Getting Personal: How Proactive Patient Care Can Change Medicine

September 13, 2010

The diagnosis and treatment of complex diseases like heart failure needs to start long before the patient presents with symptoms.

Every so often, a new concept emerges that has the potential to dramatically transform the way medicine is practice.

Ralph Snyderman, MD, Chancellor Emeritus at Duke University and James B. Duke Professor of Medicine, believes that we are on the cusp of one of those transformations. In the opening plenary session of the HFSA meeting on Monday, Sept. 13, entitled, “Personalized Medicine: From Theory to Practice,” Snyderman told attendees that the “find it and fix it” concept used by many physicians is on the same trajectory as paper records.

He believes that medicine is—and needs to be—transitioning to a new model of care that employs a proactive strategy in treating conditions like heart failure, and involves equal participation from multiple members of the coordinated care team. The “single cause and effect” approach of diagnosing and treating a disease once it has presented in a patient, and establishing a course of therapy based on a single factor, just doesn’t make sense, he said, adding that the traditional patient-physician encounter is both physician-centric and too costly.

The emerging theory that Snyderman believes offers a much-improved alternative is based on the idea that complex diseases like heart failure can be attributed to multiple causes. “This is allowing us a whole new approach to care; to be able to understand health and disease in a dynamic way and protect it and intervene early, instead of reacting to what has already happened.”

Once a disease has already presented, the ability to reverse the effects has decreased, and the cost to treat it has increased, he said. However, developing individualized plans for patients can help detect potential risk factors in patients—whether they are hereditary or environmental, and help prevent the onset of chronic heart conditions.

One key component in revolutionizing the patient-physician relationship involves developing more sophisticated decision support tools (which is one of the goals of Proventys, a company co-founded by Snyderman). The other entails enabling patients to take a more active role in their care, and making sure treatment is tailored to meet their needs. For example, he noted, patients who live in urban areas might have limited access to fresh produce, and patients who live alone might lack social support.

“All of this needs to be considered as we personalize the therapeutic plan for each individual patient,” said Snyderman. “In the rapidly emerging future, physicians and patients will develop relationships that are coordinated and ongoing, and are more of a partnership. And on top of that, we want to be able to develop a database that can be used as part of the decision support. This is where medicine is going.”

Also during the plenary session, Nancy M. Jokerst, PhD, discussed “Nanotechnology and Its Application to Cardiovascular Disease.” Among the many uses of nanotechnology in medicine are targeted therapies, novel materials such as artificial skin and joints, DNA sequencing, sensing, and imaging agents.

Researchers, according to Jokerst, are working to develop interaction systems that use nanotechnology and microtechnology materials “to enhance performance and reduce the size of today’s useful systems,” including monitoring technologies. Integrated systems that utilize nanotechnology and microtechnology, she said, can potentially play a role in personalized medicine. “We need to harness all of that technology and drag it into areas of medicine. That’s the vision of where we can go.”

For example, miniaturized sensing systems would be able to assess cardiac status, even while clinicians are in transit or even in combat. They are wearable in the operating room or in the field, cost-efficient, and can integrate wireless communication or networking.

“If we have diagnostics that can monitor our status, that is a significant savings to our society,” said Jokerst, who urges cardiologists and other clinicians to approach engineers about their needs. “What is your vision for what you need to know for personalized medicine? What are the critical aspects that technology can address in your field? That’s what we want to know.”