Most of today’s cardiology procedures, technologies, and medications were unknown or in their very early stages fifty years ago, and a new Becker’s Viewpoint by UNC cardiology chief Rick Stouffer, MD forecasts that “cardiology will change as much in the next 50 years.”
Here’s the ten core areas where he expects these changes to take place:
Personalized Medicine – Although very different patients are treated with the same medications today, unique patient characteristics (especially genetics) will play a far greater role in future medication decisions.
De-Emphasized RTCs – Randomized controlled trials might be the current gold standard for cardiology science, but improvements in EHR data will pave the way for real-time “pragmatic trials” that avoid RCTs’ delays, costs, and hassles.
Environmental Focus – We’ll see a far greater population health-level focus on addressing environmental contributors to CVD (e.g. toxins in water, air pollution, chemicals in food).
Nutrition Focus – Nutrition will become a major research focus area, noting that nutrition could have a far larger impact on overall CVD health than the CVD drugs that get most of the research attention (and funding).
Cardiomyopathy Progress – There’s currently limited options for heart failure, but the future will bring new therapies that “will recruit myocytes to the failing heart (e.g. stem cell infusions) to replace those irreversibly damaged.”
Specialist Access – The expansion of telehealth will give patients far more access to subspecialist cardiologists, while general cardiologists will lower their thresholds for subspecialist referrals.
Chronic Interventions – We’ll see more chronic diseases treated with interventional procedures, starting with renal denervation for hypertension, and followed by future interventions for “diabetes, heart failure, arrhythmias, etc.”
Family Ties – We’ll better understand family transmission of cardiovascular disease, as future research into genetic, epigenetic, and environmental factors allow us to identify and treat people with greater inherited risks.
Better and Fewer Procedures – Cardiac procedure and surgery outcomes will continue to improve due to technological and technique advances, but they will “be used less frequently as the focus turns to prevention rather than treatment.”
Preventative Weight Loss – Weight loss will become a primary focus for CVD risk management, with weight loss drugs becoming an early addition to obese patients’ CVD regimens.
What won’t change?
- Exercise will still be prescribed but rarely followed
- Cheap, non-nutritious foods will continue to be widely available
- Patients will continue to engage in behaviors that are detrimental to their health
- People will still die from heart disease
Although some of these predictions might be hard to envision (people have far more faith in RTCs than EHR data), they all make a lot of sense. And recent Cardiac Wire issues suggest that some of these trends are already underway.