Thank you for joining us for HeartRhythmTV here at HRX 2024 in Atlanta, Georgia. I'm Rebecca Epasion, an EP Nurse Practitioner and Associate Manager of CIED Operations at CardiacRMS by DOTGO. We are here to discuss emerging technology and strategies for early detection and remote monitoring for cardiac compromise. With me today, I have Dr. Reese Robinson, a seasoned innovator with extensive experience in technology, healthcare delivery, and business development. As CEO of Rodan Scientific, he focuses on pre-symptomatic detection of cardiac issues, serves as Chief Innovation Advisor at Presbyterian Healthcare Services in New Mexico, and serves on the Medical Advisory Board of CardiacRMS's parent company, DOTGO. Dr. Robinson has founded several company, holds over 50 U.S. patent applications, and is recognized for advancing non-invasive medical technologies. He earned his bachelor's and master's degrees in Mechanical Engineering from Stanford University and his medical degree from University of New Mexico. And of course, I have the inimitable Dr. Suneet Mittal, a distinguished cardiologist with a BA and MD from Boston University. He completed his residency in Cardiology Fellowship at the University of Pennsylvania and his EP Fellowship at Cornell. He is the Director of the EP Lab and Associate Chief Cardiology at Valley Hospital in New Jersey. His research focuses on AFib, unexplained syncope, implantable monitors for arrhythmias, and remote patient monitoring. Dr. Mittal is also a member of the Heart Rhythm Society's Board of Trustees. He holds editorial positions in several leading cardiology journals and is one of the producers at this year's HRX 2024. This session is powered by CardiacRMS by DOTGO. And at CardiacRMS, we lead in innovative remote monitoring solutions for cardiovascular care. Combining advanced software with expert clinicians, we enhance patient outcomes and clinic efficiency. While we specialize in remote monitoring for cardiac implantable devices, we also offer virtual care management for chronic conditions. And as leaders in the field, we continually adopt new technologies to anticipate and manage worsening heart failure, improving care from hospital to home. We're excited to share in how these innovations are transforming heart failure management and how CardiacRMS is driving this evolution. So thank you both for joining us today, and let's just dive right in. So we all know that remote monitoring has become an integral part of cardiology, including significantly enhancing the care and management of heart failure patients via CIEDs and implantable devices. By allowing continuous and real-time monitoring of vital signs, heart rhythms, and other cardiac function, it has enabled early detection of potential complications, reduced hospital readmissions, and improved patient outcomes. As this technology continues to evolve, the future of remote monitoring promises even greater advancements, including more sophisticated predictive analytics, integration with wearable devices, and expanded use in other areas of cardiovascular care. So first, to both of you, where do you see the future of remote monitoring for our heart failure patients, particularly with the ongoing advancements in AI, machine learning, and the ever-growing array of commercially available wearables? And how can existing remote monitoring companies help to seamlessly integrate these new technologies? Well, Rebecca, first of all, thank you for having me. That's a very big question, and probably something we could talk for hours about. But I think it's fair to say that remote monitoring, of course, has become the gold standard for monitoring patients with an implantable device. Today, we certainly have the opportunity to manage a small segment of heart failure patients who have a pacemaker, defibrillator, or CRT device. And as you've also mentioned, the devices have become increasingly more sophisticated in giving us some information about patients who are at high risk. As one example, we have moved from single parametric assessment of heart failure to multi-parametric assessment of heart failure, which is certainly helpful. But at this point, I think what we're looking for are things with even greater positive predictive value. We certainly know that when these indices are normal, that patients are at very low risk. But we also know that when indices are abnormal, that doesn't necessarily mean that there is a high-risk patient. I'll just give one example to highlight what is needed next. So a patient may trigger an alert for tripping some proprietary algorithm. As a clinician, I can point two scenarios. I can point a patient who I followed for years, has never tripped an alert, and for the first time trips this alert, versus someone who has a yo-yoing cycle. Without any intervention, the alerts go up, the alerts go down. Clearly, those are two different patients. I'm gonna approach them very differently. So I think the next phase is to be able to integrate the information from the EMR, look at the historical data, what was the history behind the patient, and give us more specificity in terms of patient A versus patient B. And that will be a win-win, obviously, for remote monitoring companies, but most importantly for our patients and our clinicians, because they will get more actionable information. Yeah, I'll just add on to what the good doctor said here in the sense that the value creation for remote patient monitoring is gonna be significant. And I think it'll really be driven by three influences. It's gonna be information, algorithms, and applications. So when you look at rapid changes in the use of remote technology, think about banking or insurance, it's when the information content allows the transaction of value to occur. And as you begin to think about heart failure monitoring, I listened to a number of presentations here, many companies are working on tools that are now moving from symptom detection to actually the hemodynamic components. So the information present in implanted devices will move into the wearable space. Then you think about the interactions of the algorithms, and everything's about AI, but what you're gonna see is really that ability to self-determine or have algorithms that are specific for the person. We're all aware of that through credit card fraud. Second you do, your card gets frauded, they're aware of it. So now you think about that, whether it be the dose response, or as you mentioned, the characteristics of the individual, the tools to do that are dramatically improving. And one thing, and I don't think it gets talked a lot about, but I really am a huge believer in the idea of DIY applications. And when I say that, it's do-it-yourself. And you see, Home Depot has done that at a remarkable level for doing projects at home. But when you think about, and it won't be for every person who has chronic disease, but there'll be a segment, either the individual, their spouse, or their children can take an application, if it provides the right information, really self-manage. And I see that that combination of better information, better algorithms, and better applications really being transformative. And what can happen as you begin to look at chronic care and heart disease is one of the biggest ones. Very interesting, especially the concept of the DIY and using applications that are out there now that would need to learn to integrate though with these new devices, the new wearables, and getting them to buy in and actually be a part of the solution. So as remote monitoring technology continues to evolve, what do you see as the biggest challenges in ensuring widespread adoption among not just healthcare providers, but patients themselves? And then how can the technology be tailored to better address the unique needs of a diverse patient population and ensure health-tequity? So again, if we start to look at it from the standpoint of devices that are being implanted, I would say, first of all, we have to recognize it's often not the patient's fault because providers are not always enrolling patients in remote monitoring, even though they have a device fully capable of remote monitoring. So our first hurdle is, of course, convincing our peers that remote monitoring is important as clinical guidelines come out and it becomes a level one recommendation, as has been the case. I think we're starting to cross that hurdle and more and more people are enrolled in remote monitoring. The second big hurdle that still exists is that despite all the technology we have available today, remote monitoring still requires connectivity to the system. And regrettably, for a variety of reasons, patients get disconnected and we lose the data that we need to be able to manage patients. So that's a technology solution. We need to get better at identifying patients who are disconnected and we need to help them get reconnected without interventions in our office. And then the third aspect is that patients need some feedback from their information. Right now, the patients are not involved in this process. You know, we're getting the alerts, we're trying to respond to that alert, but the patient doesn't have the immediate feedback and therefore is not able to modify their behaviors in a timely manner. So much more patient engagement is necessary to the comment that was made, but for that we need the information to go to them in a more timely manner. Yeah, I'll just build on that. You know, I think you've mentioned the information movement. Now it's kind of clunky at best. The second is, you know, for it to be useful, it's got to get integrated into the electronic medical record. And both of those are awkward today because there's a lack of standardization. And I think one of the really interesting things to look at is, and we've all been involved in this, home automation. I mean, every time you bought a tool from Google or Apple or someone had a different app. Well, that industry came together and it created a standardized communication protocol called Matters, the group that came together. And that needs to happen because no healthcare system has any interest in adopting, you know, information movement protocol for company X and then Y and then Z. It creates a barrier to adoption. And the industry, if it wants to have that adoption occur at the level that really benefits patients, creates that seamless movement of information for the patient or the provider, it needs to develop that standardization. And it's something they can do. They just need to get their act together. It's all about the data, right? It's all about the data. All right, thank you both, Dr. Mittal, Dr. Robinson. It has been such a pleasure. I appreciate your participation in this and your brilliant insights into the future of remote monitoring and heart failure care for patients. Thanks for having me, Rebecca. Thanks for having us. Thank you.

cardiac remote monitoring

AI wearable tech

predictive analytics

heart failure management

data integration