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Addressing Heart Health for $200, Alex By Dr. Ben Green

Addressing Heart Health for $200, Alex By Dr. Ben Green
Dr. Ben Green, AliveCor

As a longtime Jeopardy fan, I thought I’d start this post with an homage to the late, great Alex Trebek. I can see it going something like this:

  • Contestant 1: “I’ll take ‘Cardiac Conditions’ for $200,” Alex.”
  • Alex: “This disease currently affects 50% of the US adult population, is a leading contributor to heart disease in the US,[1] yet worldwide is controlled in only about 30% of people with this disease.”[2]
  • Contestant 2: “What is High Blood Pressure?”
  • Alex: “Correct. Also known as Hypertension, it is, in fact, the #1 global risk factor for death.[3] You have the board.”
  • Contestant 2: “Let’s continue with ‘Cardiac Conditions’ for $400,” Alex.”
  • Alex: “This cardiovascular disease currently affects 1%-2% of the US adult population,[4] with nearly 10% of adults developing this after age 75.[5] It also increases your risk of stroke by 5x.[6]
  • Contestant 2: “What is Atrial Fibrillation?”
  • Alex: “Correct again. The number of adults with Atrial Fibrillation, or Afib, also is expected to double in the next 10 years.[7] Please continue.”
  • Contestant 2: “Wait, that’s sobering, Alex…So what do we do about all of this?”

Well, of course, that last question was added for dramatic effect, but heart disease and its major risk factors remain the primary public health priority of our time. Regrettably, despite monumental advances in prevention strategies and treatment approaches, our modern society has inadequately stemmed the tide of rising heart disease burden. Lifestyle factors (sedentary behavior, obesity, alcohol use and smoking), which greatly contribute to the development or worsening of hypertension, atrial fibrillation, and coronary artery disease, are proliferating while our population continues to age. Furthermore, the COVID-19 pandemic has led many people to cut back on preventive and chronic care visits that typically contribute to effective management of heart conditions.[8] Disparities in care also are affecting people with heart disease especially hard. With primary care providers overburdened by patients with complex cardiovascular conditions, referrals to cardiologists remain high, while access to them is growing more limited and worsening still with supply gaps expected to widen further.

Primary care, the cornerstone of preventive health care and delaying disease progression, could use a hand in optimizing the heart health of our population. Disease management programs focused on heart disease have emerged as a way to intervene early in the disease course and may help slow, prevent, or in some cases reverse progression. However, motivating patients to enroll in these programs can be challenging because these programs are often disconnected from their provider (e.g., offered directly by health plans), have lukewarm engagement, and the benefits are either not tangible to the user or are very delayed (e.g. avoiding a possible stroke five years into the future). AliveCor, creators of the world’s first personal ECG device in 2012, KardiaMobile, has introduced a new enterprise solution, KardiaComplete, which is designed to bring a uniquely engaging heart disease management solution to patients intended to improve heart health outcomes while reducing the near and long-term costs of cardiac care. KardiaComplete’s virtual-first approach is directly complementary to the patient’s usual care team and is available to self-insured employers, health insurance plans, and health systems interested in improving the heart health of their rising-risk and at-risk populations. Back to our Jeopardy game for a moment…

  • Contestant 2: “OK, well now I’ll take ‘Health Care Innovators’ for $200,’ Alex.”
  • Alex: “This Dutch doctor is often credited as the inventor of the electrocardiogram, or ECG.”
  • Contestant 3: “Who is Willem Einthoven?”
  • Alex: “Correct. The first ECG machine, amazingly, weighed 600 pounds. My, how far we’ve come. You have the board.”
  • Contestant 3: “Let’s continue with ‘Health Care Innovators’ for $400, Alex.”
  • Alex: “This company’s pocket-sized, personal ECG device has been purchased by over 2M users with over 140M ECGs recorded to date.”
  • Contestant 3: “Who is AliveCor?”
  • Alex: “Correct again. That’s a lot of data. But is it reliable?”

OK, I’ve thwarted Alex’s game flow again here, but it should be noted that AliveCor’s foundation has been in delivering engaging, consumer-centric heart health solutions. KardiaComplete is built upon this vast direct-to-consumer experience, with products that have been highly valued by consumers (NPS 66, Amazon Star rating 4.5+) and trusted by healthcare providers who have been recommending it to their patients. Kardia’s FDA-cleared devices and AI-derived clinical algorithms have been extensively validated in the literature (170+ peer-reviewed publications). KardiaMobile and the accompanying Kardia app have proven to be valuable solutions both to individuals with existing heart rhythm conditions and to those requiring monitoring for them. Users, to date, have been able to accurately evaluate symptoms alongside their heart rhythm data, and share data directly with their providers for optimization of care, and avoidance of unnecessary visits.

KardiaComplete offers additional key features that provide an even more comprehensive and proactive approach to heart health. With an initial focus on individuals with hypertension and/or arrhythmias, including atrial fibrillation, enrolled members are offered the following to longitudinally track, manage, and improve their heart health:

  • Best-in-class remote personal monitoring solutions (KardiaMobile 6-Lead personal ECG and Omron Evolv blood pressure cuff)
  • Personalized and actionable analyses of heart data
  • Human-led, digital coaching program focused on heart health prevention and enhancement strategies
  • On-demand access, 7 days a week, to virtual consults by US board certified cardiologists

KardiaComplete makes it easier for patients to gather meaningful heart health data to share directly with their providers, while also providing rapid access to AliveCor-affiliated cardiologists when more timely interpretation and guidance is needed. Members and their providers now can have a “cardiologist in their pocket” coupled with an expert coach to shepherd the patient through their heart health care journey. Coaches are available to encourage behaviors and develop strategies to improve member’s quality of life and reduce the risk of disease progression. Barriers to cardiac care are now instantly removed for the members, resulting in an easier experience of care.

At its core, AliveCor’s KardiaComplete can be seen as a promising approach to addressing our nation’s ever-present challenge of effectively improving Americans’ heart health. While the long-term impacts of this novel virtual heart disease management program are still to be determined, the staggering human and economic impacts of continuing with the status quo are already upon us. Treatment of heart disease and stroke costs our health care system $216 billion per year with spending for hypertension alone projected to increase from $135 billion in 2020 to $160 billion in 2025.[9] What’s even more troubling is that in 2011, the American Heart Association predicted that by 2030, 100 million American adults would suffer from some form of cardiovascular disease. We hit that number in 2015.[10] Let’s turn to Alex one more time for Final Jeopardy, with the topic “Famous Quotes”…

  • Alex: “The phrase, ‘Insanity is doing the same thing over and over and expecting different results’ is attributed to this visionary.”
  • All Contestants: “Who is Albert Einstein?”
  • Alex: “Correct! Maybe we should listen to him this time.”

Editor’s Note: Dr. Ben Green has more than 13 years of experience in telemedicine. As SVP of Services at AliveCor, Dr. Green oversees all care delivery and clinical operations. He continuously explores new ways to deliver high-quality, clinically meaningful, and customer-centric experiences for AliveCor users.

Prior to joining AliveCor, Dr. Green spent several years at Amazon as the founding Chief Medical Officer for Amazon’s first pursuit into virtual care delivery, Amazon Care, and later as the Principal of Healthcare Innovation for Amazon Global Benefits. Dr. Green has also served as Regional Medical Director at Landmark Health, an at-risk housecall model, and spent eight years at Carena, Inc., an early telemedicine company offering virtual services for health systems and employers. Dr. Green holds a BA from Harvard University, an MD degree from UMDNJ-Robert Wood Johnson Medical school, and completed his family medicine residency at the University of Pennsylvania.

[1] CDC. High blood pressure. Available online at https://www.cdc.gov/bloodpressure/facts.htm#:~:text=Nearly%20half%20of%20adults%20in,are%20taking%20medication%20for%20hypertension.

[2] Beaney T, et al. May  Measurement  Month  2019: The  Global  Blood  Pressure  Screening  Campaign  of  the  International  Society  of  Hypertension. Hypertension. 2020;76:333-341. DOI: 10.1161/HYPERTENSIONAHA.120.14874. Available online at https://www.ahajournals.org/doi/epdf/10.1161/HYPERTENSIONAHA.120.14874

[3] World Heart Federation. Hypertension. Available online at https://world-heart-federation.org/what-we-do/hypertension/#:~:text=Hypertension%20is%20the%20number%20one.

[4] Kornej J, et al. Epidemiology of atrial fibrillation in the 21st century. Circulation Research. 2020;127:4-20. Available online at https://www.ahajournals.org/doi/10.1161/CIRCRESAHA.120.316340

[5] Schnabel RB, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study. Lancet. 2015;386:154-62. Available online at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)61774-8/fulltext

[6] Son MK, et al. Risk of ischemic stroke after atrial fibrillation diagnosis: A national sample cohort. PLoS One. 2017;12(6): e0179687. Available online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5479557/ ;

[7] Colilla S, et al. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol 2013;112:1142-1147. Available online at https://pubmed.ncbi.nlm.nih.gov/23831166/

[8] Czeisler ME, et al. Delay or avoidance of medical care because of COVID-19-related concerns — United States, June 2020. MMWR. 2020;69(36):1250-1257. Available online at https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm

[9] Statista. Projected total costs of cardiovascular disease in the U.S. from 2015 to 2035, by disease type. Available online at https://www.statista.com/statistics/671590/cardiovascular-disease-cost-forecast-us-by-disease-type/

[10] Virani SS, et al. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation. 2021;143(8):e254-e743. doi: 10.1161/CIR.0000000000000950. Available online at https://www.ahajournals.org/doi/10.1161/CIR.0000000000000950

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