Why Every Cardiac Patient Needs a Virtual Heart

the_newsbeagle writes: In the latest high-tech approach to personalized medicine, cardiologists can now create a computer model of an individual patient's heart and use that simulation to make a treatment plan. In this new field of computational medicine, doctors use a patient's MRI scans to make a model showing that patient's unique anatomy and pattern of heart disease. They can then experiment on that virtual organ in ways they simply can't with a flesh-and-blood heart. Proponents say this tech can "improve therapies, minimize the invasiveness of diagnostic procedures, and reduce health-care costs" in cardiology.

Comments

Cost less? Doubtful.

[Overzeetop]

The cost of alternative treatments is set based on the cost of the original treatment. Just because it is cheaper to produce doesn't mean that the cost to the end recipient is going to reflect that. If there is a $200,000 surgery to correct your defect, and for $180,000 we can cure you without surgery, that $18,000 sounds like a bargain. There is no effective competition, so whether that cure costs $100 or $10,000, the $180k price will stick. Of course, if surgery isn't necessary, we could do the procedure to more borderline cases - ones that might never need surgery. If we catch just 15% extra people that would have opted out of surgery, we have spent more money.

I'm not convinced that a cardiac surgeon is going to cost less if he spends 8 hours experimenting on a heart and 4 hours in surgery vs 2 hours reviewing current imaging data and 6 hours in surgery.

As someone who works with computational models, knowing the exact answer is not always going to lead to a more effective or useful result in the field. Knowing you need a 1.77245 mm incision has little value over knowing that a 1.8mm incision will work with a scalpel operator which is only accurate to 0.2mm. There will always be shoulder cases where it may make a difference, but are you willing to pay 3X the cost for every procedure to cover the 10% in which it might make a difference? (That's a trick question, by the way, because you aren't paying, your insurance company is - and I can almost guarantee what their answer will be)

Re:Cost less? Doubtful.

[hawkeyeMI]

The difference in procedure time will be substantial. Right now most of the time spent on a VT ablation is for mapping the rhythms and scar. We can pretty much eliminate that (trials ongoing), meaning the procedure can be cut from 4-12 hours down to 2-3 hours, reliably. Considering the cost of time in the EP lab, the savings can be quite large. When it comes to ICDs, risk stratification is really important. If we can avoid putting in unnecessary devices which cost (not counting implantation) $25k-$55k, that's a big savings.

Re:Cost less? Doubtful.

[AK Marc]

As someone who works with computational models, knowing the exact answer is not always going to lead to a more effective or useful result in the field. Knowing you need a 1.77245 mm incision has little value over knowing that a 1.8mm incision will work with a scalpel operator which is only accurate to 0.2mm.

You are presuming the only use is surgical accuracy. You are wrong. It could be choosing between an shunt and a stent. Or determining if a leak or defect is bad enough that it requires surgery, or if alternative treatments would be effective, forgoing surgery completely.

It's not about optimizing the surgery, but determining whether it's even needed, or what to do if it's done.

Re:Every patient?

[ShanghaiBill]

By and large, better treatment options cost less, not more, than the status quo.

It is not clear that this treatment option is "better". So far there is no evidence that 3D heart models result in better health outcomes. Even if they do, it is not clear that this is the best way to spend healthcare dollars. Doctors love shiny new technology, patients like to feel they are getting the "best" care, and neither has much incentive to care about the cost.

Re:Every patient?

[hawkeyeMI]

I'm working on the first clinical trial for this (the author is my former PhD advisor). There is good retrospective evidence in humans (described in the article) and I am trying very hard to start getting prospective data. Um. Ask me anything?

Re:Computational Medicine

[hawkeyeMI]

However, here is a peer-reviewed paper using the same technology. http://www.heartrhythmjournal....

Re:Every patient?

[AK Marc]

LOL, you expect us to believe you saw "wait times" advertised on billboards for hospitals in the US? I've never seen one in the US. Usually, if you need an ER, you don't drive around for hours shopping ERs. So there's no reason to advertise them.

Seems much more likely that you are an American who found a canadian site (probably off a conservative blog rant) and are lying to make it seem like the care in the US is anything but poor. I've been to doctors on 5 continents. The US medical system is the worst, unless you are a billionaire with a rare disease.

I looked online and could see lots of places listing Canadian or Australian wait times, but not the US. They don't list them, track them, or care about them. That you saw so many, when I've never seen one in the USA makes me think you are a liar.

Re:Every patient?

[hawkeyeMI]

1. The system is run offsite, it doesn't currently have any installation costs.
2. It depends on what you factor in. There are a lot of costs to cover engineering and so on. The patient needs an MRI if they weren't already going to have one. That's the biggest cost depending on the hosptial (~US$2k). It's not currently being sold and pricing will have to be determined.
3. We operate the backend, all the doctors have to do is upload the MRI. Minimal training is required to interpret the results. We're working on presenting the data to EPs in forms they are already familiar with.

Re:Every patient?

[hawkeyeMI]

The largest financial burden per-patient is the imaging. An MRI can cost over $2k. The rest of the cost is going to have to do with getting a software-based medical device approved, which requires substantial software re-engineering and clinical trials to satisfy the FDA.

Misses point: most heart disease nutritional

[Paul Fernhout]

https://www.drfuhrman.com/libr...
"Interventional cardiology and cardiovascular surgery is basically a scam based on a misunderstanding of the nature of heart disease. Searching for and treating obstructive plaque does not address the areas of the coronary vascular tree most likely to rupture and cause heart attacks. If there was never another CABG or angioplasty performed or stent placed, patients with heart disease would be better off. Doctors would be forced to educate our citizens that their heart disease risk is determined by what they place on their forks. Millions of lives would be dramatically extended. To abandon the theory of stretching and cutting out areas with plaque would shut down interventional cardiology, nearly all cardiovascular surgery, and many suppliers of the biotechnology. In many cases, interventional cardiology is the major income generator to hospitals. The ending of this ill-conceived, out-dated and ineffective technology would dramatically downsize hospitals in the United States and free up over $100 billion annually in medical care costs. Besides being ineffective, interventional cardiology places the responsibility in the hands of the doctor and not the patients. When patients finally realize they must take control of their heart problems with aggressive dietary modifications (and when needed medications for temporary periods) we will essentially solve the health crisis in America.
    The sad thing is surgical interventions and medications are the foundation of modern cardiology and both are relatively ineffective compared to nutritional excellence. My patients routinely reverse their heart disease, and no longer have vulnerable plaque or high blood pressure, so they do not need medical care, hospitals or cardiologists anymore. The problem is that in the real world cardiac patients are not even informed that heart disease is predictably reversed with nutritional excellence. They are not given the opportunity to choose and just corralled into these surgical interventions.
    Trying to figure out how to pay for ineffective and expensive medicine by politicians will never be a real solution. People need to know they do not have to have heart disease to begin with, and if they get it, aggressive nutrition is the most life-saving intervention. And it is free."

Re:Every patient?

[Anonymous Coward]

I got my Ph.D. in this industry as well(patient-specific cardiovascular modeling). I'm posting AC, but I'm not HawkeyeMI. There is definitely some work in this field that is probably not going to improve outcomes. Maybe the uncertainties of CT/MRI images produce simulated "outcomes" that don't match reality. Or maybe you get a good image, and do a simulation for a patient that needs a bypass graft. You find that the 'best' angle for the bypass graft in patient A is to be stitched on at 17 degrees from the native tissue, but that an error of more than a degree or two negates all benefit of your simulated result. Really, there are all kinds of reasons that efforts like this end up not being practical. Some work is so impractically expensive in terms of computational time that it will never see clinical usage for that fact alone. In defense of a lot of this, you can't really know what's workable without trying, and a lot of research codes are readily admitted to be more of a 'proof-of-concept' rather than 'ready-for-clinical-use-and-patents'. But I digress.

I've had the pleasure of hearing Dr. Trayanova speak at conferences. Conferences held in medical facilities with clinicians and surgeons speaking as well, not just computer modeling wonks. Her work really is very promising and appears to be further along than many others in this field. She has the respect of computer modellers and surgeons alike. I for one trust her if she says this is getting ready for a larger-scale rollout. She does comes off as a bit arrogant, but I'll afford her that.

Not all that response was intended for you, ShanghaiBill, but there were a couple other posts accusing her of being a walled-off engineer working in a vacuum. Thought I'd just post my point of view all in one place.