Dr Campbell Rogers, chief medical officer at HeartFlow discusses how digital technologies can play a role in helping health services identify and treat coronary heart disease.
DIgital heart
There has been a remarkable growth of digital technologies making waves in the health space in recent years. These innovations are improving patient experience, disease detection and treatment and yielding efficiencies within health services.
Heart health is no exception and, as we kick off a new decade, the way in which conditions such as coronary heart disease (CHD) – the UK’s biggest killer – are identified and treated is being revolutionised.
Making diagnosis digital
Stress testing, which monitors how the heart performs during exercise, used to be the go-to method for diagnosing CHD. But technological innovation and clinical evidence have changed practice and perception so much that stress testing is now widely recognised to be a relatively ineffective and inefficient method for diagnosing the condition. The recent ISCHEMIA trial found that sending patients with stable but moderate-to-severe abnormalities on stress testing for subsequent invasive procedures instead of treating them with medication alone, did not protect patients from outcomes such as heart attacks, hospitalisation, or death.
In recognition of these changes, the National Institute for Health and Care Excellence (NICE) issued clinical guidance (CG95) in 2017 recommending coronary computed tomography angiograms (CCTA) as a front-line test for diagnosing CHD.
Performing a CT scan of patients’ coronary arteries can help classify risk and highlight those that are clearly not in need of more aggressive intervention, such as stenting or bypass surgery. But a scan can only tell doctors so much. Particularly when CHD is found, it can remain unclear how severe a patient’s condition is, and clinicians need more information. Traditionally, a diagnostic angiogram, an invasive procedure which comes with certain risks for patients and can contribute to longer waiting lists in catheterisation labs, would be the next test used. But HeartFlow is helping doctors to acquire this clarity without the need for invasive testing.
Our AI-powered technology utilises data from a CCTA scan securely transferred via the cloud from the hospital. Leveraging deep learning and trained analysts, we create a digital, 3D model of a patient’s heart. Millions of complex algorithms are applied to the 3D model and then solved to simulate blood flow in the coronary arteries. This HeartFlow Analysis helps physicians understand how blockages are compromising blood flow and enables health care providers to develop a precise treatment plan for their patients.
In practise, this means that many patients who would otherwise have needed to undergo invasive procedures can be treated with medication alone. A substantial amount of research has shown the value of taking this approach.
A new approach fit for a new decade
HeartFlow’s technology is currently being used in over 50 NHS hospitals across England. The government is looking to make its uptake mandatory, as part of its proposed MedTech Funding Mandate Policy. This could mean that all clinicians across the country would have access to tools that help them reach a diagnosis on CHD digitally; allowing them to formulate treatment plans for their patients that could completely avoid invasive intervention or testing in many. This has clear benefits for patients who could avoid unnecessary procedures and receive a quicker diagnosis, improving their hospital experience and avoiding the potential risks that can come with an angiogram or surgery. Furthermore, this approach will help ensure that those patients who do need invasive management are efficiently diagnosed and have rapid access to these therapies.
For doctors, access to more accurate information can help them be more confident in forming treatment decisions. What’s more, a CT-first approach combined with the HeartFlow Analysis can help identify those at more serious risk and aid cardiologists in prioritising time in the catheterisation lab, making sure those who need intervention are able to get it quickly.
Improving patient care and efficiency in this way will undoubtedly have a positive impact on healthcare systems in general. Aside from reduced waiting lists and improved patient experience, hospital resources are better directed and unnecessary procedures avoided, which can lead to significant cost savings. In fact, the National Institute for Health and Care Excellence estimated that HeartFlow could save the NHS £9.1 million by avoiding invasive investigation and treatment – a saving of £214 per patient.
As our approach to identifying and tackling heart disease increasingly embraces the new, digital decade, technology has a huge role to play in transforming patient care and empowering health services to provide services fit for the modern world.
Final thoughts
We’ve already made significant strides in our ability to help patients with CHD, but we’ve only scratched the surface of what medical technology can achieve. As medicine increasingly intertwines with the digital world, the way we diagnose and treat will continue to transform.
Of course this doesn’t mean less of a role for doctors and other medical professionals, but rather that their insights will be augmented by intelligent technology and by applying the data generated by these innovations, helping them to make diagnoses and treatment plans more efficiently and with greater accuracy.
It’s clear there are some remarkable advances ahead – and the UK is leading the charge.
