Melanie Cole (Host): Welcome to Better Edge, a Northwestern
Medicine Podcast for physicians.
I'm Melanie Cole.
Joining me today is Dr.
Josh Chima.
He's an assistant professor of Cardiology at Northwestern Medicine,
and today we're discussing Dr.
Shea's recent research on Fibre Check.
Dr.
Chima, thank you so much for joining us today.
I'd like you to first start by telling us a little bit about AFib
and some of the challenges that we've known over the years of keeping
track of ongoing treatment response.
Dr Baljash Cheema: So atrial fibrillation is a heart rhythm disturbance.
In which there is essentially this chaotic movement of electricity through
the atria, the top chambers of the heart, and essentially the heart is out of sync.
And so that doesn't follow the typical rhythmic fashion where the top chambers
of the heart contract first send blood to the bottom, chambers, the ventricle,
and send blood to the entire body.
The atria sort of contract whenever they want to in their own pattern.
And that can actually have blood sitting in the heart and not adequately emptying
and creates a risk for developing a blood clot And the atri or the top chambers of
the heart, specifically the left atrium.
And That is particularly dangerous because of that blood crop
breakthroughs from the left atrium.
It can travel up to the brain and cause a stroke.
That's really the thing that we worry the most about.
There are patient's that have symptoms when they have AFib.
They may feel palpitations or their heart racing or feel some
discomfort in their chest or even a sensation of shortness of breath,
but some people don't feel it at all.
They have no symptoms at all related to the AFib, but no matter what,
it's still a risk factor for having a stroke, which can be really impairing.
Melanie Cole (Host): So then tell us a little bit about Fbri Check
And the algorithm that it uses.
what is it doing?
This is an FDA cleared tool for remote atrial fibrillation
detection and monitoring.
Right.
So it's kind of doing both.
Dr Baljash Cheema: so Fbri Check is a company that we've worked with really
to trial One of their products, and This is a algorithm that they've created,
really a technology that they've created where they're using PPG signals.
Or Photo plus Mamography, where you put your finger on the camera lens of a
smartphone and it can analyze the way the blood is flowing through the tips of your
finger And the way light is reflecting off of the blood flow in your finger, and can
get a sense of the type of heart rhythm that you're in, and whether it's a normal
one or an abnormal one, specifically AFib.
So the technological advance that they've created is the ability to detect AFib.
Through a cell phone camera lens.
Now, this fits in the, larger ecosystem of what I would say are wearable
technologies or wearable sensors.
Now, This is built into your smartphone, but it's not exactly a wearable, but it's
this group of products that patient's, or maybe they're not even patient's,
just consumers can purchase on their own accord and can use these for at home
monitoring of health-related conditions.
There's a lot of competitors in this space.
There's a lot of types of products that people and companies have created, like
now estimation of your blood pressure, estimation, of your risk of having
something called sleep apnea or asthma, or detecting how many steps you're walking
or your reveal to max your best measure of your cardio respiratory fitness.
But we are getting into the realm where.
Consumers can purchase equipment that can allow them to get close to
making a medical diagnosis on their own accord before they're coming
through the doors or a clinic or the doors of our, of hospital system,
and that's where Fbri check falls in.
Melanie Cole (Host): Wow, isn't that amazing?
There are so many, as you say, wearables on the market today and and they have
their advantages and disadvantages and some of them disadvantages might even
be the technology involved, especially for older people, but with a cell
phone, people are learning to use those.
Speak a little bit about the advantages and limitations of Fbri Check compared
to some of these other patient activated wearables that are available.
Dr Baljash Cheema: I think you outlined there one of the key advantages That
This is an application That is put on a smartphone, and specifically in our
trial here in Northwestern And what other sites, both in the US And in
Europe, we looked at the ability of this algorithm to work on many different
smartphones and many different versions of those smartphones to make sure
that it worked on, both Samsungs and iPhones and different operating systems.
But the advantage there is patient's or consumers are not required to wear.
A new system on their wrist or put their finger on, specific
sensors that are outside of their cell phone to get these readings.
This is already built into your cell phones.
There's no additional other hardware that you have to purchase.
Once you have the application, it does still require you to start the app
and put your finger on that camera.
So that has a limitation that it's not an automated system that doesn't
require any input from the user.
And so there still could be a technological barrier for some.
That's really the advantage that I see is that individuals are not having
to purchase a watch or a ring or some other kind of sensor that they're
wearing on their body when they wanna make a, prediction or a measurement on
if they're having atrial fibrillation
Melanie Cole (Host): Well, I can certainly see advantages and
disadvantages to patient's being able to buy these things for themselves.
And we all know Dr.
Google, comes in and, there's all kinds of limitations in that
respect for physicians and providers.
But speak a little bit about who.
You would like as far as patient eligibility And the methods that were
used in the research on Fbri check.
Dr Baljash Cheema: This is the part of this that I'm so excited about is I do
think we're already in a world, we're certainly gonna grow that world in which
patient's, consumers are purchasing these types of equipment on their own accord.
They are getting more educated on what is going on in their own body.
They're likely to make some of these diagnoses on their own accord or walk
through the doors of our hospital system and say, Hey, I think I have
X, Y, and Z based on these pieces of information, or this AI system that I
type my symptoms into, or this wearable sensor that I have been using to record.
My bio signals, my biomarkers, And so we have to be prepared for this.
We have to be actively involved in doing the research to make sure these
algorithms work in the first place.
And that's really one of the reasons I'm proud to be a part of this.
And so really our role here was to simply take this technology to find
patient's in the hospital that were in a normal rhythm, and patient's in the
hospital that were in an abnormal rhythm, and just test and see if the product
could do what it's supposed to do.
Now, these algorithms, these products, these technologies, these are not
clinical grade pieces of medical hardware.
They're not at the same level of restrictions, qualifications,
needs that The equipment that I use in our hospital is, they're not
regulated the same way by the FDA.
So having peer reviewed literature that speaks to the fact that
these work or don't work is really critically important in being
able to adjudicate their benefits.
Melanie Cole (Host): So then discuss the study's findings, Dr.
Chima, particularly how effective it was in detecting AFib and monitoring events.
Dr Baljash Cheema: I would say that in our study we showed that it was effective.
In the same way that this company has shown in some other other studies,
but across different age ranges from those that are young, to those that
are old, across those with different skin tones, from fair skin to dark
skin, and across different categories like your BMI or Body Mass Index.
This algorithm was pretty good at being able to detect whether someone was in
an abnormal rhythm or in, normal rhythm.
And so I can imagine patient's.
Going on to use this at home And then giving us actionable, credible
information in the clinical sector, either through messages or coming
in to see us to say, Hey, This is what my smart device detected.
What do you think?
Do you agree?
Is this AFib?
Should I be on a blood thinner?
What should I be doing to mitigate my risk of a stroke?
How should I treat this AFib?
Can I get rid of it?
What are the different strategies?
Melanie Cole (Host): Dr.
Chima, how can clinicians use this technology to detect and manage AFib?
Speak a little bit about which patient's that you would like to see using this.
Dr Baljash Cheema: so there are patient's that get treatments for atrial
fibrillation, some like an ablation that are meant to get rid of that heart rhythm.
There are patient's that have that heart rhythm and they come
in experiencing things like heart failure and have a weakened heart.
And then again, we treat that rhythm And we think that we've gotten rid of it.
So having a tool like this for monitoring at home when a patient feels palpitations
or just a randomly check a few days a week, is a good surrogate measure, a
good way for us to get more information.
And if they're experiencing this rhythm that we're just missing.
Another major bucket of patient's are those that come in with what
we call a cryptogenic strokes.
That means they have a stroke, but we don't know why.
And one of the leading causes that in those people that were first labeled
a cryptogenic stroke would then go on to get identified with a cause.
It's from AFib.
we just didn't detect it because patient's don't have to be an AFib 24
they most often have something called paroxysmal AFib that comes and goes.
And so having a tool in which you can.
Scan for whether that rhythm is present or absent when you feel
something is really powerful.
You know, in my clinic I routinely prescribe Holter monitors or
some kind of at-home monitor that can check someone's heart rhythm
for a designated period of time.
on the long end is typically two weeks.
That's a long time to ask someone to wear a monitor at home, but some of my
patient's have AFib that pops up once every month or once every few months.
And so it's very reasonable that a two week culture monitor did not
catch their AFib, and perhaps a much better system would be to tell them,
Hey, when you feel those symptoms that I know that are correlated
with your AFib, that you believe are correlated with your AFib, turn that
app on and check your heart rhythm.
Melanie Cole (Host): As we look to the future with these types of what we're
not calling them wearables, but devices that can detect and monitor AFib,
what further developments with this type of technology do you anticipate?
What would you like to see and could it be applied?
your cardiologist?
Could this be applied to other conditions?
Do you see it working for other things?
Dr Baljash Cheema: we are fortunate in Northwestern to really have some of
the leaders in the world on managing and treating and researching AFib.
Dr.
Rob Passman is a great example of that and is leading a number of
studies that are looking into this.
One of the concepts that he has talked about or educated us on is the idea
of a pill in the POCAT approach to being on a blood thinner for AFib.
And so people typically will take a blood thinner for atrial fibrillation to
reduce your chances of having a stroke.
Blood, blood thinners have their own risk, specifically the risk
of having a bleeding event.
And so there is an open question out there about how much AFib is needed
for one to be on a blood thinner.
And if you don't have AFib often, but you experience it once every few months,
should you just take a blood thinner for a period of time around that?
But I can see that science evolving and us having a clear answer
through a lot of the work that he's leading along with his colleagues.
And these types of sensors technologies can help us monitor this at home.
Outside of AFib, I think there really is an endless number of possibilities.
I'm a cardiologist, like I mentioned, but I also work in our Human Longevity
Clinic And the Human Longevity Lab with studies, biomarkers of aging,
And in patient's and individuals.
There are a number of these technologies that look at
processes that decline with aging.
And there may be a way to adjust the way that we're living our lives
And the way we're exercising And the way we're eating and where
we're managing our sleep one day.
The way we're taking supplements or pharmaceuticals that can improve some
of these biomarkers of aging that can be measured, these types of technologies that
may impact, um, the length of time that one lives their life in a healthy fashion.
And without having chronic disease systems, there really are an
incredible amount of opportunities.
Related to these types of technologies alongside machine learning and ai.
Melanie Cole (Host): It certainly is a pretty exciting time in your field, Dr.
Chima, and tell us a little bit how this demonstrates how Bloom
Cardiovascular Institute is leveraging this kind of technology.
you mentioned it just a little, but to further advance I.
Cardiovascular medicine, I'd like you to really give a great summary of
what you feel are the most important aspects and anything else that you'd
like other physicians to know about fbri Check And this study's findings.
Dr Baljash Cheema: bloom Cardiovascular Institute really aims to be a leader
in the research on cardiovascular medicine, the clinical delivery
of cardiovascular medicine And the education of cardiovascular medicine.
And so we are taking care of sick patient's and using the
greatest in technologies we have to provide excellent care.
We have many experts in the research space asking really challenging questions
that need answers and have brought extramural funding in, or internal
funding in to answer these questions and are leading large studies, And we
have dedicated educators and teachers to training the next generation of physicians
to be able to deliver in this space.
This is just one small example of the greater ecosystem of clinical
research that we're doing here.
At Bloom and I, I really feel fortunate to be a part of it.
I think this one study showed that this algorithm from a company
called Fbri Check has the ability to predict atrial fibrillation in
patient's that are experiencing it.
But really for me, it's more so that This is a telltale sign of a direction that
we're moving in, in the field of medicine, which is more at home monitoring.
More integration and use of digital health, data science,
more empowerment of our patient's.
And physicians need to have a, front row seat at this to help direct the
research to ensure that these things are working the way that they should and
to think about how to implement these technologies in the clinical space.
And so I think this really is one small study in my eyes, but a part of a,
large team of clinicians and researchers that are doing great work here.
Melanie Cole (Host): I agree, and thank you so much Dr.
Chima.
As this progresses, come back on and join us and let us know what more you find out.
But thank you so much for sharing that information with us.
And to refer your patient or for more information, please visit
our website at Breakthroughs for physicians.nm.org/cardiovascular
to get connected with one of our providers.
That concludes this episode of.
Better Edge, A Northwestern Medicine podcast for physicians.
I'm Melanie Cole.