By Prof. Nicholas Peters
Professor of Cardiology, Imperial College & NHS Trust
Nicholas is a Cardiologist specializing in implanted and on-body biosensor technologies and their role in new models for improving healthcare and outcomes. He is Professor of Cardiology at Imperial College & NHS Trust, where he has founded the Connected Care Bureau for triage and managing the hospital's patients with Long Term Conditions. Focused on systematically evolving the demand-side models of care, the Bureau incorporates and works directly with developers of supply side products drawing on strengths in reshaping thinking, clinically driven test-bed evaluation and scalable clinical adoption. He has built productive partnerships between the College & NHS Trust and external entities by combining Imperial’s permissive healthcare environment, tech support & development and Business School expertise. He is a Board Member of Digital Health.London, advises as a Consultant to companies developing technologies for better more cost-effective care delivery, and travels worldwide speaking to professional organizations and the general public on remote patient monitoring and mobile health technologies. Nicholas’ interest in remote monitoring by implanted and wearable technologies is underpinned by a research program funded principally by the British Heart Foundation, Wellcome Trust, MRC and NIH (USA). He has a number of international research collaborations, is on the Scientific and Medical Advisory Boards and is Consultant to a number of academic, publishing, commercial and governmental entities in Europe and U.S.A. He is the only non-US on Board of Trustees and Founding Research Committee of the Heart Rhythm Society (2012-), Co-founder of the European Cardiac Arrhythmia Society, Symphony Medical, Inc and CardioPolymers, Inc. He is Adjunct Professor, Columbia University, NY, USA, and Director of the ElectroCardioMaths and BHF Centre of Research Excellence Program at Imperial College, and Director of Cardiovascular Research for Imperial Healthcare NHS Trust.
Although there have been some successes in cardiovascular disease prevention in the past, principally through education appealing to the good sense of the population, disease prevention through education alone has, in general, had limited success over the current obesity-diabetes global epidemic. This is perhaps not surprising in the context that we are programmed to crave carbohydrates when they are available as a manifestation of the primitive drive to consume as much of this once scarce resource when available, and so the current, somewhat defeatist emphasis appears to be on legislation by governments to reduce sugar content in foods.
Other more interventional preventative successes include a program set up by Kaiser Permanente to treat 350,000 high-risk patients with a simple medication bundle, including aspirin, a statin, and an ACE inhibitor – all agents known to have preventative benefits. In addition, partnerships with community-based health systems helped to further extend the program to their patient populations. The program has a direct cost of $205 per year for each participating high-risk patient, which translates into a total investment of $205,000 per 1,000 participating patients. The program prevents 19 heart attacks or strokes per 1,000 participating patients per year, which results in 147 fewer unhealthy years per 1,000 high-risk patients. Those additional healthy life years have a socio-economic value of $7.8 million, giving a projected return on investment of 3,700%. Impressive though this figure is, this projected return on investment does not include savings on the resulting efficiency and cost structure of the healthcare delivery system, nor does it include a projected further halving of cardiovascular events if all eligible quit smoking, took recommended levels of exercise, and lost weight – illustrating the striking impact of behavior change.
If it can be adequately motivated, there is a veritable army – massively underused resource available to help maintain both health and wellness – the patients themselves. The quest to engage the individual to achieve this may appear to be rehashing a long sought-after and elusive hope that has at times in recent history being naively articulated and sought. So what may now be different – why is now the time? The answer lies in the fact that we now, for the first time, have tools available and the readiness of the citizen to embrace what they have long demanded – greater responsibility for their own health and wellness. As the 2016 FHI has shown, there is also an awareness that the delivery of care requires partnership with patients – no longer considering them as subjects – compliant or otherwise with what they are instructed.
For citizens and their healthcare systems alike, the biggest challenges in cardiovascular disease require fundamental reform of how healthcare is perceived and delivered. This represents the single unified solution that requires changes in attitudes and behavior, encouraged and supported by appealing and rewarding technologies that promote wellness – be it by retaining health or the state of stability in the setting of cardiovascular disease.
October 23, 2020
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