Category Archives: Cardiology

Cardiology

AHA Sums Up AI’s Potential in Cardiology, but Also the Hurdles Ahead – TCTMD

Questions about the impact of artificial intelligence (AI) on cardiovascular medicine should be qualified with a when rather than if, according to a new American Heart Association (AHA) scientific statement. Much work remains, though, before these tools can be widely trusted to improve patient care, the authors stress.

Outlining the ways AI, machine learning, and deep learning have already been engrained in medical practice as well as the tools in development, the authors express optimism about their potential to improve diagnosis and treatment as well as prevention, but had some words of caution. Despite enormous academic interest and industry financing, AI-based tools, algorithms, and systems of care have yet to improve patient outcomes at scale, the authors state.

As with any technology, we get excited about its impact, but I believe this is a technology where the impact is unknown, writing committee chair Antonis Armoundas, PhD (Massachusetts General Hospital, Boston, MA), told TCTMD.

Armoundas stressed the commitment of physicians to do no harm and pointed out that improper use of AI-based tools has the potential to adversely affect patients.

It feels like an Oppenheimer moment as we are trying to seek out how to improve outcomes for our patients, whether these are healthcare outcomes or quality of life, he explained. The speed at which this technology evolves makes us humble in being able to ground ourselves and think of the implications of what we are trying to accomplish, how we are going to achieve these goals, and being mindful of the potential negative effects that it could have.

The statement, published online last week in Circulation, is the AHAs second addressing AI this year, with the first directed specifically at its role in cardiac imaging.

What we should be seeking in the future is to build trust for these technologies, as with every other use of technology in medicine.Antonis Armoundas

With a wide variety of AI-based algorithms now available, including for reducing cath lab activation time in STEMI, detecting cardiomyopathy in pregnancy, and identifying heart failure or hypertrophic cardiomyopathy, the impact of these tools is already being felt by cardiologists. In compiling a statement of best practices and associated challenges, Armoundas said the AHA statement aimed to focus both on whats worked as well as identifying gaps and challenges, providing a framework for future efforts.

From clinicians to researchers, IT executives, and government entities, he said all invested stakeholders can take something away from the statement. This manuscript aims to provide a motive: a reason to go deeper and to look for more issues of interest, Armoundas said.

Best Practices and Associated Challenges

The authors identify six main uses and clinical applications of AI within the field of cardiology: cardiac imaging, electrocardiology, continuous bedside monitoring, mobile and wearable technologies, genetics, and electronic health records (EHR). Along with best practices for each of these categories, they list specific gaps and challenges as well. The biggest ones surround patient safety and data protection, bias and fairness, accountability and reliability, regulations and liability, cybersecurity and system upgrades, and clinical decision-making.

With in-hospital monitoring, for example, remote sensors may help improve the accuracy of alarms as well as reduce alarm fatigue. However, the authors point out that while this might sound appealing, limited data exist for these tools and the research that has been done shows that their effect can be altered by patient behavior.

Additionally, they cite the potential for AI to mine EHR data to make diagnoses and predict outcomes like in-hospital mortality. Again, though, challenges around EHR data curation and consistency have been shown to directly affect the potential for AI-based tools in this space, and the authors advise waiting until those issues are corrected before putting any algorithm into routine practice.

As exciting as many of these algorithms sound, Armoundas cautioned that there is a broad shortage of prospective data at this time, and among the studies that do have prospective designs, many are limited by narrow demographics. Increasing the generalizability of these algorithms will give these tools the chance to have a greater impact, he said. What we should be seeking in the future is to build trust for these technologies, as with every other use of technology in medicine.

This can only be done gradually, Armoundas continued, through prospective clinical trials. But the US Food and Drug Administration will also play a role in the way it labels these tools for use. If an algorithm is used as labeled by the FDA, perhaps that would provide the level of security and the level of trust when it is used by clinicians and when it has to be adopted by patients, he said, adding that this will be especially important as these tools start to be used in broader populations of patients than those in the initial studies.

Another issue, he explained, is how physicians can best incorporate their own opinions with the algorithm output when making clinical decisions. We argue that algorithms at this point are more likely to be used in conjunction with expert clinician opinion, albeit we do have evidence today, especially in imaging studies, that an algorithm can perform better than an expert clinician, Armoundas said. Going back to the point of using an algorithm on an as-labeled basis, that provides not only guidance to clinicians, but provides also a level of comfort in terms of liability.

Assigning a level of probability to these algorithms will also be imperative for incorporating them into clinical care so that clinicians can make informed judgements on how to act on the data provided, he added.

Keep an Eye on AI

In a commentary published on the AHAs Professional Heart Daily website, Caroline Marra, PhD, Joseph B. Franklin, JD, PhD, and Amy P. Abernethy, MD, PhD (all from Verily Life Sciences; South San Francisco, CA), write that though there is growing consensus on the need for adequate monitoring of AI tools, agreement on the right level of monitoring is lacking and figuring out how to accomplish monitoring across so many domains is a daunting challenge.

They argue for the creation of infrastructure to be able to simultaneously analyze multiple data sources but also acknowledge that thus far efforts to do this have generated more questions than answers.

Marra et al conclude that AI tools provide an incredible opportunity to enable continuous improvement, innovation, and equity in our healthcare systems and hold the potential to optimize health for all, with the caveat that this will only be possible and responsibly done if the performance of AI tools can be tracked as theyre deployed in practice.

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AHA Sums Up AI's Potential in Cardiology, but Also the Hurdles Ahead - TCTMD

Cardiology

Houston cardiology-focused tech platform exits to private equity, plans to scale – InnovationMap

A Houston health tech startup founded only last year has exited to a New York private equity firm.

CardioOne, which built a physician enablement platform for independent cardiologists, has been acquired by WindRose Health Investors. The complete terms of the deal were not disclosed, but according to a WindRose news release, the firm will provide up to $100 million of additional capital to go toward supporting CardioOne's growth.

The fresh influx of capital will go toward expanding and enhancing existing service options. The CardioOne leadership team will continue to be at the helm of the startup.

"We are excited for the opportunity to partner with WindRose as CardioOne embarks on its next chapter of growth," Dr. Jasen Gundersen, CardioOne's CEO and co-founder, says in the release. "We believe that working with WindRose, which has a history of successfully partnering with companies to help navigate the transition to value-based care, will empower us to continue supporting independent cardiologists while developing additional solutions that maximize each practice's potential in the shift to VBC arrangements."

Last year, CardioOne raised an $8 million seed round and announced key partnerships at clinics in New Jersey, Florida, and Pennsylvania, in addition to existing relationships in Texas and Maryland. CardioOne also partnered with MedAxiom, an organizational performance solutions provider in the industry.

"CardioOne's unique, physician-aligned model meets the market where it is and positions the Company to take advantage of the growing desire among cardiologists to maintain their independence," Oliver Moses, managing partner with WindRose, adds. "We believe CardioOne delivers a compelling tech-enabled offering to the independent cardiology market and has significant growth potential as the Company builds upon its momentum in 2023. We are excited to join forces with Jasen and his team as they continue to build upon the differentiated platform they have created."

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Houston cardiology-focused tech platform exits to private equity, plans to scale - InnovationMap

Cardiology

Global Cardiology Medical Imaging Informatics Market – Cloud-powered Telecardiology to Improve Access to Healthcare – PR Newswire

DUBLIN, March 8, 2024 /PRNewswire/ -- The"Global Cardiology Medical Imaging Informatics Market Growth Opportunities" report has been added to ResearchAndMarkets.com's offering.

Cardiology is the second-largest generator of patient image data and reports, which need to be stored/archived, analyzed, and managed. This, coupled with hospitals' need to provide timely, high-quality care to patients, given the urgency of cardiology cases, necessitates a holistic view of cardiac patient data and a well-connected, enterprise-wide hospital informatics infrastructure, propelling the growth of efficient enterprise imaging informatics solutions in the cardiology specialty.

Hospitals face various challenges, such as radiologist/cardiologist burnout, rising costs, huge data silos, decentralized work environments, and the substantial time cardiologists spend on manual reporting. These factors create demand for robust cardiology image and data management, such as cardiology workflow solutions and structured reporting covering the unique needs of cardiology imaging.

Increased disease detection and diagnosis requirements also advance technology innovations across all modalities of cardiology imaging procedures, such as hybrid imaging and fusion imaging. These procedures create highly advanced images in large volumes and require appropriate cardiology diagnosis/interpretation solutions to decode/read and interpret images quickly.

As cardiology datasets increase, on-premises storage solutions will no longer be enough to manage the growing volume of cardiology data. This will drive the adoption of cloud-based cardiology image storage solutions, which are scalable and easily accessible from anywhere. Cardiology picture archive communication systems (PACS) are shifting toward cardiovascular information systems (CVIS) to meet the demand for a comprehensive, 360-degree view of patient health data from multiple disparate systems. CVIS enables a holistic view of a patient's health parameters and reduces the turnaround time for physicians to examine each patient.

Through this report, the analyst seeks to provide stakeholders with insights into the market and enable them to capture the opportunities available over the forecast period.

The report provides an overview of the global cardiology medical imaging informatics market, with a 5-year revenue forecast from 2024-2028. Cardiology informatics is an interdisciplinary field that uses data, information, and knowledge from cardiology health systems with information and communication systems for patient care with operational and financial efficiency for the enterprise. The geographical scope of this study covers 4 main regions: North America, Europe, Asia-Pacific, and the rest of the world (Latin America, Africa, and the Middle East).

The study forecast is categorized into 4 segments:

Other vital information:

Key Growth Opportunities

Key Topics Covered:

Growth Opportunity Analysis

Cardiology Imaging Informatics

Cardiovascular PACS

Cardiology Image Analysis and Visualization

Cardiology Workflow Solutions

Cardiology Enterprise Imaging

Competitive Landscape

For more information about this report visit https://www.researchandmarkets.com/r/hfjx2s

About ResearchAndMarkets.com ResearchAndMarkets.com is the world's leading source for international market research reports and market data. We provide you with the latest data on international and regional markets, key industries, the top companies, new products and the latest trends.

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Global Cardiology Medical Imaging Informatics Market - Cloud-powered Telecardiology to Improve Access to Healthcare - PR Newswire

Cardiology

Valley Health cardiologist talks regional heart health | Nvdaily | nvdaily.com – Northern Virginia Daily

As the leading cause of death for Americans, one person dies from heart disease every 33 seconds in the country, according to the Centers for Disease Control and Prevention.

With American Heart Month recently coming to a close in February, Dr. Saif Al-Najafi from Winchester Medical Center shared what area residents should know about caring for their blood-pumping muscle year-round.

In the past 10 to 20 years, we advanced from a prognosis of heart failure being similar to cancer to almost people living a normal life on medications, Al-Najafi said.

Despite treatment improvements, it is still crucial for folks to stay away from smoking, poor diet choices and other causes of high blood pressure and high cholesterol, which can lead to developing a weak heart, he said.

Smoking and obesity both seem to be highly prevalent in the community treated at Winchester Medical Center, according to the observations of Al-Najafi and his cardiologist colleagues.

Once you have a weak heart, we want to prevent hospitalizations. And that's easily preventable as well with a good education, he said. For example, with heart failure, they come again and get admitted and many times it's just lack of education when it comes to salt intake.

One diet misconception the doctor often sees is overconsumption of canned soups, which are sometimes perceived as healthy, but usually contain high amounts of sodium. Instead, one should aim to consume less than 2 grams of salt per day, especially in cases of a weak heart, he said.

His recommended diet is intermittent fasting, which consists of restricted eating during certain periods of time. Contrary to popular belief, the keto diet raises cholesterol due to increased consumption of foods such as red meat, he said. If one chooses to go the keto route, Al-Najafi advises attempting a modified version that eliminates or lessens food high in cholesterol.

An estimated 80% of the hospitals cardiac patients are elderly, with much fewer being young. One reason Al-Najafi suggested to explain this is that the surrounding community seems to be a place where people settle down after retirement.

Older people tend to experience more heart issues, he said. But placing an emphasis on healthy lifestyles as a young person is an extremely helpful heart disease prevention tactic, he expressed.

You don't just suddenly get morbidly obese because there's stages to get there, he said. And I think discussions happen relatively later than sooner and that's a problem.

Coronary artery disease (CAD), the most common type of heart disease, is almost entirely preventable based on lifestyle choices, he said. However, genetics can certainly play a role and he recommends being screened for a family history of premature CAD.

CAD is the primary cause of heart attacks, according to the CDC.

We have actually one of the fastest or shortest response times when it comes to heart attacks in the state of Virginia, Al-Najafi said. I think last year we were number one.

Al-Najafi, who specializes in advanced cardiac imaging, reported that Winchester Medical Center has roughly 90% of the most advanced imaging technologies, such as the ability to perform cardiac CT and MRI scans.

Other specializations at the center are electrophysiology, which focuses on patients who need pacemakers or have an irregular heartbeat, as well as interventional cardiology and heart failure specialists.

In the cases where Winchester Medical Center is unable to provide the help a patient needs, it connects with nearby institutions with which it has a working relationship, Al-Najafi explained.

I think the community is lucky to have such a hospital here that, at least from the cardiology standpoint, I would say provides 90% of what is needed by the community, he said.

The good fortune goes both ways, the doctor expressed.

We're very lucky to work in a community such as Winchester where most people are extremely nice and appreciative, Al-Najafi said.

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Valley Health cardiologist talks regional heart health | Nvdaily | nvdaily.com - Northern Virginia Daily

Cardiology

The Daylight Saving Time Health Effects You Might Not Be Expecting, According to a Cardiology Specialist (Exclusive) – PEOPLE

As you prepare to spring ahead when Daylight Saving Time starts this weekend, prepare for the various health effects that could come with it as well.

On Sunday, March 10 at 2:00 a.m. local time, clocks across the United States and Canada will turn forward one hour to 3:00 a.m. local time. The biannual temporal event allows for more daylight at night between mid-March to early November.

Some love the extra sunlight in their day, but for those who like to catch their full eight hours of shuteye (or parents who want their kids to stay in bed longer), it's a less popular practice. This is because the Sunday time leap results in one less hour of sleep.

Dr. Rachana Kulkarni, regional Director of Cardiovascular Services for RWJBarnabas Health and Director of its Women's Heart Center, tells PEOPLE that "everyone" is affected by Daylight Saving Time because of circadian rhythm.

Commonly referred to as our internal body clock, a circadian rhythm is "the discipline the body goes by" that dictates multiple processes in the body. When that gets disrupted, Dr. Kulkarni says "the whole body and its basic metabolic function gets affected."

While ackowledging the "wonderful" extra hour of light that comes with Daylight Savings, Dr. Kulkarni who's board certified in cardiology and nuclear cardiology says it also comes with "some health challenges," which she attributes to "the disruption of the circadian rhythm."

Since sleep is "one of life's essential aids," Dr. Kulkarni says, it's among the most essential qualities to maintain good cardiovascular health. When our circadian rhythm is disturbed, our sleep is impacted.

Fortunately, she says "the most vulnerability comes in the first week" of our body's initial response to getting one less hour of sleep.

Read on for the negative and positive health effects associated with Daylight Saving Time and the helpful ways to combat the challenges.

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Because the time change causes everyone to lose one hour of sleep, a disrupted circadian rhythm can result in some difficulty adjusting to the new schedule.

The American Health Association offers several detailed tips to combat this challenge, but Dr. Kulkarni highlighted some of the standouts. She says "we need to start thinking of this and transitioning our own health habits to get better" in the days leading up to Daylight Saving Time.

One easy way to acclimate your body: "getting out and get as much natural light as possible each day" after the time change occurs. And Saturday night before the leap, "wind down a little earlier."

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There are certain cardiovascular risks associated with Daylight Saving Time, according to Dr. Kulkarni, including an increase in risks for stroke and heart attack.

Even during typical weeks, she says, emergency rooms and cardiologists see "a significant increase" in heart attack and strokes on Mondays, though the reason is unclear; "there is lot of debate in cardiology literature as to why this happens," she says.

"Now add that to disruption of the circadian rhythm," Dr. Kulkarni says of Daylight Saving Time and the number goes up furhter.

"There's a marked increase in heart attack and strokes" in the days following the change, she says, and that increase can last for up to a week.

Dr. Kulkarni says those who are "at risk for heart disease" and "risk factors like diabetes, high blood pressure, high cholesterol, family history" should be attentive to their health during this time. One particular group she mentions is post-menopausal women, who are "very prone for heart and health risks because of lack of sleep and interruption of the circadian rhythm."

"We have data and research to support that one in four post menopausal women are at risk for having irregular heart rhythm, such as atrial fibrillation," she explains. "Sleep disturbance is very common in perimenopausal and post menopausal women and that increases their risk."

As a result of disrupted sleep or sleep deprivation, cognitive function may be impacted. This is because our bodies need "seven to nine hours of sleep" to rest our bodies, hearts and brains, says Dr. Kulkarni.

Lack of good sleep "can lead to cognitive decline because you are unable to focus," she explains. "If your body is not rested, you are unable to focus that next day."

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"Studies have shown that lack of good sleep, which is our body's reset point for the next day, or irregular sleep, can lead to depression," says Dr. Kulkarni. "Studies have shown that younger people are more likely to face depression and obesity due to lack of sleep."

Dr. Kulkarni says disrupted sleep and poor nighttime habits are correlated with weight issues linked to diabetes and cardiovascular disease.

When we feel tired, she explains we're "less likely to exercise." She says studies have shown sleep loss can "increases the risk of visceral obesity, which increases your cardiovascular risk."

Younger people "are more likely to face depression and obesity due to lack of sleep," while older people "are more likely to have cognitive decline ... and higher cardiovascular risk."

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There also many benefits associated with Daylight Saving Time, including the most obvious: More sunlight!

"If we are prudent about how to transition our body, there are so many positives that we get with more daylight," Dr. Kulkarni says.

"It allows us to get more natural light, which is good for the body... So we need to take advantage of all those positives," she continues. "Exposure to natural light is a wonderful thing to do."

Dr. Kulkarni points out the benefits of natural light. She says it "allows better health" thanks to increased Vitamin D, but also says "it's amazing" for our bodies and our psyche.

Increased daylight and warming temperatures make physical fitness much more enticing during the hibernation-friendly winter months.

"My suggestion is to go outside and start exercising," Dr. Kulkarni says.

"We are going to now have light when we go out [before work] and when we come home," she explains. "So take advantage of the extra light that we have."

Dr. Kulkarni suggests going outside for a walk or a run whatever form of activity will "get yourself some fresh air." She says these are all great benefits to "turn this challenge" of Daylight Saving Time "into opportunity."

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Despite the inevitable circadian rhythm disruption which affects sleep, there are ways to get your health back on track during Daylight Saving Time.

"We should know that these are the challenges and we should prep ourselves in a better way," Dr. Kulkarni says. "Get our bodies adjusted, start sleeping a little early, avoid caffeine, get into a good health hygiene so then, you are going to reap benefits of all the positives of Daylight Saving Time."

"Fear risks, mitigate [them], get into good sleep hygiene, and then it's all good," Dr. Kulkarni continues. "It's up to us. I always say knowledge is power!"

Maintaining good sleep hygiene and cutting back on screen time at night is also "super important to incorporate those good health habits," adds Dr. Kulkarni. "Avoid devices in the bedroom and shut all the devices down an hour before your bedtime to reduce the exposure to blue light."

Dr. Kulkarni's "appeal to all people" during Daylight Saving Time: "Limit use of technology. This is a good time to get out!"

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The Daylight Saving Time Health Effects You Might Not Be Expecting, According to a Cardiology Specialist (Exclusive) - PEOPLE

Cardiology

How a big CMS update on carotid stenting could impact interventional cardiology – Cardiovascular Business

The decision received widespread support from U.S. medical societies, including those in the fields of neurology, radiology and cardiology. More than 800 comments were received during the CMS review process, with the majority expressing support for the expanded coverage.

"There were 14 medical societies or organizations that came out in favor, that includes the American Association of Neurology, and all of the cardiac, radiology and neurology communities entirely coming out in favor," explained Ken Rosenfield, MD, MSCA member and section head of vascular medicine and intervention, and chairman of STEMI and Acute MI Quality Improvement Committee at Massachusetts General Hospital.

He said MSCA worked to show consensus among many of the experts from the various specialties involved in carotid care and submit the request for review that included a clear and referenced outline of the clinical evidence.

The new CMS national coverage determination has greatly broadened the number of patients eligible for reimbursement when they undergo minimally invasive, catheter-based stenting. The biggest thing the CMS change does is lift off the restriction of payment being the deciding factor for care rather than what is best for a patient.

"I don't think it changes the hospital's business model or bottom line, but I think what it really does is improves patient quality outcomes. Because what you have now is the option to do multiple approaches to a patient without restriction by payment. So if medical therapy is the right thing to do, that's what you do. And if I'm a carotid center, but I think the right thing to do is endarterectomy because a patient has a bulky lesion or a type 3 arch or something like that, I'm going to send 'em a surgery and there's no inhibition for crossing over for the therapeutic which is most appropriate for the patient. And in the end, that reduces total mortality and total neurologic complications," Gray explained.

Rosenfield said patients will also benefit from having more informed decision-making.

"One thing that was important in the decision that CMS finally issued was that there should be a shared decision-making process that patients go through with their physician, be it a surgeon, a cardiologist, a radiologist, a neurologist or a neurosurgeon, and that all of the options are required to be presented to the patient so that the patient can make an informed decision. Now, in many instances, it might be the most appropriate thing to do an endarterectomy or to do optimal medical therapy. But in some instances, it will be clear that stenting is the right approach, and then there's going to be this big gray zone where patients will have the option of transcarotid artery revascularization (TCAR) using stenting or endarterectomy. And in that case, now the patient will actually be able to make their own informed decision for elective procedures," Rosenfield explained.

CMS now approves carotid stenting for asymptomatic patients with a stenosis of 70% or more, and symptomatic patients with more than 50% stenosis, Gray said. The decision allows for various catheter vascular access options including transfemoral, transradial or transcarotid.

While many patients may opt for the less invasive procedure if they have a choice, he said there are a lot of good clinical reasons for open surgical procedures, including the presence of comorbidities or anatomic issues that make catheter navigation difficult. Each patient case will have different circumstances, so ideally there should be a team-based approach to CEA or CAS.

"That doesn't necessarily mean that you have to have sign off for carotid procedure by one or another specialty. In fact, CMS rejected that and they agreed that anybody who's managing carotid disease should have full knowledge of all of the different options and their pluses and minuses and should present a balanced approach to the patient. The Multi-Specialty Carotid Alliance is really keen on ensuring that we end up with optimal outcomes for these patients that we think quality should be monitored and assured and that patients deserve that. So we're going to work very intensively on that with all of our colleagues from all different specialties to try to achieve that," Rosenfield said.

Often in medicine, when a solution to a problem is developed, such as a drug or device, the screening for patients with that condition increases and it is often found there is much larger patient population that originally thought. This certainly happened with the development of transcatheter aortic valve replacement (TAVR) as an alternative to open heart surgery, where much larger population of of aortic stenosis patients came out of the woodwork and surprised cardiology in the past decade. The same thing happened when the FDA cleared use of transcatheter closure devices for patent foramen ovale (PFO), Gray said.

"When you create a therapy for patients, we find those patients and there's more surveillance for that problem. When you have limited options for that, it becomes less attractive. It's not great. I mean, that's not the way medicine should be practiced, but that's the reality of it," Gray explained.

Rosenfield said if CAS procedure volume goes up, it also will likely spur new investment to develop better interventional therapies. Keep in mind that the currently available stents, catheters and embolic protection systems for CAS were developed 15-20 years ago with little new innovation since. Rosenfield said the lack of innovation is mainly due to the lack of reimbursement and resulting lower numbers of CAS patients.

"I think that one of the things that happened as a result of the lack of coverage for CAS is a complete absence of investment in the carotid innovation space. There are a couple of notable exceptions, but by and large, there hasn't been a lot of innovation in this space," he said. I firmly believe we're going to get there."

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How a big CMS update on carotid stenting could impact interventional cardiology - Cardiovascular Business

Cardiology

With the correct research, AI in pediatric cardiology has great potential – Contemporary Pediatrics

Scott Ceresnak, MD, cardiac electrophysiologist, director, of the Pediatric Electrophysiology Program, Stanford Medicine Childrens Health, Palo Alto, California, shared his excitement regarding the potential of artificial intelligence (AI) technology in the pediatric cardiology space, including wearable technology, in this video interview with Contemporary Pediatrics.

Ceresnak noted mass research is needed to figure out how AI can further be used in health care, but explained trials are underway in various health care spaces.

Transcript (edited for clarity):

Contemporary Pediatrics:

Dr. Ceresnak, when it comes to AI, it's dominating the headlines in the medical field for a varying number of reasons, but we have seen in some indications and populations, that technology trickle into the pediatric space. From a cardiology perspective, what are some of those findings and what are you starting to see be rolled out, or tested if nothing else?

Scott Ceresnak, MD:

You know, AI is such a hot topic now. And, really, there's so much promise with the technology going forward. I would say a couple of things with AI, first of all, as you mentioned, so much of the AI data that's being generated, and algorithms that are being generated are adult centric, right?

So I think we have to be a bit careful. And just because these algorithms work well, on adults, we don't know if that's going to trickle down if those specific algorithms are going to work in children. So I think the first step is, for most AI algorithms, you need big data, right? So you need a big data sets to understand how can you distinguish normal or abnormal. Then you need a good big group to validate that algorithm. Does it work? So, we need big datasets in children that can really, A.) Provide good machine learning algorithms, and then B.) validate them and see do they work or not.

I think that's a big step for us is really getting a lot of big data to generate these algorithms and generate specific pediatric level algorithms. So I think the first steps that are coming is do these algorithms work in children? Do the adult algorithms working children? And then can we develop our own pediatric specific elements? And I think there's a lot of work in CG space, electrocardiograms, and that there's a lot of work that a bunch of groups are doing here at Stanford and a bunch of other groups across the country, great centers are doing a lot of machine learning work on ECGs.

As I mentioned before, echocardiography, looking sonograms of the heart, one of my colleagues at Stanford Charitha Reddy is doing great work looking at, can we create artificial intelligence-based readings of these echocardiograms? Can we distinguish normal from abnormal and take away the human part of the reading. And really, I think amazing work is being done. I feel like we're sort of at the tip of the iceberg and what we can do and what we're starting to see in the pediatric space and I'm super excited about what's to come, really on the electrophysiology side and ECG algorithms and other arrhythmia detection algorithms. But then also, looking at in hospital infection of arrhythmias and early detection of potential events in the hospital, and imaging wise. I think, on the imaging side, this is going to revolutionize the way we sort of see echocardiograms and other imaging modalities in children.

I'm excited about this space, especially wearables, and I think they carry great promise and I think they carry a lot of hope for arrhythmia detection in children. I would caution people too to say that, as I mentioned before, all these algorithms are built for adults.

I think we have to be careful how we interpret the data and the combination of using the watch and using the data that we can get from these smartwatches, but also using the clinical judgment of important people who are experts in the field, is going to be really important to strike that balance between not raising anxiety too much in terms of families, but also, truly picking up the arrhythmias that we can treat and we can help kids going forward.

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With the correct research, AI in pediatric cardiology has great potential - Contemporary Pediatrics

Cardiology

Researcher promotes subsidies to bring cardiac care closer to home in rural areas – Montana Right Now

A model of the mammalian heart (Photo by Souza e Silva via Wikimedia Commons | CC-BY-SA 4.0).

Luring cardiologists to rural parts of Iowa may mean subsidizing their salaries, a new study has found.

Tom Gruca, a marketing professor at the University of Iowas Tippie College of Business, looked at data from more than 40 years of public health in his state. His study, Bringing the Doctor to the Patients: Cardiology Outreach to Rural Areas, found that paying doctors to participate in traveling practice models could help alleviate the coming cardiologist shortage in his state.

Using subsidies and an existing Visiting Consultant Clinic model would be a better and more cost-effective way to get cardiology care to rural patients, he said.

A VCC model is a formal arrangement between a rural hospital or clinic and a specialist physician, typically from an urban area nearby. In a VCC arrangement, the specialists travel to rural areas on a regular basis to see patients in their own communities. There, they can use the rural hospital to examine them and provide basic support and non-invasive procedures, and treat them in larger hospitals for more complex procedures.

The policy that the American Heart Association and everybody else always talks about is lets get doctors to move to rural areas, Gruca said in an interview with the Daily Yonder. That might work with the primary care physician because if theres a hospital there, theres probably enough equipment and staff for them to do what theyre doing. This will not work for almost any specialist because they need the imaging equipment, the surgical equipment, the surgery nurses, and all that other stuff to do their jobs.

The VCC model is used in every state, he said. Looking at the numbers the research found that the model would not only provide rural patients with access to care, but save money.

Putting a cardiologist in a rural community would mean the doctor would not have enough patients or patient visits to support their practice, Gruca said. And paying cardiologists on a per-mile basis to drive to rural communities would be excessively expensive. In some cases, getting doctors to give up patient time to spend up to three hours of windshield time to get rural communities to participate in the VCC model was a challenge.

His research found that a state investment of about $430,000 per year would provide doctors with the necessary funding to cover windshield time and still provide current levels of cardiology coverage in the state.

Getting that cardiology care to rural communities is important on a number of levels, he said. First, rural residents are more likely to have cardiology issues. According to one study, between 2010 and 2015, the death rate for rural residents from coronary heart disease was significantly higher than it was for those in urban areas. And a 2017 study found that people in rural areas have a 30 percent higher risk of dying from a stroke due to their increased chronic disease, and reduced access to pre-hospital care.

Second, research shows that rural residents who have access to cardiology care are better off for it.

What we can say is that the difference between having VCC outreach and not having VCC outreach means anywhere between 700,000 and a million rural residents having better access, he said. And studies show that Medicaid patients who see a specialist at least once a year are way more likely to stay out of the hospital and way more likely to live for another year.

Even more important, he said, is that rural America is facing a pending shortage of cardiologists. Currently, the state has fewer than 200 cardiologists, Gruca said, almost all of them in urban areas. Nationally, the number of cardiologists is expected to decline by as much as 10% due to retirement and aging workloads. While fellowship programs graduate about 1,500 new cardiologists a year, he said, about 2,000 leave the practice annually.

I thought, whats going to happen when the number of cardiologists goes down? he said. When this shortage actually hits If we lose 10% of our current cardiologists there are a lot of cities (in Iowa) that will get no outreach at all.

Similar programs have worked in Australia, he said. The same kind of subsidies could be successful in encouraging specialist physicians to work in rural areas as well.

Even though the program was expensive, he said, it will still save states money over the alternative.

We looked at what it would take to hire people and put them into rural areas and the cost was many, many times (the annual subsidies) simply because they would have very little to do, he said. If we pay them some amount to do this outreach and we build a mathematical model to figure out how much would we have to pay them per mile or per minute its actually really many, many, many times the $400,000 for the subsidy that we calculated.

This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.

The post Researcher promotes subsidies to bring cardiac care closer to home in rural areas appeared first on Daily Montanan.

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Researcher promotes subsidies to bring cardiac care closer to home in rural areas - Montana Right Now

Cardiology

Cardiologist aims to improve care, reduce costly air transport – The Taos News

Without a cardiologist since Dr. Geilan Ismail retired in 2022, any replacement arriving at Holy Cross Medical Center would be newsworthy.

Dr. Tiziano Scarabelli, the hospital's new cardiologist, is introducing heart patients to newer diagnostic methods, which he said not only save lives but will also reduce airlifts out of Taos and improve patient care and their overall quality of life.

By using a top-of-the-line CT scan machine Holy Cross obtained in 2023 in conjunction with software that compiles a detailed 3D image of a patient's heart, Scarabelli said he is able to diagnose patients more accurately and discharge non-emergent patients quicker than ever before at Holy Cross.

"When there was a patient coming to the [emergency department] with chest pain, there was the conventional approach," he said, explaining that echocardiogram stress tests either physical or using nuclear medicine require a patient to stay at the hospital for up to 36 hours.

While he still employs both tests regularly at Holy Cross, he said coronary CT angiograms can be performed without injecting any drug and don't require patients to fast, allowing them to be "discharged in [as few as] six hours," Scarabelli said.The test works by revealing calcified coronary arteries indicating coronary plaques immediately and clearly in the imaging, which can be completed in 20 minutes.

Scarabelli shared a PowerPoint presentation with the Taos News of 3D images of hearts, some in various stages of visible to a layman coronary artery disease. In fact one of the goals of the imaging is to very clearly communicate to patients the consequences of a poor diet, obesity, a lack of physical activity or not taking one's prescribed heart or diabetes medicine, for example.

"It has a very significant impact in terms of changes of behavior," Scarabelli said. "That is very important to provide a pictorial representation of the work done by the patients."

Holy Cross CEO James Kiser agreed the CT angiogram is able to provide imaging of the heart faster and with a high degree of accuracy. He said Scarabelli is an expert in using the technology and interpreting the detailed information it provides.

Scarabelli was born and raised in Vercelli, Italy. He has taught at several universities and is licensed to practice medicine in over a dozen states. As a young man, he graduated with a degree in medicine from the University of Turin, then completed a fellowship in cardiology at the University of Brescia. He subsequently moved to England, where he carried out research projects for several years.

Tizianos subspecialty is cardio-oncology, whose primary goal is to prevent and treat cardiovascular complications of cancer, chemotherapy and/or radiation therapy, according to his hospital bio. Kiser has said that one of his priorities is to bring a cancer treatment clinic to Holy Cross.

"We are blessed to have Dr. Tiziano Scarabelli and his wife, Carol Chen-Scarabelli, NP, staffing the Holy Cross Cardiology Department," Dr. Lucas Schreiber said. "It is unusual to find such well-trained and academically inclined clinicians practicing in such a small community. When Dr. Geilan Ismail retired, I feared we would not find a replacement of her caliber. In Dr. Scarabelli, the Taos community is once again receiving state-of-the-art, highly competent and guideline-driven cardiac care."

Scarabelli's wife, Nurse Practitioner Carol Chen-Scarabelli, came to work at Holy Cross with her husband, and shares his drive to serve the folks who live within the hospital's service area.

"With the multimodality imaging we have, including the coronary CT scanner, in order to rule out any significant blockage in the arteries or your heart, it's making a huge difference," Chen-Scarabelli said. "Before, if someone came in with chest pain and you weren't sure if they were having a heart attack and you had to airlift them out. They're getting a $75,000 bill for airlifting, not counting your hospital bill.

"I told [Christus St. Vincent Hospital in Santa Fe] when they came up to visit, I said, 'Well, if they didn't have a heart attack, then they'll get one when they see that bill,'" Chen-Scarabelli said. "If the coronary CT helps us to diagnose rapidly, if they have significant blockage, they do need to be airlifted; [but] we've had some but they weren't urgent like that, and they were able to drive down or have a family member take them instead of being airlifted."

Scarabelli said just three patients he's seen have had to be airlifted out of Taos for treatment at a larger clinic. All three required surgery.

"The negative predictive value of a negative CT angiogram is 100 percent," Scarabelli said, clapping his hands with finality. "If I say it is negative to the patient, 'Go home,' it is done. It's the power of the procedure that allows this hospital to make big jumps in care."

Scarabelli said that after a quarter-century teaching medicine and heading up departments at learning hospitals or running clinical practices in several larger communities in the United States, Taos feels like the right place to be.

"The reality is, I've been an academician all my life," he said. "I became a professor of medicine at Wayne State University [in Michigan] when I started 22 years ago. I'm a professor of medicine at the Royal College. I continue to do that; I'm still an academician. But they no longer pay me.

"I'm sick and tired of the political thing in academia," Scarabelli added. "Academia is worse than the politics in the White House. Here, I'm surrounded by people who have the most genuine desire to help me to do things well."

After renting for six months in Taos, Scarabelli said he, his wife and 14-year-old daughter Caroline have moved into their own home.

"For my first time ever and I'm very honest with you, not even in Italy, not in England, where I lived many years, not in the U.S., I always felt not accepted I feel part of the community," Scarabelli said.

"I used the term community in the past and it was, like, something up there; I didn't understand what it means," Scarabelli said, gesturing to overhead to something out of reach. "I have become aware of that."

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Cardiologist aims to improve care, reduce costly air transport - The Taos News