths each year.[2] Stuart Long, CEO of InfoBionic, a digital health company that created the MoMe Kardia Platform, confirms that remote cardiac monitoring that is FDA cleared for diagnosis of arrhythmias is the next logical step after an alert from an athletes’ consumer wearable if confirmed by a physician.
Stuart Long
According to a recent study by the University of Toronto, health screenings only identify young athletes who are at risk for cardiac arrest. However, more than 80 percent of cardiac cases are not discovered through systematic screening, researchers say. In fact, a significant problem with current screenings is that they exclude people whom are perceived healthy enough to safely engage in sports.3
A separate study sponsored by the National Institute for Health of 2,640 competitive soccer players featured data collected from 1974 until April 2004. From this population, there were 62 reported cardiac arrests; 24 were sudden death events; and 38 were resuscitated from cardiac arrest.4 SCA is responsible for as many as 20 percent of all deaths in the U.S., according to the study, and “50 percent of sudden cardiac deaths are first cardiac events, meaning the patient did not know they had heart disease,” Dr. Robert J. Myerburg, a professor at the University of Miami (Fla.) and a cardiologist said.5
In the U.S., on average, one young competitive athlete dies suddenly every three days. Young athletes are twice as likely to experience SCA than young non-athletes. Exacerbating the issue is that no two heart conditions are the same, as demonstrated by several young professional athletes who have suffered in-competition cardiac events.6,7
Consumer wearable devices can detect worrisome irregular heartbeat in many cases. However, the perceived lack of accuracy is leading to skepticism around false positives. For example, devices that employ electrocardiogram-like technology can be hindered when an athlete’s skin is wet, limiting or impairing the device’s readout, especially impacted by artifact or noise during intense activity. Wearers who receive an alert through the watch’s technology are instructed to consult a physician who can provide further diagnostics.8
With a recent study revealing a substantial rise in heart attacks among younger women, developers of cardiac medical technology are seeking to help reverse this trend. The study, published in the journal Circulation, examined the incidence of heart attacks in women ages 35 to 55, finding: From 1995 through 1999, this population accounted for 21 percent of reported heart attacks among all women; and from 2010 through 2014, that number increased to 31 percent of reported heart attacks among women.
That’s an increase of nearly a third in just 10 to 15 years – a huge jump in epidemiology terms for a cardiovascular condition that is not known to be communicable. It’s especially disconcerting because the incidence of heart attacks among men in the same age group barely budged during that time.
Heart disease in women often goes undetected or un-diagnosed. Then, when a cardiac event finally strikes, it is much more lethal:
Younger women have worse heart attack outcomes than men of a similar age.
Ages younger than 45 is a known predictor of 30-day survival for men, but not for women.
Gender differences in cardiac events
There are a number of reasons for these poor outcomes. Because the symptoms of a heart attack are different for women than men, women often attribute their symptoms something far less serious. But even when younger women experiencing heart attack symptoms do seek medical treatment, doctors themselves have struggled to get to an accurate and timely diagnosis.
Women are less likely to experience dramatic chest pains. Instead, they are more likely to experience fatigue, nausea, dizziness/lightheadedness and vomiting – symptoms that can cause doctors to mistakenly diagnose women with other conditions, thus delaying treatment.
The difficulty is compounded by the fact that spontaneous coronary arterial dissection (SCAD) – a form of heart attack that overwhelmingly affects women – is not as highly correlated with known heart attack precursors such as diabetes and hypertension. Unlike myocardial infarction, SCAD often strikes healthy women, with an average onset age of about 42 – with reported cases as young as 14.
These relatively healthy and active women are not thought of as high risk for a heart attack when they present, and so are even less likely to receive important diagnostic procedures like CT angiograms, coronary calcium scans and remote cardiac monitoring.
According to a study from the University of Leeds, women who had a final diagnosis of ST-elevation myocardial infarction (STEMI) were initially misdiagnosed 59 percent more often than men, while women who had a final diagnosis of non-ST elevation myocardial infarction (NSTEMI) were initially misdiagnosed 41 percent than men.
Early misdiagnosis predictably led to substantially higher mortality among young women experiencing their first heart attack. Even when women do seek treatment, and get a cardiac event diagnosis, they are less likely to receive the same treatments that men do:
A study published in the International Journal of Cardiology showed that both younger and older women with acute coronary syndrome are less likely to receive reperfusion.
Women with blocked coronary arteries were 34 percent less likely than men to receive stents or bypass surgery.
Women were 24 percent less likely to be prescribed statins.
Women with known heart issues were also 16 percent less likely to be put on an aspirin regimen.
Medical technology advancements
Fortunately, new technology can play an important role in the fight to track and diagnose cardiac events earlier and faster. Advances in data storage and management, deep learning, artificial intelligence and secure telecommunications are helping to make cardiac monitoring and diagnosis easier, faster, less invasive, more convenient and more economical for patients and doctors alike.
