William discusses ‘Divine Intervention’ and the Digital Health Revolution with CardioPulse at ESC Congress 2017 William Wijns is Co-Director of EuroPCR and Chairman of PCR. In 2016, he was appointed Professor of Interventional Cardiology at the Lambe Institute for Translational Medicine at the National University of Ireland, Galway. He leads a research project to develop wearable sensors that can monitor high-risk patients, alert them to potential danger signs and help prevent heart attacks. The Irish project will ultimately lead to the production of devices to monitor an individual’s vital signs which will put the patient at the centre of his or her own diagnosis and treatment. Such devices, along with the emergence of specially enabled smartphones and the patient-generated data they provide will move away from what innovator and author Eric Topol MD refers to as ‘medical paternalism’ towards a more democratic patient-centred form of medicine. The connected health/technology enabled care (TEC) revolution is coming to a wristwatch or smartphone near you—if it isn’t already there. Wijns says: ‘That is where the future is heading and it’s not just wearables and the data they collect but also access to genetic information that patients will make available to doctors. A patient will come with their genetic profile and some identified abnormalities and will ask the doctor what should be done about the problem. It’s not so different to what happens now, but it will be patient driven’. Some clinicians fear this will result in the physician being relegated to the role of technician, but Wijns sees it at as an opportunity to reset the patient–doctor relationship. For interventional cardiology, it offers unprecedented opportunities to evaluate, to anticipate, and to plan interventions as opposed to waiting until patients arrive at the more advanced stages of disease when there is structural damage to vessels or valves. Wijns says there is a precedent in the way interventional cardiology changed the physician’s role. ‘When I started medicine, cardiology was a contemplative discipline involving measuring, documenting, and analysing diseases, which was interesting but irrelevant from the patient perspective. Intervention changed our discipline and many others to become therapeutic by giving us a combination of drugs and devices to use. Treatment had previously been the role of the surgeon and the cardiologist existed to make diagnoses’. The rise of monitoring devices and the shift in emphasis towards the patient as an arbiter of data in the journey to diagnosis, is Wijns suggests, a cause for celebration rather than a development to be resisted. ‘We will have more time to talk to the patient and discuss things. Smart computers will learn how to make a probability diagnosis from analysing data which will be far superior to the performance of the best physician, so there’s going to be disruption, but we have seen this coming. We will still need to do the biopsies and perform procedures, but these will be better integrated than in previous times’. Wijns points out that health professionals also need to be mindful of the fact that outcome is not only driven by technical intervention; planning, preparation, and follow-up are all important. He says: ‘These new devices will give us time to organize care in a more structured way. Most of it will happen outside the hospital, and we will be able to standardize and plan the care process more efficiently which will deliver a much better outcome from the patient perspective’. This requires staff who know exactly what the patient is coming to the hospital for, and time before and after the procedure to talk over any concerns. The patient experience he says, will be much more personalized in this way. Interventionists especially should recognize that this approach will complement the hands-on part of the treatment and ensure the whole pathway is as patient friendly as possible. The tech revolution will also place greater emphasis on what patients believe has been a successful procedure—often in contrast to what the data illustrate. Wijns highlights PCI via the endovascular route as a case in point. The endovascular approach is popular with patients because it offers simplicity, non-invasive ease of access, and a short recovery time compared with surgical procedures such as coronary artery bypass graft. ‘Even if doctors give patients the facts that surgery might give a better long-term result, they will still tend to go for PCI as a preferred option. The concept that you should give more weight to what the patient perceives as a successful procedure vs. what the doctor perceives as a successful procedure—patient related outcomes—isn’t new but we are trained to do procedures and not to reflect on how we can improve perception and outcome from the patient perspective’. Improving the patient perception can be achieved, he says, by ensuring the care pathway and the procedure is engineered better in practical terms, so the interventionist isn’t preoccupied with details such as blood tests. This will free up time for more simple but effective one-to-one communication which will enhance the patient experience. The minimally invasive approach which was spearheaded by interventional cardiology has over the years spread to other disciplines and created an expectation that all procedures should be similarly straightforward with a short recovery time. ‘That is what PCI has contributed to medicine’, Wijns says, ‘using the endovascular route is minimally invasive, you can go anywhere, reach any organ and do whatever needs to be done’. Miniaturization of devices has been a great help to the development of PCI as have improvements in imaging. He says: ‘It is just incredible what you can see inside now compared to the early days of PCI when you had to rely on getting films developed. It gives you much more understanding of what you are doing’. The pace of progress in interventional cardiology over the past 40 years has helped refine and standardize techniques to a level where they can be passed on to trainees who in turn can apply their knowledge in a clinical setting. The advent of TAVI a mere 15 years ago and its maturation into a well-controlled procedure which is comparatively patient friendly is another example of how technical advances can enhance patient perception. Just as interventional cardiology raised patient expectation of straightforward, non-invasive solutions to cardiovascular disease, so the digital revolution promises a more person-centred approach with the patient in control. Wijns believes that the benefits of the digital revolution should be extended to all mankind-not just those who live in the richer nations on earth. ‘All these beautiful treatments we have developed are currently the privilege of the few while there are twice as many people, or perhaps more, who have no access to anything whatsoever. We will have to change the process of care delivery in such a way that we make some of this care available to the 3 billion people who have zero access at this current time. This revolution, which comes from many factors such as user-connected health, simplifying procedures and the endovascular approach, should allow the delivery of better care to more patients’. He believes that industry has now realized that this vast unmet need is where future growth is now that modern medicine has now reached a level of complexity in which it is difficult to improve outcomes in an ageing post-industrial population any further. ‘People are crying out for it, they know that there is a solution to their problem, industry is going to support it because it is growth and doctors just need to accept the fact they need to be part of this and be in the driving seat instead of resisting the change’. Conflict of interest: none declared. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: firstname.lastname@example.org. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
European Heart Journal – Oxford University Press
Published: May 7, 2018
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