What will the cardiology department look like in 2010? Health Imaging & IT sought expert opinions on what imaging technologies and applications are in the works, how demographics are changing and where cardiac care is headed over the next five years. The big picture may surprise you.
More patients and sophisticated imaging techniques as well as a shift to prevention of coronary artery disease will be cardiology hallmarks in five years. Patient data management will drive improved care as physicians located in multiple, disparate enterprises can provide optimal patient care with complete patient information—including images—at their fingertips. As we look at the demographic, clinical and technical factors that will converge to create the cardiology department of 2010, consider:
- In 2010, the first baby boomers turn 65. Stir in the epidemic of obesity and diabetes and the number of Americans at risk for cardiovascular disease reaches 100 million.
- CT and MR angiography will continue to gain acceptance in the market, changing the function of the cath lab. Look for the first 256-slice CT scanners to arrive by 2010.
- New tests could allow physicians to detect coronary artery disease earlier. "Today, we treat cardiovascular patients when they become symptomatic. By 2010, there will be a forward shift to the asymptomatic patient," says Frederic Pla, general manager for cardiology care, GE Healthcare.
- PET-CT and SPECT-CT may be deployed to diagnose medium to high-risk patients.
- Look for the advent of the lifetime patient record and technologies and structures to support its access and distribution.
The patient population
"The cardiology market is growing," sums Ronald Razmi, MD, director of cardiovascular MR/CT at The Heart Center of Indiana (Indianapolis). "We have an epidemic of obesity and diabetes that is projected to grow over the next 10 to 15 years. We'll see more vascular disease in younger people, and they will need imaging and stress tests to look at the coronary and peripheral vessels."
Technology will impact the patient population. Sixty-four slice CT presents a viable, non-invasive alternative to conventional cardiac catheterization. "A lot of physicians are reluctant to send a borderline patient for an invasive procedure. They will pull the trigger faster with a non-invasive option," predicts Razmi. This means more patients to be imaged and earlier detection of disease for some patients.
But 64-slice technology isn't the holy grail of detection. "There will be simple, non-invasive tests to stratify low-risk and high-risk patients," says Pla. Carotid IMT (intima-media thickness) ultrasound can be used to measure the thickness of the carotid and look at the morphology of the carotid wall to determine which patients are likely to have coronary artery disease and should be referred for additional tests like CT or MR angiography. John Elsholz, vice president of product development at Witt Biomedical adds, "We'll see increasing use of proteomics and genomics in both diagnostic and treatment regimens for patients who are at risk for vascular disease." And preventative therapies based on genetic markers may be used to treat cardiac disease before it occurs.
Cardiac CT revs up
Sixty-four slice CT screeched into the cardiology arena in 2004, providing a new option to evaluate some cardiac patients. Key questions to consider include:
- How will cardiac CT evolve over the next five years?
- How will the cath lab be impacted?
"CT will play a major role in the cardiology department of 2010," predicts Sudhir Kulkarni, director of strategic solutions, cardiology for Siemens Medical Solutions. Kulkarni says several factors will determine acceptance of cardiac CT; reimbursement, training for cardiologists and cardiac applications, availability of the technology, research to define and compare CT angiography to x-ray angiography and acceptance by surgeons. "The earlier these happen, the sooner CT will become more prevalent over x-ray angiography. But diagnostic catheterization will not be completely eliminated," sums Kulkarni. CT may grab invasive diagnostic procedures from the cath lab; however, it cannot be deployed for interventional procedures as pushing stents requires continuous streaming video.
In fact, cardiac CT may feed cath labs. "We're seeing a proliferation of cardiac-enabled CT scanners in the ER, and a lot of customers are building cath or electrophysiology labs in or adjacent to the ER," says John Desch, vice president,