the time for DIGITAL CARDIOLOGY is now
to find needs, one simply needs to follow the patient journey
March 2022
by Himanshu Sharma
Nina Capital is no stranger to the unmet needs in the cardiology space, having already invested in four companies across Europe tackling opportunities for improving care in a wide range of settings (from emergency departments to echocardiography rooms). We believe our work here has just begun, and as the healthcare ecosystem continues to evolve, we see even more gaps emerging, each one an opportunity of improving access and quality of care via technology.
Cardiovascular diseases are the number one public health threat
Cardiovascular diseases (CVDs) are a group of disorders of the heart and blood vessels. CVDs are the number one cause of death globally (about 32% of deaths). They are expensive, too. Total costs of cardiovascular disease are expected to reach $1.1 trillion in 2035, with direct medical costs expected to reach $748.7 billion and indirect costs estimated to reach $368 billion in the US alone. And in the face of this growing threat, there are simply not enough specialists. Cardiologists are in shortage already and this trend is expected to continue, leading to a shortage in hundreds of thousands globally.
Cardiology conditions are mainly caused by some controllable (diet, inactivity) and uncontrollable (age, genetics) risk factors. Left unchecked, they can lead to severe consequences ranging from muscle weakness and fatigue to stroke and heart failure.
“The problem with heart disease is that the first symptom is often fatal.” — Michael Phelps
Tech-enabled cardiology can help mitigate this threat
Prevention by diet and exercise is without question and by far the most effective lever to control population heart health. The second, we believe, is the use of information and communication technologies in cardiology to treat patients with CVD, develop appropriate CVD surveillance, conduct technology-based clinical research, and educate peers and colleagues. We call this “digital cardiology.” For both preventive measures and digital cardiology, the time to invest is now.
Digital cardiology is heavily underutilized
Take telehealth as an example. Utilization of telehealth in cardiology is at the same level as in dentistry, which is at the minimum puzzling as one would expect a bigger utilization of cardiology services than dental services virtually. There is a tremendous opportunity for the right startup to position itself for success in capturing a meaningful share of the large market in digital cardiology.
Regulatory tailwinds ease adoption
Covid has drastically altered how patients seek care. There has been an increase in telehealth services for most specialties. Regulatory bodies such as CMS have tried to ease the burden on providers by expanding telehealth coverage and access. Specific to cardiology care, CMS has added 11 new codes for reimbursement including cardiac rehab and remote patient monitoring.
Digital adoption is growing
Patients are more satisfied than ever with the digital forms of interactions than they have been in the past. Patients are accessing care services in various forms such as text messages, emails, video calls, and apps. And with the advancement in wearable technologies we are already collecting health metrics that are useful in diagnosing and monitoring heart conditions.
Opportunity is everywhere — just follow the patient journey
To better understand where companies can help cardiology patients, we look at a typical patient journey.
awareness. CVDs are considered ‘silent killers’ as there is a lack of awareness. Most of the time, a patient ignores symptoms as these are day to day symptoms such as ‘out of breath’, fatigue, etc.
diagnosis. Diagnosis is usually made by providers based on blood tests and other vital measurements such as blood pressure, cholesterol, and weight. The major issue is that these data are “in dots” and the most information is in their progression. This makes early diagnosis hard.
non-medical care. Once the condition is diagnosed, a physician will try for non-medical care if the case is not severe. Providers will advise changes to lifestyle but there is low compliance from patients and the care team does not have visibility into the patient’s behavior.
medical treatment. If there is no improvement from the lifestyle modifications, a physician will prescribe specific medications for each condition. However, similar to non-medical care there is no visibility into patient compliance.
adherence. Adherence is self-reported by patients typically. However, adherence is low, and it could be because of multiple reasons such as socioeconomic factors, side effects, and laziness.
desired outcome. Because of the issues mentioned above the desired outcome is typically not met which could lead to surgical intervention.
In summary,
we know some great companies that are solving parts of this patient’s journey for several conditions — a few of which we are proudly backing with our capital and active support. HelloHeart has found success in hypertension. Recora health is helping post-surgical recovery. Both in our portfolio, Cardiomatics provides convenient, automated ECG interpretation to healthcare professionals in order to improve its accuracy and efficiency, and Ultromics reduces variability in interpreting measurements from echocardiograms, for the accurate assessment of cardiovascular diseases.
We believe there is an opportunity for technology companies to capture the entire value chain and support patients, and that our work in this specialty area has just begun. If you are a founder focusing on digital cardiology, our heart beats for you and would love to connect :).
Himanshu Sharma —(Incoming!) Sr. Associate Summer Intern, ‘22
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