Episode 1: Dr David Steinhaus

[Music] Created by the World Heart Federation, World Heart Day on September 29th informs people around the globe that cardiovascular disease, which includes heart disease on stroke, is the world's leading cause of death, claiming 18.6 million lives each year, and highlights the actions that individuals can take to prevent uncontrolled cardiovascular disease. It aims to drive action to educate people that by controlling risk factors such as tobacco use on healthy diet and physical inactivity, at least 80% of premature deaths from heart disease and stroke could be avoided. The theme for World Heart Day 2022 is "use heart for every heart". In the context of B.Cure, this aligns with recognizing the devastating and widespread impact cardiovascular disease has on individuals and communities across the world, and creating technology helps address the issue. "Use heart" means to think differently, to make the right decisions, attack with courage, to help others, to engage with this important cause. The heart is the only organ you can hear and feel. It is the first and last sign of life. It is one of the few things with the potential to unite all of us as people. I'm delighted to introduce my first guest to Health at Heart. Dr. David Steinauce is graduate from Harvard Medical School and later Harvard Business School. He served for 20 years in cardiology, practice at Kansas City, Missouri, and St. Luke's Hospital in Mid-America Heart Institute, where he was chief of cardiology. Dr. Steinauce then moved to Medtronic, one of the largest medical device companies in the world, where he served for 14 years as medical director and vice president. I'm pleased to say B.Cure persuaded Dr. Steinauce out of retirement to sit on our management team as America's advisor to the board. David, you're very welcome to our first episode of Health at Heart. Thanks, B.Cure. It's great to be with you. And every time I speak to you, apart from the amazing advice that I get and all the information that you provide, it seems to me that retirement is really, really good fun, and I'm hoping to get there someday. It has been great, in fact, I've spent just been to the last month on small island in France. It's been great. Very good. David, you've been advising B.Cure for about a year now. Could you tell me a brief bit about your background from your time in cardiology and then with Medtronic. I guess you have a unique perspective on digital health. Well, I am a very first and foremost, like I said, in my self-position. I went to medical school, loved practicing medicine initially. I started out as a practicing cardiologist in electrophysiology. But things came along and I became the manager of a large physician group. And then ultimately the manager of a heart hospital in addition to my clinical practice. Finally, about 15 years ago or so, I went to Medtronic as initially chief medical officer for one of their large televisions. And ultimately, when it had general manager, I was general manager of heart failure. Now I'm retired and I have interesting small companies that are early startups and early stage medical devices. Fantastic. A huge wealth of experience. David, I'll try it carefully here. But I guess during your long career you will have witnessed huge transformations in the capabilities and the appearance of medical devices. Can you share some of your experiences? Sure. I think the one that comes directly to mind to me is a treatment of sudden cardiac arrest. As you know, it's a huge problem because of the huge number of deaths in the United States and around the world. What was developed, actually when I was a fellow and I was in training, they developed an implantable defibrillator, which of course could recognize the legally-driven, which causes this intruderia called ventricular fibrillation, could then charge a capacitor and then shock the patient back to normal rhythm. And as you can see, as much as you see on the street with CPR and paramedics doing all of that, that was developed as a huge device. You had to do a big implant. You had to crack the chest open and put leads on the outside of the heart and the implant only lasted for about two years. Moreover, all it really did was just sit there. If you had the arrhythmia, it could shock you back in a normal rhythm course, which is somewhere painful. So the course of years, but on the other hand, this has really been incredible because I remember actually the second patient I ever implanted. Patient was doing fine and was actually at the grocery store, you know, pushing along one of those grocery carts and actually literally had a cardiac arrest fell into the grocery cart. The device actually recognized his rhythm problem, shocked him back to normal rhythm. He got up, finished his grocery shopping and went home. You're kidding me. And this was so dramatic because this guy would have died. I mean, he's just no doubt about it. So these were tremendously effective devices, even though they were bulky and hard to implant and didn't last very long. Of course, over the next 30 or 40 years, it has been a huge improvement in electronics and miniaturization and all of that. And so now we have a device that's about 30 cc's very small, less about 12 years. You put it in the pre-pectoral space up here with one lead that goes inside the heart. And not only shocks the patient out of rhythm, but it has a potential for backup pacing of patients heart rate is too slow or also pace terminating these some of these rhythms called ventricular tech or cardiac without a painful shock. So it's incredible because you can have patients who have episodes of these lethal arrhythmias don't even know they had them. And then when you interrogate the devices because it stores all of this in memory, you can actually find out what happened with the patient and maybe the patient would have died without it. So it's been an incredible revolution over that period of time and the way we deal with this problem and the way the devices do it is probably. Just incredible progress. David, what is it about the work that B Secure is doing that excites you and has persuaded you to come and work with us? Well, B Secure is an interesting company. First of all, I like all the people with some exceptions. That's good. And I think they're really bright group. What they have basically is they have really good understanding of hardware related to dry electrode systems and also software related to electric program recording and cleaning up signals and interpretation. And that's really fascinating because you can imagine that it flies into places. It applies for things like Fitbits and Woosh, which we all use all the time to record our race and our exercise capabilities. But it also can apply to the medical space because we have medical grade devices that record heart rhythms over a long period of time. And those heart rhythms need to be accurate and secure and needs to be high quality for interpretation and piece of your as a capability of doing that. So that's kind of what really attracted me to them initially. But I think what really attracts me to be secure is this idea that it's got to go beyond. Either sophisticated consumer devices or more sophisticated medical devices because it's going to be a convergence of the two. I think B Secure understands that. I think B Secure is evolving into a software company which can manage very different types of information related to patient conditions and chronic disease management. And then can help physicians patients learn to live with these and manage their uses. That's really interesting. And you know you've called out the two particular industries. And that this convergence is happening. How do you see this convergence developing over the next five years? Well, that's a really good question. I think the two groups don't really understand each other very well. I mean the consumer side, you know, as you know, they're what they produce lots of devices. They have, you know, lower margins. They have a very low barrier to entry. You just kind of put the device on and it works pretty well for most people. Of course, the medical space is totally different, right? They're much higher margins, but the barriers to entry are a lot higher. You got to worry about being totally accurate. You got to have good quality controls. You have to have good regulatory systems because you know, to be reimbursed when needs to have the proof that this actually works in clinical trials and all of that. And so I think one of the problems with consumer companies and medical wise companies is they don't really understand their positions. On the other hand, they both desperately want to get into each other's spaces. The consumer electron group wants to get medical space. Why? Because the harm margins and the medical companies want to get the consumer space because I think they have something to offer for broad patient management in a much larger group of patients. And so I think it will be very interesting to see over the course of the next five or 10 years, how this all evolves. And we've seen that, for example, Amazon and Google have purchased medical companies. And some of the medical vice companies have picked their toes into patient management systems. And so I think it's going to be very interesting to see will they cooperate? Will one by the other? Will they compete? It's hard to know. Fascinating. And with this convergence and you know, the fact you've got consumer and now medical devices coming together effectively. Converging as you say. There could be more information directly to the user. You know, what type of information do you believe is the most beneficial for patients and consumers? Obviously to have access to enable them to have healthier lives. I think it really is patient. and I think it's already for chronic disease management. Disease is like diabetes, hypertension, heart failure. I think, you know, we always talk a lot about personalized medicine, but nobody completely understands what that is. I'll give you an example. In heart failure, we have made dramatic strides in the last 30 or 40 years in the treatment of heart failure. Again, I remember when I was a fellow, if you had the diagnosis of heart failure, you had a 50% chance of dying within the next two years. Now, over the next several decades, we've improved that. It's not perfect, it's still high more calorie, but it's about a 50% chance of dying in over five years. So we've significantly improved that with multiple medications and devices and all of that. The problem is we tend to do this on a totally population basis. In fact, we take studies that looked at 1,000 people who we gave the drug to and 1,000 people. We didn't give the drug to which did better. And so we tend to prescribe the same medications for everybody. Of course, we know they don't work in everybody. So it may be that one medication is better for one person or one medication is better for another or a combination is better. We don't really know how to do that. I think one of the great promises of giving people better crimes is more personalized to these medicines. So we'll know what kinds of medications and what kinds of devices will benefit certain kinds of patients better or worse to really deliver personalized medicine. That incredible opportunity, absolutely. Tell me from your experience of working in hospitals, how can remote patient monitoring improve the clinical pathway, help medical professionals make more diagnosis, and ultimately save more lives? Well, it's really not so much in a hospital space, but it's more in the outpatient space. And again, as I said, it's about crime patient management. It's about giving the patient more information, specifically related to that particular patient, and specifically that patient can take more action based on that information. And have more confidence. That's one of the issues, which is, you know, we tend to prescribe all these medications, right? Positions, you know, you kind of my office, and I get part there, and I give you a prescription to go get a medication. But what we find out is that not all the patients take the medications. Right. Because some have slide effects, some are too expensive, so I'm just getting tired of taking them. I don't believe they're effective. And so can we better manage that? Can we actually get the patients on their right medications for them, ensure that they keep taking the medications and get the benefits? Very good. The next generation medical devices, are they generally viewed by cardiologists? And if there are question marks, what would help remove them? Well, I think most cardiologists are enthusiastic about the changes that we've seen. Both in medications and also in medical devices. I think some cardiologists, particularly the heartbeard cardiologists, tend to lean a little bit more toward medication use than they do toward device use, and they're more oriented in that way. But I think most cardiologists are pretty accepting of new technologies. The key, however, is proof. Right. I mean, you can't give me this, like when you say, I'll get a fit fit, for example. You can say, well, it's going to improve your exercise. And you're going to be better, and you're going to be stronger, and you're going to be fitter, et cetera, et cetera. You can say that, right. In the medical space, you can't just say you have to prove it. So physicians are skeptical and should be. Right. They should demand high quality proof, from randomized clinical trials, which actually demonstrate effectiveness before they just go and accept this for their patients. Absolutely. This is a question I want to ask all my guests. What development in heart health technology excites you the most? There are too many to say. I mean, I think that most recently, the three areas that I have kind of been interested in are, first of all, my old area. And what's happened in electrophysiology with a riddeny ablation with a miniaturization devices so that now we can actually put a very tiny face maker that's one CC tiny, tiny face maker into the heart that lasts for 10 or 12 years. Also, the idea of defibrillators, and what's happened with them, I was actually explained before. And then, of course, the secondary, which is valve management, is exciting. We now have valves that one can put in percutaneously through one of the vessels. We can actually put a new valve into your heart. Used to be required open heart surgery, which is several hours, and two or three months recovery from that open heart surgery. Now we can do this procedure in an hour, and you can go home the next day feeling perfectly fine. That's really remarkable. And we're going to see more in that field. And then finally, the other field that I'm really interested in is heart failure. And we've seen a huge, as I mentioned before, improvement in longevity based on medications and sophisticated medical devices and defibrillators. And then, of course, heart pumps, you know, which are available now. And I think we're going to see interesting changes over the next 10 years and those, which will dramatically shift what happens with heart failure as well. Very, very exciting, incredible space to be in. Last question. What impact do you see technology like B skiers, heart key having? Heart keys really exciting for a couple of reasons. One is it's easy to use, right? I mean, you can in the cloud, you can take any device, put it in, get your answer out relatively quickly. Very simple. So that's more. Second is it's more accurate. And that's really important because if I'm using this for medical grade activities, like ultra monitors, 24 hour monitoring or ambitory monitoring, other ways, then it has to be right. It has to be accurate. And that's got to give me a good diagnosis. So, so that's the second thing. The third thing is it eliminates a lot of the noise that has existed in previous tracings, which has made interpretation more difficult. And for a position, again, these guys are busy. They want to get these things done quickly and they want to know that it works in the know that it's accurate without having to spend a lot of time with it. I think heart key offers that ability despite what kind of ultra monitor you have, what companies using it, et cetera, et cetera, they can all filter through heart key, which can give a more accurate, quicker diagnosis without all the noise. I think there's some interesting opportunities here. And I think one of the opportunities would be to try to combine some of the things you're able to measure with other things that can be measured externally to give you a better sense of patients well being overall. An example I might get would be in heart failure, there's a device that exists now, which can be implanted in the body in the pulmonary artery, which can measure pressures inside the pulmonary artery. That's a pretty direct measurement of how the heart is doing overall. What I'm wondering, I think, might be very interesting is, are there various things we can do externally, which might even predict better than that signal what we have to do with an implantable device so that we can get all the information and give the patient better chronic disease management even without that implantable expensive device. I think that's the kind of thing that that be secure is working on. An example would be bio impedance. And can you combine some of these things? For example, let's say you're a heart failure patient. And let's say you're a normal person. I'm sitting here in this chair. And my heart rates may be 60. And if I go walk applied to stairs, and it might go up to 70 or 75. And if I'm a heart failure patient, because my heart doesn't work quite as well, I might be sitting here at 70 or 75. And if I go up the stairs, I might go over 100 because it's trying to work and it has to work harder. And if we now could take that kind of information, you can also imagine if I'm a heart failure patient. And when I go up that flight of stairs, I go to 100. But tomorrow, because I've had too much salt or whatever, I go up those stairs and I go to 120. You can imagine that's telling me my heart's not doing as well. And so can we take that kind of information, which we can get right? I mean, if we have a cell phone, I can tell you how far people have gone. How far they walk that I can tell you what their altitude is. I can tell you that they're going up or down or what they're with a three-dimensional accelerometer, what their attitude is. So we take that and combine it with the weather and the temperature and all those sorts of things in heart rate. And biolimpedance, can we make an algorithm using machine learning and AI that will actually better inform a patient that maybe even this internal device, which is expensive and has complications and doesn't last forever. Absolutely. So it's all that uncelerated information from a combination of devices, all the sensory information that really can come together. And instead of just being reactive, being more predictive. And I think what's interesting about it is even though each individual piece of information isn't as good as, for example, that pressure measurement would be. If you can figure out how to combine them and put them all together, maybe it can be better. Absolutely. Very exciting and huge opportunities. Not just for one technology company, but partnerships, technologies coming together. Perhaps that's where these things are going. David is back. It's been a privilege to speak to you as always and to be able to pick your brain on what is such a fascinating subject. But unfortunately time has beaten us and I just wanted to thank you for your time today and wish you safe travels back to the US. Thanks so much for having me. It's been a pleasure speaking to you. To find out more about how B Secure is helping to facilitate convergence between consumer and medical devices and helping to improve heart health outcomes globally, visit www.bhifnsecure.com or follow us on LinkedIn and Twitter. You can also listen back to this podcast on the B Secure website. Finally, thank you for listening. I hope you have found this podcast insightful. Join us next week when my request will be Dr. Andrew Mitchell, consultant cardiologist at Jersey General Hospital. [MUSIC]