Thoughts on World Heart Day today

By Dr. M.N. Ravi, Senior Heart Specialist & Clinical Director, Narayana Multispeciality Hospital, Mysore

An initiative of the World Heart Federation, World Heart Day is celebrated on 29th September every year. This is an opportunity to create awareness in the community that Cardiovascular Disease (CVD) including heart disease and stroke is the world’s leading cause of death and therefore nudge people to adopt heart healthy lifestyles. It is interesting to note the theme of World Heart Day 2021 — Harnessing the power of digital health to improve awareness, prevention and management of CVD. 

I said it was interesting because much before we read this international theme our humble rural populace showed a way forward during the middle of Covid-19 lockdown by harnessing the power of their smartphones. Since there were lockdowns and no public transport available, our rural-based patients utilised audio and video consultation, they paid online, took healthcare appointments online for video calls, passed on their previous consultation notes, medicine lists, lab and radiology reports online and doctors responded with appropriate suggestions — patient at his home in a village and doctor at the hospital or clinic or even at home. Patients saved the cost of travel for at least two people to the hospital in city, cost of food and other expenses and, of course, saved time and prevented loss of at least two working days (patient and one or two attendants). Regular checks and monitoring of hypertension, diabetes, chronic ailments like COPD, heart failure, neurological issues etc., were taken care of satisfactorily. 

During the pandemic, issues developing economies struggled with included almost negligible access to real-time and authentic healthcare data. People scrambled to get access to real-time information on beds and hospitals since most of our healthcare systems work in silos. Solution lies in digital health and digital transformation. Adoption of technologies like block chain for data management, AI for societal health management and big data analysis on EMR, EHR data to improve healthcare operation is critical.

In 2020, the penetration rate of smartphones in India reached 54%. While 94% urban internet users access the internet daily, 90% rural users access internet on a regular basis. Rural India registered 13% growth in internet users in 2020 (vs 4% urban). Moving at a growth pace over 3x faster than urban India, by 2025, rural India is likely to have more internet users (smartphone) than urban India. Rural areas will likely force many changes in how the internet is accessed and the digital ecosystem including digital health.

Digital Health: Use of information and communication technologies in medicine to manage illnesses, health risks and promote wellness. Digital health includes mobile health, health information and technology, wearable devices (smart watch), telehealth and telemedicine. Examples include mobile health apps, Electronic Medical Records (EMR), handheld imaging devices. Digital tools provide us with a more holistic view of patient health through access to data and giving patients more control over their health. Important vitals like heart rate, blood pressure, oxygen saturation can be monitored and transmitted across devices. mApp i ECG is one such example to diagnose heart attack. The family or health care worker can provide life-saving first-aid to such patients.  

Hypertension, diabetes, heart failure and medication adherence monitoring have seen significant advances across most technological categories. As new technologies are developed, data derived from m health devices should be integrated into clinical workflows. In general, a closed data loop is necessary and involves a cycle initiated by patient or provider, cloud based data transfer, interpretation of these findings or automated algorithms and data being returned to patient and provider for clinical decisions. 

An i ECG is an important example taken earlier. A smartphone 3 inch strip that incorporates electrodes for wireless cardiac telemetry monitoring (AliveCor). This produces a rhythm strip ECG and is captured by the smartphone microphone, which can be transmitted into another app ready phone or telemetry screen in an ICU for immediate decision- making and save lives. 

An Asha care worker can be trained to transmit i ECG of a patient from a PHC in a village near  Chamarajanagar or Madikeri to the smartphone of a doctor in Mysuru for immediate action.

Wireless and Wearable Devices: Continuous blood pressure and glucose monitoring technologies have been developed. Continuous 24- hour ambulatory devices can be fitted to watch-like device. This could be used to monitor drug resistant hypertension.

Continuous glucose monitoring involves implantation of a small transcutaneous electrode in the arm. The glucose oxidase chemical reaction produces a current reflecting the interstitial glucose concentrations and is transmitted into a smartphone for real-time monitoring. This technology is proving effective in diabetic patients in preventing low sugar episodes with early detection and as a method for long-term sugar control resulting from positive behavioural changes such as exercise, diet and medication compliance.

Will patients use and engage with m health devices for effective large scale transformation in digital health?  Changing patient behaviour and sustaining these changes might be a challenge. An expectation from the use of m health is a positive behavioural change resulting from patients actively participating in self-care and shared decision-making.

Therefore, the theme of World Heart Day-2021 of harnessing the power of digital health to improve heart health is apt and could be a game-changer. We have to innovate, collaborate and involve the rural population to achieve nationwide digital health transformation. ‘Digital health is expected to predict and prevent and not just diagnose and treat’ to borrow a quote.