Precision medicine: The future of cardiology?

Cardiology is facing technical and financial challenges. Demographic change also demands a new way of thinking about the specialty.

Future developments in cardiology

Cardiovascular diseases are globally responsible for the highest number of avoidable deaths. But this could change in the future, according to Prof. Stefan Blankenberg, MD, Clinic Director of the UKE (Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany) and Medical Director of the University Heart and Vascular Centre Hamburg.1

One of the biggest future roles with regard to modern medical technology will probably be played by genomics. Using the common disease of atrial fibrillation as an example, Prof. Blankenberg made clear how genomics can provide information about which genetic loci qualify heredity for a risk of atrial fibrillation. Building on this, one could take individual preventive measures against stroke, which can often be a harbinger of atrial fibrillation. Similarly, in the case of coronary heart disease, a very early risk assessment can be made by measuring lipoprotein(a) levels. Based on this, an individual prevention strategy can be developed, or a specific therapy can be carried out. Genomics is used to determine which 5% of patients are at particularly high risk of cardiovascular events and would therefore benefit greatly from statin therapy, for example.1 Thanks to the use of genomics, overtreatment can be effectively avoided.2

In addition, intelligent decision support systems are being integrated more and more into the practice: Cardiologists are often confronted with the symptom of chest pain. By means of a decision support system, it will be possible to quickly and reliably determine which patient can be sent home with a clear conscience in the future, since the chest pain is not based on any dangerous causes. This, in turn, would relieve the strain on clinics, which are short-staffed.1

The challenge of demographic change

Demographic change not only manifests itself in an ageing society, but also in a necessary shift in the structures of our health care system.3 This is because fewer human resources are available to treat the growing number of patients. At the same time, there is an increasing specialisation in medicine, which runs counter to the trend of multimorbidity and multisystem diseases.4 According to Prof. David Leistner (Professor of Cardiology and Clinic Director of the University Hospital Frankfurt am Main, Germany) and speaker at this year's DGK Congress, three central challenges can be derived for cardiology in the future:

  1. With extremely limited human resources, many complexly ill "octogenarians" need to be treated in hospitals that are no longer staffed or functioning at all.
  2. New care concepts are needed. These must be inexpensive, effective, and non-human, because care needs, in view of current trends, will increase by 150 % in just a few years.
  3. The cardiology field of the year 2050 must be evidence-based and, above all, personalised. Before an intervention, the frailty of patients must be examined and then a personalised therapy must be carried out based on meaningful individual endpoints. This is the only way to avoid overtreatment and to ensure that only those patients are treated who will benefit from an intervention.3

To minimise these challenges, raising awareness about the prevention of cardiovascular events is also an important issue in the cardiology of the future.5

Cardiovascular precision medicine: The solution to all problems?

Individual precision medicine makes it possible to treat numerous patients with complex diseases with a high degree of precision, in a way that spares resources and with higher quality than current standards. At present, treatment is mostly carried out according to the "one-size-fits-all principle", due to personnel and structural circumstances in the health sector.

So how can we change medicine in five to seven years? Based on current approaches, the integration of whole genome data sets will give better predictions of cardiac health. Other imaging developments will also significantly change clinical practice.1,3

Precision medicine currently faces many structural challenges in our healthcare system. "We can only close the gap in human resources through digitalisation," Prof. Leistner notes. The integration of digital tools helps in prevention, diagnostics, and therapy, making digital medicine the key element for turning precision medicine feasible in the first place, and compensates for the drastic lack of personnel in the medical sector. However, this requires the adaptation of our health system on many levels, including a national care strategy.3

The solution is therefore already in its first stages and is eagerly awaited - not only by the speakers at the DGK Congress, but the global cardiology community.

References:
  1. Blankenberg, Stefan. Lecture: A look into the crystal ball - What developments can be expected? (Original Title: "Blick in die Glaskugel – Welche Entwicklungen sind zu erwarten?"). Session: Chances, visions and limitations of modern heart medicine (Original German session title: Chancen, Visionen und Limitationen der modernen Herzmedizin), DGK 2023. 
  2. Laufs, Ulrich. Lecture: "How can overtherapy be countered?" (Original Title: "Wie lässt sich einer Übertherapie begegnen?"). Session: Chances, visions and limitations of modern heart medicine (Original German session title: Chancen, Visionen und Limitationen der modernen Herzmedizin), DGK 2023. 
  3. Leistner, David. Lecture: "Increasingly effective therapy for a society that is also ageing - What challenges are we facing?" (Original Title: "Immer effektivere Therapie einer zudem alternden Gesellschaft – Welche Herausforderungen kommen auf uns zu?"). Session: Chances, visions and limitations of modern heart medicine (Original German session title: Chancen, Visionen und Limitationen der modernen Herzmedizin), DGK 2023. 
  4. Bosch, Ralph. Lecture: "What are the dangers of specialisation, digitalisation and artificial intelligence?" (Original Title: "Welche Gefahren liegen in Spezialisierung, Digitalisierung und künstlicher Intelligenz?"). Session: Chances, visions and limitations of modern heart medicine (Original German session title: Chancen, Visionen und Limitationen der modernen Herzmedizin), DGK 2023. 
  5. Hambrecht, Rainer. "Warum spielt Prävention in unserem Alltag keine Rolle?". Session: Chances, visions and limitations of modern heart medicine (Original German session title: Chancen, Visionen und Limitationen der modernen Herzmedizin), DGK 2023.