Arindam Sen, Director of Heartnet speaks how CVD’s can be detected efficiently even in areas far from urban facilities.
Today, the alarming incidences of cardiovascular diseases (CVD) are evident, fueled by various factors including unhealthy lifestyles, smoking, obesity, hypertension, diabetes, exposure to air pollution, and so on. This rising trend in CVD incidence has heightened concerns, particularly due to the increased occurrence of deaths of public figures.
For example, famous actor, Sidharth Shukla, died from a heart attack at his home in Mumbai, in September 2021. Another incident, on June 2022, the famous singer KK suddenly died of a cardiac arrest after singing at a concert in Kolkata. These gloomy events remind us that CVD can happen to anyone, regardless of age, and have sparked widespread fear and concern regarding personal health and well-being.
A lot of experts believe that due to asymptomatic conditions the CVDs remain undetected, and which leads to sudden causes of deaths.
To solve this mystery of CVDs, Heartnet an IoT-based solution was established in 2016 to target heart health. The company wants to address the gap in cardiac health screening and access to cardiologists’ services across India through its IoT-based device solution ASAAN.
According to the World Health Organization (WHO), low- and middle-income countries lack comprehensive primary healthcare programs for early detection and treatment of cardiovascular diseases (CVDs). As a result, individuals in these countries often face barriers in accessing effective and equitable healthcare services tailored to their needs. This disparity leads to premature deaths.
As per Cureus’ medical journal Challenges for Lower-Middle-Income Countries in Achieving Universal Healthcare: An Indian Perspective, India is the largest lower-middle-income country, accounting for almost 18% of the world’s population, thus becomes one of the leading contributors of unexpected deaths.
Arindam Sen, Director of Heartnet, shifted from radiology to focusing on heart health due to increasing heart problems among young people, even in remote areas. He believes improved technology can help more people, regardless of their location.
Heartnet reported, prior to the COVID-19 era, out of the total 17.4 million cardiovascular disease (CVD) deaths worldwide, 13.4 million occurred in low-income countries. In India, 37.26% of recorded deaths in 2019 were attributed to CVD as post-COVID-19, the data on CVD deaths has become diluted.
According to Sen post COVID-19 pandemic, there has been a notable rise of CVD cases in the last two years, although the exact reasons for CVDs remain inconclusive. Additionally, incidents of CVDs have been observed in younger age groups, a shift from the previously higher age brackets.
“What began as primarily a concern for the 40-plus age bracket and urban dwellers has now permeated into the 20 to 30 age group and even semi-urban and rural regions. To address this evolving landscape, we must view the cardiac care cycle holistically and leverage technology to enhance accessibility and effectiveness,” says Sen.
Solving cardiac screening challenges
A lot of deaths caused due to CVDs remain undetected and untreated and that is because lack of resources, Sen says, “In Indian, wellness screening and healthcare setups often cater to the urban affluent, leaving a significant portion of the population underserved due to barriers like access, cost, and infrastructure limitations.”
Cardiology services are often difficult to access, particularly for patients residing far from urban centers. Access is often limited even in tier two towns with cardiac setups, and cardiologists may only be available once a week. This highlights the need for efficient screening methods to connect patients with clinicians and obtain cardiology expertise.
Sen says, “Recognizing these complexities, we envisioned Heartnet as a network involving physicians, cardiologists, and patients. We devised a solution: providing access to cardiologists’ opinions or services through physicians in a more affordable and accessible manner. This approach enables screenings to be conducted at physicians’ facilities, facilitated by technology and the expertise of cardiologists. This marks the initial phase of Heartnet.”
Apart from accessibility, the cost of cardiac screening is another issue which Heartnet has solved. The cost of a cardiologist’s diagnosis is typically around a few thousand rupees. Sen says, “However, using our technology in rural areas and our developed infrastructure for cardiologists can reduce the overall cost per screening to just a couple of hundred rupees, a significant improvement of nearly 10 times in cost efficiency. Additionally, our system increases output, allowing cardiologists to examine up to 12 cases per hour, tripling throughput and tenfold reducing costs, significantly enhancing screening capacity in rural areas.”
Tech behind the Heartnet’s screening
Technology plays a crucial role in the healthcare system. Today, artificial intelligence (AI) serves as a powerful tool aimed at enhancing both speed and precision. One of its prominent applications involves diagnosing patients. Utilizing AI algorithms, medical imaging data, including X-rays, MRIs, and CT scans, undergo thorough analysis to aid healthcare professionals in making swift and precise diagnoses.
However, there are ifs and buts in diagnosing cardiac health through AI. Sen believes “While pure technology-driven solutions hold promise, the current data available for AI in the cardiology field may not always suffice for conclusive diagnosis. Therefore, Heartnet’s approach involves a predictive algorithm that flags potential issues for review by a cardiologist. The final diagnosis is made by the cardiologist based on factors such as family history, clinical condition, and electrocardiogram results.”
They emphasize the essential role of clinicians and cardiologists in the diagnostic journey of a patient.
The IoT device, developed by HeartNet, is installed at the physician’s office, and operates on a Wi-Fi network. It has been designed to function on the Android platform and can also operate on 4G or 5G connectivity, with 3G being sufficient. The device offers a comprehensive workflow for screening, guiding physicians on what data to capture. Additionally, it includes a high-performance 12-channel ECG device, enabling physicians to easily conduct ECG tests on patients.
This independent IoT box is programmed to primarily connect to the HeartNet cloud, however it can also be configured to work with other clouds if necessary. The device is portable, equipped with its own battery, capable of performing over 100 ECGs on a single charge, and lightweight for ease of use.
It has been utilized by various healthcare professionals, including paramedics, nurses, and ASHA workers, highlighting its user-friendly design and versatility.
Heartnet operates on a replacement deal policy rather than repairing faulty boxes. Additionally, they utilize a subscription model where there are no charges for the device itself. This approach significantly lowers the cost of cardiac screening.
Heartnet’s Screening process
According to Sen Heartnet’s fundamental model places the patient at its core.
Cardiac screening process starts at a physician’s chamber, where patients undergo a thorough screening. Data and clinical parameters are captured and analyzed in the Heartnet cloud, pre-processed with a predictive algorithm. The data is then forwarded to a cardiac care specialist or cardiologist for interpretation. Cardiologists evaluate the Heartnet’s suggested data points and the patient’s data to interpret the reports. The physician then provides detailed explanations and treatment guidance if needed basis on the returned report.
The company has implemented a periodic audit mechanism and quality checks to ensure the accuracy and reliability of reports. If any discrepancies are detected, a secondary level of audit is available where senior cardiologists review and verify the findings, adhering to rigorous standard operating protocols (SOPs).
“This comprehensive approach ensures that critical information is captured and analyzed effectively, ultimately leading to more accurate diagnoses and tailored treatment plans,” Sen says.
Collaborative approach of cardiologists and physicians
Heartnet uses two models to support cardiac care. The first model involves cardiologists from larger hospitals using their outreach capabilities to screen patients referred by physicians. This model is effective due to the robust infrastructure and resources in larger hospitals.
The second model involves smaller catheterization labs encouraging physicians to conduct screenings before referring patients. This approach encourages collaboration between labs and healthcare providers, enhancing cardiac care delivery. Both models expand the network and provide cardiologists with crucial support in interpreting screening results beyond just technological analysis.
Heartnet plans to raise awareness about the importance of cardiac health by partnering with doctors’ clinics to educate patients about the significance of cardiac screenings based on factors like age and medical history.
In the near term, Heartnet does not have any plans to directly approach patients. However, they envision reaching patients directly in the future. Where online ordering for cardiac screenings will be like ordering food online, which will allow patients to undergo screenings conveniently from any location. Before implementing such initiatives, Heartnet aims to expand its network extensively.
They have a substantial number of cardiologists on board a mix of senior cardiologists overseeing the operations, along with several junior cardiologists actively working on the platform. Sen says, “Our plan is to expand our network further, aiming to onboard close to 100 cardiologists within the next year, as needed to meet the demand.”
Heartnet aims to target an audience of approximately 1.5 million physicians, though their market reach is still in its early stages despite three years of operation. Following a revival of their efforts in March 2023, they have conducted field exercises, trials, and pilots to refine their approach.
Currently, they have secured agreements with significant agencies, including in Calcutta, Maharashtra, and discussions ongoing in Karnataka and Telangana over the coming quarters.
Over the next two years, they aim to ramp up 10,000 to 20,000 installations, with the potential to screen millions of patients annually. While they plan to invest in more infrastructure and resources to accelerate their growth, they remain focused on their current objectives “Healthy heart for all”.
