How 5 cardiology leaders see the field transforming in 3 years

Five cardiology leaders discuss changes they expect to see in the cardiology arena over the next three years.

Respondents shared their insights with Becker's June 23-29. Responses were lightly edited for clarity and length and are presented alphabetically.

Question: What are the biggest transformations we can expect in cardiology by 2023?

Mario J. Garcia, MD, chief of the cardiology division at Albert Einstein College of Medicine - Montefiore Health System and co-director of the Montefiore Einstein Center for Heart and Vascular Care in New York City.

The most important transformation in the field of cardiology is the use of telemedicine. If used appropriately, it can allow more rapid access for first-time consultations, remote management of chronic disease and efficient scheduling of tests — reducing the need for multiple in-person visits. Indirectly, the incorporation of telemedicine also increases capacity without requiring significant expansion of facilities and personnel. Most importantly, it will improve access to subspecialty care in suburban and rural areas. I believe we will see increased development and utilization of remote-monitoring systems, and through more complete biofeedback, improvement in personalized medicine.

Independently, we should expect continued growth of minimally invasive procedures for management of coronary, vascular and valvular heart disease and device therapies for management of arrhythmias and heart failure.

Lastly, quality metrics should continue to expand and become more available and transparent to the public, who is becoming more aware and conscious about disparities.

Linda D. Gillam, MD, chair of cardiovascular medicine, Atlantic Health System in Morristown, N.J.

A rare silver lining to the COVID-19 pandemic has been expanded options and reimbursement for telemedicine. While face-to-face visits will remain essential in cardiac care, telehealth options will expand to include more remote-monitoring devices, particularly for cardiac rhythm disorders and heart failure, as well as better ways of communicating with patients.

Artificial intelligence/machine learning will play an expanded role in diagnosis and management. Examples include providing feedback to train imaging technicians to optimize images as well as tools to streamline interpretation and reporting. Big data analyses will facilitate more personalized medicine, and with that, the potential for more rapid testing of new drugs.

With the development of new devices, catheter-based alternatives to surgery, particularly for structural heart disease, will continue to expand, although surgery will continue to be essential in the care of some patients.

Patrick McCarthy, MD, executive director of the Northwestern Medicine Bluhm Cardiovascular Institute in Chicago.

By 2023, telehealth appointments will become routine. Patients appreciate the convenience for many routine appointments and the ability to receive a second opinion remotely. For physicians, these are the new 'house calls,' and the quality of the connection, both personal and through the technology portals, has exceeded expectations.

Gregory Mishkel, MD, chief of cardiology, vice president of the cardiac service line and co-director of the Cardiovascular Institute at NorthShore University HealthSystem in Evanston, Ill.

Cardiology will undoubtedly be shaped by the events of 2020. Telehealth will play a larger role and impact patient and physician expectations and engagement, as well as the possible 'nationalization' of healthcare delivery if the ability to practice across state lines continues post-COVID. Imagine large nationally recognized organizations coming 'virtually' into a local market with telehealth.

COVID likely also will accelerate integration, as small MD groups weigh the financial impacts of the crisis.

There will be greater critical thinking about the necessity of many elective procedures. Yes, more patients suffered myocardial infarction and cerebrovascular accidents [or stroke] during COVID in attempts to resist care, but many patients learned that maybe they didn't really need that atrial fibrillation ablation, or Watchman implant, or coronary stent for angina. There is potential to impact revenue stream of hospitals, MD income and training programs.

Artificial intelligence has the potential of impacting how and when we report studies, as well as becoming a more useful tool to enhance the clinical interaction between patient and provider.

We will see a greater emphasis on population health and disparities in healthcare delivery. This will also include greater attention to addressing disparities in leadership and underrepresentation of minorities in healthcare.

The hospital 'system' is not dead. The pre-COVID perception that 'hospitals aren't relevant anymore — we just need more community healthcare centers' can have calamitous results when facing local/regional/national healthcare disasters. There will be greater attention to supply chain both by healthcare providers but also by national governments with 'onshoring' of vital assets and intellectual property.

And finally, large national and regional meetings will incorporate more virtual gatherings, and reciprocally, likely less face-to-face and large group gatherings.

Manesh Patel, MD, chief of the division of cardiology and co-director of the heart center at Duke Health in Durham, N.C.

On the science side, I think the biggest things will be happening around single-stranded interfering RNA molecules or molecules that you can give in prolonged fashion to lower people's cholesterol or affect their heart in other ways. Right now, we tell people to take these statin medications every day, and some patients do, and some don't. So, the broad topic here would be, we're going to transform how we prevent cardiovascular disease. Today, we do a variety of pills; we don't change behavior. But there are now scientific therapies coming where I can inject the patient twice a year and get their LDL [bad cholesterol] down to 30 and prevent heart attacks. We'll see if the science shows that, but I think it's going to.

I think it'll transform our practice in that, COVID or not, we're going to have care closer to home, and care-delivery models that include things like freestanding catheterization laboratories and freestanding electrophysiology procedures — more minimally invasive [procedure options] closer to home, and not always at the hospital. Imagine most of the patients in your health system and practice can potentially be monitored or managed remotely, so that instead of clinic visits, we are going to have a variety of ways in which we manage their blood pressure or cholesterol.

The other big innovation that's hard not to see coming is the transformation of data into augmented intelligence. So that instead of every patient getting the same sets of tests and evaluations, we'll be able to use a variety of machine-learning models to determine when a patient is going to decompensate from a heart perspective or [is] doing well and [does] not require a test.  Additionally, we have several ways in which augmented intelligence will help us determine how to help patients intraprocedurally.

The other big disruptors are places like Walmart and others that are starting to deliver their own care. Obviously, they have their spine Centers of Excellence, but as they start to set up heart Centers of Excellence and start to think about how they manage their own employee workforce's cardiovascular risk, they are going to be a disruptor, and we're going to have to learn how to partner and manage people from afar.



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