Addressing Chest Pain Evaluations for 50 million Americans
Of the 10M patients that are sent or present to an ED each year in the US for “chest pain” up to 90% of visits are recognized as “non-urgent” or medically unnecessary. mHeart is an AI/ML enabled mobile health platform that aims to transform the evaluation of chest pain. Invented by a Cardiologist, mHeart will stratify risk to help patients and clinicians determine the best course of action for acute events and chronic disease management at anytime and from anywhere.
Evaluating Chest Pain vs Cardiac Monitoring.
Cardiac Monitoring refers to the continuous or intermittent monitoring of heart activity to assess the patient’s condition relative to their cardiac rhythm. Evaluating chest pain refers to understanding the physiology and the relationship between pain and its causes to differentiate what may be inducing the patient’s pain. Chest pain doesn’t always signal a heart attack but all chest pain should be evaluated expeditiously by a doctor.
Chest Pain Syndrome has become a Costly Diagnostic Challenge.
- Chest pain accounts for ~10% of all ED visits at a cost to the US health system in the tens of billions of dollars.
- Over 30M Americans suffer from noncardiac chest pain resulting in high healthcare utilization and significant work absenteeism. The cost of these diagnostic visits is in billions of dollars.
- Six in ten Americans live with at least one chronic disease, like heart disease and stroke, cancer, or diabetes.
- Heart Disease and stroke cost our health care system $214 billion per year and causing $138 billion in lost productivity on the job.
“Chest Pain Syndrome” is inclusive of symptoms that may be caused by acute myocardial ischemia and includes such diverse complaints as chest pain, chest pressure, neck pain, jaw pain, shoulder pain, epigastric pain, back pain, palpitations, dyspnea, cough, nausea, weakness and malaise, or dizziness.
“Noncardiac Chest Pain” is defined as recurrent chest pain that is indistinguishable from ischemic heart pain after a reasonable workup has excluded a cardiac cause.
Chest Pain Evaluation in Acute Life-Sustaining Care
The two main goals are the early, accurate diagnosis of an acute coronary syndrome event (ACS; ie heart attack) and the rapid, efficient recognition of low-risk patients who do not need a hospital admission.
Early Detection Remains A Critical Unmet Medical Need.
For the 1.1M patients who present to the ED with a major adverse cardiac event (MACE), early detection and reducing pre-hospital delays (i.e. “time to ED door”), from 2-4 hours on avg. to 60 min. will reduce complications, heart damage and death.
Cardiologists, Patients, and Hospital Administrators will love mHeart
- Reduces unnecessary visits to the ER for chest pain evaluations.
- Reduces costs for patients, payers, and provider systems.
- Enhances provider revenue up to 1.7k per patient, per year.
- Reduces delays in care by removing busy clinicians as the first point of contact.
- Assists patients in rapidly and accurately triaging themselves to the ER when it is most appropriate.
- Improves patient outcomes and quality of life for patients and clinicians.
- Improves care access, care coordination, and care continuity.
mHeart Platform for Acute and Chronic Care
The mHeart platform is comprised of a multi-parameter wearable device called the vEKG, the mHeart app, and the mHeart cloud. mHeart addresses two care paths to improve long-term quality of care for patients while providing rapid and efficient triage for acute chest pain. Clinicians will prescribe mHeart to facilitate and enhance the doctor-patient relationship and quality care by “being present” for all events no matter where the patient or clinician may be.
Patients Who Experience Acute Chest Pain
mHeart MT for Mobile Triage can rapidly and accurately determine if their “chest pain” warrants emergent vs. elective treatment without having to engage a clinician as the first point of contact or a hospital’s emergency department (ED) as their only option. Symptoms alone are insufficient for an adequate evaluation. In 2019, 10 million patients either headed to the ED or were instructed to go there by their doctor so that a 10/12 lead EKG could be performed and interpreted by medical professionals.
Patients with Chronic Diseases
The same patients with acute chest pain are ones who need their chronic diseases managed. mHeart RPM for remote patient monitoring enables care continuity and coordination between a patient and their clinician. mHeart RPM pushes notifications to patients for regular serial vEKG tracking; routine medication reconciliation/adherence; serial clinical symptom updates and exercise routines. Regular use by patients and remote patient monitoring by clinicians may help identify new observations or patterns in their patients’ physiology before it becomes an emergency. mHeart RPM represents long term management while mHeart MT represents acute management.
Large Addressable Market
- 45M Americans suffer from Cardiac and Non-cardiac Chest Pain.
- 50 million patients with a history of heart disease, diabetes or multiple cardiac risk factors, including prior ACS events (i.e. heart attacks).
- 30 million non-cardiac patients with recurrent episodes of chest pain syndrome under a physician’s care.
- mHeart RPM is reimbursable using Chronic Care Management (CCM)and Remote Patient monitoring Codes (RPM).
- CCM and RPM codes can enhance a physician’s revenue by $1500-$1700 per patient per year.
Patient-Initiated Care Anytime - Anywhere
The patient initiates an acute or serial chest evaluation by applying the vEKG to their chest. The multi-parameter vEKG captures a precise 30-second 10 lead EKG, heart rate, respiratory rate, oxygen levels, and temperature via embedded oximetric and temperature sensors. The vEKG’s palm-sized, bluetooth acquisition device collects and transmits this data to the mHeart cloud via the mHeart app. The mHeart app transforms the patient’s cell phone into a Virtual Medical Assistant and includes a “how-to” tutorial on vEKG lead placement. With triage underway, the mHeart app guides the patient through a “chest pain” symptoms questionnaire using natural language processing. The mHeart cloud is HIPAA compliant and retains the patient’s medical/surgical/family/social history, medication list, and allergies in a personal health record (PHR); captured during the on-boarding process.
AI/ML in Cardiology will Power the New Tools that Drive the Field.
mHeart will use rules-based algorithms and AI/Machine Learning to evaluate the user’s chest pain. According to the research, machine learning is particularly good at identifying patterns, which is deeply relevant to assessing a patient’s Acute Coronary Syndrome (ACS) risk. mHeart’s AL/ML algorithms will analyze the patient history, the symptoms questionnaire, and the vEKG data in accordance with evidence-based assessments including HEART and TIMI to indicate whether the patient needs emergent care or elective treatment. If a patient is deemed high risk, then he/she will be given a red-light alert and mHeart will call 911. If a patient is deemed low risk, then he/she will be given a green-light, which would provide an opportunity to seek care electively from their physician. Patients at an intermediate risk level will be instructed to seek an opinion from their doctor. Importantly, a patient’s physician or provider organization will always be notified and have access to mHeart for clinical decision support.
It’s a New Day.
With mHeart, patients and their doctors will no longer have to rely on symptoms alone or an emergency department (ED) as their only option to evaluate their chest pain. mHeart reduces the cost of care, improve patient outcomes and expand access to care, care coordination and care continuity.
Rakesh Shah, MD, MBA