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Rethinking the future of heart care through the prism of technology

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A recent study revealed that 80 per cent COVID-19 patients report cardiac issues post-recovery and therefore cardiologists would require latest technologies for better patient outcomes. On World Heart Day, Dr Shirish Hiremath, consultant cardiologist and director, cardiac cath lab, Ruby Hall Clinic, Pune therefore makes the point that as we fight the pandemic, it becomes even more critical to look into how advancement in technology is paving the way for improved quality of treatment and better patient outcomes, especially to fight the CVD burden in India

At the other end of the pandemic stands a deeper underlying concern on how the future of healthcare will be viewed post COVID-19. Reports of doctors protesting the shortage of equipment and non-COVID patients complaining about lack of services have thrown light on a more pressing issue that India has been grappling with, for decades— the burden of non-communicable diseases (NCDs).

As per the World Heart Federation, “NCDs, including cardiovascular diseases (CVDs), are estimated to account for 60 percent of total adult deaths in India with CVDs accounting for over a quarter (26 per cent) of these deaths.” Today, these patients are at a higher risk of contracting the novel virus.

Over the decades, technology has helped us manage, and address this burden affectively. These are innovations driven by robust clinical trials, years of research and advanced technologies. As we fight the pandemic, it becomes even more critical to look into how advancement in technology is paving the way for improved quality of treatment and better patient outcomes, especially to fight the CVD burden in India.

Treating patients through minimal invasion

It is interesting to see how we are managing the disease burden with advanced therapeutic facilities, technological breakthroughs and monitoring systems that promise better prognosis and give patients an improved quality of life. Today, when people have socially distanced themselves and are looking for virtual ways of connecting with their doctors, we have remote monitoring systems that help patients to record and analyse the condition of their heart.

For instance, for patients with heart arrhythmias that cause the heart to beat too quickly, slowly, or out of rhythm, there are technologies that detect irregular heartbeats and transmit data using Bluetooth to the patient’s smart phone. This information can be further shared with the doctor who can get a real time access to the heart condition of the patient, being anywhere in the world.

Even when devices are available, determining in which cases to use these, has remained the biggest challenge for a cardiologist. There is no ‘one size fits all’ approach when it comes to cardiac care. A person with diabetes and another one with kidney disease may require different kind of stents as different patients have different needs. In some cases, patients undergo a stenting or surgery based on the angiographic result alone.

A more precise way of determining if a stent is required is through technologies like Fractional Flow Reserve (FFR). FFR measures the volume of the blood flow and supply of oxygen to the distal part of the blocked artery. The technology provides an assessment of the severity of the coronary artery lesion and the blood supply to the affected areas of the heart. The measurement received during this procedure aids the cardiologist in evaluating the severity of a coronary artery lesion and helps in deciding whether stenting is required or not. When angiography is not clear, FFR helps in identifying the precise location of the lesion. FFR is the first line of assessment in developed countries such as the UA and Japan having the highest level of evidence and it is a part of ESC international guidelines.

Not just for treatment, medical breakthroughs are also helping doctors achieve precision while stenting through advanced imaging tools such as Optical Coherence Tomography (OCT). This enables a doctor to visualise the minutest details of the heart vessels and optimises the implant results.

Technologies have specially helped in cases of multi vessel coronary artery diseases (CAD) and coronary artery blockage between 30 per cent to 70 per cent. Techniques like Percutaneous Coronary Intervention (PCI) are used to open coronary artery blockages by minimally invasive methods in which, with the use of catheter-based devices, coronary stents are implanted.

Medical breakthroughs have solutions for patients of all ages

Science today also has solutions for elderly patients or a patient with a weak heart and a history of non-cardiac conditions involving lungs, kidneys, or brain. For decades, people with a leaky mitral valve had to either take medicines or undergo a traditional open-heart surgery. Open heart surgery meant opening the chest in a four to six-hour long surgery, followed by six to eight weeks of strict recovery procedure. With minimally invasive surgeries which are carried using a catheter and a clip, now a leaking mitral valve can be repaired without opening the heart. The therapy can bring recovery time down to a single day.

For infants, among the many available treatments today are different kinds of occluders that can be placed in the heart to close birth defects such as the patent foramen ovale (PFO) from a minimally invasive catheter procedure. This device closes the opening in the heart, ensuring that blood clots are not released which are the prime cause of strokes. In the last few years, India has witnessed a surge in stroke cases. Credit it to technology, we now have new methods of treating heart defects that aim to outperform the approach that has been used conventionally in stroke units.

Cardiac care in India is evolving like never before. We now have a plethora of options for patients of all age. The objective is to provide best treatment options for varying patient needs without compromising on the quality of healthcare. As we fight a pandemic today, it is imperative to look at a future that will encourage innovations and keep patient safety as a priority always.

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