In an ideal world, what would the perfect healthcare system look like to treat heart disease?
In a vision that hovers on a distant horizon, every citizen will recall their blood pressure and cholesterol levels as easily as their bank card PIN number.
Most would have trained in cardio pulmonary resuscitation (CPR) and the location of the nearest life-saving defibrillator machine would be triggered by an emergency call.
Drones would fly in medication to beat traffic delays, medical-grade scanning booths could be positioned at supermarkets while condition-tracking sensors would be implanted in our bodies making hospital care an element of heart health rather than the overbearing and budget-draining norm.
The notion of designing a new cardiovascular healthcare system from scratch unleashes creative forces and an intriguing question of what could be possible as the world heads towards a demographic nightmare.
The current healthcare system struggling to cope with CVD
Cardiovascular disease (CVD) claims 17.9 million lives globally while 422 million are living with its debilitating impact as many a healthcare system strains to fund treatment. CVD care costs in the United States are expected to rise by 20 per cent to more than $1 trillion by 2030. The world population is ageing and seeing out its twilight years with greater levels of illness, so a new way of addressing the biggest global killer is essential.
A perfect healthcare system would have people taking much better control of their own health, along with us utilising big advances in technology
Starting with a blank page is an energising exercise in the art of the probable. It is also a reminder of the societal and structural mountains that need to be moved.
Technology is advancing so rapidly that blue-sky thinking soon becomes developmental reality. But experts believe that gadgets and connectivity will not be truly transformative unless they are combined with seismic shifts in health behaviour and care delivery.
The ideal system would promote prevention
“An ideal system would promote a healthy lifestyle and prevent disease in the first place,” says Professor Sir Nilesh Samani, a distinguished cardiologist and now medical director of the British Heart Foundation (BHF). “Some of the seeds of poor CVD health are laid very early on, so education in early-years schooling and with the family is a key component.
“A perfect healthcare system would have people taking much better control of their own health, along with us utilising big advances in technology. All this comes at a price, but there is lack of precision treatment at the moment, with some people on medication who don’t need to be and poor adherence rates, and smart systems of the future would be cost efficient.
“There are tremendous advances and patient empowerment is coming. I am excited that patients are going to be much more in control via monitoring devices and access to their health records. But the biggest gains will be harnessing this in prevention.”
The prevention mantra is echoed by Jan Kimpen, chief medical officer at Philips, healthcare technology giants. “If I could design it from scratch, it would be a continuum of care, not the fragmented systems we have now,” he says. “We need to live and eat healthy, not use excessive alcohol, take exercise and not smoke, and I would design a system that helps that through digitisation.”
Direct-to-consumer gadgets are a step in the right direction
Apps to guide and nudge behaviour are already available, but they need to be integrated across healthcare and be an essential element of more fluid hospital workflows with minimal hospital stays and aftercare monitored by at-home devices, he adds.
“It is not about the innovation of products, but how we innovate the healthcare system,” says Mr Kimpen. “We need to push towards value-based outcomes, not volume-driven systems. I am confident we can build a better future because of two reasons: healthcare costs are growing faster than national economies, which is unsustainable; and patients are becoming consumers and their demands are going to shift healthcare systems. It will not happen overnight but it will happen.”
The perfect cardiovascular healthcare system will feature the use of data, super powerful computing strength, with the wonder of medical advances, inspiring people to play their part in heart health
Sensor technology and miniaturisation are already taking space-age devices from the drawing board to the human body, such as Proteus Discover, an ingestible sensor that can track medication adherence and performance, which was approved recently.
But the American College of Cardiology (ACC), in welcoming the potential of technology, cautions about the clamour for direct-to-consumer gadgets.
“You can feel the tension in the cardiac community over this,” says Sanjeev Bhavnani, physician scientist and cardiologist at Scripps Clinic and Research Foundation in San Diego, California, who is lead author of the ACC Roadmap to Innovation policy statement. “We should be deploying those technologies that are proven. My wishes for the future are that we have an evidence-based approach to technology and that partnerships between stakeholders can generate evidence before consumers purchase healthcare devices.”
Evaluation will be as important as innovation
The use of patient data, artificial intelligence (AI) and linked devices can have a paradigm shift, but the breathless charge for innovation should not eclipse the need for evaluation.
“By 2050, we will see nano sensors embedded in people, implantable technology that monitors health passively and will alert rather like engine check lights in cars. Our vital metrics will be monitored all the time, in homes, cars and the wider environment,” says Dr Bhavnani. “We are rapidly innovating and the next 20 years will be about how we bring this to the mainstream. It might be every home is going to have mirrors with sensors, which monitor heart rate and rhythm, and there will sensors in the body that detect diseases earlier, when they are more treatable, and that is an exciting prospect.
“Groups are already working on sensors that will detect the likelihood of heart attack before someone even has symptoms.”
Collaboration is advancing with Philips identifying its Heart Safe City programme, running in Copenhagen, Seattle and Dubai, as an example. It connects emergency services via an app and trains people in CPR to improve the chances of surviving a sudden cardiac arrest.
The perfect healthcare system is just waiting to be created
The BHF is also working with Microsoft on cloud-based programme that identifies every defibrillator, so members of the public can access a device while ambulances are en route.
“Our big challenge is how we integrate advances with the healthcare system and the lives we live now,” says Jacob West, BHF director of healthcare innovation. “We don’t want gimmicks and bolt-ons that don’t work with the health system. We need the two to converge.
“But it is not that science fiction to think of a world where you have a digital health assistant, a next-generation of Google Home or Alexa, that contains all your personal medical history, and takes feeds from devices and sensor technology, which contain all the medical science and accumulated patient experiences relating to your health. Saying ‘Alexa, I have a pain in my chest’ could provide you with a credible first-line response in a way that might take you several weeks through appointments at the moment.
“There will be bumps on the road as we mesh more technology into our heart health systems, but none will be impassable.”
The perfect cardiovascular healthcare system will feature the use of data, super powerful computing strength, with the wonder of medical advances, inspiring people to play their part in heart health. But the role of controlling and integrating technology, although less glamorous, is a critical component of care that can eliminate inequalities and have a fundamental influence on society and our ability to cope with shifting demographics without bankrupting nations.
The statistics of the future heart health burden are sobering, but there is comfort in the reforming words of Abraham Lincoln, who is credited with saying: “The best way to predict the future is to create it.”