tarakji wearables and digital health in cardiology€¦ · director, center for digital health,...

4th Annual Comprehensive CV Disease Management: From Fundamentals to Innovations 2020

Khaldoun G. Tarakji, MD MPH

@khaldountarakjiAssociate Section Head, Section of Cardiac Electrophysiology

Director, Center for Digital Health, Heart and Vascular Institute

Director, Center for International Medical Education, Education Institute

Cleveland Clinic, Cleveland Ohio

Wearables and Digital Health in Cardiology

Comprehensive CV Disease Management: Fundamentals to Innovation 2020Valley Health System & Cleveland Clinic

February 7, 2020

Ridgewood, New Jersey

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Technology

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The Prediction

Physicians: The Concerns

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Bad Precedents

Main Stream and Social Media

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Burnout

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• > half of individuals who purchase a wearable device stop using it (one third of these before 6 months)

• The gap between recording information and changing behavior is substantial

• Scaring the healthy: Demanding 100% accuracy

Are Patients / Consumers Ready?

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Proposed Path to the Evolution of Digital Health

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Physicians: The Opportunities

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Opportunities

Patient care

Research

Cost / Value

Global and Future Opportunities

Zungsontiporn N. BMJ 2018

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Why EP?

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Patient care

Research

Cost / Value


Opportunities

Need: Atrial Fibrillation

• Most common arrhythmia affecting > 5 million people – Chronic condition

• Projected 12 million by 2050

• AF accounts for 15 – 20 % of strokes in US

• Strokes secondary to AF are more detrimental

• 18% of AF triggered strokes present with AF that is newly detected

Benjamin EJ et. al. Circulation. 2018Miyasaka Y et. al. Circulation. 2016Marini C. et. Al. Stroke. 2005Lin HJ et. al. Stroke. 1995

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Validation: Smartphone ECG Example

Tarakji el al. Heart Rhythm Journal 2015 William AD et. al. Heart Rhythm. 2018 Oct;15(10):1531‐1535

They work

Patients will adopt them

Automated algorithms are good but not perfect

For clinical decisions, still need physician over‐read

They work

Patients will adopt them

Automated algorithms are good but not perfect

For clinical decisions, still need physician over‐read

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So what do I tell my patients?

Daily symptomsPVCs (Burden)

Tired with bradycardiaFrequent episodes

every week

Mittal S et. al. J Am Coll Cardiol 2011

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Random episodes Palpitation every

few months

58 year man with palpitation diagnosed as anxiety attacks

DiagnoseDiagnose

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62 year old man overseas

I was just diagnosed with AF and had a cardioversion

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44 year old man with atrial fibrillation

ManageManage

Started DOAC

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Wasserlauf J et al. Circulation AE. 2019

Can wearables replace loops?

What do I tell my neighbors?

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• 0.5% got the notification• 34% of those had AF on

subsequent patch• 84% of notification correlated with

AF with simultaneous patch

• What about the other 99.5%• what to do with the info?

• Stay tuned for Guard AF, Heartline

Perez MV et. al. NEJM. 2019

What do I tell my neighbors?

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Opportunities

Patient care

Research

Cost / Value


Steinhubl et. al. JAMA. 2018Turakhia MP et. al. Am Heart J. Sep 2018*Courtesy Dr. Rod Passman, Northwestern Medical Center

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Rhythm Evaluation for AnticoagulationTherapy for Atrial Fibrillation (REACT‐AF)*

Paradigm shift in conducting research

New Terminology: Site‐Less StudyDirect to Consumer Studye‐consentSelf reporting

Innovative Ideas

Paradigm shift in conducting research

New Terminology: Site‐Less StudyDirect to Consumer Studye‐consentSelf reporting

Innovative Ideas

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Opportunities

Patient care

Research

Cost / Value


• 100 patients presenting for elective cardioversion for AF

• ECG pre and post Cardioversion

• Simultaneous Kardia Band Smart Watch recording

8% of patients were in sinus rhythm and did not need cardioversion

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68 year old woman s/p redo AF ablationRedo PVI

Virtual Visit

Follow up

Virtual Visit

Follow up

• Telehealth market is expected to rapidly rise to 12.13B by 2022

• The Medical Virtualist

• Change in medical school curriculum

• Bedside manner vs Webside manner?

• Telemedicine ≠ Video Chat but could be of great value when supported by additional tools

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Opportunities

Patient care

Research

Cost / Value


Therapies for the rich

Pekka Raatikainen MJ et. al. Europace. 2014

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Smart Devices: Not limited to the rich

Professional Societies and Regulatory Agencies

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• 2019 CMS new CPT codes:

• CPT code 99454

• initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days” (technical component)

• CPT code 99457

• “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcareprofessional time in a calendar month requiring interactive communication with the patient/caregiver during the month” (professional component)

Remote Patient Monitoring Reimbursement

Slotwiner DJ, Tarakji KG, et. al. Heart Rhythm. 2019; 16

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2020

Technology

Patients

Physicians

Regulators

• Wearables and apps should be an asset and not a threat or burden

• It is not about the device but about the indication

• Smart devices are only smart if used intelligently

• Work flow is as important as the device itself

Key Takeaways

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Thank You

@khaldountarakji

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tarakji wearables and digital health in cardiology€¦ · director, center for digital health,...

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