LiveWell Talk On...Technology and its Impact on Heart Health and Heart

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Ep. 2 - LiveWell Talk On...Technology and its Impact on Heart Health and Heart Care

episode 2

Ep. 2 - LiveWell Talk On...Technology and its Impact on Heart Health and Heart Care


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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health - St. Luke's Hospital

Guest: Dr. Georges Hajj, cardiologist, UnityPoint Health - Cedar Rapids Heart and Vascular Institute and St. Luke's Cardiology
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Dr. Arnold:
This is LiveWell Talk On... Technology and its Impact on Heart Health and Heart Care. I'm Dr. Dustin Arnold, chief medical officer at UnityPoint Health - St. Luke's Hospital. Wearable devices that measure various health functions are on the rise. Fitness trackers, smart watches and other mobile phone apps can track our steps, the foods we eat, our heart beats per minute. This technology continues to advance providing, increased information which individuals may even want to share with their healthcare providers. And it's not just in the consumer world. We are seeing and using more sophisticated wearable devices in health clinics and hospitals, which allow us to better serve our patients. Joining me to talk more about this is cardiologist, Dr. Georges Hajj, from UnityPoint Health - Cedar Rapids Heart and Vascular Institute and St. Luke' s Cardiology. Thanks for taking the time to talk about this topic today. First off, wearable health tracking devices are becoming so commonplace, how's that influencing your practice? What are you seeing?

Dr. Hajj:

More and more, we're seeing patients that are actually coming to the office for the sole chief complaint of my iWatch or my trackable device has noted an irregular heartbeat or an extra heartbeat or a fast heartbeat, or my heart rate is not increasing properly with exercise or it's going too high with exercise. So I'm definitely seeing more and more patients coming in for these complaints and certainly many of them are real and correct and, end up diagnosing medical problems, cardiac problems. Of course some of them are not and some of them are not very accurate.

Dr. Arnold:

What percentage do you think demonstrate pathology?

Dr. Hajj:
I would say at least 30 to 40 percent.

Dr. Arnold:
You know, I'm older than you, and so I practiced medicine before the Internet.

Dr. Hajj:
Yep.

Dr. Arnold:
And then the internet came along, Late nineties, and you know, so the patients had access to information that they'd never had access before. So we had a policy in our office, in my previous practice, my first practice, that we would talk about anything you brought in from five particular websites and it was CDC website, National Institutes of Health, ADA, American Heart Association, etc. And we'd talk, whatever you brought in, we'd talk about it. From any other website, we wouldn't, you know, we just apologize. Do you have that sort of philosophy with these devices? Like are there certain devices that, that you see of greater value than others? That you pay more attention to perhaps?

Dr. Hajj:
Almost always the patient brings the device with them, whether it's the phone or whether it's the watch or whether whatever the device is, they bring it with them. And I look at the device, I look at the data and I actually look at the heart rate, look at the time, what time of the day these heart rates were recorded, what the patient was doing during that time. I can't say that I can discriminate between vendors at this time saying this is more accurate than that, or more likely to demonstrate pathology than that. I can't really say per vendor that it is different. Certainly not with accuracy. And I'm not aware of any trials or studies that compare these different devices and told us as physicians and as patients whether one is superior to the other in regards to accuracy. Of course these websites you talked about, they're very respected, well respected, medical journals and medical associations. And it's somewhat easy to say, okay, these are reliable resources, but we just don't have enough data from these new devices yet maybe. Maybe in the future that would be a very interesting field to study more.

Dr. Arnold:
Now you've mentioned that the vital sign devices, heart rate, blood pressure, of course. How about the, I know there's different devices for diets, Keto count, calorie count, carb count, particularly the diabetics, a carb count, some sort of function there works well. Is there one that you favor as far as a device to help guide patients in their dietary discipline?

Dr. Hajj:
I would say this is very dependent on the patient. So some patients are, mostly the younger population who are really interested in doing things electronically, matches their lifestyle better of being able to punch in numbers in their device and keep tracking on the go as the day goes. And I think these patients would greatly benefit from that for sure. And like you mentioned, calorie count sort of almost fell out of favor because of all these new fancier diets and but I always go back to the calorie count because at the end, all these other diets, what they're trying to do is just change the amount of, or quality of food that the patient's eating so that they're less hungry and then they're ingesting less calories. So at the end of the day, it's the number of calories that's gonna mostly impact the weight loss program. But certainly the more middle aged or older patients that are not that savvy in punching in numbers into their apps are not going to benefit as much versus the heart rate and the vitals are a little easier. The patient doesn't really have to put any information in other than they just put there one time only putting their weight and height and age and the app will take it from there. And even just as simple as a fib, it will be detected by certain devices and so certainly helpful for certain subset of patients to use the diet apps, but it takes a certain particular kind of patient,

Dr. Arnold:
You know, historically with atrial fibrillation, the rapid ventricular response, control of the heart rate, not letting it go too fast as patients may become symptomatic, but as you know, not making it too slow because then they may become symptomatic.

Dr. Hajj:
Right.


Dr. Arnold:
These devices probably do help sometimes with that rather than strapping on an event monitor, holter monitor, you probably do gather some data that's of value. I can imagine that.


Dr. Hajj:
Certainly. I can't speak to the fact that they are as accurate because with the event monitor, with the holter monitor, we actually get an actual tracing that proves that this is atrial fibrillation. But these devices serve when the patient's already been diagnosed with atrial fibrillation for example and the watch or the phone is telling them they're having irregular heartbeat, even if the irregular heartbeat is in the normal range. Say they are having episodes of intermittent atrial fibrillation or paroxysmal atrial fibrillation at 80 beats a minute. They may not be symptomatic, but if they've had an ablation or a cardioversion and we've taken them off blood thinners because we think this is gone and it's back and they have certain other risk factors like high blood pressure or diabetes or a certain age, then we may want to reconsider putting them on blood thinners to prevent stroke. And so these devices telling the patient that they have an irregular heartbeat, which again could be just a PVC or a PAC. So it needs more evaluation by an actual event monitor or a holter monitor. So I see the event monitor holter monitor as a complimentary, not as a replacement and vice versa. I see the electronic devices as a complimentary, not as a replacement of a holter monitor.

Dr. Arnold:
I can imagine. I think it was a German study where patients were told to come to the ER when they felt they went in atrial fibrillation and they would say, "Oh I just went into it," and the average time they'd been in it was a week before, because they feel when it gets fast.


Dr. Hajj:
Yeah, exactly. Exactly. The feeling is definitely not reliable.

Dr. Arnold:

Staying on the technology topic. How about the patient portal and communication that way. How's that influenced your practice?

Dr. Hajj:

Tremendously. It influences my practice a lot because first of all it is much faster to get their questions answered, substantially faster, within hours they can get their question answered, at least in my experience. Because I use actually I access health medical records through also myself through also portable devices. So even if I'm not physically in the office, I have the ability to access my patients' charts. And if they send information or questions or sometimes I ask them to check their vitals or have any new medical issues, then they can be addressed pretty much within the same day. The other route is going to be to call the office, wait for an answer. The nurse or the medical staff in the office needs to get ahold of me or of the physician. The second reason that it's good is the fact that the patient will be more involved in their health care. When they go in their chart they know, in my opinion, they get more involved in their own healthcare and that's half the battle. If the patient is looking at their chart, seeing what their blood pressure recordings were at the office visit, seeing what their body mass index were, reading their medical diagnosis, getting educated about what their diseases are. In my opinion, that leads to higher compliance with medical treatment, whether it's testing or medications or because they have a full understanding of what exactly is going on. So in brief, I think that I personally use it as a patient, not as a doctor and I'm very pleased with it and when my provider tries to get, when I tried to get ahold of my provider, it was a lot more challenging before I sign up for electronic health record, for MyChart.


Dr. Arnold:
Beyond the technology we talked about, on the horizon, is there any new technology that you see coming to your practice?

Dr. Hajj:
There are a couple things that we are investigating or I would say not investigating, I would say there are a couple of things that we are checking into. Specifically event monitors or holter monitors, more so event monitors, that don't have the hassle of the leads. We've had patients, especially in the older population or even young patients that are very active that want to be more active, and the hassle of these wires connected to the chest. There's a patch kind where it doesn't have any wires. It's a patch. It's usually a one week duration battery. So, they may have to just remove it and put it back on if we want a four week duration monitoring period. But maybe in one week we get all information we need and we'll be done. And it's a lot more convenient for these patients. So in a way, it's sort of trying to mimic these portable devices because what it is, It's just a patch on the skin and the EKG electrodes are embedded in that patch itself. And I really see a lot of patients that right now refuse or rather not wear a monitor for a month, would actually not mind wearing the monitor for a month. And that would lead to better and more accurate diagnosis of a lot of arrhythmias.

Dr. Arnold:
Yeah, I worked yesterday in the hospital, making rounds, and I always think to myself, those telemetry monitors, which are heavy, bulky, multiple wires, but yet in the age of the microchip, we can't have something smaller, you know? And I think that's something that would be positive for physicians and patients.


Dr. Hajj:
Exactly.

Dr. Arnold:
You know, I wanted to mention today before you wrap this up. I don't think a lot of people are aware of the Heart and Vascular Institute. It's a center of excellence for vascular care. Can you just give me an overview of what that is and the direction, directionally what's going to be happening with the HVI in the coming year?

Dr. Hajj:
Certainly. HVI is crucial in my opinion. Let me just explain. HVI is Heart and Vascular Institute and each one of these three words I think has a major impact. Obviously heart, vascular, because this is heart disease and vascular disease. And the word institute means that there are multiple highly experienced and trained physicians in highly sub-specialized areas of expertise that work together in order to provide very advanced treatments that may not be available in other areas in the region. So to give you an example, because of the Heart and Vascular Institute, many new treatments have been introduced to the Cedar Rapids area including Transcatheter Aortic Valve Replacement (TAVR), where we replace aortic valves from the groin with a minimally invasive procedure where we don't actually cut the chest open. This isn't a one person job, this isn't a one man show. This is a procedure that involves collaboration between multiple members of the HVI. For example, we need an interventional cardiologist, which is a physician like myself who needs to be trained in manipulating wires and catheters and able to deploy valve replacement, but that alone doesn't work because we need an expert in cardiac imaging, a person who can, another cardiologist who can visualize the heart and the valve and detect the position and the outcome of the valve deployment. In addition to that, we need a vascular provider who is able to manage vascular access because we're accessing the blood vessels in the groin in order to get to the heart. And so we need someone who is an expert vascular diseases in case this blood vessel is not accommodating or is not cooperating with the catheter going through it. We also, in addition to that need anesthesia services and these services are in order to make sure that the patient is asleep during this procedure in addition to that. So you add to all this the fact that this is only during the procedure, but this procedure is not done, it's not like any other simple surgery where we say, okay, come back tomorrow and we'll take care of it. A lot of planning happens before this procedure. For example, the HVI members have to meet multiple times and discuss every single patient's case over a while, over at least half an hour each case before hand. And we need to have every single other aspect of the patient's healthcare reviewed. Whether they have diabetes, whether they have atrial fibrillation, whether they have other medical problems and a CT scan is performed of the heart and the blood vessels and an expert in cardiac CT reading, which could be a cardiologist or a radiologist, needs to review all these in order to tell us what the exact size of the valve is, what the exact size of the blood vessels in the legs and in the belly are in order to be able to reach the heart with all these large catheters that we need to get there. So in brief, this is just a simple example of how HVI works and Heart and Vascular Institute kind of puts all these, put all these providers under the same umbrella so they can collaborate together to make this happen. Without the collaboration of these physicians, this procedure and this sort of service would not be possible in any place.


Dr. Arnold:
Well reinforces my axiom that medicine is a team sport and that certainly is demonstrated there. One last question. Why did you become a cardiologist?


Dr. Hajj:
I decided to be a cardiologist very early in my career. I was probably within my first year of medical school and the main reason that I decided to be a cardiologist is I really enjoyed somewhat complex hemodynamics and logical thinking. I'm a math and physics major, but at the same time I wanted to also do procedures and cardiology is very unique in that aspect because as you're doing the procedures, any procedure in cardiology or most procedures in cardiology, it combines both the aspect of the fact that you actually as you are doing highly doing procedures that require high skill, at the same time you're thinking about the hemodynamics and the numbers that are happening momentarily as you are doing this procedure. So it is a place where it combines medicine and procedure. I don't want to say surgery because it's not considered surgery, and at the same time you see the patient in the office, you see them in the hospital, whether they come as patients who are dying, having a heart attack. And then the most rewarding part of the job is when you see them afterwards in the office and you see them with their families, with their loved ones. And that's where, that's what makes the whole thing worth it. That's the best part of cardiology is when you see patients in the office that they may not have been there if it wasn't for cardiology in the first place. And of course there's more education and and work to do afterwards. But the most rewarding part is when they come walking to the office after they had a massive heart attack or they were in shock or they were very, very ill and I had the privilege and the honor to treat them from the moment they got to the hospital till they got to my office.

Dr. Arnold:
That's really great information, Dr. Hajj, and I want to thank you for taking time out of your busy schedule to talk today. Again, this is Dr. Georges Hajj, one of the over 500 specialists and highly trained physicians we have on staff here at St. Luke's and he's a member of St Luke's Cardiology and Heart and Vascular Institute. If you have a topic you'd like to suggest for our LiveWell Talk On... podcast, shoot us an email at stlukescr@unitypoint.org and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.


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