Timely AI-enabled interventions with implantable devices could significantly impact heart patients by potentially preventing cardiac events before they occur.

Medical device innovations are expanding cardiovascular disease treatments, offering diverse options for patients. From lifestyle adjustments to novel treatment and prevention, possibilities are enhancing both longevity and wellbeing.

Cardiovascular devices are increasingly vital, bridging the gap between therapy and prevention, not only post-cardiac events but also in proactive healthcare approaches.

Implantable therapy for cardiovascular disease

Alex Nepogodiev is Executive Vice President of Elixir Medical, a Silicon Valley-based medical technology and therapeutics company bringing high-quality engineering to resolve the challenges of cardiovascular care.

Nepogodiev points to how artificial intelligence (AI) — coupled with evolving scanning modalities, techniques and diagnostic software — is changing how patients may benefit from implantable medical devices as part of comprehensive treatment pathway.

He explains that medical technologies are driving a better understanding of cardiovascular disease (CVD), which remains a leading cause of death; in the US, for example, there are 805,000 annual heart attacks, and 200,000 are recurrent — which points to an opportunity to improve treatment of CAD.

AI-enhanced scans aid prevention

Non-invasive scans, such as CT angiograms interpreted by AI, can look inside the arteries and heart structure. They also examine the cellular and tissue level of diseases. This capability potentially highlights scenarios where a heart attack is prevented with timely implantable therapy.

“These insights are giving us better ways of understanding the disease, what stage of progression cardiovascular disease is at and how it can be most appropriately treated,” explains Nepogodiev.

Physicians can better tailor treatments that
are specific and unique to that patient.

Revascularisation implant restores arterial function

Elixir’s latest advancements in treating vascular disease mainly target cardiovascular and peripheral conditions via revascularisation (restoring blood flow in blocked arteries/veins) procedures.

Among its products is the Coronary Bioadaptor System, an implant designed to reopen blocked arteries and restore arterial function. “Bioadaptor is a smart prosthesis that implants in the artery like a stent but unlocks and enables the artery to pulsate and restore more normal function,” says Nepogodiev. “It helps reduce repeat heart attacks or repeat procedures for patients.”

He underlines the importance of AI in the process, analysing information from scans to reconstruct 3D models of arteries. These technologies help identify blockages, determine their location and severity, and define treatment protocols.

Tailored treatment optimises outcomes

That may mean intervening with lifestyle and dietary changes, pharmaceuticals, bypass surgery or angioplasty and introducing devices sooner that restore vessel function and prevent a heart attack.

Such information enables clinicians to use the technology and implants, like bioadaptor, with precision. “We know exactly the best location in the artery for it to be implanted, so it has the best value for restoring heart function. Based on that information, we can start the process earlier in the disease journey,” suggests Nepogodiev. “Physicians can better tailor treatments that are specific and unique to that patient.”

Bioadaptor also has drug-eluting properties. The company is working on multiple drugs that can be placed in the bioresorbable polymer, including anti-clotting medication to prevent thrombus formation post-procedure. This has the potential to reduce the pharmacology burden on a patient.

Stringent regulations and evolving healthcare approaches

The field of medical devices has grown over the last 30–40 years, and Nepogodiev emphasises that such technologies are still developed with high levels of rigour and research to meet stringent regulatory requirements across the globe. “That is important to note,” he urges. “The regulatory process truly validates the safety and efficacy of these devices.”

Healthcare in the cardiac arena is evolving. More recently, there has been a convergence of cardiology specialists collaborating to treat CVD patients with a ‘Heart Team approach.’ These specialists aim to develop the best clinical strategy while positioning patients as decision-makers and advocates.

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New arterial implants are revolutionising atherosclerosis treatment. Unlike stents, they promote normal vessel function and decrease the risk of major adverse coronary events.

Coronary artery disease, caused by atherosclerosis, can be fatal. It occurs when fatty material (atheroma) builds up inside the arteries, which transport blood around our bodies. If this plaque blocks or narrows an artery and restricts blood flow, it can result in heart attack.

Modifiable vs unmodifiable atherosclerosis risk factors

Various risk factors increase a person’s chances of developing atherosclerosis, explains Dr Joaquin Azpilicueta, Medical Director, Iberia and Latin America at cardiovascular technologies company, Elixir Medical. “Some of these are modifiable, such as eating a healthier diet, stopping smoking and ensuring hypertension is well-treated,” he says.

“Other risk factors are unmodifiable. For example, genetic factors can play a part in progression of atherosclerosis. So does being male. Then there’s the ageing process because, just as our skin gets dry and thin with age, our vessels deteriorate in their own way.”

Stent technology advantages and drawbacks

Thankfully, significant medical advances have helped patients with coronary artery disease. These include a minimally invasive procedure known as a percutaneous coronary angioplasty (PTCA), which holds blocked or narrowed arteries open with a wire mesh tube called a stent, improving blood flow.

Yet, as groundbreaking and lifesaving stent technology has been, it does have drawbacks. “It’s not a perfect solution,” admits Dr Azpilicueta. “After the procedure, the healing process in the inside of the artery leaves a scar, which can further restrict blood flow. This is why drugs are put into stents to prevent excessive scar tissue growth — an extremely successful development.”

With a bioadaptor implant, plaque volume
decreases in patients with lipid-rich lesions.

Addressing stent limitations to preserve arterial physiology

Another, more subtle, problem is that stents are rigid structures. “They act like a corset,” notes Dr Azpilicueta. They ‘cage’ and constrain the normal functions of an artery and affect its ability to dilate, pulse, twist and flex. Unfortunately, this unnatural rigidity can affect the function of hormone-producing cells, which have a positive impact on an artery’s function and health.

“As a result, a stented artery is more prone to develop atherosclerosis than a native artery,” says Dr Azpilicueta. “This increases the risk of the patient experiencing further major adverse coronary events (MACE) over time. So, the cardiovascular community has been seeking to develop implant solutions that preserve the physiological nature of an artery, thus improving its vital cell function and overall health.”

Introduction of a groundbreaking vascular implant

That’s why there is excitement about a new, recently approved technology called a bioadaptor, developed to replace stents in an important number of patients. Like a stent, a bioadaptor is implanted via the same minimally invasive procedure and left behind in the artery to hold it open.

However, it is fundamentally different in composition because it’s made of three separate helical strands, which are temporarily interlocked and joined by a bioabsorbable material. This disappears in six months as new artery muscle and hormone producing cells grow around it; then, as the strands separate and become a flexible and dynamic structure of the vessel wall, the artery is able to recover its pulsatility, flexibility and plasticity (adaptability of an organism to change in its environment).

Bioadaptors help prevent major adverse coronary events

“This solution is strong enough to keep the artery open but gentle enough for its physiology to play a significant role in expanding the life and health span of our patients,” says Dr Azpilicueta.

Plus, it offers another major gain. “In a controlled trial, we observed that, with a bioadaptor implant, plaque volume decreases in patients with lipid-rich lesions,” reveals Dr Azpilicueta. “In comparison, stented arteries record an increase in plaque volume. Taking all these benefits into consideration, we expect bioadaptor technology to contribute to a significant reduction of MACE in the mid to long-term compared to stents.”

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A local community heart check programme is using pioneering testing technology to identify ‘at-risk’ patients and ensure they have early access to healthcare interventions.

In the UK, it is estimated that up to 1 million people are living with heart failure (HF) with approximately 200,000 people diagnosed every year. It is also thought that 300,000 could be living with unidentified heart failure. However, the condition is treatable if found early, with speedier diagnoses leading to better outcomes.

Left too late, it can be fatal or severely reduce quality of life, placing a significant and avoidable burden on the NHS.

Free testing for speedier interventions

To raise awareness, patient-led HF charity Pumping Marvellous Foundation has launched the BEAT HF Healthy Heart Bus initiative. This is a programme of 12 events offering free heart health checks in communities across England, Scotland, Wales and Northern Ireland.

With LumiraDx, we can analyse blood from a simple finger prick test … in just 12 minutes.

“Think of it as a complimentary ‘heart MOT’” says Nick Hartshorne-Evans, Pumping Marvellous Foundation’s Founder and Chief Executive. “We want to educate people about their cardiovascular health and find those who are at risk of HF,” he explains. “Intervening early — rather than treating them in hospital when their condition becomes acute — is better for them and prevents pressure building on the healthcare system.”

Advanced point-of-care testing technology

Each BEAT HF Healthy Heart Bus event is managed by local hospital trusts, GP primary care networks, local council teams and other third-sector organisations. It offers members of the public blood pressure, atrial fibrillation and heart murmur checks. Plus, it aims to help people understand HF symptoms through the acronym ‘BEAT’ (if you’re Breathless, Exhausted and have Ankle swelling, it’s Time to speak to your GP).

Every event features pioneering point-of-care testing technology developed in the UK by LumiraDx. “Previously, a phlebotomist blood test would be needed to rule out HF, with blood samples sent away to a lab for 24 or 48 hours,” explains Hartshorne-Evans. “However, with LumiraDx, we can analyse blood from a simple finger prick test … in just 12 minutes, which indicates if further investigations are necessary. It’s speedy, efficient and offers those who need it a quicker way into the healthcare system.”

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Stroke doctors redesign arrhythmia pathways with an advanced AI heart monitor that detects arrhythmias more effectively.

Atrial fibrillation (AF) is the most common type of arrhythmia, a condition where the heart rhythm is either irregular, too fast or too slow. It’s a leading cause of stroke — and can be difficult to diagnose.

Wearable monitoring devices for arrhythmia

“We ask patients with suspected AF to wear heart monitoring devices to pick up abnormal rhythms,” explains Dr Saeedur Rahman, Consultant Stroke Physician, Darent Valley Hospital, Dartford and Gravesham NHS Trust. “However, this can be complicated by a type of AF called paroxysmal atrial fibrillation because symptoms can come and go.”

Conventional ECG monitors (holter monitors) are usually only worn for 24 hours or up to seven days; so, if patient does not develop abnormal rhythm during that time, the condition could be missed. Plus, holters are cumbersome, so patient compliance can be low. For hospital staff, it’s labour-intensive, as a cardiac physiologist has to manually assess large ECG datasets recorded by the devices.

We ask patients with suspected AF to wear heart
monitoring devices to pick up abnormal rhythms.

Dr Rahman and team following an internal review of pathway, felt that in between a 12 lead ECG and an implantable loop recorder (ILR), there need to be an intermediary duration of rhythm monitoring. The team decided to redesign their pathway to provide another option before ILR, “We needed a monitoring device that was somewhere between a traditional monitor and implantable loop recorder,” says Dr Rahman.

Varied benefits of monitoring for longer

The team identified an advanced, AI-enabled ECG monitoring service, Zio XT service from iRhythm Technologies, which consists of the Zio monitor worn for up to 14 days, AI with Cardiac Physiologist analysis and an ECG report. “Longer monitoring times are better because the pick-up rates are higher, and there are fewer false readings,” notes Dr Rahman.

Darent Valley experienced several other benefits through the redesigned pathway. First, the Zio XT device is smaller and showerproof, unlike traditional holter monitors, resulting in improved patient compliance. Second, datasets are analysed by AI and iRhythm’s team of Cardiac Physiologists, leading to faster diagnosis and reduced burden on hospital staff.

This is good for patients who need treatment quickly since they are diagnosed faster compared to typical holter practice; potentially reducing secondary strokes and the associated costs. It’s also good for the NHS by increasing capacity and productivity through reduced need to repeat tests.

“Clinicians need to use it in the right context and embed it in a very structured pathway,” says Dr Rahman. “We succeeded because we planned well and partnered with iRhythm to ensure we had the right staff training and evaluated our progress throughout.”

This represents Dr. Rahman’s experience at his facility and my not reflect every facility experience. Adopting Adhesive Single lead Cardiac Patch in Improving rhythm analysis strategy for patients with TIA and Ischaemic strokes, A. Ahad 1, P. Aghoram 2, S. Botes 3, S. Rahman 4, Poster from ESOC 2023

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While most people will know the importance of their heart rate, many do not realise that it is just as important to know your heart rhythm.

Does your heart beat like a drum? Does it race like a cheetah or flap like a fish? You could have an arrhythmia (heart rhythm disorder). This could prove fatal, despite simple, quick treatments being available.

Common heart rhythm disorders

Atrial fibrillation (AF) is the most common heart rhythm disorder. It can affect adults of any age but is more common as people get older, affecting about 10% of over-65s. If left untreated, it can cause an AF-related stroke, which often proves to be fatal. Yet, with a simple pulse check, it can detect AF, and treatments to manage and reduce your risk exist.

Another common but often unrecognised condition is supraventricular tachycardia (SVT).  SVT causes a heart rhythm of over 100 beats per minute. It leads to palpitations, breathlessness, chest pain, dizziness and, sometimes, loss of consciousness.

Although it is not life-threatening, SVT can be very frightening. Imagine living with your heart racing, trying to catch your breath and the panic it causes. A simple pulse check takes just 30 seconds and can detect AF and symptoms of SVT.

If we can detect and record the rhythm
of our hearts using digital technology,
we can provide the evidence that
doctors need to speed up diagnosis.

Early diagnosis saves families

If I had known 30 years ago what I know now, my daughter, who was suffering unexplained loss of consciousness, would have been diagnosed sooner (it took over three years to obtain a diagnosis).

If my husband had had heart check-ups, he may still be alive today; and if my parents had been monitored with their anticoagulation therapy for AF maybe, they would not have suffered AF-related strokes — all of this due to irregular heart rhythm conditions.

Know your pulse and detect heart rhythm

We must learn to help ourselves by knowing our pulse; it’s so simple and potentially lifesaving. The public must be able to help themselves and help our over-burdened healthcare services.

If we can detect and record the rhythm of our hearts using digital technology, we can provide the evidence that doctors need to speed up diagnosis and therefore receive treatment quicker. Remember, your heart is not just a muscle to pump blood around your body; it also has electrics to ensure the rhythm of your heart does not ‘short-circuit.’

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In 2022, an average of 750 people died weekly from conditions including heart attacks, coronary disease and stroke before their 75th birthday.

Recent British Heart Foundation (BHF) analysis shows that the number and rate of people dying before 75 in England from heart and circulatory diseases is at its highest for over a decade.

Rising cardiovascular disease mortality

It’s the third successive year the premature death rate has risen and the first time in almost 60 years that we’ve seen the reversal of hard-won progress to reduce early death from cardiovascular disease.

These stark statistics are heartbreaking evidence of a crisis many years in the making. Ultimately, we don’t know exactly what is driving the rise in early deaths from cardiovascular disease.

Disruption caused by the pandemic and ongoing, increasing pressure on the NHS has undoubtedly had a significant impact. People living with heart disease must contend with long waits for tests and treatment; intervals between their medical reviews are becoming too long. The direct impact of Covid-19 illness on the heart has also likely played a part. However, warning signs of lost progress have been present for over a decade.

Despite the efforts of hard-working
NHS staff, heart care services
are struggling at every step.

Closing heart health disparities

Since 2010, the health gap between rich and poor has significantly widened. Meanwhile, there hasn’t been enough action over the last decade to address cardiovascular risk factors like high blood pressure, raised cholesterol, type 2 diabetes and obesity — storing up huge challenges for the future.

Despite the efforts of hard-working NHS staff, heart care services are struggling at every step — from prevention, diagnosis, treatment and recovery to crucial research that could give us faster and better treatments.

We can’t let this tragedy continue. With urgent and long-overdue intervention, we can regain lost progress and save more lives from cardiovascular disease.

Stopping the heart care crisis

Three main courses of action are needed:

1. Improving prevention of cardiovascular disease causes, focused on the drivers of health inequalities such as obesity and smoking;
2. Making NHS heart care a priority, with specific plans for cardiovascular disease that identify and address NHS cardiac staffing gaps, so patients get necessary care more quickly;
3. Supercharging cardiovascular research to unlock groundbreaking treatments and cures.

Reducing deaths from cardiovascular disease was once the nation’s big success story, thanks to bold public health measures and groundbreaking science. With immediate, sweeping action and enough political willpower, it can be that way again.

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Learn how innovation in the NHS is helping to tackle cardiovascular disease.

The Health Innovation Network is the innovation arm of the NHS — operating as a collective voice for our 15 local networks, working within local regions to transform healthcare through innovation.

In line with the aims set out in the NHS Long Term plan,¹ cardiovascular disease (CVD) has been a key focus for us. We’ve embedded innovative ways of working across the country to increase the detection of high-risk cardiovascular conditions as well as strategies to improve their management.

FH early detection and treatment

Familial hypercholesterolaemia (FH) has an estimated population prevalence of 1 in 250 in the UK. If left undetected and untreated, 50% of men by the age of 50 and 30% of women by the age of 60 may develop coronary heart disease and suffer a heart attack.²

The early detection programme enables earlier treatment and provision of lifestyle advice for those at risk. Through our FH programme, we’ve expanded access to genetic testing via screening of electronic records to identify adults who are undiagnosed and/or sub-optimally managed.

To increase rates of detection, we’re also piloting an innovative pathway, which will allow for identification of FH in young children and, subsequently, one or both parents as part of the child-parent screening programme.

50% of men by the age of 50 and 30% of
women by the age of 60 may develop coronary
heart disease and suffer a heart attack.

Tailored care management strategy

Hypercholesterolaemia and hypertension are also associated with premature and avoidable adverse cardiovascular outcomes. To support healthcare teams in primary and secondary care, we’ve broadened patient access to innovative lipid management medications, following evidence-based NICE-endorsed guidance for preventing and treating cardiovascular disease.

Rather than a one-size-fits-all innovation strategy, we tailor each programme to local regions, collaborating with healthcare professionals to ensure alignment with their local needs and priorities.

Supporting future innovation

The Network’s strength lies in our experience in enabling innovation adoption at scale within the NHS. Proven innovations are considered for spread across the Network, as was the case with our atrial fibrillation (AF) programme. AF is the most common cause of an irregular heart rhythm and the cause of 20% of strokes. The national programme helped increase detection of the condition and supported healthcare professionals in offering optimal medication to patients.

We’re supporting over 100 new CVD innovations through our innovation pipeline. These encompass early-phase concepts, products and solutions, which could further improve cardiovascular care. All are at different stages of maturity, and we’re committed to working with our partners so that these innovations can be embedded into the health and social care system, ultimately improving patient outcomes.

[1] NHS Long Term Plan
[2] Family Heart, Public Health England

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Early defibrillation helps save lives. Defibrillators are easy to use—you just need to switch it on, and it will tell you how to manage a cardiac arrest.

When someone has a cardiac arrest, their heart stops beating. Their only chance of survival will be the quick actions of those around them. Early defibrillation within three to five minutes of collapse can more than double their survival chances.

Anyone can use a defibrillator

Worryingly, recent data commissioned by the University of Warwick reveals that over half of people (61%) aren’t confident enough to use a defib, and a recent survey we conducted revealed that 40% of people thought you needed prior training to use one. This isn’t true. Anyone can use a public-access defib. Thousands of lives could be saved each year if more members of the public understood this.

Free defibrillator demonstration animation

Everyone in the UK must be defib-confident. This will ensure that, in the ultimate medical emergency, we can give people their best chance of survival. That’s why we’ve created an engaging and informative animation starring Defib Dani — a green, talking defibrillator who demonstrates how simple it is to use one.

The free-to-watch animation, which has also been translated into Welsh and Urdu, aims to give people the confidence to use a defib during a cardiac arrest. The animation is set in a supermarket, where Defib Dani calmly guides you through the simple steps of using a defib, emphasising that no prior training is needed. The device’s clear instructions ensure that anyone can step in and help save a life. The animation caters to all age groups — empowering everyone to be a potential lifesaver.

If you are looking after a defib, please
register your device on the national
defibrillator network: The Circuit.

Easy to access and locate

We are urging everyone looking after a defib — such as those in charge of pubs, sports clubs, community centres, churches, mosques and village halls — to make this lifesaving device available to the wider community, ensure it is unlocked and, where possible, accessible to the public 24/7.

If you are looking after a defib, please register your device on the national defibrillator network: The Circuit. This will ensure ambulance services can immediately direct bystanders to their nearest defib, helping to save valuable time.

Learn CPR in minutes 

Our ‘CPQR code’ allows you to scan and learn CPR in two minutes. More than 20,000 people have scanned the code. Let’s ensure we combine CPR with defibrillation wherever possible to help increase survival rates of cardiac arrest.

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Artificial intelligence (AI) used to sound like a distant concept, a pastime of computer tinkerers; today, AI feels like a real companion. So can it improve healthcare equitably?

Artificial intelligence (AI) offers hope in combating heart conditions, which claim over 20 million lives annually. By rapidly identifying seemingly innocuous symptoms that could indicate a serious condition, such as nausea or muscle aches, AI can help distinguish potential cardiovascular issues like arterial blockages or irregular heart rhythms.

How AI improves heart care

Detection and management tools such as the echocardiogram, EKG, pacemaker, wearable devices for heart rhythm monitoring and implantable cardioversion devices will improve with increasing precision, facilitated by AI. We are seeing AI used to diagnose and monitor at-risk patients, determining patterns and predicting probabilities.

AI can enhance the interpretation of medical imaging, enabling quicker and more accurate diagnosis. One example is the use of algorithms to analyse data that would pinpoint rare heart diseases such as cardiac amyloidosis. In some places, robotic-assisted interventions are guiding stent placement in patients.

Preventing development of heart conditions

Prevention of risk is the best first line of defence against disease. Awareness is increasing about straightforward lifestyle measures: curbing intake of sugar and processed foods, stopping smoking, reducing harmful use of alcohol, staying active and monitoring blood pressure. AI tools can support positive health outcomes, tracking risk management and encouraging adherence to treatment.

AI can enhance the interpretation of medical imaging, enabling quicker and more accurate diagnosis.

Alongside AI advancements, we must bolster infrastructure and policy frameworks to strengthen patient and caregiver education, promote screening, open access to affordable medication and ensure Universal Health Coverage.

AI equity and data handling

Data collection drives the development of algorithms that underpin AI. To ensure AI tools benefit low to middle-income countries (LMICs), it is crucial to obtain high-quality data

that accurately reflects these countries’ unique contexts and challenges. Sharper AI tools in one place contribute to global efforts for high-performing AI that benefits everyone.

Protecting data and ensuring patient privacy are crucial. Regulations and protocols, such as those detailed by WHO, will help create trust in appropriate data use. This includes addressing privacy and data protection in the design and development of systems.

If we can teach machines, surely, we can overcome health challenges, making the best of all worlds — AI, prevention, equity, privacy protection — and ensuring access for everyone. 

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Learn the alarming statistics, economic impact and cost-effective power of cardiovascular disease prevention. Help reduce incidence rates in the UK.

An estimated 6.4 million people are living with cardiovascular disease (CVD). One of the leading causes of CVD is high cholesterol, which affects almost half the UK’s adult population.

Why do we need to reduce CVD?

Around 125,445 people died from CVD in 2021, and 30% of these deaths were premature. That makes it the second biggest killer in England, and rates are worryingly increasing. If we continue on this path, the impact on the health system and wider society will be devastating. Evidently, current approaches to tackling the issue aren’t working. We need to reverse this by doing things differently.

How does CVD impact the NHS and wider economy?

The cost to the NHS is high — around £1,137,819,050 per year. When coupled with the wider economic impact, this increases to an estimated £2,481,876,050.

Focusing on CVD prevention

There is hope. The NHS already pays for prevention in numerous ways, including the NHS Health Check Programme and use of cholesterol-lowering therapies (eg. statins). These have an estimated annual cost of £235,663,426.28. Increasing this would reduce the number of CVD events.

Tests are often available through pharmacies, some
community locations or through your GP practice.

How prevention can pay

If the NHS were to increase spending on prevention, it would generate significant savings over the longer term. HEART UK analysis suggests that doubling prevention spending to £471,326,852.56 could save around £2,010,549,197.44 per year through reduced CVD events, effectively paying for itself.

Are there other costs or savings?

Beyond financial savings, a more comprehensive approach to prevention would also save emotional heartbreak for families. Sadly, these costs are difficult to accurately measure. The costs can be significant for families, especially after an unexpected heart attack or stroke. If a family member cannot work for some time or ever again, or need care, what then? With increasing pressure on the care system, the onus falls inevitably on families to provide additional care.

What action can you take?

Cholesterol is a silent killer. It’s important to know and understand your numbers so that you can take appropriate action. Get tested, especially if you have had a heart attack or stroke or have early (under 60) heart disease in your family. Tests are often available through pharmacies, some community locations or through your GP practice. After all, this is manageable, and we are all responsible for our own CVD health.

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