Innovation Partner (Viz.AI) - Heart Rhythm TV Episode (HRX 2024): Innovating AFib Care w/ Viz.ai's Data-Driven Solutions to Overcome Challenges-Innovation Partner HRX24 Interview (Viz.AI)

Innovation Partner HRX24 Interview (Viz.AI)

Video Transcription

This is Heart Rhythm TV. My name is Janet Han, and we're coming to you live from HRX 2024, and I have my lovely friend, Dr. Jonathan Su here from me.  He's my neighbor to the south at UCSD. I'm just up the road at UCLA. So welcome to the show. Thanks, Janet. It's been a great meeting so far. Really happy to be here.  That's awesome. So we know each other, and I know that you're an electrophysiology guy, but you want to give our audience a little bit of your background maybe?  Yeah, sure. So I've been at faculty practice at UC San Diego for 12 years now, professor of medicine there. EP has just been a profoundly fulfilling career path.  The journey to electrophysiology has been really great. Figuring out the puzzles of arrhythmias is certainly what drives us on a daily basis,  and the innovation that we have at showcase here at HRX is really a big part of what makes I think our jobs fulfilling. And I think meetings like HRX really showcase  kind of early adoption, AI, the internet, really important aspects that we use on a daily basis in our jobs that really make this feel really fulfilling. No, absolutely.  I feel like EP has really been at the forefront for decades, honestly, right? Like we've started with remote monitoring. We've done digital devices for decades at a time.  And we've been treating a multitude of arrhythmias, not just with devices, but really, we really started with AF, right? So I feel like AF has been a huge problem,  continues to be a huge problem. And so I kind of wanted to get your perspective a little bit. I have done some work with our own neurologists  because I have an interest in AF monitoring and looking sort of at cryptogenic stroke and how do we really detect those arrhythmias, right? For our stroke patients.  And I know that you've had some experience and interest in that as well.  Why do you think AF and cryptogenic stroke are such challenging problems still today? Yeah, well, atrial fibrillation, as we know, is the most common cardiac arrhythmia.  It's just very prevalent. And unfortunately, we know it can be asymptomatic and the first manifestation can be stroke. Certainly our neurostroke colleagues know  that this is a problem. And sometimes we're not even aware that a patient is in-house or hospitalized for a stroke that could be suspected for atrial fibrillation.  Because the first manifestation, as you know, Janet, as well as I do, could be stroke, really getting these patients the right type of monitoring,  whether that's an external monitoring or implantable loop recorder, can be really instrumental in their care pathway. And some of the biggest problems,  if you talk to our neurostroke colleagues, 15 to 20% of those individuals that come in with ESYS or cryptogenic stroke, they suspect they have atrial fibrillation as the etiology.  They're gonna put on antiplatelet therapy instead of oral anticoagulation. So a diagnosis of atrial fibrillation  will completely change their treatment landscape. It's really getting these patients to the right, on the right workflow and the care pathway to get what the stroke neurologists  really feel that they need. So at our institution at UC San Diego,  it was very difficult for these patients to really find the care that the stroke neurologist really wanted them to have, which was either an external monitor  or implantable loop recorder. What we instituted was a workflow pathway  with Viz AI and the VizConnect platform. Basically, it's an app that allows HIPAA-compliant communication for a referral between neurostroke and the EP department,  which implants the implantable loop recorder or helps with external monitor. Directly between neural and EP, not even an intermediary at that point. Correct.  We didn't even know that that was an issue at UC San Diego. We thought these patients existed. We thought we were seeing them. We thought we were getting consults for them.  But this is a actual workflow pathway where an app is on both services,  both the neurostroke service and the EP service, and when AF is suspected and an external monitor or implantable loop recorder is requested,  that comes directly in a HIPAA-compliant platform to us for that direct referral. What we found over the three years that we've been instituting this process,  one year before and then two years after, is that implantable loop recorders, on average,  we were implanting about three per year in cryptogenic stroke patients. That went to 50 the subsequent year. Three per year. And now it's up to annualized to 90.  So just by instituting this workflow pathway, we've instituted something that really can get these patients the right service that they need.  So we accept the referral within five minutes on average. The average change in implantable loop recorder time went from one month as an outpatient oftentimes  to seven hours as an inpatient oftentimes. And those numbers that we just talked about, we certainly see today in regards to referrals  from neurostroke to electrophysiology. So certainly our stroke neurology colleagues have been very happy with this workflow.  It's also patients really organically want this workflow. They get to choose between external monitoring and implantable loop recorders. Over 60% choose implantable loop recorders.  And that's part of the data that our group at UC San Diego presented with our stroke neurologists. Yesterday was our abstract looking at  what patients choose and what percentage of the time patients get this implantable loop recorder. We over 10 times increased the amount  of implantable loop recorders that we're implanting for this indication of cryptogenic stroke. So it sounds like the pathway is really sort of facilitated  between stroke neurology, right, EP, and then really involving the patients, having them really have a say in what they want and their care pathway, it seems like.  Definitely, as you know, Janet, shared decision-making is very important nowadays in taking care of our patients.  For them to have a choice, we know that there are data with EMBRACE. We know that there are data with CRYSTAL-AF looking at this cryptogenic stroke population  in some type of monitoring. There are a lot of different types of monitors. There are even wearables that we can consider. But basically, if we follow  the randomized controlled trial data, some type of monitor should be implanted. And empowering the patient to choose that and have the ability to get these patients  directly to electrophysiology to get that done has been instrumental, I think, in getting these patients the care that they really need. And our stroke neurologists have been happy,  and our patients. As you can imagine, the attrition for a patient leaving the hospital with a stroke where they may have a little bit of debilitation,  hopefully not severe debilitation, to get them back to have a monitor placed or an implantable loop recorder implanted can be very challenging. So the amount of patient attrition  has dramatically gone down with this care pathway that we've chosen. Yeah, really getting their care rapidly and sort of facilitated is key, absolutely.  I know that you were involved in one of the HRX roundtables on cryptogenic stroke and AF. Any other takeaways from that? Yeah, it was a really great roundtable discussion, Janet.  There were some thought leaders, really, in the area. I think the consensus is that stroke neurologists really, truly feel that they understand that there is this problem.  I think CRYSTAL-AF really elucidated that. And even Stroke-AF, the study, really showed that we probably should be monitoring more on these patients.  And stroke neurologists are buying into this and really do want an easier way to communicate with electrophysiology and cardiology and get the right thing for their patient.  So I think we identified that, first of all, ESYS or cryptogenic stroke is really important, that AFib is lingering and is there. We just need to look for it.  Just because they're in sinus rhythm doesn't mean they don't have AFib as the cause of their stroke. And we do need certain care pathways,  such as this AI, to help us communicate and be able to get the patients what they need. Absolutely, gosh, that's wonderful and outstanding work, really,  to facilitate that care pathway. I think many hospitals will need that. I know my own hospital has instituted some care pathways, not as slick so far as what you've described,  but for sure, multitudes of patients probably could benefit from this. So thanks so much for taking the time to sit with us today. I think it's great education that you've provided.  Yeah, it's been a pleasure and it's been a great HRX meeting, so thanks so much, Janet. Absolutely, thanks. So, once again, this is HeartRhythmTV at HRX 2024.  I'm Janet Han with Jonathan Su. Thanks so much for watching.

Video Summary

Dr. Jonathan Su discusses advancements in electrophysiology (EP) at HRX 2024 with Janet Han. He highlights the implementation of a streamlined care pathway at UC San Diego using Viz AI, which significantly improved atrial fibrillation (AF) monitoring in cryptogenic stroke patients. By facilitating direct communication between neurostroke and EP departments, this approach increased the annual implantation of loop recorders. The process allows patients to choose between external monitoring and implantable devices, enhancing patient autonomy. The program successfully reduced patient attrition and improved care, with similar initiatives suggested for other hospitals.