By Heather R. Johnson
President Lyndon B. Johnson proclaimed February 1964 the first American Heart Month. For 54 years, we’ve raised heart disease awareness on a national and global level. We have medications, medical devices and recovery protocols that weren’t even thought of in 1964. Annual deaths from cardiovascular disease and stroke have fallen dramatically. And we have a much better understanding of the risk factors that can lead to heart disease.
Yet heart disease remains the No. 1 killer in the United States and worldwide. Why? Partly because Americans aren’t doing a good job of controlling the risk factors that lead to heart disease, like smoking, becoming overweight and not controlling cholesterol and blood pressure. For instance, about 15% of Americans still smoke. (That’s down from 42 % in 1964 — a huge improvement but still too high.) About one in three U.S. adults do not engage in regular physical activity. And the percentage of Americans with high blood pressure has increased slightly — from 29% in 1964 to about 33% today.
To be sure, there’s plenty of room for improvement. But clinicians and researchers in the cardiology world are excited about advancements in technology, precision medicine and population health efforts aimed at preventing and treating heart disease.
“We’re making huge strides in health technology,” says Nancy Artinian, chair for the American Heart Assocation’s Council on Cardiovascular & Stroke Nursing. Smartphone apps and accessories can now track a patient’s weight, heart rate, activity level, and sleep habits. They can even do an electrocardiogram! The information these devices gather can be wirelessly (and securely) transmitted to his or her doctor’s office.
“Telemonitoring allows people to communicate remotely when they can’t visit their doctor in person,” says Artinian, who is also a visiting professor
at Michigan State University. This can make it easier for doctors to catch and treat symptoms before they progress to something serious. Telemonitoring can also help patients avoid costly ER visits or hospital admissions if their condition is caught and treated early.
In addition to monitoring things like activity level and heart rate, apps can help patients with another health hurdle: taking medications as directed. Artinian says adherence to doctors’ recommendations plays a big role in uncontrolled blood pressure. When patients have to take two or three medications per day, they may miss a dose or stop taking medications altogether.
Innovative health apps remind patients to take their medications, perform rehab exercises or put on their nicotine patch. “Simple things like sending text messages or timed reminders are big breakthroughs in care,” says Elliott Antman, M.D., a senior cardiologist at Brigham and Women’s Hospital and former American Heart Association president.
Soon, wearable sensors sewn into clothes may monitor a person’s blood glucose levels, heart rate and heart rhythm. “In the next 10 to 20 years, we’ll see even more technological advancements that will help people stay healthy,” Artinian says.
Technological advancements have also led to a number of improvements to medical devices. Thanks to smaller battery size, cardiac devices that once required open chest surgery for implantation can now be placed through less invasive means. The results are faster recovery times and fewer days in the hospital. (See “Incredible Shrinking Heart Devices” in the January/February 2017 issue of Heartbeat for more.)
Also, certain pacemakers now offer automatic monitoring to track patients’ daily respiration, heart rate and other data. And unlike devices of the 1960s, which only paced the right ventricle, today’s pacemakers pace left and right ventricles, and coordinate timing. Device makers have even developed implantable cardiac defibrillators (ICDs) that also have a pacemaker component.
Other recent, life-prolonging advancements include long-term use of left
ventricular assist devices (LVADs) in heart failure patients. Drug-eluting stents emit a drug that helps prevent renarrowing of the arteries. And people with aortic stenosis can now receive a transcatheter aortic valve replacement (TAVR), which allows for faster recovery than standard valve replacement.
“Until a few years ago, cardiac surgeons had to sew in a new valve,” says Dr. Antman. “Now we can insert a new valve in the cath lab just like a stent.”
Martha Gulati, M.D., professor of medicine and cardiology division chief at The University of Arizona-Phoenix and editor-in-chief of the American College of Cardiology’s CardioSmart, says new drug developments have improved survival for heart failure patients. One of them, the combination pill Entresto, reduces mortality risk and shortens hospital stays for these patients. Dr. Antman says statins to reduce cholesterol levels have also improved, as have alternatives to the blood-thinner Warfarin. More notable than new drugs, however, is a greater understanding of how people respond to them.
By launching precision medicine initiatives, health systems can essentially
customize care. Using diagnostics, genome sequencing and data analytics,
doctors can tailor treatment regimens to the patient, sparing them side effects from a drug that doesn’t work for them.
“The goal is to understand all the factors that contribute to an individual’s
transition from ideal health to heart disease or stroke,” Dr. Antman says. “This relates to genetic makeup, the bacteria in your body, where you live and what you’re exposed to. Going forward, we need to be more proactive in terms of risk for disease and targeted treatment.”
While precision medicine aims to personalize treatment, population health
uses data to predict the outcomes of certain communities and segments of communities. From there, health systems can launch programs to target areas with higher heart disease and stroke risk.
Possible solutions for more successful prevention and treatment include
making cardio rehab more accessible. “I think that’s what it’s going to take for individuals who don’t have the resources to commute to the clinic,” Artinian says. “We need programs that are easy to get to, and I’m not seeing that.”
Dr. Antman would like to see community programs that address risk factors: exercise programs at the local high school and/or cardiac rehab and heart health education at the local community center. “We need to see system changes in our society and in our communities so that the healthy choice becomes the default choice.”