Optimizing Healthcare for Heart Disease with HeartFlow | E. 62

Learn about HeartFlow, the technology revolutionizing precision heart care.

Episode Introduction 

Heart disease is the leading cause of death in the US. HeartFlow’s non-invasive, cutting edge technology aims to improve the patient experience and make cardiovascular care easier for physicians. Topics include, the barriers to obtaining an accurate diagnosis of coronary artery disease (CAD), condensing the patient experience into a single CAT scan, the data supporting the new technology, and why 80% of the top 50 heart hospitals in the US use HeartFlow. 

 

 

Show Topics

 

 

The challenge of diagnosing CAD Invasive treatments impact the patient experience Condensing the patient journey into one CAT scan  The importance of data in making treatment decisions HeartFlow is revolutionizing precision healthcare Embracing new technologies

 

 

 

12:00 The challenge of diagnosing CAD 

Lauren highlighted the difficulty in getting an accurate diagnosis for the causes of chest pain with existing processes. 

 

‘’….heart disease is the number one killer of all Americans. One in every four deaths is going to be related to heart disease. And when someone has stable chest pain, so I'm not talking about MI, the big MIs, those are going to go right to the cath lab or surgery, but when someone has stable chest pain, historically this would trigger a clinician to order a stress test, whether that be exercise, an echo, there's different nuclear scans, all of which have their right place within the medical field and can be very useful. However, specifically for coronary artery disease, these tests show areas of decreased blood flow in a particular area of the heart, or raw motion abnormalities. But it's not clearly answering the question at hand, which is, "Do I have coronary artery disease that is causing my chest pain? Where? Which artery? Is it several? Is it just one? At what spot?" When you want to ask these specific questions, those tests really don't answer those questions. And in fact, 20 to 30% of the time when you go for these tests, they are inconclusive or can give a false reading. So that's pretty concerning. That was surprising to me, personally.’’

 

 

13:30 Invasive treatments impact the patient experience

Lauren said that over half of patients undergo diagnostic cardiac catheterization unnecessarily. 

 

‘’Imagine you have this chest pain and they say, "Oh, we don't know what it is," or, "Looks great." Then something bad happens or looks bad and you end up with further testing that ends up being nothing. So usually it starts with some type of non-invasive test. If the chest pain continues, then the patient would typically be sent for an invasive cardiac catheterization. We're using needles catheters, it's usually in the groin or the arm, dye and radiation are administered. You shoot that dye and you can visualize the coronary arteries on a 2D image that looks like an x-ray in the cath lab. And that's often the gold standard of historically ruling out, that true coronary artery disease, yes or no.  Another surprising thing I found when I came to HeartFlow, 60% of the time when patients go for this invasive test, the coronaries are found to not be obstructed. More than half. More than half of the people going to get a diagnostic cardiac catheterization, either they find nothing or they find something that can't be intervened. So you have a ton of patients in a healthcare system getting tests that may not be helpful in their diagnosis for creating a treatment plan. And this causes a real strain on the patient experience, so they're getting bopped around from test to test, not quite getting their answers yet. Staffing, huge issue right now. Costs to the healthcare system, accuracy of the diagnosis, like you mentioned with your family member, and ultimately the outcomes. There is a problem that we are definitely trying to solve here.’’

 

 

16:30 Condensing the patient journey into one CAT scan

Lauren explained the proposed new testing pathway with HeartFlow and the benefits to the patient experience. 

 

‘’HeartFlow, it takes the coronary CT angiogram, so a CAT scan of coronary arteries, which is then analyzed by our proprietary software to provide non-invasive CT derived FFR. So we refer to this as FFR CT and we can help physicians understand the physiology and clinical significance of a disease in the coronary artery now in a non-invasive way. So everything that we just talked about, that historical patient journey, can be condensed into one CAT scan, and we can get you so much information in one short visit. So the proposed new testing pathway, which has been... It's in the guidelines as well, the patient undergoes a typical coronary CT angiogram. This is fairly quick, it's not invasive, your coronary CT is extremely accurate in providing the anatomy. So this has been proven. Your CT can show narrowing versus not narrowed arteries. Physician sits down, they're reviewing the images, and they notice a narrowing of 40 to 90%. At that point, he or she can request a HeartFlow analysis. So the raw scan images are sent to our artificial intelligence-based technology that creates a 3D model of the patient's arteries. So it's a combination of both artificial intelligence, deep learning, and people, because the next step is that trained analysts, human beings, review the model for accuracy. So at least two people, sometimes up to five, depending on how complex it is, will actually sit down, look at every lumen, look at every tracing that the computer has derived to say, "Is this accurate?" And then the model uses some pretty high brow mathematics and computational fluid dynamics to quantify the blood flow in those modeled arteries. The completed analysis is then returned back to the hospital via the PAX imaging system and/or the EMR, the electronic medical record, within about four hours. And we even have the abilities... It's very cloud-based as well, so that you can also access it on a phone, an iPad, or any PC using our HeartFlow user interface, which is certainly securely stored. And then after that initial CT scan, there's no additional testing to get the HeartFlow analysis. That's really important. The patient doesn't have to come back in. We can just apply the technology to those who need it. And in about 30 to 40% of coronary CTs this will be applicable.’’

 

 

20:30 The importance of data in making treatment decisions

Lauren said the data supporting HeartFlow helps to ensure doctors don’t put stents into people who don’t need them. 

 

‘’A clinician now has information on both anatomy and physiology regarding patient specific coronary arteries. And it's amazing how those two do not always match…..And even with very visually narrowed arteries, like 70 to 90%, there's still a one in four chance that it's not physiologically significant. So the fact that those two things don't always match or they're discordant means that we really need information on both. And there is a risk, there really is a risk of doctors putting stents in people who don't need them. It's Not a benign procedure, and ultimately what we are providing is the data for physicians to make the right decisions for the right treatments at the right time…. And it's also backed by long-term studies with data out to five years. We have evidence from over 500 peer reviewed publications. It's recognized in the professional guidelines. Just last year in 2021, the chest pain guidelines were revised, I think for the first time in 10 years by the ACCAHA organizations. So now FFRCT, which is only offered by HeartFlow, is in those guidelines, and you may even hear the term CT first as a hot buzzword out there, and that's a result of the guidelines that getting that coronary CT scan is a level 1A recommendation for stable chest pain…

 

 

23:30 HeartFlow is revolutionizing precision heartcare

Lauren explained how HeartFlow empowers the patient with a comprehensive and rapid analysis. 

 

‘’… we're patient centric because we offer the first and only test in the market that helps physicians give the patient answers about their heart disease in a non-invasive way. I imagine if you or I had chest pain, I kind of want to know the answers pretty quickly to what's going on with that, knowing what we know. And my favorite part of the job, as you mentioned, is when a patient sees that model of their 3D analysis, seeing that visual…..So medication and health compliance, discussing care plans, and certainly even follow up to the primary care provider or that referring physician is impactful. These physicians are sending the patient for a test and it's wonderful to empower them to understand what's going on in those arteries and then be able to pass that along to the patient family. And we even take it a step further. We have a recent FDA clearance of two additional offerings, so we're not stopping at just FFRCT. We are going a step further. We have the roadmap analysis, so that provides support for a quick analysis of potential stenosis areas in an anatomical model. And then plaque analysis helps physicians to identify and quantify plaque in the coronary arteries. This is phenomenal. I think it's going to be a game changer. So we're the first and only company to offer a full analysis on your anatomy, physiology, as well as plaque, putting all those pieces together. So that's how we're moving the needle forward.’’

 

 

32:30 Embracing new technologies

Laurie said that ultimately, the adoption of new technologies is often based on the patient experience.

 

‘’I think for clinicians the science has to be solid, number one. The workflow must be easy. I mean, clinicians have so much on their plate nowadays in such limited time that it has to be efficient. And ultimately, adoption, in my opinion, seems to be based on the patient experience. The first time a clinician gets information on that suspicious lesion that's further validated by HeartFlow, FFRCT, they can feel confident in making their assessment and treatment plan. They can approach the patient and say, "See, we have a lot of information right here telling us you need a stent." Or conversely, "Hey, based on this, we saved you a trip to the cath lab, but let's talk about your lipid management to prevent further issues down the road." And that feels really good to know that we're helping physicians in crafting that right treatment plan with the right information. For hospitals, it's probably a little different as far as what ultimately persuades them. I think one, meeting an unmet need in their community, should be number one. But sometimes being the first to bring something to the area or to market is a nice thing for hospital administration. We certainly have an opportunity to show them how workflow efficiency and cost savings to the organization could be beneficial. And that's really fun about my job is I get to interact with people at all different levels of the hospital to figure out what matters most to them all while serving the patients' best interest.’’

 

 

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You’ll Also Hear:

 

Lauren’s career journey, from critical care nurse at York hospital to district sales manager at HeartFlow, and getting comfortable with the business side of medicine. 

 

Turning it around in under two hours with Heartflow’s ‘’prioritization’’ button. ‘’We've seen some application to that for folks who want to use this modality in the emergency room setting for stable chest vein… you can get your answers sooner than later in that setting.’’

 

How HeartFlow is transforming the cath lab from a diagnostic facility to a treatment facility. ‘’Our global prospective randomized trial PRECISE demonstrated that you're 78% more likely to find patients who need revascularization when using the CT first testing modality. And you're twice as likely to keep patients out of the lab who don't need an intervention.’’

 

HeartFlow: the benefits of Software as a Service: ‘’Our business model is considered software as a service. So you are only charged if the physician receives our FFRCT analysis. There are no initial startup costs involved…And to date, this technology's been adopted by more than 725 hospitals, including 80% of the top 50 heart hospitals in the US, and clinicians have been using our technology to reach more than 135,000 patients.’’

 

Overcoming objections to new technologies and why ‘’this is the way we’ve always done it’’ is the most dangerous phrase in medicine. 

 

 

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