Evo Terra (Host): Digitization of all things is coming at us fast, and that holds true for medicine as well. To help understand how these fast changes are impacting cardiology patients, I'll chat with Dr. Nirav Shah, Medical Director of MSLC's Kaplan Family Center for Cardiovascular Medicine and Interventional Radiology. 

Welcome to DocTalk, presented by Montefiore St. Luke's Cornwall. I'm your host, Evo Terra. Dr. Shah, welcome back to the program.

Niravkumar Shah, MD, FACC, FSCAI: Good to be here. Thank you.

Host: So I'm old enough to remember when blood pressure cuffs were the analog device and it required a medical professional to use them. But tomorrow, my watch is going to beep at me if my pressure gets too high. I want to first say, this is a good thing that we're putting this information in consumers hands now. Yes?

Niravkumar Shah, MD, FACC, FSCAI: I think so, because, you know, again, digital health in cardiology, it's for every branch of the medicine, but mostly we talk about the cardiology. I mean, the technology to improve the patient care, the outcome, the reducing the cost in, and most importantly, increase access to the care, and awareness. And that tool can help diagnose, treat and even patient education. So I think it's very important era of the medicine where we can use this digital technology.

Host: You know, I think we're all used to the normal stuff, checking heart rate, now we've got blood oxygen sensors, blood pressure, those sorts of things in there, but I found out recently, well, I've known this for a while, my mother, her late 70s, has AFib, atrial fibrillation, and her doctor advised her to get an Apple Watch.

Niravkumar Shah, MD, FACC, FSCAI: That's correct.

Host: Why is that?

Niravkumar Shah, MD, FACC, FSCAI: So what Apple Watch does is that they detect your pulse rate, right? So when the pulse rate is irregular, it will alert you in a way so that one can pay attention to it. If it's fast, slow, those kinds of things, even the certain watches can even take your blood pressure to see when the heart rate is high, what reacts to the blood pressure is goes low, goes high and so forth.

Because atrial fibrillation is one of the diseases, which is treated appropriately can prevent the stroke, right? So when someone with atrial fibrillation with certain risk factors, they need to be on a blood thinner in order to prevent the stroke. So it's very important to detect. Sometimes patients say that, yes, I feel palpitations, but we don't know what it is, whether it's a fast heartbeat, whether it's irregular heartbeats. So this kind of a device, either Apple Watch or certain apps such as Kardia app that you can install on your phone and you know when you feel something you can put your two fingers and you can monitor your heart rhythm so that you can detect whether it's just a regular fast heartbeat or if it's atrial fibrillation. So one can treat appropriately to prevent further issues in health going forward.

Host: So fascinating. Staying with devices for a moment. I know that some devices like, CGMs, the constant glucose monitors, those require, I assume some sort of a prescription, I guess, from a medical professional. But these other devices like the aforementioned Apple Watch are available for anyone to buy. Are there other over the counter, I guess, devices that you're really excited about?

Niravkumar Shah, MD, FACC, FSCAI: So again, as you mentioned earlier about the blood pressure cuff. Now the blood pressure cuffs are now available with the Bluetooth capability. So when you take your blood pressure, it transmits to your phone and you can monitor that very closely. You can take a graph of it. You can transfer that to the physician.

And even in certain cases, like your weight, your blood pressure, and all those things are all Wi Fi related that directly go to your heart failure clinic. So when you gain couple pound of weight, the doctor or the nurses who's monitoring your weight will know that whether it's going up or not.

And based on that, you manage your medicine, you know, increase your diuretic to get the little bit fluid off, or if the blood pressure is high, then you can increase the medicine. So I think there are a lot of stuff is available and we are using in certain extent to prevent recurrent hospitalization. So that's one of the most important thing right now. And more than that is to treat the patients to prevent their symptoms or, being them sick and go to the hospital.

Host: Going back to the professional grade and prescribed devices, what are you sending your patients home with to help them and to monitor their health?

Niravkumar Shah, MD, FACC, FSCAI: Well, I mean, you know, in generalized term, when I see my patient in cardiology, I can tell them to monitor your heart rate and blood pressure closely. That doesn't need to be transmit to me all the time, but yeah, they can monitor that. It's all app driven, Bluetooth driven.

They can put a graph in your phone. And when they come next time to me for follow up in two to three months, depending on when their follow up, they will show me and I can look at that, compare with their previous graph and advise them what to do, or even if the graph is going up, then we can increase the medications, or if any pulse shows irregularity, then they need to be further investigated.

So I think it's important for any patients to monitor their health, especially the heart rate, the blood pressure, and even certain extent, the pulse ox monitor, which is now also available as a Bluetooth. As mentioned, certain just watches, just take the blood pressure as well.

So, I mean, there are many things that patients can do to be on top of their health other than the provider. So I think it's very important to be aware, as a patient perspective, to see what they can do to get their health in a good shape.

Host: Absolutely. And now with you know, tele visits being all the rage thanks to the last four years, I'm assuming there are applications for these digital devices for you and others to use in tele health visits.  

Niravkumar Shah, MD, FACC, FSCAI: So one of the digital health is the telemedicine and that we use quite a bit. I mean, you know, the telemedicine is just not only the telephone visit, it's just mostly the video visit where you see your patient, where you see symptoms, can show us whether they have swelling on the legs or not.

But again, the importantly, the patient needs to be a little bit, I wouldn't say computer savvy, but they have to be using the smartphone or tablet or iPad, or, some sort of a device to connect with the physician and go over that. And it's very convenient because, if someone cannot get to the office, they can do this kind of visit.

I mean, chronic condition that require frequent follow up, which can be done by a telemedicine, the quality of care will improve. Of course the infectious control point of view, you know, especially in what we had, the COVID era one can stay home and manage that kind of thing. And I, I think it's also a cost timing to the patients, but again, Televideo medicine is not for everybody, not for a hundred percent of the time, but in between, I would say, because still we need to see them in the office in order to examine us and, do the EKG. I'm just talking specific to cardiology point of view, but again, they don't have to come each visit. In between, we can do the televideo visit and make sure that they are in, in control because now they can able to check their pulse. They can able to do the blood pressure so we can get an accurate reading while we're doing the telemedicine.

Host: I really love those visits, you know, especially for things like going over test results or, just those, the standard six month follow up to make, how are you feeling type conversations. Why get in the car and drive to my physician when I can hop on the video call with them. 

Niravkumar Shah, MD, FACC, FSCAI: For conversational point of view, it's a perfect way to get the follow up. And as you mentioned earlier about the prescription device versus over the counter device, but I think, a lot of stuff, which is available over the counter and I mentioned about the blood pressure cuffs or the watches or pulse oximeter.

Those are the main vital sign device, but then there are not, I would say prescription, but comes to the doctor's office like variable patches where we put the small patch on the chest, which is a Bluetooth connected with the phone to monitor heart rate and rhythm for 7 hours up to the 7 days and some in certain extent up to 30 days.

What we call is an event monitor. It's completely wireless, Bluetooth driven device and it's alive because through the app, the Bluetooth device and the phone, it will connect to the iCloud. And, if patient is having some symptoms, I can see it in my computer while sitting in my office.

So I think, you know, it's a lot of advances in that way. There are vests is available for, cardio version or defibrillation point of view is called Life Vest in someone with the decreased heart function, so there are few things are already in the market available and patients are using it. So it's very helpful. It's very, advantageous in a way to diagnose, detect, and treat certain conditions effectively.

Host: I have a couple of questions left before I let you go. The first one is personal. Heart disease runs in my family. I'm not looking for a diagnosis, doctor, but heart disease does run in my family and I'm good at avoiding the risk factors. I don't smoke. I exercise. I try to eat well on the Mediterranean or the DASH diet.

Those are great. But knowing that, and I'm only 56, so I've got a couple, decades before the real problems start hitting like the others did. Are there digital devices that I should be using, do you think? To keep me healthy?

Niravkumar Shah, MD, FACC, FSCAI: The standard risk factors, as you already mentioned, and you've been doing that is, the high blood pressure, the cholesterol, diabetes, exercise, and decrease obesity and all those things. And those are the risk factor one can prevent. But at the same time, I mean, controlling the blood pressure is important, right? So, I mean, you know, even if you don't have high blood pressure, I would suggest one should take blood pressure at least once a week, right? I mean, every Sunday, just like as we go to church, we can take a blood pressure and make sure they are normal.

If they are normal, it gives reinforcers to keep doing what we're doing. And if there is changes that will give us also some sort of an alert in order to do something, maybe less salt diet, stuff like that, or even if it's too high, then connect to the doctor and get appropriate treatment.

So yeah, I mean, there is nothing one can or one cannot do even if the healthy person should check the blood work like yearly, routine blood work, including the cholesterol and blood count and kidney liver function and those kinds of preventive stuff is very important for every individual.

Host: Do you think we'll get to a point where like, I'm on a statin as well; will a, a digital device I wear on me be able to detect if there's excess cholesterol in my serum?

Niravkumar Shah, MD, FACC, FSCAI: Yeah. So that require the blood sampling, So again in diabetes we still have. We have the patch that we put it on and you know it connects with the Bluetooth and the blood sugar goes up or you touch the device with your phone to that device and you can get a blood sugar level possible.

I mean, so far I don't see that in a horizon, might be under research but I'm not aware of that is available. I think if it's available that would be great because then one cannot, excuse that I don't have the blood work, right one can. So, you know, but again, it helps to prevent certain things for sure.

Host: Right, right. What is on the horizon? Is there something that's coming that you hope is coming or you know is coming that we should all be excited about?

Niravkumar Shah, MD, FACC, FSCAI: There is always a new technologies. And most of the technology is driven by the app. There are so many apps are available and they are coming, for all the times. So, I think we always look for how digitalization, changes the I wouldn't say, diagnosis or management, but the awareness, right?

That's the most important thing, the prevention and awareness. There are so many apps that are available. I think, we as a physician, sometimes not aware of patients, tells us this is how should we look into that. But as far as the management and the diagnosis point of view, I think these are so far what we have. There are a lot of remote monitoring systems are available even now, especially for the pacemaker and defibrillator point of view.

There are also, for example, as you mentioned earlier that your mom has atrial fibrillation, but even before diagnosis of atrial fibrillation, there is a chip available that we insert under the skin called loop recorder, that lasts for three years. And you can, diagnose heart rate and rhythm via Bluetooth where that patient doesn't have to do anything.

It just connects via device that you have it at home and it transmit data to us in a physician's office. So there are certain things that in last few years have come up and you know, there are a few things that are already under investigation. So I think, because everything require again, patient safety and protocols and FDA approval. So, once starts may takes five to seven years before it comes to the market, sometimes maybe longer.

Host: Well it sure sounds like the future of digital health is very bright. Dr. Shah, thank you very much for your time today.

Niravkumar Shah, MD, FACC, FSCAI: Thank you. I appreciate that. It was good conversation.

Host: Once again, that was Dr. Nirav Shah, Medical Director of MSLC's Kaplan Family Center for Cardiovascular Medicine and Interventional Radiology. And thanks for listening to DocTalk, presented by Montefiore St. Luke's Cornwall. For more information on all of our cardiovascular services, please visit montefioreslc.org. That's M-O-N-T-E-F-I-O-R-E-S-L-C.org.

Please remember to subscribe, rate, and review this podcast and all the other Montefiore St. Luke's Cornwall podcasts. I'm Evo Tera and this has been DocTalk presented by Montefiore St. Luke's Cornwall. Thanks for listening.