How cardiology could change in 50 years, per 8 leaders

From treating heart disease at home with wearable devices to utilizing artificial intelligence and advanced procedures, cardiology leaders say there are a number of possibilities to look forward to in the next 50 years.

Here, eight leaders weigh in on their vision of cardiology in 2073:

J.C. Brenes, MD. Medical Director at Memorial Regional Hospital (Hollywood, Fla): The young will use technology to monitor all aspects of their diet, exercise and internal functions, with devices making accurate diagnosis of medical issues before a physician is even consulted. For the elderly that will be affected by arrhythmias and aortic stenosis, technology will deliver even less invasive, more immediate solutions. AI, already an important tactic, can be as much a game-changer as when cardiac catheterization replaced some open-chest procedures. Fifty years of advancements in genetics will help cardiologists more efficiently screen for problems, predict and prevent cardiac events. I'm hopeful and optimistic that by 2073, technological advances that are safely implemented will ultimately prevent heart disease and prolong the lives we lead.

Gopi Dandamudi, MD. Executive Medical Director of the Center for Cardiovascular Health at Virginia Mason Franciscan Health (Tacoma, Wash.): Cardiology is a fast-evolving specialty and will continue to be critical in the next 50 years, particularly as heart disease is the leading cause of death in the U.S. As we look ahead to the next few decades, I anticipate we'll continue to see innovative technological advances that alter the ease of monitoring heart conditions for both patients and their providers. In a continuously connected world, I believe our monitoring devices, such as wearables, will become so refined that providers can monitor their patients without needing an in-person appointment, unless it's an emergency, which would be convenient for busy patients. Furthermore, I anticipate we'll see an expansion of acute virtual care such as cardiac monitoring and acute nursing that provides the same high quality of care to patients while adapting to the shifts in workforce, as we are currently experiencing.

Joseph Ebinger, MD. Director of Clinical Analytics at the Smidt Heart Institute at Cedars-Sinai (Los Angeles): Advances in imaging, molecular markers and our fundamental understanding of cardiovascular pathology will improve our ability to diagnose disease early on. These, paired with innovations in pharmacology and device development, will usher in an era focused on prevention — stopping patients from suffering cardiovascular events in the first place. Importantly, these advances must be partnered with investments in health services and care delivery, ensuring benefits are equally available to everyone.

Ty Gluckman, MD. Medical Director of the Center for Cardiovascular Analytics, Research and Data Science at Providence (Renton, Wash.): While 50 years seems like a lifetime, many important issues need to be addressed well in advance of 2073. Cardiovascular disease remains the No. 1 cause of death in men and women alike. Even though this statistic is not new, rising rates of obesity, high blood pressure, diabetes and high cholesterol in the U.S. will create unprecedented cardiology demand. Combine this with a growing shortage of physicians, nurses and other allied health professionals, and one has a major workforce crisis on their hands. No single solution is likely to remedy this; rather, a multipronged approach will be necessary. 

This effort will demand greater prioritization of preventive efforts. This includes payment reform that incentivizes health promotion to reduce the growing burden of cardiovascular risk factors, innovative ways to monitor and support patients at increased cardiovascular risk and incorporation of nontraditional approaches into our treatment armamentarium (e.g., virtual care, home-based care, support by health coaches, community health workers and experts in care redesign). Technological innovation also will need to be a major part of this, leveraging artificial intelligence, wearables and insights from big data. With a continued push into miniaturization of devices, identification of novel targets to reduce cardiovascular risk and growth in precision medicine, advances in cardiology will continue to abound. Yet, we will need to find ways to do more with less, embrace outcomes that matter most to patients and prioritize quality, all the while reducing inequities and inequalities in the care that we deliver.  While I have no doubt that the field of cardiology will be resilient and thrive over the next half century, it is likely to come with enormous change.

Rick Stouffer, MD. Chief of Cardiology at UNC Health (Chapel Hill, N.C.): Almost nothing that we view as modern cardiology was available 50 years ago. Cardiac procedures and surgery, cardiac intensive care units, almost all cardiovascular medications, and even cardiology as a specialty were either unknown or very early in development in the early 1970s. It is likely that cardiology will change as much in the next 50 years as it has in the last 50 years. Two notable changes that are already in progress and will continue during the next 50 years are: 1) Cardiac procedures and cardiac surgery will have better outcomes due to improved technology and techniques but will be used less frequently as the focus turns to prevention rather than treatment; and 2) Weight reduction will become a primary focus for cardiovascular risk factor management. For obese patients, use of a glucagon-like peptide-1 (GLP-1) agonist and other weight loss medications will be an early addition to help reduce blood pressure, lipid levels and glucose levels. 

However, a few things won't change. One is that exercise will still be prescribed but rarely followed. Second is that the widespread availability of cheap, non-nutritious calories will continue to be a scourge. Third, patients will continue to engage in behaviors that are detrimental to their health. While specific behaviors might change (e.g. less cigarette usage), other harmful behaviors will arise. And no matter how much progress we make, people will still die from heart disease.

Tom Stys, MD. Interventional Cardiologist at Sanford Health (Sioux Falls, S.D.): Computer and robotic assistance will continue to make procedural and surgical technologies in management of cardiovascular disease safer, more effective and available to a much broader spectrum of patients. In addition, artificial intelligence will radically change the process and fundamentals of clinical diagnosis decision-making, enhancing patient care.

Mitchell Weinberg, MD. Chair of the Department of Cardiology at Staten Island University Hospital (New York City): I believe the development which will have the most transformational impact on cardiology in upcoming decades is AI. But there are a number of threshold hurdles that AI must achieve first. The digital AI transformation requires the rapid growth of costly digital, wireless platforms, the amelioration of concerns about privacy, and the design of appropriate AI regulatory bodies. Once this is achieved, I expect artificial intelligence and advanced computing to recenter the patient-provider exchange; drive the miniaturization and automation of monitors, handhelds and implantable devices; produce rapid results for diagnostic studies, such as the cardiac CT scan, nuclear stress test and cardiac MRI; and support clinical decision-making in both the hospital and outpatient settings. With further advances in AI could come advances in robots and the rapid development of an independent functioning robot.

Jonathan Weinsaft, MD. Chief of Cardiology at Weill Cornell Medicine and NewYork-Presbyterian (New York City): In 50 years, I think cardiology is going to be more focused on tailored therapies for cardiovascular disease, both primary and secondary and for identifying patients at risk for given events or in need of particular therapies. Whether molecular, advanced imaging or otherwise, I think we're going to be transformed in terms of identifying and recognizing personalized treatment and applying that approach.

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