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27th January 2023

Artificial Intelligence in heart care is as much about the small as it is about the grand things

Wendy Davis was a healthy runner in her late twenties when she experienced a sudden heart failure for the first time which led to her being implanted with a pacemaker. Some years later her 8-year-old son had to save her life in the middle of the night by calling an ambulance. She went on to have open heart surgery and has since the start been actively advocating for patient empowerment towards actively shaping the Artificial Intelligence (AI) health space.

Up until when I was 28 years old, I was very healthy and fit, I ran regularly. However, suddenly I started collapsing for no reason. I would lie down on the floor and eventually pass out. Doctors investigated to see if it was epilepsy or heart-related issues. They said that I would have a medical device implanted for about six months and perhaps it may pick up an arrhythmia. I had the implantable loop recorder for two weeks when I collapsed and was hospitalised. It turned out that my heart had stopped 22 times over those two weeks, so when I thought I was fainting, my heart was actually stopping. The next day I had a pacemaker fitted that saved my life.

The Implantable Loop recorder was quite new technology at the time and it was a trial in Eastbourne Hospital where they chose just 100 patients, and I was lucky to be patient #100. I was fortunate to be in the right place at the right time.

About five years ago, I woke up in the middle of the night feeling unwell. I collapsed and my son, who was only eight at the time, suddenly heard a noise and saw I had fainted. He called the ambulance and saved my life which led to him winning a national bravery award. It turned out that the reason I had collapsed was a very rare occurrence where one of the pacing wires from my pacemaker, which at that point had been implanted 9 years previously, had moved. This then lead me to have open heart surgery to have the wires adjusted and a mechanical heart valve fitted.

Last year when I started fainting again I didn’t understand what was happening & feared surgery again but luckily I was fitted with a non-obtrusive bio patch which was able to pinpoint the issues with my heart pattern and showed how my pacemaker needed to be reconfigured.  This was cleverly done at the hospital using Bluetooth technology to communicate with my pacemaker. This adjustment meant I did not require surgery and greatly contributed to my better quality of life.

In addition, I also have a small bedside cardiac monitoring tool at home that sends any vital information straight to hospital specialists, which is revolutionary in a sense. This means AI is monitoring any heartbeat of mine and nobody has to watch a screen all day to check that I am well. These technologies require access to the internet. However, cases where it is unavailable, are not an issue as this is just an added benefit for doctors to see my journey in real-time. It also reassures me that the cardiologist will be notified of any issues along the way, and I will be notified in due time rather than waiting for my next appointment. That said, in addition to the physical health advantages that AI medical technologies offer, there is an unmeasurable positive impact on patients’ mental health, too.

Comprehending the digital health world as a patient

The COVID-19 pandemic exacerbated my atrial fibrillation condition. In fact, whilst my remote device was working, low hospital staff numbers meant that if practitioners would see an issue pop up on my account, they could not take timely and appropriate action. I had to be proactive instead and seek out help.

Many clinical trial opportunities can help patients understand how AI technology is developed and empower them to participate and co-shape the present and future realities of healthcare. The problem lies in promoting these opportunities and proactively informing patients that they can partake. It would be beneficial if universities and the myriad of medical research companies reached out to patients via their respective national health systems rather than individuals proactively looking for ways to help through various organisations. I would love to see more trials happening that are accessible to everybody.

Another aspect of the patient journey through innovative technologies is personalisation. For example, it is assumed that patients requiring pacemakers are older people living a sedentary life. Because of that, adjustments to my pacemaker were needed along my journey, based on my age. The more we know about different types of patients, the better access to care and the better journeys patients will have, which comes down to health data availability. This attracted me to the AIDAVA project that I have recently started working on with the European Heart Network. It looks at technology and large datasets and how they can help patients learn and understand their own data.

AI is the future for patients with heart conditions: how to get it right

Educating patients on their health condition for me plays a substantial role in the future of healthcare. AI tools following patients’ habits and providing recommendations on that basis would be very useful. Ensuring patient data is anonymised for conducting research and informing patients in a practical and visual way of the transformative power of AI can make patients better predisposed to share their data. Additionally, patients should be involved in AI health research from the start.  It is only when clinicians and patients work together that one can obtain a robust view of how AI can be advantageous.

A call for a uniform robust policy framework

It is important to realise that AI is about the small things as much as it is about the grand things. That being said, you need to understand what AI is before you can regulate it. AI in medicine can be something as simple as creating a tool that informs the patient when to take their tablets. Therefore, the risk classification of AI technologies should be based on the actual risk they pose. Currently, there are various fragmented legal frameworks that govern AI technologies. In my opinion, there is a need for a solid EU framework and clear guidelines as well as collaboration between the EU and non-EU countries such as the UK to learn from best practices and together build the best AI tools for the benefit of patients.

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