“Eighty percent of premature heart attacks and strokes are preventable”

The increase in heart attacks in India is a concerning trend that can be attributed to various factors. Digital interventions play a significant role in cardiac care by providing innovative ways to prevent, monitor, and manage heart conditions.

In an exclusive interaction, Dr Dhiren Shah, Director – Cardio Thoracic & Vascular Surgeon, Marengo CIMS Hospital, Ahmedabad shares insights on the various aspects of digital healthcare interventions in cardiology including latest trends and role of digital technologies in bettering cardiac surgery and treatment.

Which factors are contributing to the recent rise in heart attack cases and resulting mortality in India? 

Common culprits include underlying heart conditions such as coronary artery disease, irregular heart rhythms (arrhythmias), and structural abnormalities. Lifestyle factors like poor diet, lack of physical activity, tobacco use, and excessive stress can significantly heighten the risk. In fact, Indians have genetic predisposition for Cardiac Disease.

WHO had predicted way back in start of 21^st century, that of total burden of cardiac diseases in world, 50% patients will be in India by 2020. Along with that India is progressing Economical and financially. This brings along with it, lifestyle diseases like Heart attacks, Diabetes, Hypertension, Obesity, Stress, etc. This all are precursor of heart diseases in India. So, I would say that for Indians, gun is loaded with genetic predisposition and changing lifestyle is working as a trigger and hence sudden rise of heart diseases in India.

Can timely interventions help in averting preventable deaths? 

The good news is that 80% of premature heart attacks and strokes are preventable. A healthy diet, regular physical activity, and not using tobacco products are the keys to prevention. Checking and controlling risk factors for heart disease and stroke such as high blood pressure, high cholesterol and high blood sugar or diabetes is also very important.

Importantly, with increasing lifestyle diseases in India, it is imperative that regular health check-ups are start from the age of 35 years. From this age onwards, every 2 years one should get health check-ups to identify the disease early and hence can be controlled at a very early stage. Also, if there is any risk factor like family history, diabetes, hypertension, stressful lifestyle then it is important that everyone should start with statin medication, so as to reduce the Blood cholesterols particularly LDL cholesterol to below 100. This can reduce the chances of heart attacks in future.

What role are digital technologies playing in bettering cardiac surgery and treatment? Any upcoming trends in this space? 

Digital technologies continue to revolutionize cardiac surgery and treatment, offering new avenues for improving patient outcomes, enhancing efficiency, and expanding access to quality care. The COVID-19 pandemic has accelerated the acceptability and implementation of a range of digital technologies, including remote monitoring and health tracking, mobile health (wearable technology and smartphone-based applications), and the use of machine learning to augment data interpretation and decision-making.

Digital technologies such as 3D imaging, MRI, and CT scans provide detailed insights into the patient’s cardiac anatomy. Robotic systems enable surgeons to perform minimally invasive cardiac surgeries with greater precision and control. Telemedicine platforms allow cardiologists to remotely monitor patients’ heart health, provide consultations, and adjust treatment plans as needed. This improves access to care, especially for patients in remote or underserved areas.

AI algorithms can analyze large datasets of patient information to identify patterns, predict cardiac events, and personalize treatment plans. Wearable devices such as smartwatches and fitness trackers can continuously monitor heart rate, rhythm, and other vital signs.

In terms of upcoming trends, the advancements in genomic sequencing and biomarker research are paving the way for personalized treatment approaches tailored to each patient’s genetic makeup and specific cardiac condition. As healthcare systems accumulate more data, there will be greater emphasis on integrating and analysing this information to uncover insights, trends, and correlations that can inform cardiac care strategies. Machine Learning will help in creating common treatment pathways for routine diseases.

With the growing popularity of remote monitoring technologies and home-based care models, patients can receive continuous cardiac monitoring and support outside of traditional clinical settings, improving convenience and accessibility of care.

Research in bioelectronic medicine involves developing implantable devices that can modulate nerve signals to treat various health conditions, including cardiac disorders. This emerging field holds potential for innovative treatment options for heart diseases.

How does the deployment of LifeSigns’ remote patient monitoring biosensors at Marengo CIMS Hospital in Ahmedabad help in saving lives? Any unique experiences?

LifeSigns’ remote patient monitoring biosensors deployed at Marengo CIMS Hospital in Ahmedabad offer several ways to save lives. The biosensors allow for the continuous monitoring of patients’ vital signs, including heart rate, blood pressure, oxygen saturation, and temperature. This continuous monitoring enables healthcare providers to detect any abnormalities or signs of deterioration promptly, allowing for early intervention and potentially preventing adverse events.

By remotely monitoring patients’ vital signs in real-time, healthcare providers can identify early warning signs of complications such as cardiac arrhythmias, respiratory distress, or sepsis. Early detection allows for timely intervention, reducing the risk of complications and potentially saving lives.

With remote patient monitoring, healthcare providers can receive early warning scores (EWS), alerts and notifications in case of any concerning changes in patient’s vital signs. This enables them to respond quickly and provide appropriate medical care, even if the patient is not physically present in the hospital.

Remote patient monitoring data provides valuable insights into patients’ health trends and responses to treatment. Healthcare providers can use this information to tailor and optimize treatment plans, ensuring that patients receive the most effective care for their specific needs.

In last six months, 169 post Cardiac surgery patients (who had been high risk) have been monitored using Biosensor devise.  Of which 92 alerts were generated and of which 13 patients had high alerts requiring code blue activation and Code purple activation. Immediate actions were taken and all patients were treated and saved with zero mortality. One of the incidence of this alert was of a patient post Bypass surgery who had very weak heart. He developed very fast heart rate called as Ventricular Tachycardia, which was detected within seconds and immediate Cardioversion was done in the ward, just preventing a catastrophic outcome.

How does the biosensor system work in a hospital space? What is the approximate cost for its deployment in a 200 bed hospital in a tier-2 city?

The LifeSignsIMS biosensor system we use in our hospital typically consists of wearable patch that continuously monitor patients’ 7 vital signs and other physiological parameters. These sensors are connected to a central monitoring system, which collects and analysis the data in real-time. A general overview of how the biosensor system works in a hospital space:

Sensor placement: Patients wear biosensor patch that are capable of measuring various vital signs such as heart rate, blood pressure, oxygen saturation, temperature, and respiratory rate. These sensors may be worn as patches, wristbands, or other wearable devices, or they may be implanted subcutaneously for continuous monitoring.

Data collection: The sensors continuously collect data from the patient’s body and transmit it wirelessly to a central monitoring system. This system may be located within the hospital premises or hosted on a cloud-based platform for remote access.

Data analysis and alerting: The central monitoring system analyzes the incoming data in real-time, looking for any abnormalities or concerning trends. Healthcare providers can set thresholds for vital signs and receive alerts if any parameters fall outside of the normal range or if there are sudden changes that may indicate a medical emergency.

Patient monitoring and intervention: Healthcare providers can access the patient’s vital sign data through a user interface or dashboard, allowing them to monitor patients remotely. If an alert is triggered or if healthcare providers notice any concerning trends, they can intervene by contacting the patient, adjusting medication dosages, or initiating emergency protocols as needed.

How do you view the latest medical technology trends in the cardiac surgery space? 

Probably the amount of technological advancement that has occurred in medical science, Cardiac sciences has witnessed the maximum technological advancement. From no touch to heart we have reached a stage of heart transplantation. In future advances are being made in minimally invasive Cardiac surgery, Robotic cardiac surgery.

Moving from lot of blood required for Cardiac surgery to Blood less Heart surgery and Heart Transplantation. In fact we have recently performed first Blood less Heart Transplantation of South Asia at our centre in Ahmedabad using Werfen Goal directed blood management technique

In valvular heart disease, we are moving towards Catheter based Valve replacement procedures, which we may turn Cardiac procedure into Day care procedure. Hybrid Cardiac Procedure is another way forward to minimise the hospital stay and doing procedures in very high-risk cases, in which open heart procedure can be difficult. Machine learning and Artificial intelligence will help patients in choosing the right modality of treatment for that particular patient with best outcomes.

In ICU monitoring area, new gadgets and monitoring devices are coming, which will help in analysing the heart and bodies condition, beat to beat.  Along with that, machine learning will help creating algorithm for treatment pathway.