singularity university: exponential cardiology gsp14
DESCRIPTION
This is a talk I gave at Singularity University regarding the Future of Cardiology. It was designed for the GSP group to show areas of tremendous potential for medical innovation.TRANSCRIPT
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