From diagnostics to therapeutics, artificial intelligence is set to change the way cardiovascular diseases are identified and treated By Marjo Johne
A diagnosis of coronary artery disease usually comes after a series of procedures, including blood tests, exercise to reproduce symptoms, an electrocardiogram, a chest X-ray and, finally, cardiac catheterization, where
a thin tube is inserted through the heart’s blood vessels to check blood flow and function in various parts of the organ.
It can take weeks, even months, for each patient to go through these gold-standard procedures. But this decades-old way of diagnosing coronary artery disease could soon be a thing of the past, thanks to artificial intelligence (AI) technology.
“With our technology, you just lay down, take off your shirt and, with a hand-held, battery-operated device, your doctor can take a three-minute recording that collects 10 million data points,” explains Don Crawford,
president and CEO of Analytics 4 Life Inc., a Toronto-based company focused on artificial intelligence-based medical devices. “This data is then sent to a cloud storage device, and from there our computers take that data and create a three-dimensional image of the heart, along with a detailed report,” explains Mr. Crawford.
“By the time the patient has their shirt back on, the physician has already received the report on their computer. And based on this report, they can let their patients know whether or not they need to go to the
The Analytics 4 Life technology, currently being tested in a dozen hospitals in the United States, is at the leading edge of artificial intelligence in cardiac care – an emerging field of science that’s set to change the way
cardiovascular diseases are diagnosed and perhaps even treated.
At the University of Nottingham in England, researchers used machine learning – where AI algorithms trained themselves – in order to find patterns to predict which patients would have their first heart attack over the next 10 years. After scanning close to 300,000 patient records, the researchers found that the AI algorithms did significantly better in predicting heart attacks than assessments based on the commonly used American College of Cardiology/American Heart Association guidelines.
In India, a start-up called Cardiotrack recently rolled out a technology platform that uses a hand-held device, cloud storage and artificial intelligence to capture and analyze electrocardiogram signals for specific
“The possibilities with artificial intelligence are truly exciting,” says Brian Golden, Sandra Rotman Chair in Health Sector Strategy at the University of Toronto (U of T) and the University Health Network (UHN) and vicedean
of professional programs at U of T’s Rotman School of Management.
“The ability to instantly recognize patterns and make sense of data from these patterns will improve diagnosis speed and quality, reduce wait times, improve health outcomes and reduce costs.”
In Canada, the stage is set for AI to transform how heart disease is diagnosed, treated and managed. And the Peter Munk Cardiac Centre (PMCC) is right in the centre of this exciting transformation, powered by digital data, ubiquitous connectivity and intelligent machines.
Armed with a $100-million donation from the Peter and Melanie Munk Charitable Foundation, the centre has forged a partnership with U of T’s Vector Institute for Artificial Intelligence, which was launched last March
to advance deep learning research and develop world-leading AI talent.
“This is the first formal health-care partnership that the Vector Institute has engaged in, and we anticipate that what we do with the Vector [Institute] will be the model for what it does subsequently with cancer, neurosciences and other health disciplines,” says Dr. Barry Rubin, Chair and Program Medical Director, Peter Munk Cardiac Centre
Together, the PMCC and the Vector Institute will build an AI team that includes a lead computer scientist, software engineers and PMCC clinicians. This team will work to identify heart problems that can be solved
through AI and machine learning.
“We will use predictive models and decision support to tailor patients’ care to their unique clinical and genomic traits,” says Dr. Rubin. “We will use natural language processing to communicate with patients in real time, no matter what language they are speaking. Taken together, this will improve the efficiency of health-care delivery, outcomes and patient satisfaction.” What will AI-supported cardiac care look like to patients and healthcare
professionals? Dr. Rubin paints a sample scenario, where doctors can remotely monitor patients with conditions such as abnormal heart rhythms and then bring to the hospital those who are identified as at risk of death or serious heart damage, based on AI algorithms that can analyze billions of biological and research data points.
“You can use the AI approach to pinpoint which patients face potentially lethal events, and bring them to the hospital before that happens,” says Dr. Rubin. “So you’re managing patients outside the hospital and using the
real value of AI to predict and prevent these lethal events.”
The great wealth and quality of digital health and research data at the PMCC are critical to the success of the centre’s AI goals, says Dr. Rubin. The PMCC recently flowed six of 47 disparate clinical and research databases
into a vast “data lake,” and it is now working to bring the remaining databases into the same central reservoir.
By integrating all this data – blood tests, clinical notes, X-rays, ultrasounds, CT and MRI scans, pathology slides and genetic information – in one location, clinicians and researchers can use AI to discover potential
causes of heart disease. These discoveries, in turn, can lead to new cures.
“For example, if we have data on 10,000 patients with a narrow heart valve, and it turns out that 2,000 of these patients have a similar gene mutation, we could determine how that gene works and develop new
therapies that would prevent the heart valve disease from ever developing in patients with that mutation,” says Dr. Rubin.
Toronto is one of the two epicentres for thought leadership in AI – the other place is Silicon Valley in California – and boasts a robust ecosystem for AI- and digital-based health-care innovations, says Ying Tam, head of health at the venture services for MaRS Discovery District, a Toronto innovation hub that connects entrepreneurs, business experts, researchers, educators and social scientists.
He points to Ontario companies such as Cloud DX and Deep Genomics, which use AI and machine learning to diagnose disease and design more targeted therapies.
While AI champions continue to innovate in health care, it will likely take years before many of these new technologies are adopted in clinical practice, says Mr. Tam. Regulations that govern medical technology are complicated, says Mr. Tam, and could work against the very nature of artificial intelligence. For instance, when an organization such as the U.S. Food and Drug Administration approves a medical solution, it does so based on a specific information package. With AI, information continues to change as the underlying algorithms learn from existing and new data
“What we do with the Vector [Institute] will be the model for what it does
subsequently with cancer, neurosciences and other health disciplines.” Dr. Barry Rubin, Chair and Program Medical Director, PMCC
Nevertheless, AI solutions have already been proven in other areas in health care. Dr. David Jaffray, Senior Scientist at Princess Margaret Cancer Centre in Toronto, points to the use of algorithms at the hospital
to automate the design of treatments for cancer patients.
“The technology is very attractive because it allows us to design the treatment sooner, treat patients sooner and even ensure that the treatment plans follow the appropriate protocols,” he says.
This level of AI-enabled efficiency can, in the future, also help hospitals to optimize the use of their resources, while ensuring the best outcomes for patients, says Dr. Rubin.
“If we had complete data on all of our patients, we could use AI to predict which patients that had heart valve surgery would stay in hospital three days or 10 days after their operation,” he says. “Using this AI-based
approach, we will be able to better plan and better utilize our health-care resources.”
Having cemented its partnership with the Vector Institute, the PMCC must now work to integrate AI into practice – an undertaking that requires a shift in mindset around patient care.
“We will need to train clinicians and students at the PMCC to work in environments where AI-based predictions will inform treatment decisions and the management of patients,” says Dr. Rubin. “There’s no question that
AI and machine learning are the future.”
Arun Jaitley and Jeff Bezos
Searching the vast Internet, I was unable to find a site or a news item where India’s Finance Minister Arun Jaitley and world’s richest man Jeff Bezos are mentioned together. And, yet as I got up this morning, both were on my mind because they have both decided to do something about making healthcare more affordable for people from low income families in two of the world’s largest democracies.
As part of the India’s 2018 Budget, Arun Jaitley announced a health insurance plan for 500 million low income citizens of India. Almost at the same time, Jeff Bezos announced low cost healthcare services to many of people in USA who are finding it increasingly difficult to get healthcare services.
Is this a coincidence? Or is this caused by super blue blood moon of 2018? We will never know.
And, look at the contrasting public health spending in these two countries – Present public healthcare spending in the USA is USD 4800 per citizen, while in India the figure is USD 26 per citizen. From public healthcare spending point of view, these two countries are almost two ends of the spectrum. It turns out that no healthcare system in any country is perfect, barring Singapore which has less population than a suburb of Bangalore. Common problems faced by healthcare planners are:
– Huge imbalance in demand (number of patients) and supply (physicians, specialists, care facility and infrastructure)
– High concentration of healthcare infrastructure in urban centers thus leaving a significant population base with very few care facilities
– Sharp increase in chronic disease patients
– High cost to the society due to avoidable invasive procedures
– Distance to diagnostics centers and tertiary care facilities
– Many avoidable deaths and huge loss of productivity due to delayed diagnosis
The root cause of these problems is the fact that significant investments have gone into technologies and infrastructure for tertiary care and decline of primary care or care close to home. Both Jaitley and Bezos have proposed plans that almost identical in their approach to address the healthcare problems in India and the USA:
– Better healthcare services at home or closer to home. In India, the emphasis is to improve primary care significantly. In the US, the approach is greater use of tele-medicine
– Success of both these plans depend on better use of technologies to deliver better care outcomes and reduce cost to the beneficiaries
What Jaitley and Bezos need is greater use of IoT and AI to make this happen. Companies like Cardiotrack and American Well are likely beneficiaries of these initiatives. These companies have demonstrated how technology can be deployed to optimally use available resources and drive down costs and provide better health outcomes.
Congratulations – @arunjaitley and @JeffBezos for your bold move to provide better healthcare to people who can least afford it. This is nation building at its best.
It has been scientifically proven that cardiovascular problems are genetically coded in South Asians so it is particularly critical to the Indian sub-continent where about 2.3 million people die of cardiovascular diseases every year.
Clearly the need of the hour is preventive care, something that warns against impending heart attacks. Something as simple as quick heart check-up while visiting the family doctor or neighbourhood clinic can save millions of lives. An easy, non-invasive test that gives both doctor and patient (if she asks for it) a snapshot of her cardiac condition. The answer is, Cardiotrack – a smartphone size device that is AI powered and gives clinical grade ECG readings.
Cardiotrack’s journey has been reasonably well documented, however what needs careful attention now is its metamorphosis from medical device company to cardiac care evangelist. By reading and assimilating information which is then routed through the AI platform, the humble little device has created an evocative picture of heart health across age groups and geographies. The result is a series of stories of how individuals who were almost at the cusp of a heart attack were saved because cardiac diagnosis was possible close to home.
While this is indeed heartening for the co-founders of the company what makes it even more worthwhile is the fact that many of the lives saved are of poor farmers whose deaths would’ve orphaned their families.
In over 60-70 scans taken per day at least one critical condition like STEMI or myocardial infarction is found translating to almost 20 critical cases per month and this is just for a small area within India. What is scarier than these numbers is the fact that most of these patients are unaware of their poor heart health condition.
Addressing a complex and chronic problem like cardiovascular diseases is a global challenge that needs to be solved and Cardiotrack is working to prove that the combination of Artificial Intelligence and IoT will help in breaching the numbers. An additional advantage is that this will lay the foundation for preventive cardiac care in the overall healthcare scenario.
Cardiotrack’s IoT (internet of things) device captures a patient’s heart signals accurately and the AI platform gives an accurate diagnosis, which allows both the general physician and the patient a glimpse into her heart condition even if there is no cardiologist available. The diagnosis is sufficient to trigger an intervention if necessary. The enormity of this is truly amazing and in the case of the patient, life-saving.
A simple, pragmatic and scaleable solution…that’s what cardiac care needs to save lives consistently and help it to leapfrog the urban-rural divide.
The data that the device has gathered creates a cardiac health map of the regions where it is used extensively, cutting across age groups and ethnicities. The result is that government healthcare bodies, hospitals, physicians, drug manufacturers and medical researchers can use it to make cardiac care more predictive and preventive.
As an organization that is working to ensure that heart health is not within the reach of only a privileged few, Cardiotrack believes in the fact that data should not be a proprietary asset. Instead, it should be used judiciously for the greater good.
The future of cardiac care is on track for better times. With Cardiotrack working to ensure that more people from disadvantaged regions and communities come within the purview of preventive cardiac care, a healthier nation and society is within grasp.
Business Wire India
Bangalore-based start-up, Cardiotrack, which provides best-in-class predictive diagnosis for cardiovascular diseases announced today that it has expanded its presence in North India with its partnership with Gurgaon based multi-speciality hospital, Paras Hospitals, Gurgaon. This expansion will consolidate Cardiotrack’s position as a leading provider of AI-based cardiac care solutions.
Cardiovascular-related deaths continue to be a cause for concern in India. More people die of heart diseases than respiratory diseases, tuberculosis, and cancer put together.
The partnership with Paras Hospitals is the right step forward to address the growing concern with regard to heart disease, and deliver cardiac solutions that are real-time and preventive in nature. A life saved from cardiovascular diseases is a family saved.
Speaking on the partnership, Dr. D.K. Jhamb, Director & HOD, Cardiology, Paras Hospitals, Gurgaon said, “We are delighted to partner with Cardiotrack to reach out to a wide spectrum of population in Gurgaon and surrounding areas. By providing them with excellent preventive cardiac care we are working hard to ensure that the number of cardiovascular deaths is brought down.”
Paras Hospitals, Gurgaon has consistently noticed a steady rate of increase in the number of patients with heart problems in the scans that are done across their different hospitals. And the hospital chain is looking to reverse this worrying trend.
Cardiotrack will be deployed across all Paras centres. The hand-held IoT device that is driven by Artificial Intelligence (AI) will capture clinical grade ECG data using cutting-edge technology and ensure data portability through smart android-based devices.
Ashim Roy, Co-Founder and CEO, Cardiotrack said, “Heart diseases continue to be one of the main causes of death, globally and across age groups. 50% of these deaths can be averted if the delay in seeking the right medical advice is reduced. The best way to achieve this is preventive care and early diagnosis. We at Cardiotrack, pride ourselves on providing accurate and timely diagnosis for all cardiac related issues. Currently, Cardiotrack is present across India with leading hospitals adopting our technology to address the challenges in cardiac care. The partnership with Paras Hospitals, Gurgaon, is a step towards making cardiac care accessible to a larger number of people and thereby, saving lives.”
Headquartered in Singapore, Cardiotrack has a presence in over 15 countries including Myanmar, Mexico, Indonesia, Tanzania, Norway, Canada and Argentina among other countries. The pocket sized device has been well received by hospitals and primary health centres in tier 2 cities and rural areas.
The Cardiotrack platform is designed to fulfil all the basic requirements of a primary care clinic. Using Cardiotrack’s technology and AI platform, doctors can detect heart health problems accurately, consult specialists, refer and track patients, maintain medical history and start the intervention process. Cardiotrack platform includes multi-parameter, light weight healthcare IoT devices and mobile health software that helps to screen illnesses such as cardiovascular diseases and hypertension and helps doctors to perform diagnosis and then safely store the patient records.
The Cardiotrack device was launched in September 2015 and it has been deployed across India, Myanmar, Indonesia, Mexico and U.S.A. The primary reason for getting traction in the market has been affordability, ease of use and mobility that the product renders to its users. Most of the expensive health diagnostics products can only be operated in hospital environments, which are air-conditioned. However, working environment at the primary care facilities in the developing economies is different. The diagnostics sensors used in Cardiotrack function at extreme temperatures, and dust ridden and humid environments. The Cardiotrack platform is built to overcome limited availability of specialists, lack of transportation, infrastructure and power breakdowns that are common constraints in emerging economies and provide effortless remote patient management and disease care.
Cardiotrack, Sumita Chakrabarty, +91-9880295991
Bangalore, Karnataka, India
Bangalore-based start-up, Cardiotrack, which provides best-in-class predictive diagnosis for cardiovascular diseases announced today that it has expanded its presence in North India with its partnership with Gurgaon based multi-speciality hospital, Paras Hospitals, Gurgaon. This expansion will consolidate Cardiotrack’s position
“We are delighted to partner with Cardiotrack to reach out to a wide spectrum of population in Gurgaon and surrounding areas. By providing them with excellent preventive cardiac care we are working hard to ensure that the number of cardiovascular deaths is brought down.”