Cardiovascular Diseases Management:
Hello and welcome to another episode of Global Healthcare Archives. For those of you who caught last week’s episode on Covid19, mutations and vaccinations, welcome back. For those who didn’t, don’t fret, just follow the link below.
Now this week, we are going to tackle an equally pressing, if not more deadly matter - cardiovascular diseases or CVDs. Remarkably, CVDs were and continue to be the #1 cause of global mortality.
In fact, for patients with CVD, the risk of Covid19 is even deadlier due to potential comorbidity. The pandemic is only adding to deaths caused by CVD. On the other hand, a fair number of patients who recovered from Covid19 report long-lasting cardiac damage, painting an even more worrisome picture for CVD in the future.
A common misconception is that CVD primarily occurs in those with unhealthy lifestyles - poor diet, liquor abuse, sedentary lifestyle and such - but as the recent case of Saurav Ganguly has shown, CVD can impact anyone regardless of the level of fitness or quality of lifestyle.
Latest updates in Cardiovascular Diseases Management
1) Clinical Management
Don’t get me wrong - those are definitely substantial factors leading to CVD, but let’s not get into the specifics of what it is and what causes it and such. Instead, in this video, we are going a step further to look at some of the advancements in the clinical management of it.
Among the many developments, a big move was repurposing existing medication to treat CVDs. For example, drugs used to treat diabetes, such as sodium glucose transporter 2 (SGLT2) inhibitors have been found to help patients with heart failure, and to promising results
It’s important to note that treating CVD involved the management of three major risk factor, namely increased tri-gly-cerides, hyper-gly-cemia, and inflammation. And each factor involves multiple drugs for management and treatment. Naturally, this means a patient must consume a large amount of drugs, which could lead to polypharmacy. Now that in itself is a growing problem due to the adverse effects associated with each individual drug. Bringing another set of drugs to counter that too. For example, the pharmaceutical company, Afimmune developed an omega-3 fatty acid, Epeleuton, to address polypharmacy. Currently in Phase II trials, Epeleuton which is a highly-purified synthetic version of the fish oil capsules we have all consumed as kids, decreases tri-gly-cerides, improves gly-caemic control, and improves markers of inflammation.
Now along with development in the pharmaceutical management of CVD, there is substantial change in surgical management too. Let us have a look at some of these advancements.
With the growing number of CVDs, the placement of cardiac stents and pacemakers has become almost routine. A cardiac stent is a thin wire, like a tube, that is inserted into the blocked artery to prevent it from closing again, thereby preventing another ischemic episode. However, stents increase the risk of thrombus formation or vessel rupture.
Bioresorbable stents that gradually dissolve within a year may help sidestep this problem. The currently available bioresorbable stents are rigid and difficult to place within an artery. However, research conducted to develop a flexible option may allow replacement of metal stents with this variety.
A pacemaker is a small, battery-operated electrical device that is placed in the sternum to regularize irregular heartbeats. Traditional pacemakers consist of leads that deliver electrical impulses to the heart muscle to help maintain a normal heartbeat. However, a broken lead can cause a malfunction or infection at the insertion site. A leadless pacemaker, which is a tiny, self-contained unit that is placed on the inside wall of the heart through a catheter, is being developed to overcome this issue.
2) Technological management
Having looked at both the clinical and surgical management of CVD, lets talk about some of the technology innovations that are happening in this space.
Remote cardiac monitoring has become vital, especially after the pandemic. The constant monitoring of patients who have undergone cardiac surgery and high-risk cardiac patients reduces the risk of surprise cardiac episodes. Biotronik Home Monitoring developed by Biotronik aims to replace unnecessary doctor’s visits through early detection of cardiac health risks. These devices are equipped with an antenna that connects to a patient device called Cardio Messenger, collects clinical data, and sends it to the HCP.
Similarly, Latitude NXT, an in-home patient monitoring system developed by Boston Scientific, allows a healthcare team to monitor connected devices in-between primary care visits. The device sends data from blood pressure monitors, pacemakers, cardiac monitors, weight scales, and other connected health devices to HCPs at regularly scheduled times.
This allows the remote monitoring of patients who have undergone cardiac surgery, without the unnecessary physical and emotional stress associated with hospital visits.
Stem cells have been suggested for the potential regeneration of damaged heart muscle. BioCardia, a biotechnology company co-founded by Dr. Simon Stertzer, the doctor behind the first coronary balloon angioplasty, is attempting to develop stem cell therapy for the treatment of heart failure.
Harvard University and Boston Children’s Hospital researchers came up with a soft robot that fits around the heart and helps it beat. This removes the need for potentially dangerous blood thinner medications.
3) Rehabilitation of CVD
Now that we have had a look at the treatment of CVDs, let us also have a look at what happens next: namely, rehabilitation. Cardiac rehabilitation mainly involves adopting a heart-healthy lifestyle to reduce the risk factors for CVDs. This comprises a phased program to reduce stress and assist a return to an active life.
The first phase begins in the hospital itself after the cardiac episode. It mainly consists of counselling and education on the cardiovascular risk factors and the signs and symptoms of cardiac problems. Patients are then given home-exercise guidelines as required. The next outpatient phase is prescribed for 3-6 weeks and starts immediately after discharge from the hospital. This requires visits to the cardiac rehab department of hospitals and includes monitoring of responses to gradually intensifying exercises. If the patient responds well to the first 2 phases, he is considered ready to operate independently, and is then placed in the maintenance program.
If you have experienced a cardiac event, make sure that you adhere to the cardiac rehab prescribed by your doctor. It is a crucial step to improve your health and quality of life, reduce the need for medicines, decrease the chance you will go back to a hospital or emergency room, prevent future heart problems, and help you live longer.
If you have not had a cardiac episode till now, good for you! Let's look at ways to keep it that way. Regularly monitor your blood pressure, cholesterol, blood sugar, and triglyceride levels. Stay at a healthy weight, eat a healthy diet, get regular exercise, limit alcohol, don't smoke, manage stress, and make sure that you get enough sleep.
Also learn more about the top courses after MBBS that you might be interested to upskill yourself with.