Atherosclerotic cardiovascular disease is responsible for the highest percentage of morbidity and mortality in the Unites States. At the present time, institutions such as the American Heart Association devote major efforts to promote wellness and prevent arteriosclerotic cardiovascular disease.
In cardiology practices it is imperative to emphasize that smoking, hypertension and LDL-cholesterol elevation importantly determine arteriosclerotic cardiovascular risk and therefore their control is a sine qua nom to minimize cardiovascular risk.
Lack of control of risk factors of arteriosclerotic cardiovascular disease leads, for example, to the catastrophic acute coronary syndromes with predictable increases in mortality and also increases the incidence of both heart failure and cardiac arrhythmias.
Acute coronary syndromes demand prompt medical attention. This translates into activation of a coordinated paramedical and medical team after the use of a simple 911 call.
An example of a critical area for control of risk factors that foster arteriosclerotic cardiovascular disease is hypertension control. Systolic blood pressure inexorably edges up linearly and continuously as a function of age.
In the vast majority of cases diuretics, angiotensin inhibitors, angiotensin receptor blockers, cardio-selective beta blockers and dihydropyridine calcium channel blockers bring blood pressure under control.
However, physician involvement and patient compliance with therapy are required to efficiently bring down and maintain the blood pressure below 140/90 mmHg (or below 150/90 mmHg in individuals older than 65 years of age).
There is an essential need for health care providers to insist on accurate measurement of blood pressure and appropriate medication dosing for patients with hypertension.
Statins are at the top of the list of commonest used pharmaceuticals and overall they consistently lower cardiovascular risk from increased LDL-cholesterol with a low percentage of side effects.
Other important aspects of cardiovascular risk control are a healthy Mediterranean-like diet such as the DASH diet, weight management and weekly planned exercise.
These three directives of the American Heart Association are under the designation of lifestyle controls. In this section, smoking cessation, the monitoring and management of blood sugar and hemoglobin A1C, control of stress and judicious use of alcohol are also included.
In 1995, the internet came to the forefront of daily living under the rubric of the information superhighway. Needless to say, it revolutionized digital communication and it has made all knowledge available at an instant click.
Today, almost 20 years later, we live in the epoch of the smartphone and of an endless number of apps. Other appliances in the same genre are the tablet PCs and other wireless devices. They all allow instant text messaging, teleconferencing, and all sorts of multimedia implementation.
What about the use of mobile information for usage in cardiology? A recent publication (1) discusses the use of mobile cardiac applications. It hierarchically lists areas of potential applications: a) wellness and prevention (in the areas of cardiovascular risk as discussed above), b) pre-and in-hospital acute care, and c) out-of-hospital sub-acute care, rehabilitation and long-term care.
Of course, some of these services are already in use…
After a 911 call, within minutes the ambulance arrives. The EMS team assesses and then treats the patient.
It transmits ECGs to the hospital, receives feedback from the physician about other treatments and makes decisions to promptly deliver the patient to a hospital for fibrinolysis, or rather, for transfer of the patient to an alternate hospital capable of coronary angiography and coronary stenting. (Thus, the all important metrics of symptom-to-stenting and door-to-stenting times are realized). In this process digital communication is already maximized.
In the area of cardiac arrhythmias, many patients need continuing investigation for paroxysmal atrial fibrillation, monitoring of atrial fibrillation after ablation or in cases of paroxysmal ventricular tachycardia.
With event recorders the patient uses a wearable miniaturized instrument that records ECG-like activity upon activation by the patient’s symptoms. The data is transmitted to a dedicated analytical center where data is processed and the physician of the patient promptly notified. Again, this is a mature technology and an application system which is fully implemented.
The areas where mobile devices can make a major impact in cardiology (2) are therefore: 1) decreasing cardiovascular risk and 2) post-hospital care (sub-acute cardiac care, rehabilitation and long-term cardiac care).
As in all areas of the economy, progress in these cardiac needs will be a function of demand and supply, investment, politics, insurance coverage, comparative effectiveness, patient safety and patient privacy.
References
- E Honeyman, H Ding, M Varnfield, M Karunanithi. Mobile Health Applications in Cardiac Care. Interventional Cardiology. 2014;6(2):227-240.
- N Chesanow Transformative Medicine: Patient visits move Online. Virtual visits benefit physicians as well as patients. Medscape/Cardiology. September 25 2014