According to Dr. Irving Kent Loh, chief medical officer and co-founder of Infermedica, an artificial intelligence in healthcare company focused on clinical decision support, the future of healthcare is headed for vast changes in the next decade.
Dr. Loh, a cardiologist, reports on three areas of cardiovascular medicine that he sees as being key in the future of cardio health.
Focuses on assessment of and risk reduction in high-risk cardiovascular disease patients are the first areas of change he foresees. Two recent study results anticipate a change in standard operating procedure.
The ISCHEMIA trial may alter future guidelines for cardiologists on how they evaluate patients with evidence of coronary artery disease. Basically, the study says an initial invasive approach (catheterization and possibly bypass surgery) compared to a conservative approach, such as anti-platelet drugs, statins, beta-blockers, and other medication, in stable ischemic heart disease (SIHD) patients with moderate-severe ischemia did not reduce risk of death or heart attack at a median of 3.3 years.
The results of the REDUCE-IT trial involved 8200 mildly elevated triglyceride level patients with cardiovascular disease and diabetic patients with two other cardiac risk factors. These patient populations had a 25% reduction in major cardiovascular events on the medication compared to placebo. Despite the demonstrated clinical benefits of lowering LDL-C with statins, significant residual cardiovascular risk remains for statin-treated patients. Vascepa, brand name of icosapent ethyl [ethyl-EPA] being developed by Amarin Pharma Inc., was studied in REDUCE-IT as an add-on to statin therapy to further reduce cardiovascular risk, not as a replacement for statin therapy.
The second pending breakthrough will deal with tools for genetic modifications that may yield permanent repairs for patients and their offspring. Many cardiovascular diseases are genetically based and consequently heritable. These include lethal diseases, such as familial hypercholesterolemia, long QT syndrome, some cardiomyopathies, and many others. Early experiences with CRISPR-cas9 in humans have demonstrated that this gene-editing technology works, though much research remains to be done to ensure no off-target effects and, critically, that the ethics of such interventions are sorted out.
The third area with the greatest impact on all of us will be the rapidly evolving application of artificial intelligence (AI), machine learning, and deep learning to healthcare. Beyond the mundane administrative efficiencies where rudimentary applications are in current use, the impact on the Big Data that overwhelms the ability of humans to comprehend and derive useful and actionable information from the myriad sources of relevant healthcare data, will be huge. These technologies will affect not only the individual patient (precision medicine) but also much larger groups of patients (population health), and the impact will be profound. In the world Dr. Loh envisions, artificial intelligence will assist, not replace, the well trained clinician, who will apply the information to the human condition with empathy and touch.