Singularity University Exponential Cardiology Christian Assad-Kottner MD Twitter: @Christianassad
Aug 22, 2014
Singularity University Exponential Cardiology
Christian Assad-Kottner MD Twitter: @Christianassad
FutureMed 2011
The future of cardiology
to understand the future
one must understand the past
Risk Factors
hypertension Diabetes Age M>55 F>65 obesity
gfr < 60ML/MIN TOBACCO SEDENTARISM FAMHX
the core of cards
DIABETES
HYPERTENSION
OBESITY
DYSLIPIDEMIA
SMOKING
DEFINITION
DIABETES FASTING GLUCOSE > 100 2 HOUR GLUCOSE TOLERANCE TEST > 200 HGBA1C >6.5
HYPERTENSION
NORMAL <120 / <80 PREHYPERTENSIVE 121-139/80-89 HYPERTENSION 1 140-159/90/99 HYPERTENSION 2 >160/>100
DYSLIPIDEMIA
NO RISK FACTORS LDL <160 1-2 LDL <130 >2 LDL <100 PREFERABLY <70
SMOKING ATHEROSCLEROSIS, DECREASED NO
OBESITY
BMI: 18-25 NORMAL 25-30 OVERWEIGHT 30-39 OBESITY >40 MORBID OBESITY > ORLISTAT - GASTRIC BYPASS
POPULATION AFFECTED Cost
DIABETES 29 million. 8m dont know they have it
$245 billion
HYPERTENSION 67 million $47.5 billion
DYSLIPIDEMIA 71 million $35 billion
SMOKING 42.1 million $193 billion
OBESITY 78 million $210 billion
http://www.cdc.gov/heartdisease/!
CORONARY ARTERY
DISEASE
HEART FAILURE
PERIPHERAL ARTERIAL DISEASE
DIAGNOSTIC TESTS
EKG TTE/TEE CT/MRI/PET CORONARY ANGIOGRAPHY LABS
IMAGING STUDIES ECHO CT/MRI LABS
ABI ARTERIAL DUPLEX CT ANGIOGRAPHY
MEDICATIONS
Aspirin ACEi/ARB BBlockers Statins CCB C2PY12 Inhibitors
BBlockers Acei Statins Inotropic Agents Drips: Milrinone, Dobutamine, Dopamine
Good Luck Cilostazole
INTERVENTIONS
Revascularization Bypass Surgery Percutaneous Intervention
Inotropic Medications Heart Transplant
ATHERECTOMY BALLOON ANGIOPLASTY
DEVICES IABP IMPELLA ECHMO
IABP IMPELLA LVAD: HEART MATE
LASER WILDCAT SILVERHAWK OCELLOT JETSTREAM
the present
ATHEROSCLEROSIS
CORONARIES / PVD - STENTS - ANGIOPLASTY - ATHERECTOMY - THROMBECTOMY - CABG ARRYTHMIAS -AICD -CRT -PACEMAKERS VALVULAR DISEASE -OPEN HEART -TAVR -MITRAL HEART FAILURE - TRANSPLANT - LVADS
STENTS/BALLOONS - BARE METAL STENTS - DRUG ELUTING STENTS - BIOABSORBABLE
SUPPORT DEVICES - IABP - IMPELLA
LEFT VENTRICULAR ASSIST DEVICES - HEART MATE II
ATHERECTOMY DEVICES -TurboElite Excimer Laser - DIAMONDBACK 360 ORBITAL - SILVERHAWK/TURBOHAWK - JETSTREAM
TRANSPLANTATION - PACEMAKERS/AICD/CRT
AORTIC VALVES - Direct Flow - Sadra Lotus - St. Jude Portico - Engager - Symetis Acurate - Jena Valve
MV replacement - CardiAQ - mitral clip - EndoValve - Valtech Cardiovalve - ValveXchange - Lutter Valve - Neovasc - Medtronic - Edwards
IABP - Impella Valve Replacement
Atherectomy Devices
Thoracic Endovascular Aortic Repair
MITRAL CLIP
evar
140,000
to
180,000
euros
Carmat estimates 100,000 could benefit from its artificial heart, a market worth more than 16 billion euros ($22 billion)
December 18, 2013 at Georges Pompidou European Hospital team in Paris (France) - a world first. Died in March 2 (75 days)
Carmat
imaging
By 2030, approximately 40% of the U.S. population is expected to have some form of CVD. !
http://www.cdc.gov/heartdisease/!
As a result, direct medical costs for CVD in the U.S. are expected to triple from $273 billion
currently to $818 billion in 2030.!
After 2030 we will be adding one year of life for every year that passess.
how to tackle cvd?
THE FUTURE OF CARDIOLOGY
COMES IN 2 FLAVORS
THIS IS ONE…
ai
Sensors
3D Printing
emr
Tissue
Engineering
genomics
invasive
prev
Nanotechnology
Tissue Engineering/3d printing
Tissue Engineering/3d printing
Using hydrogels, and combination of microCT imaging, custom algorithms, and 3D printing to generate cell-seeded valves!
http://www.bme.cornell.edu/!
Tissue Engineering/3d printing
Adenoviral Vector to insert T-box 18 gene related to development of SA NODE. Converts cardiomyocytes into pacemaker cells.
Biological
Pacemaker?
http://stm.sciencemag.org/content/6/245/245ra94!
Genetically modified pigs (GTKOhTg.hCD46.hTM) with modified targeted immunosuppression (anti CD40) achieved long term cardiac xenograft survival
preventive
POPULATION AFFECTED Cost
DIABETES 29 million. 8m dont know they have it
$245 billion
HYPERTENSION 67 million $47.5 billion
DYSLIPIDEMIA 71 million $35 billion
SMOKING 42.1 million $193 billion
OBESITY 78 million $210 billion
!
Predictive!
preventive!
personalized!
participatory!
!
!
4p!
http://www.nature.com/polopoly_fs/1.14702!/menu/main/topColumns/topLeftColumn/pdf/506144a.pdf!
!
march 2014 !
pilot study!
“the Hundred
Person Wellness
Project”!!
!
leroy Hood !
!
president of the !
I nst i tute for
Systems Biology!!National Medal of Science!!
ISB will sequence whole genome of each participant"Wear digital devices that will continuously record activity, sleep, vital signs"Every 3 months researchers will gather samples of participants"Blood- CBC,BMP plus 20 less-commonly monitored variables"Urine- Measure 5 biochemicals"Saliva- Measure 5 biochemicals "Stool- Major microbial species"
Implantable Wireless Biosensors!
i-IronIC puede detectar distintos metabolitos "
What does that
data mean?
SENSORS EMR
GAMIFICATION
80%!
20%!
Healthcare Provider + AI Team
50%!
50%!
20%!
80%!
Stage I
Empower
Stage II
Equal to MD
Stage III
replace
ai roll to assess Big Data, EMRs, Genetic Testing, Symptoms and environment for a/P
• innovate do not renovate
• not because we do things one way means that it is the “right way”
• preventive focus is what can save healthcare
• invasive focus is what will save our aging patients
• there is a right project for your particular stage in life. do not limit yourself
points
Thank You E-mail: [email protected] Twitter:@christianassad http://about.me/christianassad exponentialmed.com