A window into the heart
[Editor’s note] Kronostories has always celebrated the beauty of travel, of places and of the care that people are capable of showing towards them. But there is an even more intimate realm to safeguard: that of the human body. With a contribution from Dr Lucy Barone, we open a window onto a form of medicine that is learning to listen to the signals of those most in need.
The heart reveals itself, no longer just during routine check-ups, but in everyday life thanks to devices capable of acting as discreet sentinels of cardiovascular health.
This is the approach that Dr Lucy Barone, Head of Cardiology at the AOU Policlinico Tor Vergata in Rome, outlines for us in the following article: that of a cardiology which is learning to prevent before it even treats.
A valuable contribution, reminding us that technology, when put at the service of medicine, never replaces the doctor’s assessment of the patient — but makes that assessment more attentive and timely, to give patients back a freer, more peaceful and fuller life. [end of editor’s note]
Listening to hearts with heart failure every day, even on vacation
Summer is synonymous with holidays, relaxation and the desire to get away. Even for those living with heart failure, travelling no longer needs to be seen as a risk or something to be given up. Through the remote monitoring of implantable cardiac devices, it is possible to maintain a constant link with your specialist centre, even from a distance. This technology automatically transmits information about the heart’s condition to the doctor, who can identify any warning signs at an early stage and, if necessary, contact the patient to provide prompt advice, thereby helping to make holidays more peaceful and safe.
Heart failure is one of the most common and challenging chronic conditions. It does not mean that the heart stops beating, but that it can no longer pump blood with the strength required to meet the body’s needs.
It represents one of the leading causes of morbidity, mortality and hospitalisation worldwide. It is estimated to affect around 56 million people worldwide, with a global prevalence of between 1% and 3%. Over the last decade, the prevalence of the condition has increased by around 29% and, despite significant therapeutic advances, the prognosis remains poor, with a 5-year survival rate of less than 50%.
Thanks to medical advances, many patients now live longer and enjoy a better quality of life. However, the risk of sudden deterioration, hospital admissions and potentially serious arrhythmias remains high.
In recent years, research has focused not only on the development of new treatments, but also on new tools to better understand the progression of the disease. A study recently published in the *Journal of Clinical Medicine* by the University of Rome Tor Vergata fits into this context.
The idea behind the study is simple yet innovative: rather than relying solely on periodic check-ups, it is possible to monitor the heart on a daily basis thanks to implantable defibrillators and the latest generation of cardiac resynchronisation devices, which automatically transmit a large amount of data to specialist centres via remote monitoring.
When technology becomes an ally in prevention, as well as in treatment
Implantable devices are best known for recognising and treating potentially life-threatening arrhythmias. In reality, they also perform another function, one that is less well known but increasingly important.
Every day, they automatically record data on the heart’s functioning and transmit it to cardiologists. This is not merely a matter of flagging an arrhythmia or a device malfunction, but of monitoring the progression of the condition over time.
This represents a significant change from the past. Whereas, until a few years ago, a cardiologist could only assess a patient during outpatient appointments, they now have access to information collected on a daily basis during the patient’s normal daily life, even when the patient is not experiencing any symptoms.
What has been studied
The research involved patients with heart failure and reduced ejection fraction who were being treated with sacubitril/valsartan, one of the medicines currently recommended by international guidelines.
The aim was not to confirm its clinical efficacy, which has already been demonstrated by large international studies, but to assess whether the treatment was also associated with an improvement in the function of the autonomic nervous system, the complex system that automatically regulates the heart rate.
To do this, a number of parameters recorded daily by implantable devices were analysed, including heart rate variability and nocturnal heart rate – indirect indicators of the balance between the sympathetic and parasympathetic nervous systems.
The results
The analysis showed that, even in the first few months of treatment, some of these parameters improved significantly. In particular, an increase in heart rate variability and a reduction in both the average and nocturnal heart rates were observed.
Although these changes were numerically modest, their physiological significance is considerable as they suggest at least a partial restoration of the balance of the autonomic nervous system and greater cardiac stability.
As regards arrhythmias, however, the results call for caution. No statistically significant reduction in arrhythmic episodes was observed across the entire study population. However, in patients who had already experienced ventricular arrhythmias before the start of treatment, the number of events fell significantly, suggesting a possible benefit in those at higher risk. Larger studies will, however, be needed to confirm this observation.
The real innovation: continuous monitoring
The most important message from the study, however, concerns the method.
Implantable devices are not merely therapeutic tools capable of intervening when an arrhythmia occurs. They can become genuine ‘sentinels’ of cardiovascular health, capable of tracking the progression of heart failure day by day and showing how the heart responds to treatments in real life.
Remote monitoring makes it possible to observe physiological changes that often precede the onset of symptoms, offering the opportunity to better understand the progression of the disease and to assess the response to treatment more accurately.
A look to the future
Cardiology is evolving towards an increasingly personalised and predictive form of medicine. The ability to collect continuous data directly from the heart opens up new possibilities for both research and patient care.
The aim is not to replace the doctor-patient relationship, but to enrich it with information that was unavailable until just a few years ago. Understanding how the heart responds to treatment on a day-to-day basis means being able to intervene more promptly and tailor care ever more closely to the individual.
In this context, remote monitoring is not merely a technology for controlling an implantable device, but a tool capable of helping doctors to better understand heart failure and anticipate its progression. It is one of the most promising directions in modern cardiology: not waiting for the disease to manifest itself through clinical deterioration, but learning to recognise the signs much earlier.
Dr Lucy Barone – biography
Born in 1982, she is a Senior Consultant in Cardiology at the AOU Policlinico Tor Vergata in Rome, where, since 2016, she has been dedicated to the care of patients with arrhythmias and the management of implantable devices. Having graduated and completed her specialisation with honours at the Catholic University of the Sacred Heart in Rome, she went on to successfully complete her PhD in Experimental and Systems Medicine.
She is also a tutor on the Postgraduate School of Cardiology and a university lecturer at the University of Rome Tor Vergata, and has recently been re-elected as Regional Councillor for Lazio of the Italian Society of Cardiology (SIC). She has over 30 international scientific publications to her name, covering topics such as the link between mental health and cardiovascular diseases.
Photo credits:
Pixabay users – orzalaga, pexels, Gigiisprod, Johan_Benitez99co, nowaja-go-along
We would like to thank Dr Lucy Barone for the text and photos.
Giornalista detentore dal 2015 del Guinness World Records TV e Ambasciatore Borghi più Belli d’Italia.
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