digital health and clinical practice guidelines...digital health and clinical practice guidelines....
TRANSCRIPT
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Ulf Landmesser, MDESC Clinical Practice Guidelines Committee
Chairman, Department of Cardiology
Charite University Medicine, Berlin, Germany
Digital Health and Clinical Practice Guidelines
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Advanced mHealth
(e.g. biosensors)
Apps, Wearables
Big data
(e.g. genetics)
Artificial
Intelligence
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Digital Health and
Clinical Practice Guidelines
(1) Education• ESC Clinical Practice Guidelines Apps
• Integration of ESC Guidelines into EHR-based Decision Tools
(2) Evaluation of Evidence for Digital Health in CVD Prevention and Management• Mobile Health• AI-based algorhythms
• Integration of genetics•
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9 0
45
1 8
34
1 5
33
79
7
54
6
35
8
26
6
13
7
15
00
3
3 9
23
4 0
13
2 1
77
1 9
01
1 6
18
1 9
95
27
7
28
17
14
7 5 5 4
4 0
17
0
2 000
4 000
6 000
8 000
10 000
12 000
14 000
16 000
35 & under 36-39 40-45 46-50 51-55 56-60 Over 60 Unknown age
Age and Gender of ESC GL App Users 2018
Female Male Unknown gender
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Simplicity
• Easier and rapid access to flow-charts and tables
• Better navigation and full table view
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ESC Guidelines into the digital health solutions
ESC guidelines based decision support tools can be implemented in electronic medical reports.
ESC – Digital Health Cardiovascualr Roundtable
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Digital Health – EducationESC Guidelines – Digital applications
- ESC guidelines Apps
- ESC guidelines-based decision support
ESC – Digital Health Cardiovascualr Roundtable
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Digital Health and
Clinical Practice Guidelines
(1) Education• ESC Clinical Practice Guidelines Apps
• Integration of ESC Guidelines based Decision support into HER
(2) Evaluation of Evidence for Digital Health in CVD Prevention and Management• Mobile Health• AI-based algorhythms
• Integration of genetics•
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Digital Health recommendations in
Clinical Practice Guidelines
Careful development of
algorhythms for remote
monitoring important.
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mHealth
(e.g. biosensors)
Apps,
Wearables
Big data
(e.g. genetics)
Artificial
Intelligence
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Sensors and Biomedical Data Aquisition
Piwek et al (2016) The Rise of Consumer Health Wearables: Promises and Barriers. PLOS Medicine
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Example: Apple Watch and the Detection of
Atrial Fibrillation
HEARTLINE Study:
• Plans to enroll up to 150,000 Americans 65 and older, randomized to receive either an Apple Watch coupled with HEARTLINE app, or no watch(ECG app on the latest Series 4 Apple Watch)
• Primary outcome: Clinically confirmed diagnosis rate of AF ? • Secondary outcome: MACE (stroke, MI, all-cause death)
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Novel approaches for detection of Atrial Fibrillation
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Landmesser U, MacRae C. Lancet Digital Health 2019 – in press
• Comments on digital health-based self-managing systems for patients with coronary disease
• E.g. Ischemia/ACS detection• AngelMed (FDA approved for patients wit recent
ACS)• RELF algorhythm
• ESC guidelines recommendations ?
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ESC will take a leadership role in convergence of
digital health and artificial intelligence (AI) in CVD
Lancet. 2019 Sep 20 [Epub ahead of print]
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mHealth
(e.g. biosensors)
Apps, Wearables
Big data
(e.g. genetics)
Artificial
Intelligence
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Digital Health and
Clinical Practice Guidelines
(1) Education• ESC Clinical Practice Guidelines Apps
• Integration of ESC Guidelines based Decision support into EHR
(2) Evaluation of Evidence for Digital Health in CVD Prevention and Management• Mobile Health• AI-based algorhythms
• Integration of genetics•
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Lancet 2019; 394: 861–67; Published Online August 1, 2019
650 000 ECGs from a cohort of 180 922 patients aged >18 years
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Lancet 2019; 394: 861–67; Published Online August 1, 2019
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Digital Health and
Clinical Practice Guidelines
(1) Education• ESC Clinical Practice Guidelines Apps
• Integration of ESC Guidelines based Decision support into EHR
(2) Evaluation of Evidence for Digital Health in CVD Prevention and Management• Mobile Health• AI-based algorhythms
• Integration of Big data (genetics)•
![Page 21: Digital Health and Clinical Practice Guidelines...Digital Health and Clinical Practice Guidelines. Advanced mHealth (e.g. biosensors) Apps, Wearables Big data (e.g. genetics) Artificial](https://reader034.vdocuments.mx/reader034/viewer/2022042709/5f506fb1b76f66060919cbdb/html5/thumbnails/21.jpg)
FUTURE: Personalised Maintenance of CV Health Genomics, Biomarkers, Advanced Phenotyping (Imaging, Digital) – Integrated by AI-based algorhythms
GENOMICS
CLINIAL DATA
BIOMARKERS,
WEARABLES
01
03
ADVANCED DEEP
PHENOTYPING
(eg Imaging of Subclinical Disease)
02
Novel Artificial Intelligence-Based Algorhythms
Digital Precision
Medicine:
Personalised Maintenance of CV Health/Managment of CV Disease by Targeting Causal Pathophysiological Mechanisms of Disease Progression
Adapted and modified from :
Leistner D, Landmesser U. Eur Heart J 2019; 40: 9-12
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ESC-CPG Methodology Task Force
Started in 2018, will provide a document for methodology for ESC Clinical Practice Guidelines
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Topics of Methodology Consensus Document Levels of Evidence/Grading
➢ Therapeutic decisions
➢ Meta-analyses vs single RCTs
➢ Role of observational studies
➢ Prognostic information
➢ RCTs not required
➢ Diagnostic tools
➢ When are observational studies enough?
➢ When are RCTs required?
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Levels of Evidence/Grading for Therapeutic Decisions
➢ Meta-analyses
➢ Based on systematic review
➢ Size of 2 largest trials (patients, events)
➢ Funnel plot
➢ Heterogeneity between trials: I2, t2, t
➢ Effect estimate (HR, RR etc.)
➢ 95% confidence interval or p-value as evidence against null hypothesis (p<0.005)
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Digital Health and
Clinical Practice Guidelines
(1) Education• ESC Clinical Practice Guidelines Apps
• Integration of ESC Guidelines based Decision support into EHR
(2) Evaluation of Evidence for Digital Health in CVD Prevention and Management• Mobile Health• AI-based algorhythms
• Integration of Big data (genetics)•