Addressing The Nation’s Leading Cause of Death: How Digital Health Can Unclog America’s Heart Health Problem

Our nation is suffering from a cardiac disease endemic that has taken a deathly toll on too many Americans. Startlingly, one person dies every 34 seconds in the US due to heart disease, accounting for 1 in 5 deaths. A dramatic rise in the prevalence of the risk factors that contribute to cardiovascular disease (CVD), including obesity, high blood pressure, and Type 2 diabetes, is now setting the stage for an unprecedented increase in the number of Americans living with CVD. In a frightening reversal, the overall decline in CVD mortality rates has flattened to less than 1 percent per year since 2011. For our most vulnerable populations, CVD mortality rates paint an even more dire picture of the nation’s health. Since 1975, mortality rates for heart disease and stroke remain 20% and 40% higher, respectively, for Black Americans compared to their White counterparts. Unchecked, the cardiac health crisis in the US will continue to deteriorate. Estimates project a 45% increase in heart failure diagnoses by 2030, costing the nation $1.1T in annual health expenditures – one of the most costly healthcare expenses the country will face.

As the leading cause of death in the US, CVD and its risk factors have been extensively researched and published in the medical community. Contrary to popular opinion, only 30% of CVD cases are related to genetic factors. For the other 70% of CVD cases, behavioral and environmental factors including smoking, obesity, diet, and exercise influence the stage and severity. Hypertension, one of the largest drivers of CVD, impacts 1 in 3 US adults. One of the more subtle risk factors is lack of sleep — in fact, people who sleep less than 6 hours per night have a 20% higher chance of having a heart attack. While there have been major gains in early detection, intervention, and disease management, there is a clear opportunity to drive change upstream via behavioral changes and the integration of preventative care services into the healthcare system to strengthen our nation’s ability to prevent avoidable disease.

Unfortunately, consumers are ill-equipped with the proper resources and guidance to proactively manage their cardiac health. Consumers have limited access to primary and specialty care due to the active and growing provider shortage, resulting in a 21-day average wait time to see a cardiologist. When consumers eventually see a provider, they face overburdened clinicians that have minimal time and limited resources to appropriately educate patients on cardiac risk and disease management. Providers are understaffed and have misaligned incentives, ultimately resulting in delayed diagnoses and avoidable acute events. Thus, it is not surprising that 50% of consumers with risk of heart disease report not knowing what to do for preventative care or condition self-management, and 75% of individuals with hypertension don’t have their blood pressure under control.

For underserved communities, the picture is more devastating. Meaningful health barriers such as poor access to specialists, limited access to nutritious and affordable foods, and gender bias stand in the way of receiving efficacious cardiac care. In fact, 30-40% of the mortality differences between Black and White populations are driven by CVD, making it the primary driver of life expectancy disparities between these communities.  For adults with low socio-economic status, the incidence of heart attacks and CVD deaths is 2x higher. These disparities are also seen along gender lines as evidenced by women having a 37% higher chance of an incorrect initial diagnosis relative to men due to the lack of substantiated research on the female model of CVD.

For a country that spends $365B annually on CVD, why are we still witnessing 870K+ deaths a year? Woefully, 20% of these victims are under the age of 65. Too many consumers have fallen through the cracks of the system and countless opportunities for early intervention have been ignored. To understand how to best address the cardiac needs of consumers, we at 7wireVentures categorize consumers into four distinct segments: Mostly Healthy & Independent, Diagnosed & Managed, Chronic, and Complex.

The attributes and needs of consumers vary significantly across these four segments. Individuals differ based on lifestyle behaviors, genetics, existing conditions, and frequency of clinical visits – all factors that drive CVD risk and long-term needs from the healthcare system. The unique characteristics of these consumer segments demonstrate the need to utilize innovative digital cardiac health solutions to equip consumers with accessible and multi-modal tools to become greater stewards of their own cardiac care.

Cardiac Care Landscape

Private funding for digital cardiac solutions has meaningfully accelerated since 2012, expanding 14x to $670M at the height of the pandemic in 2020 and expecting to settle at $550M by the end of 20221. Several large, later-stage megadeals in this space include AliveCor’s $65M Series E financing and HeartFlow’s $240M Series E financing.

Given the momentum and appetite for digital cardiac solutions in the market, we at 7wireVentures have segmented the cardiac health market into six buckets:  Remote Patient Monitoring, Consumer-Oriented Wearables and Devices, Clinical Decision Support, Coaching and Engagement, Virtual Care Services, and Post-Discharge Rehab.

[1] Pitchbook

Digital Cardiac Health Solution Market Map

Remote Patient Monitoring

By sending real-time information on vitals, remote patient monitoring (RPM) devices play a crucial role in bridging the longitudinal data gap between providers and patients. Providers will be immediately alerted of abnormalities that arise in risk factors such as blood pressure and can intervene further upstream to prevent cardiovascular events for at-risk patients. Demand for these solutions is surging as over 75% of cardiac providers are interested in deploying RPM capabilities across their patients. This demand isn’t surprising as RPM devices have driven a 76% reduction in hospital readmissions. Companies across various stages are leveraging both hardware and software solutions to enable highly precise RPM solutions. Endotronix, for example, has developed an integrated platform that leverages a cloud-based disease management data system and an implantable pulmonary artery pressure sensor for detection of heart failure. Utilizing a similar hybrid model, Infobionic has created a cardiac monitoring solution that includes sensors, a Bluetooth-enabled transmitter, and cloud-based analytic tools to assist clinicians in early diagnosis and intervention.

Consumer-Oriented Wearables and Devices

As roughly 30% of Americans now use wearable healthcare devices, there is a compelling opportunity to increase patient engagement and accountability for daily lifestyle choices. These wearable devices provide consumers with access to real-time, data-driven insights and gamified content to incentivize proactive behavior modifications. These devices are efficacious as studies have shown a 38% reduction in heart failure among patients using wearables to track heart health. While encouraging, poor connectivity often limits provider ability to access this rich data and thus delays critical clinical decisions. One company working to solve this problem is AliveCor, which develops personalized EKG devices to enable remote cardiac health monitoring by a cardiologist. AliveCor’s Kardia device is the first AI-enabled platform to help providers and consumers accurately detect atrial fibrillation. Better yet, the device is easy to use and takes under 30 seconds for heart rate detection.

Clinical Decision Support

Health Systems and providers are partnering with AI-enabled clinical decision support tools to increase productivity and treatment efficacy by accelerating accurate diagnosis and supporting the development of personalized patient treatment plans. These solutions are gaining acceptance among clinicians, with 75% of cardiologists leveraging clinical decision support tools and following the recommendations they provide. Companies like Eko and Tesseract are developing diagnostic solutions to help clinicians detect heart disease faster and more accurately. Eko’s digital stethoscope has smart disease detection capabilities to help providers detect cardiac disease during annual physicals, while Tesseract is building a portable, cloud-connected retinal imaging device to accurately predict cardiovascular risk.

Coaching and Engagement

While 80% of Americans are seeking greater control over their healthcare, they are often disappointed with the lack of available resources to support them in effectively managing their health. Since the average American spends 5.4 hours daily on their phone, multi-modal apps and interactive mobile platforms can pave the way for optimal consumer engagement and education outside the traditional healthcare ecosystem. Health apps deploy a variety of strategies to encourage healthier lifestyle behaviors, including diet recommendations, medication reminders, and sleep tracking, while also providing education on the risk factors for CVD. Habitnu and HelloHeart are two app-based solutions that empower consumers to build healthy habits by offering lifestyle tips, live coaching, and personalized nudges.

Virtual Care Services

With the US expecting to bear a shortage of 120K cardiologists by 2030, the 21-day average wait time to see a cardiologist will only increase. This access problem is further exacerbated for consumers living in rural areas, where the average travel time to receive in-person cardiac care is over 50 minutes. Accessible, easy-to-use telehealth platforms can play a meaningful role in alleviating barriers to cardiac care. Given telehealth’s convenient, “always-on” nature, 60% of patients want to further increase their use of virtual care solutions to manage their condition. There is a plethora of virtual cardiac care solutions targeting the cardiac health market today. One notable company is Heartbeat Health — a virtual-first platform that offers a comprehensive suite of cardiac care solutions including telemedicine, diagnostic services, medication management, and lifestyle guidance. The company recently partnered with Caption Heath to provide remote ultrasounds that increase access to early cardiac evaluations. Another promising company, Homeward delivers a hybrid virtual and in-person model of care for aging rural communities in need of primary and specialty care services and is initially focusing on cardiology. With Homeward, patients receive remote patient monitoring to detect the early signs of heart failure, in-home visits to test, diagnose and treat their condition, and follow-up virtual visits to support patients in managing their heart health.

Post-Discharge Rehab

Traditional cardiac rehab programs experience  patient enrollment rates as low as 10% due to the long wait times, limited access to conveniently located rehab centers, and cost burdens that consumers face. As technological advances have allowed the shift to virtual, home-based rehabilitation programs, there is a huge opportunity to drive improved outcomes and lower readmission rates through virtual solutions. Virtual cardiac rehab programs drive a 26% higher adherence rate than their brick-and-mortar counterparts due to their added convenience and accessibility. Further, from an outcomes perspective, studies have shown that there is no difference in functional improvements between in-person and virtual programs. Through virtual solutions, patients and providers can leverage data to prevent relapses or readmissions, track progress in real-time, and make immediate adjustments to treatment plans. Moving Analytics, for example, offers personalized virtual cardiac rehab programs to reduce readmissions and empower patients in their daily lives.

7wireVentures Predictions

PREDICTION 1: Given mounting costs to treat and manage cardiovascular conditions, health plans and employers will focus on addressing cardiovascular conditions further upstream and partner with highly engaging digital solutions that have a proven ROI.

To address the multiplicity of factors that inform consumer lifestyle decisions and act as key determinants of cardiac health outcomes, stakeholders will partner with hyper-personalized preventative care platforms that seek to drive behavioral change through a data-driven understanding of the consumer’s context. The widely recognized efficacy of diet and exercise on lowered CVD risk has spurred a large volume of digital health organizations focused on supporting consumers in addressing positive lifestyle habits. However, as stakeholder expectations for engagement and ROI increase, there will be escalated pressure within the digital health market to demonstrate best-in-class engagement through novel behavior change approaches. Long term, there will be continued advancement and widespread use of deep learning applications in the cardiovascular space that will open the door to noninvasive methods for highly accurate predictions of cardiovascular risk.

PREDICTION 2: As value-based care continues to grow, provider demand for innovative diagnostic, treatment decision support, and care management solutions will push the cardiovascular digital health market to new levels of precision and utilization.

With 30% of private practice cardiologists switching from private practice to employment in provider networks, where they are incentivized to provide value-based care, there will be a rising uptake of innovative technologies that span the patient journey, with a focus on solutions that accurately predict CVD events and reduce time to treatment. As a growing body of research reevaluates the benefit of invasive cardiovascular surgeries for patients, providers will increasingly rely on clinical decision support (CDS) tools to enhance the efficiency and effectiveness of care delivery. To uncover the largest benefit from CDS platforms, health systems and cardiology practices will need to invest in IT infrastructure that allows for the integration of wearable, sensor, genetic testing, pharmacy claims, and EHR data. Furthermore, the cardiovascular remote monitoring market continues to become increasingly crowded with minimal levels of differentiation across players. To demonstrate a salient value proposition to providers, clinically-focused remote monitoring organizations will need to expand their feature sets and focus on driving patient utilization to support the shift to value.

PREDICTION 3: The continued proliferation of health information gathered across numerous clinical settings will place increased pressure on all stakeholders to adopt data-focused healthcare models.

As much as 30% of the world’s data is generated by the healthcare industry. Given the massive scale of the data collected by wearables and RPM devices, development of efficient pathways to translate raw data into clinically actionable information will be paramount. To limit clinician burdens, health systems will need to partner with solutions that apply machine learning methodologies that identify actionable information automatically as well as deliver automated decision support that guides follow-up testing, treatment, and diagnosis. There is a huge need to improve the specificity of patient data prioritization and reduce the detection of nonevents. Avoiding clinician “alarm fatigue” by reducing the “signal-to-noise” ratio will become a core objective of providers’ RPM strategies. Lastly, as more patients gain access to consumer devices capable of monitoring cardiac health, there will be an immense need to screen and assess the most effective strategies for driving behavioral changes based on individualized consumer contexts.

As the burden of CVD is now growing faster than our ability to combat it, there is an urgent need to tackle the cardiac health endemic that continues to plague our country. Digital health presents compelling solutions to increase access to personalized, preventative care and to help transform patients into Informed Connected Health Consumers who are well-equipped to make healthier lifestyle decisions. While digital health provides the foundation upon which our healthcare system can shift from providing reactive to proactive care, it is the responsibility of all key healthcare stakeholders to work collaboratively to improve the cardiac care of Americans.