Technological innovation and education fundamental to the future of interventional cardiology
Introducing the first PCR President and Friends Dinner debate during EuroPCR 2016, William Wijns said, "This debate is really about shaping the future of interventional cardiology and joining in the journey".
Eminent interventional cardiologist Peter Fitzgerald (Stanford, USA), and physicians moved into industry, Martyn Thomas (Edwards Lifesciences) and Martin Rothman (Medtronic) sat on the debate panel. P. Fitzgerald kicked off the session by arguing that interventional cardiologists should refocus their efforts on patients themselves and their families, rather than just on developing technological "widgets". He argued that technological innovation should be used to improve both treatment for patients, and the healthcare system itself, saying, "The future in interventional cardiology is challenging. It is time to put the patients and the healthcare system in front, using innovation to help us do that."
Commenting on the current state of interventional cardiology, M. Thomas said, "The last six months have changed the entire landscape in terms of data. I see the future as now seriously accelerating towards endovascular therapies. This is going to put a huge strain on heart teams. I am rather fearful for the surgeons - especially for the trainees."
The importance of nurturing young cardiology trainees was clear throughout the debate, with all panelists agreeing that emerging technologies and changes in healthcare systems would not just impact, but be driven by, the training physicians of today. Courses like EuroPCR, they agreed, were fundamental to ensuring that young cardiologists benefit from the networking opportunities uniquely offered by such a meeting. "You cannot replace this. It is these interactions that actually help move innovation all the way to execution." P. Fitzgerald asserted, remarking that whilst format and sponsorship might change, courses such as EuroPCR would remain fundamental. M. Thomas added, "From my personal clinical experience, I can think of a handful of patients that have directly benefited from a single corridor conversation."
Moving on to discuss how to nurture medical device innovation specifically, young audience member Jonathan Chen (San Francisco, USA) asked the panelists who should fund the early-stage device development in a changing investment climate.
The panelists responded by arguing that there was a large amount of money available for medical device development, but that it was not being made available to early-stage devices. P. Fitzgerald asserted that rather than looking for venture capital investment, early-stage innovation funding should be driven by large medical device companies. M. Rothman, however, disagreed, asserting that strategic companies focused investment on fully-fledged, post-market devices. Early-stage investment, he said, had to come from "angels, family and friends", in a market concerned with risk.
Moving on to discuss how to mitigate risk in clinical trial investment, P. Fitzgerald argued that investment in basic science research was key to success, rather than in clinical research. M. Thomas contended that randomised controlled trials in their current state fail, by design, to adequately capture patient outcomes, focusing too heavily on clinical markers such as mortality rather than on the patient quality of life and the patient recorded outcomes. "Surely it is the patient's journey that is the most important metric," he said. Continuing this line of argument, M. Rothman argued that clinical research was at risk of irrelevance because of high rates of patient non-compliance in the real world. "Somehow or other, clever technology has to help us," he asserted. In response, R. Fitzgerald argued again that "behaviour can definitely change" with the help of technology, suggesting that mobile phone usage could be exploited using telehealth incentives to prompt compliance.
Commenting on the difficulties which can arise from rapid developments in complex devices and techniques, M. Thomas said, "And then, of course, we end up with a two-tier system." As technology develops, he asserted, it will be necessary to make sure that health disparities do not continue to grow as training becomes inevitably more complex, procedures increasingly expensive, and demand for care in emerging countries more pressing. P. Fitzgerald argued that technological innovation could actually help to encourage delivery of healthcare solutions to patients in danger of economic exclusion from even adequate healthcare, given the global proliferation of smartphone technology. "This will be an important conduit for the patient. There is no reason why patients should not get advanced care, and I think one of the ways we can do that is with technology."
Concluding the debate, the panelists rounded off the session by discussing how technological innovation could be used not only to incentivise patients, but also to collect accurate health data that could be used to inform trial design and treatment plans on a public health scale. Such data, too, could help practitioners and trial designers to navigate differing cultural boundaries, and negotiate health disparities in developed and emerging markets around the world. M. Rothman asserted, "The connection between the patient, the payer, the family practitioner - all of those things join up together to actually incentivise the patient, and to give us true information about what the patient is doing."
After the debate had concluded, J. Chen told The Daily Wire that "sessions like this crystalise some of the sharper issues that our industry is facing - offering great dialogue and a great opportunity to get insights from experts."
Commenting on the success of the debate, EuroPCR course director William Wijns told The Daily Wire, "The objective was to get together with colleagues from around the world to reflect on the future of a field experiencing acceleration, challenge, and opportunity. The three speakers contributed very thoughtful insights to essential issues: innovation; the importance of the young generation; the delivery of care; access to treatment; clinical trials, and the future of medical meetings. I think it was thoughtful, and I am sure it will resonate."