heart attack risk calculator

- but, in part, i will tell you that this is not the organization that i was involved with 20 years ago. the symbols may be the same, the mission is still pretty much the same,

heart attack risk calculator, but the tools and technologies,and things that it's using, its techniques to make a difference are in part changingas a function of time. so you're hearing now about

the institute of precision medicine, and today i'm here to talk to you about the health technology& innovation center. so in part, i will begin with just things that you already know. the world is changing rapidly around us, and in part that's why ourtechniques need to change. go back, please. slide back.

great. in part, we know that patientsare becoming more empowered, positions in part arechanging what they have, they're giving up a bit of autonomy but they're gaining teams. care coordination has become a buzzword and in part is veryactive to try to translate patients through the systemand then ultimately out towards their homes ina healthy and happy way.

insurers have gone from just billing to the idea of managing populations. and then even the pharmaceuticaland device industry are realizing it's notabout their technology, but about the idea thatthey can actually fit that technology and treatment into a disease management strategy. where we deliver health careis also changing rapidly. when i began, in my practiceit was all about the hospital,

but now it's about the health care system both with in & outpatient clinics, and in the future as we heard last night, it'll be about taking that health care and health promotion into the home. we heard a lot last night about the varieties of new technologies and the wonders thatare coming up every day from our engineers across thecountry and across the globe.

the opportunities to use this technology to change how we deliver health care or ultimately to promotehealth is phenomenal. and you'll hear much more about this through the rest of this conference. but the investment herehas been incredible. 4.5 billion dollars has been invested in digital health technologies, over 100,000 healthcareapps have been developed.

this is now over past what we're now investing in devices in medical care. and the reasons why it mattersabout cardiovascular disease were in part given by nancy's statement which gave the amount towhich cardiovascular and other related conditions areaffecting lives of individuals. this puts it in terms of dollars, and if you look at themost expensive diagnosis in the us and around the world,

you'll see that heart conditions,diabetes, hyperlipidemia et cetera are at the leading edge of this. the question is, can weuse technology though to help address these issues? in an article in jama, wetalked about the ability to use health applicationsand mobile technologies to in part address these hugeand massive and global issues. the question though is,do we have the information that is needed to show that

these new technologies actually work? we did a literature review as is done by the american heart association to try to see what is known about whether these new applications can actually help promote health, and the seven wondersthat nancy talked about, the techniques and foundationof the heart association. we found that many of these were lacking

the evidence that we actually needed. rather than end this ona negative note, though, we talked about the need forresearchers and health systems to get involved, to in partembrace this new technology, and then try to discover which parts work versus those that don't. there is varieties of this,sometimes when we test new technologies we find that in fact there was limited benefit.

this was a study wetalked about last night which showed that infact among a small study when they randomized patients to receive a fitbit-like technology to inpart improve the weight loss, they found that in factit didn't improve that. but, you can look at thisfrom a very different angle. in part, if you look atthis from the other side, we talked about the degree to which these were now two & three &four year old technologies

and don't represent exactlywhat people are doing today, so there may be explanations for why this rapidly moving field hasn't been yet shown to be evidence based. but that doesn't give us an excuse for not actually trying to evaluate these in more rapid and real time manners. the other gulf that existscame from our first conference. this is a very interesting pose,

if you're into bodylanguage, on the one side was the tech community,on the other side was uh, yeah, that's me. and look at the faces,this was the digital divide that existed in that first conference. here was my description on that conference i'm a 50 year old, idon't wear a smart watch, i'm not tech-savvy, idon't adopt anything novel without evidence, i'm your problem.

which dr. harrington was very good enough to tweet out to the world. peterson, this is actually truth, "peterson is the problem." so, we've got it, nailed. but there is a gulf that exists also at the both patient andphysician level, not just with me but in part if you talk tophysicians around the world they're gonna talk about the idea

that are ehrs helping or hurting? what type of applications should i be recommending to my patients? how do i integrate that into my practice? if you talk to patients themselves, they'll talk about the idea as is any of this data meaningful? how do i interpret all this stuff that's coming off my watch?

how do i get my doctor to actually care about using that tohelp make me healthier? so it really is this triangle between the digital anddevice application companies who are developing allthis wonderful technology, the clinicians who inpart have to figure out how to use this in theirroutine clinical practice, and ultimately the patientwho has to adhere to this and buy into the idea thatthis could make them healthier.

the american heart associationisn't new to this game, it's become quite clicheto be involved now in tech, it's like the cool thing. i get to wear no ties anymore, it's great. (audience laughs) but the reality is we wereinvolved in this way back when. in 2007, they started to develop a heart attack risk calculator. we worked with various companies

to develop a bloodpressure monitoring system we'll talk about in just a second. heart of diabetes in 2009,my life check in 2010, an intel large project 2013, you can look across this,but throughout the years there's been a varietyof cutting edge efforts that are now becoming sortof just getting into vogue but they were actually started maybe up toward a decade beforeby the heart association.

in fact, dan jones, whenhe was the president of the heart associationwrote this editorial talking about the idea thatwe should be using technology working with systems toultimately help patients manage their blood pressure better. in that day, it was arather novel concept. but in fact, the heartassociation worked diligently to in part develop a technology along with microsoft in those days

that would allow you tomonitor blood pressure in your own home environment. not only did we helpdevelop that technology, put into it the rules and guidance that came from our evidence and science, but we in part helped to test out the first times it would be used in a randomized clinical trial. now this is back in 2008.

we first tested it in a kaiser system, which is sort of an integratedhealthcare delivery system, but then we tried it in thisvery challenging institutions called duke medicine. (whistles) in both of these wefound positive results, so we said well, let's take it out of the randomized controlled setting and put it into community practice.

can it be used by average everyday citizens within durham county? and lo and behold itshowed great promise there, so then we said can we scale this, can we take it to 17communities across the us and then check change the control effort. again we found differences in responses but we did find overall that the program was remarkably successful in helping

to start to change blood pressure. now working with various organizations we're starting to try to, again, take this to a generalizablecommunity level. so now i'm here to talkbriefly about the idea of where is the centergoing, and i can tell you that each and every one ofyou has a great role today, it's to help us to find what the center should be emphasizing.

we wanna emphasize sort of three things. first, the idea thatwe're gonna engage you all and are engaged our patients. the ultimate goal of this is that we know to improve outcomes and that that triple gold star would be to lower cost as well. in part, this kindaconference is an opportunity to bring together the techworld, the clinicians,

the researchers, alldevoted to the idea of how can we make our patients better, and then how can we developthe evidence to show that this'll be the right thing to do. at the heart association meetings now has become a showcase to not only show the newest drugs and the newest devices, but also how new technologymight be changing how we deliver care inthe lives of our patients.

some of the competitionsthat we're holding there have been quite fun,and they'll be continued through scientific sessions this year. the idea that we can useand put into these products the very best evidence inthis idea the aha inside. can we put into these things not only just sorta what you come up as what you think theright suggestions are, but what nancy talkedabout, the newest guidelines

would summarize the very best evidence injected into these products. in part we have theopportunity to convene you all in settings like this so that together we can come up with what arethe solutions for tomorrow. ultimately the goal isto have major impact. and the major impact, i hate to say, is very broad, this isgonna be a challenge. there's a lot of challenging issues

in cardiovascular disease as shown on the left side of this slide. everything from blood pressure problems to peripheral artery disease,to metabolic syndromes. so we have a lot of work cut out for us, and deciding whichtargets to go after first is a major challenge. in addition, what fallsinto the category of tech is also quite broad.

everything from mhealth toworking on behavioral change, telemedicine, to decision support you heard about last night. so in part, the goodness is that we have a lot of opportunity to make a difference. the challenge is there's a lot to do. so in fact i'm happy to havea lot of friends together to help make that happen. some ideas we've been havingabout exactly specifics

the center will be taking on. in part it'll be a clearinghouse where new technologies can be both bedded and ultimately those that are shown to beeffective to be disseminated. we'd like to help to guide both physicians as well as patients to understandwhat is working out there and what are the opportunities to develop these new technologies. we wanna integrate this in with the

aha's institute for precision medicine because again, there there'llbe great amounts of data and this in part will both contribute data but we'll use that data to help understand what is working and what is not. ultimately we wanna workwith you as those innovators in the field to determinehow we can best use your innovations to deliverbetter cardiovascular care. and ultimately bettercardiovascular health.

and then finally we get to the idea that we might help youas well develop systems where you can test outyour new technologies, and those that are found to beeffective to be disseminated to the rest of the world. how can you get engaged? well there's multiple opportunities, i will advise you to talk to patrick, who's the expert on this.

but there'll be a numberof different opportunities where small companies and largecompanies can work together in terms of how they can partnerwith the heart association both to test out their technologies, as well as put aha inside. so as an end note, i'll just note the aha has been a remarkableorganization to work with, it's got the right goals inmind and the right mission. it has the right capacity and reach

and brand associated with it. and ultimately, it can bring to better and be a convener of you and us working together for good causes. thank you very much. (applause)