In the original Star Trek series, if a crew member became ill, they would visit Dr Leonard “Bones” McCoy. Dr McCoy would wave his medical tricorder over his stricken colleague and have a diagnosis. The tricorder was hand-held, noninvasive, did not require an intravenous catheter, did not use radiation and was risk free. How close are we to developing and implementing a medical tricorder type of device in our world?
Shortness of breath is one of the most common complaints when a patient presents to an emergency room. In general, shortness of breath can be due to anemia (low blood count), lung disease or heart disease. One of the most common heart causes of shortness of breath is congestive heart failure (CHF), fluid building up in the lungs. CHF is extremely common and carries high morbidity and mortality. CHF affects more than 60 million people worldwide. In people over the age of 55 in the United States, there are 1 million new cases of CHF diagnosed each year. In 2016, there were 1.9 million doctor visits due to CHF and more than 400,000 emergency room visits for CHF. CHF is the most common diagnosis for hospital admission. After a hospital admission for CHF, 83% of patients will be readmitted with CHF. Considering all of the doctor visits, emergency room evaluations, hospital admissions and readmissions, CHF exacts an enormous economic toll. More Medicare dollars are spent on CHF than any other diagnosis. In 2020, 32 billion dollars were spent on CHF. CHF exacts another high toll, mortality. After a patient develops CHF, the prognosis is poor as 42% will die within 5 years.
When a patient with shortness of breath comes to the emergency room, the physical examination, chest X Ray and lab tests can help determine if there is CHF. However, in many cases, the diagnosis is still uncertain with the basic evaluation. It would be great if there was a hand-held, noninvasive device that could be brought to the bedside and reliably diagnose CHF without risk to the patient. A device like McCoy’s tricorder. Such a device exists and is currently in use in emergency rooms. The device, Point of Care Ultrasound (POCUS), consists of a wand with an ultrasound probe that connects to a portable console or a cell phone. POCUS can distinguish CHF from other causes of shortness of breath with great accuracy. POCUS can determine if there is fluid in the lungs, the body’s overall volume status (excess volume means CHF) and can assess the heart’s function (if the heart muscle is weakened, the diagnosis of CHF is highly likely).
POCUS is very neat space age technology, but it is not available to everybody. Smartphone apps would give the general public the ability to diagnose CHF. Currently, two apps are being developed and tested. One app detects changes in the motion of the heart. Heart motion is transmitted throughout the chest and these vibrations can be picked up on the skin. Using commercially available smartphones, with sensors already present as part of their technology, these heart vibrations can be assessed. The smartphone is placed on a person’s sternum (breast bone) and subtle changes in cardiac motion can differentiate between a patient in CHF and someone who is not in CHF with great accuracy. Another app uses speech recognition technology. Changes in a person’s voice can determine if someone is in CHF. The app can tell if the person has a “wet’ voice, signaling fluid overload, or a “dry” voice consistent with normal fluid levels. The apps will be important because they will be widely available and will allow early detection and early administration of medications, to prevent CHF from happening. This will alleviate symptoms from occurring and avoid hospitalizations. The voice app was able to detect CHF 20 days before hospitalization became necessary.
While waiting for the apps to become available, what can be done to prevent CHF? There are four modifiable risk factors for CHF, hypertension, diabetes, obesity and diet. With hypertension, each 20 mmHg increase in systolic blood pressure increases the risk for CHF by 28%. Lowering the blood pressure by 10 mmHg wipes out that 28% increase. Obesity is another major risk factor. In patients with CHF and normal heart function, more than 80% are overweight or obese. A body mass index (BMI) greater than 30 kg/m2 (normal 18-25, overweight 25-30, obese > 30) doubles the risk for CHF. A 10% reduction in fat mass reduces the CHF risk by about 20%. A sedentary lifestyle puts a person at risk for CHF. A high amount of physical activity decreases the risk for CHF by 23%. Lastly, treating diabetes will decrease the risk for CHF. Treatment with a glucagon-like peptide 1 receptor agonist (GLP1 agonist, for example Ozempic, Zebound or Mounjaro) reduces the risk for CHF by 18%. Similarly, treatment with a sodium glucose cotransporter 2 inhibitor (SGLT2, for example Jardiance or Farxiga) reduces the risk for CHF by 30%. What type of diet is best to avoid CHF? A plant-based, Mediterranean style diet is associated with a 41% lower risk for CHF hospitalization, while a Southern diet increased the risk for CHF. Other modifiable factors include low alcohol consumption and keeping sodium (salt) in the diet to a low level. The prevention of CHF doesn’t involve space age technology, but relies on good old fashioned hard work and perseverance.
In the near future, if you have shortness of breath, you’ll be able to talk into the phone tricorder resting on your chest and know if you have CHF. Until then, manage the modifiable risk factors noted above to avoid being a CHF statistic.
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