Self-driving cars were "popping wheelies" on the Las Vegas strip and low-flying drones were overhead. But the real buzz of the massive 2020 Consumer Electronics Show (CES) in January was inside – where the focus was advances in the digital health space.

Your ACC was there, as part of its leadership in building a roadmap for creating and incorporating digital solutions into clinical practice to transform cardiovascular care and improve heart health.

While artificial intelligence (AI) provides the power behind these digital solutions, it's "augmented" intelligence that could increase patient and clinician interaction by improving clinical efficiency, says ACC's Chief Innovation Officer and Chief Science and Quality Officer John S. Rumsfeld, MD, PhD, FACC.

The field of digital health technology has reached the point where collaboration with clinically focused organizations with the structure to evaluate and disseminate technology is needed to take digital health tech from novel to actionable. This reality led to the ACC collaborating with CES showrunner Consumer Technology Association to co-lead a featured track called Disruptive Innovations in Health Care.

ACC leaders Dipti Itchhaporia, MD, FACC, and Thomas Maddox, MD, MSc, FACC, were among featured panelists, along with other health care providers, payers, pharmacists, and retailer and tech company representatives.

In his introduction to the track, Rumsfeld reminded the diverse audience of start-up entrepreneurs, venture capitalists and large pharmaceutical and technology companies, as well as academic and hospital leadership, that large-scale partnerships are essential to advance digital health in a productive and high-quality manner.

Home-based health care as well as patient-directed health care are burgeoning areas of activity for many companies. Through the CES sessions, the ACC engaged with leaders from BestBuy Health, Samsung, United Healthcare and Dispatch Health to discuss creating clinically relevant solutions for health care in the home.

Verily Health Platforms, Livongo, CVS Health and Ginger participated in a discussion about achieving higher value health care by concentrating on healthy patient behaviors. Panelists shared perspectives on lowering health care costs by reaching large populations in the community and in their homes and addressing epidemics such as mental health issues and diabetes directly with the patient concurrent with traditional health care.

What are some of the expected benefits of moving care from the clinic to the home? According to a panel of patients, providers and technology companies, they include increased patient convenience and compliance, reduced cost of care, and unloading of the hospital and large specialty clinics when the appropriate health care is performed in the community, thus improving access for all.

From the perspective of large medical centers, digital technology companies and most importantly patients, the panel made it clear that outpatient care will soon move away from large centralized facilities and shift towards community-based access.

We're at an inflection point between hype and reality for AI in cardiology, says Rumsfeld, and he sees four major areas where AI may be best deployed in the clinical practice of cardiology:

1. Imaging
2. Algorithms – using known formulas or guidelines and mapping them to large datasets
3. Prediction of risk and outcomes
4. Diagnostic or treatment decision-making.

Imaging applications of AI will progress most rapidly, because of high data quality and more straightforward ability to validate results. This is also generally true for algorithms, says Rumsfeld. More time, however, will be needed for risk and outcome predictions for clinical decision support and definitely for diagnosis and treatment.

Another area ripe for AI and digital health technology is the conduct of clinical trials.

Following on the heels of a proof-of-principle study, the Apple Study presented at ACC.19, the Heartline study is another large-scale clinical trial using wearables and apps to evaluate hard endpoints for cardiovascular disease. These trials and others like them are taking us into the future of clinical trials, where digital and analog approaches converge within mainline research protocols.

Within cardiology, preliminary studies being published hint at real potential, even if not yet ready for "clinical prime time." In one preliminary study, AI was trained to identify and differentiate between standard echo 2D views with very high accuracy, and to recognize conditions such as hypertrophic cardiomyopathy, cardiac amyloid and pulmonary hypertension.

Major companies like GE, Siemens and Phillips already use AI in their software, including optimizing standard echo views and edge detection. It's not hard to imagine that in perhaps three to five years that AI could "pre-read" echocardiograms in clinical practice, with a high degree of accuracy.

Another recent study showed that among normal ECGs, AI could determine with a high degree of accuracy the patients who had experienced atrial fibrillation. In another study, AI was used to evaluate patterns of aortic stenosis with characterization of more subtle degrees of disease and risk. This hints at another strength of AI: it can handle more data over time, and with time-varying variables, which have been notoriously difficult to deal with in risk prediction.

The ACC held its first Applied Artificial Intelligence Symposium, in December 2019. The Symposium brought together ACC member experts, along with patient/consumer, health system, industry and tech stakeholders to discuss the potential for AI in transforming health care delivery.

The day-long event outlined ACC's goals in the digital transformation space; how to move AI from concept to practice; and the importance of multistakeholder collaboration to effectively achieve applied AI.

The digital transformation of health care is here. The College is partnering with like-minded organizations – both in the U.S. and globally – to promote evidence and clinical integration of AI solutions in a responsible way that will help cardiovascular professionals take better care of patients.

Keywords: ACC Publications, Cardiology Magazine, Automobiles, Motivation, Leadership, Pharmacists, Outpatients, Cost Savings, Ambulatory Care, Mental Health, Patient Compliance, Health Behavior, Health Care Costs, Biomedical Technology, Diabetes Mellitus, Preventive Health Services, Epidemics, Pharmaceutical Preparations, Heartline, acc20, Clinical Trial

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