Hey there.
Every Monday in November and December, we'll be featuring our future of medicine series, where we'll be spotlighting groundbreaking researchers, cutting edge treatments and diagnostic innovations for everything from heart disease cancer, brain health, metabolic dysfunction, aging and pain, and also sharing breakthroughs in areas like regenerative medicine, medical technology, AI and beyond.
It's a brave new world in medicine with so many new innovations here now and so much coming in the next five to 10 years.
And we're going to introduce you to the people, players and world changing discoveries that are changing the face of medicine today and beyond in this powerful two month future of medicine series.
So be sure to tune in every Monday through the end of the year and follow Good Life Project to be sure you don't miss an episode.
And today we're bringing you a conversation about what happens when cardiovascular medicine meets AI and technology.
These two fields are intersecting in ways that really seem like science fiction just a few years ago.
From wearable devices that track our heart health in real time to new diagnostic tools that can identify unstable arterial plaques before they cause problems.
The landscape of cardiac care is transforming so quickly.
And, at the same time, Technology is making world-class care more available in places where access and equity have been huge issues.
My guest today is Dr Ami Bhatt, Chief Innovation Officer at the American College of Cardiology and a practicing cardiologist who's leading the charge in reimagining how we deliver cardiovascular care.
As a global health leader and national systems architect, she's known for designing real-world health systems that blend digital tools, clinical insight and human needs.
In our conversation, Dr Bhatt reveals how AI is helping doctors identify heart problems earlier than ever before and shares a fascinating vision for the future, where technology and human care work together to create better outcomes for everyone.
We explore how new innovations in cardiac care connectivity and technology could help solve the healthcare access crisis, while never losing sight of essential human connection between doctor and patient.
So excited to share this conversation with you.
I'm Jonathan Fields.
And this is Good Life Project.
As we sit here now in this conversation, in the larger context of our Future of Medicine series, I really want to dive into cardiovascular health and also cardiovascular illness.
A big question maybe to center to start us off.
When we talk about cardiovascular health or cardiovascular disease, what are we actually talking about?
The phrase is a little bit of a catch-all because we're talking about our heart and the blood vessels throughout our body.
That includes kind of the brain arms legs, abdomen.
And oftentimes we're not just talking about the heart, we're actually talking about the risk factors before you develop heart disease.
When we encompass that kind of word in cardiovascular
So the heart itself acts as a pump.
So when you hear phrases like heart failure which, by the way, I don't like, but that's kind of weak heart muscle
Then there are valves, which are kind of doors that open and close in the heart and let the blood flow through.
So when you hear phrases like aortic stenosis, mitral valve prolapse.
You're talking about those doors or those valves.
There's the electricity in the heart and that can either be a sudden cardiac death event from a severe arrhythmia or atrial fibrillation.
And then there's the one that most people refer to, which is the coronary arteries are the arteries that feed blood first and foremost to the heart, before blood gets to anywhere else in your body.
And that fresh red blood goes through the coronary arteries, but that's where cholesterol deposits occur.
That's where blockages occur and that's where you can develop a heart attack.
And so I think that's probably the most commonly known cardiovascular disease that people talk about.
It's also the one that is most likely to kill a majority of Americans and people globally in terms of non-communicable diseases.
When we talk about that then we're really sort of like talking very broadly about a whole system and the health of the whole system the vessels, the pump, all the different places that it affects people.
One thing you didn't mention, which I'm curious about, is stroke.
Would that be considered part of cardiovascular and is that part of the risk that we're looking at?
Yeah, absolutely.
So when I was talking about the blood vessels going to the brain, that's 100% related to stroke.
And the same thing we talked about with the coronary arteries getting plaque or blockages.
Same process anywhere in the body, including the brain, that can lead to a stroke.
Okay.
Okay.
So let's deconstruct some fairly common terms then, just so we're all on the same page, because I think these are things that a lot of us have heard about, we're probably scared about, but we probably also don't really understand what it is or isn't.
You know, the classic quote, heart attack.
What are we actually talking about here?
When someone has actually had a heart attack, what happens is the arteries that we just talked about, the coronary arteries that feed blood to right back to the heart muscle right.
When the heart pumps out, the first thing that does is feed itself.
Those arteries are the ones that can get some cholesterol plaque development.
And essentially, if you look at those arteries, they look like this and you end up getting plaque that obstructs it and obstructs it.
At some point, there's no blood flow.
That can lead to a heart attack, which is the heart muscle is now saying I'm getting no nutrients, no food.
I can't function.
And that's that typical heart attack we talk about.
Angina, which sometimes comes before a heart attack, is the heart muscle saying hey, things seem to be getting narrow in here.
I am not getting what I need.
I'm experiencing something that I'm going to translate into pain for you, or GI symptoms for you, or back pain sometimes if you're a woman.
We say this typical left arm chin crushing elephants on your chest, presents in so many different ways, because it's however your body interprets.
I'm not getting enough blood flow.
I need you to pay attention to me.
The one shared common feeling by everybody is there is something really wrong.
That impending doom feeling, if it comes with back pain, if it comes with indigestion, if it comes with typical pain, that's that feeling we say please listen to it.
You know, please listen to it because you're about to have a real problem.
And that's really interesting.
So what you're saying is we have this physical symptomology right, some of which can mimic a sore back or a backache, some of which can mimic GI-like things which could be completely unrelated.
But what you're saying is there's also this compounding sensation that most people report, which is there's a sense of almost like psychological doom or fear that accompanies it.
That is not normal.
Something is not right.
Yeah.
That's right.
Do you have a sense for where that comes from and why that kicks in?
I'm a big fan of the mind-body connection.
I really think...
We know when something's not right with us.
You know, it's funny, we talk about this.
Denial is probably one of the strongest things that humans have.
And doctors make the worst patients, partly because we can really exercise that denial muscle, because you know, we know.
But the brain is able to really sense when your body is not acting the way it should be, right?
We see it in little things, like if it's going to rain.
Somebody with arthritis of the knee says hey, I can tell.
And sure, you could say that's pressure and that's moving.
There's probably some physiology, but some of it is.
There's some gestalt in there.
That happens right.
Or even that uneasy feeling when you say, hey, I don't think this is right.
And so I really think there's a mind-body connection.
There's no place where it's stronger than with the heart.
If your life is about to be taken away from you.
The entire body has connections from nerves everywhere.
And there's no way that those nerves don't get to the brain and actually give you that at least inherent feeling of that something is very wrong.
Yeah.
So that's one of the big signals that we look for then, is not just this feeling of an ache or GI symptoms, but this other psychological experience that says there's something bigger happening here.
And the most important thing about that is to trust yourself.
I tell people this all the time.
I would much rather see you come into the emergency room or come into my clinic with a symptom when you were really worried and tell you it's not a heart attack, than have you say, oh well, it's not the typical thing that I thought I've heard of.
Even though I'm pretty sure something's wrong with you.
I'm going to stay home, because then I may never get to meet you.
So I'd rather you take yourself seriously.
So that brings up a really interesting curiosity then, because we know that certain populations are very often treated differently, sometimes straight up gaslit.
Do you see this happening when somebody comes in?
Is there a pattern of somebody saying like I have these symptoms and there's something telling me there's something really not right?
And then them kind of being depending on who you are potentially sent home and saying no no no, you're okay.
We had a women's health panel at the HLTH Health Conference in Las Vegas two weeks ago.
And then I asked the audience, I said, how many people here have gone in with a real symptom and been told that you had anxiety?
It was about an 80% female audience.
And a majority of women, including myself, raised their hand and said yeah, you've been told that it was anxiety.
And I think a lot of it is just cultural and bias and centuries old that we need to continue to work on.
But the most important thing is to advocate for yourself and remind people.
And we do a lot of implicit bias training now in the hospital.
And you realize things about yourself.
Even the most unbiased in certain ways, people have other biases that they didn't know.
And so knowing what your biases are is the first step to being able to say hey, am I treating this person differently because of something?
But yes, it happens all All the time.
It happens all the time.
It still does.
And knowing what the biases are is so important.
I would imagine.
Do you see that becoming an increasing part of just core medical education?
Or do you feel like it's still not quite where it needs to be?
No, it is 100% part of core medical education.
I don't think you can find.
You know well in the medical schools that I have experienced.
The people there have been very clear that this kind of training needs to be a core value training of who becomes a clinician doctor nurse, pharmacist and it doesn't matter.
That's an essential part of just what humans need to be aware of today.
Right.
So you describe this thing that we often common know as a quote, heart attack and just the basics of what's really happening there.
You also reference a number of times the cardinary arteries and this thing called cholesterol or plaque.
And I guess this is sort of like the precondition, it sounds like, for this to eventually get to the heart or to the brain and cause real damage.
Tell me the process of accumulation here.
Yeah.
So there's kind of five key things that we like to watch for in terms of kind of your risk of developing coronary artery disease.
So the first is cholesterol.
There is a good cholesterol and a bad cholesterol.
And then there are whole lots of other cholesterol particles that we didn't use to pay as much attention to.
But if you're just learning in the beginning, there's a HDL or high density lipoprotein.
That is kind of like a good cholesterol.
It does good stuff in your body.
The bad guy is the low density lipoprotein.
That's the one you get from saturated fats, tons of fried foods, right?
Those kind of unhealthy pre-processed things, too much red meat.
I'm not saying never, I'm saying too much of certain things.
And that's a number that you need to check.
You need to go to your doctor and you tell them, you know, I need my cholesterol checked.
When they check it, they'll get you a total cholesterol, which is a way of adding together your high density, low density and a little other stuff.
And that low density cholesterol is the one LDL that we want you to check and we want you to keep it in check.
What happens over time is that too much of that circulating in the blood can actually deposit in the arteries.
Now, there are other things that happen too.
We recently had guidelines that talked about inflammation and how inflammation can make you more likely to have heart attack stroke, vascular disease.
We know about diabetes, so higher sugar levels can lead to this, right.
And then where does diabetes kind of come from?
Well, there's a genetic version, and then there's a version that kind of comes from us and our truncal obesity right, the belly obesity.
There can be what we call and people who have diabetes.
That seems hidden because they seem like they're not that heavy and yet they have diabetes.
And so, measuring your sugar, the metric that i best like is the hemoglobin a1c, hgb a1c, and most primary cares will order that for you Because it's kind of a screen.
In the past three months, how high has your sugar been, right?
And you can't fast forward the night before, which is great because you want the real truth, right?
So the LDL, the bad cholesterol, the hemoglobin A1C, increasingly thinking about inflammation in the body, blood pressure, that is everything.
Having a normal blood pressure.
We keep lowering your goal of blood pressure, lower and lower, because we know that that pressure on the arteries is really causing damage.
Those are kind of the things we look for.
Now, does sleep also affect your healthfulness?
Sure.
Does stress affect your healthfulness?
Sure.
But when you say direct plaque development, the inflammation, the cholesterol, the tendency of diabetic people to basically be considered coronary artery disease people,
If you have diabetes, I presume you have coronary disease.
And then your blood pressure.
Those are the things that we want you to be aware of.
And in the American Heart Association, we call life simple. eight.
We've included sleep as one of those, but we really want you to kind of watch all these things that are happening in your body.
Yeah.
Cholesterol is interesting.
What's the relationship between dietary cholesterol and blood-borne cholesterol?
Because it seems like the old recommendations have changed.
Interesting.
If you actually think about cholesterol, you never want to say anything is kind of bad for you.
Like you need to have it in your body, right?
However, The dietary cholesterol you eat, there are bad types of fats and the bad fats, right?
The saturated fats.
Those are things that are going to transition into the bad cholesterol in your body.
And there's no doubt about that.
I am a big fan of a balanced diet of everything in moderation.
I find that when people try to go crazy in one direction or another, right?
You either make something go wrong because you did too much of something now, or you're missing key nutrients that you would have gotten from another food, or you rebound.
And then it's like, oh, all hope is lost.
It didn't work for very long.
And so saturated fats in the diet, those fried foods, those saturated, that's what you don't want to eat, right?
Those are the things that you first want to avoid.
However, there are types of cholesterol that are genetic.
They're just elevated in your body.
So there's this one called lipoprotein, lowercase a, L-P-A.
And we've been hearing a lot about that especially in South Asian populations, Hispanic and Black populations, but also in all different races and ethnicities.
It's there.
And people sometimes have a family history of having that level be high.
And that is a real tendency towards developing plaque.
So we're learning new things about different cholesterols that may be genetic and then ones that are from your diet.
I had a friend just come up to me recently and say hey, she's a woman, 45 and, And her LDL is quite high and has been for a long time.
When she showed me her labs.
And she said, yeah, my dad had a heart attack when he was 50.
My aunt had a stents place when she was 47.
And I said, well, this is likely, you know, she said, I'm trying to eat less cholesterol.
I said, you know, no, I don't know how much cholesterol you can avoid.
This is probably genetic, right?
Look at your family.
And so that also brings me to family history.
If you have a strong family history, then, you know, you got to check those numbers.
And try and get them down naturally.
But there's a point at which too, like how much are you not going to eat?
Why not get yourself some medications to help lower that?
Because there may be a level at which you just need that help.
And that's what you talk to your primary care about and kind of figure out.
Yeah.
And we'll be right back after a word from our sponsors.
Is age a factor in here?
Can you have a healthy lifestyle?
Your genes are what they are.
And you have great numbers when you're younger.
But then you hit 40, you hit 60, you hit 70.
Can this be a factor that changes it simply because of your age?
Oh, gosh.
So today, don't get me started on perimenopause, but let me tell you, aging is a real thing.
So what I will say is the following.
If you can make it to age 50 with no high blood pressure diabetes, significant cholesterol, you are likely to live 14 years longer than if you had those things.
14 years.
I was recently presenting at a longevity conference.
People were coming up with all sorts of great stuff that's in mouse models.
I'm excited to follow all of this.
And I was like, but I have a solution.
Be heart healthy.
It can buy you literally 14 years.
Now, some people might say, well, I'm over age 50 and I have hypertension.
So all that's off for me.
No, in fact, getting your blood pressure in range can buy you a couple of years.
Getting your sugar in range buys you a couple of years.
So you can actually prolong your life at any point, getting these things in check.
But yes, if you pay attention early and you keep all of those in check until age 50, then the likelihood that you will develop significant illness moving forward is lower, but not zero, because our metabolism does slow, both male and female, and you know, all gender hormones change around that midlife.
It's not just women, i happen, things happen to everybody.
And then age means your arteries.
You know we talked about the arteries that go all through the body right, They get stiffer as you get older.
That's just a fact.
A stiffer artery leads to more blood pressure.
And so everybody can develop higher blood pressure as you get older.
So watching yourself and checking your numbers, really important, really important.
But definitely being heart healthy by age 50, you're gaining a decade of life.
You mentioned also inflammation.
I'm curious about the mechanism there, because I can understand the mechanism where cholesterol, basically plaque, gets deposited and slowly builds over time, includes the vessels and makes it so that you can't actually get the blood that you need.
I see how that happens.
How does inflammation cause issues?
This is a series of 200 podcasts to fully dive into.
However, there's biologic evidence of changes actually in your blood vessels, changes in your body's immune system, tendencies towards more disease when you have more periods of time spent in an inflammatory state.
And so there's tons of research on this happening kind of everywhere.
Some of the groups we saw this in, where we got this in first is people who have kind of inflammatory diseases like rheumatoid arthritis lupus, others.
They had a higher tendency towards developing cardiovascular disease.
And so we had kind of seen signs of inflammatory disorders being related to heart disorders.
But now we really see that prolonged inflammatory states not only hurt your vasculature, but they can actually kind of hurt other parts of your body too.
It's probably not just cardiovascular disease.
And so that brings you to how do you decrease inflammation?
That is a field that is going to burgeon in the next five years, right?
We're going to see a whole lot about it.
And some of those solutions are going to be natural solutions.
And I am certain that there are going to be medical solutions to this.
Remember, some degree of inflammation is important as a protective mechanism in the body, but inflammation really has a lot of biologic effects that we're still learning about.
Let's switch gears a little bit into diagnosis and treatment, in terms of what's the current sort of like state of play today?
If we think about let's start out with diagnostics.
Something's going on or you're just.
You don't feel anything, but you're at a certain age.
You just want to make sure you're checking the right boxes.
What is sort of like the commonly available or common set of diagnostics that we might be invited to explore when we're trying to really keep tabs on heart health.
So the first thing is your body mass index.
I'm sorry to go boring and hard all at the same time, right?
We really want you to be in an ideal body mass index.
That's a combination of your height and weight.
You can find BMI calculators online on your phone or computer and calculate yours.
Slightly different for men and women calculation.
And ideally, you want that to be under 25, over 25, we call overweight.
BMI of over 30, we say obese. if you are of South Asian descent.
However, for example, we're learning that a BMI of 23 is actually more important because there's such a tendency towards diabetes and heart disease in that population that you really have to stay on that kind of thinner side.
But you also don't just want to be thin.
You want to have muscle mass.
Muscle mass is actually, lean muscle mass is really important.
And we've learned a lot about that.
And so that's kind of the, I think the first thing you can do is just try and be healthy.
Now, Yes, build some muscle mass.
So lightweight lifting, or if you can't do that, just use your own body weight and do things, right?
Walking, if you can walk, walking is essential.
You don't need to do crazy hit gym exercise.
By all means, if you can get yourself into that high zone and that's what you enjoy, and if it gives you endorphins, keeps you from being depressed or anxious, like all of the benefits of exercise, fantastic.
Team-based sports, bracket sports, having a partner, all great.
However, you just need to walk.
And if you can spend time walking each week and just get started.
And yes, there are ideal walking times and limits, but what I tell my patients is I just want you to start.
I want you to start with 10 minutes once a day, 20 minutes twice a day, 30 minutes, right?
Maybe three times a day and then just stop.
That's it for you.
That gets you into the habit.
And the most important thing we can do for cardiovascular disease is habits.
So that's one healthy lifestyle.
So eat moderately, eat whatever you want.
Within reason, right?
Don't eat too much of anything.
Don't eat too little of anything.
Have a well-balanced diet.
Walk regularly.
Do something for your muscles.
We know that the muscles are important in the body.
Keep that BMI down.
Okay, so that's the hardest stuff.
What's easier?
Go to your doctor.
Get your blood pressure checked or check it at home.
Buy a blood pressure cuff at home.
I love home blood pressure cuffs.
Check your cholesterol.
Check for your sugar.
That's the easier part than all of the healthy living.
Right, so that's like we're laying the foundation there.
These are the basics.
If you have a family history, then I want you to make sure that you were looking for those more family history related things.
So you both want to get those standard labs checked, but you also want to make sure they're checking that lipoprotein little A.
You want to tell them if I have a genetic family history towards this.
Can you check those labs for me please?
And push that.
If they say there's nothing special and they'll say no no, Dr Batt said on the Good Life podcast that there is something special.
Please get it for me right.
So that's kind of that next level, right?
Stress. is actually a big thing, and sleep.
So those two kind of also need to be in check.
Should you walk around and get a cardiac cath where they put a catheter into your wrist and up and take a?
No, not unless some doctor tells you.
Not unless you're having significant symptoms right.
Should you get a whole body CAT scan because you just want to know if you have heart disease?
Not great evidence that that's a smart idea as a screening tool, right?
Right now, the likelihood of you finding something that's significant, that you're going to intervene on, versus the money, the other stuff that goes into it.
Like at a population level, it doesn't make sense.
And do you want to find benign things that you didn't know you have that don't really matter?
You know, I don't know.
Depends on your level of health related anxiety, but most of us are pretty anxious about our health.
I would say it seems not very attractive to like do the boring things.
But in fact doing the boring screening weight, blood pressure, cholesterol sugars that is the best thing you can do.
And you need to do it all the time, like every year and ideally more than once a year.
Blood pressure right.
If I tell your listeners one thing, it's one out of two of them have high blood pressure, and the majority of them don't know it.
Go get your blood pressure checked today.
Get a blood pressure cuff at home.
Share one amongst your families or your bowling club.
It doesn't matter to me.
Check the blood pressure.
What about... testing for inflammation.
I know things like CRP, homocysteine are things that I'm hearing are more regular being included.
Do those have value in looking at on a regular basis?
We're adding them into the guidelines and suggesting that things like CRP and IL-6 would be helpful to check on, because if those levels are elevated, then right now what it does is it raises our or lowers our threshold for taking you seriously and getting all those risk factors under control.
Eventually, people will orient medications and diet and other things towards it.
But right now we're just recognizing that information really is important, not just for heart health but overall health.
And therefore, at some point, knowing what that is would be a reasonable thing for people to check.
Increasingly, people are using wearable devices to monitor all sorts of different things.
And among them we have heart rate, we have resting heart rate and we have this thing called heart rate variability.
Yeah.
Tell me about this and what the value is.
I'm a huge fan.
I mean, you can see the smile on my face.
I am a huge fan of wearables, right?
For the first reason is, gosh, it's our health.
So why we're going to somebody else to measure it for us, I don't know.
It's our health.
So we should be on top of it.
We should be our own kind of agents of our own health.
And in which case, we need reliable ways to measure it.
And the wearables of today are incredibly reliable.
They will really tell you What is your range of heart rate?
How is it going?
If you have three drinks tonight, what's gonna happen to your heart rate tomorrow?
It's gonna be higher overnight.
Your sleep is gonna be poor according to your watch or your ring or your mat or whatever you're using.
And it's gonna give you the signals that tell you hey, when you do this with your body, your body gets happier.
When you do that with your body, clearly it's having a physical effect on you.
And so it both tells you about your baseline, right?
Where do I live?
What's my baseline heart rate?
What's my HRV?
Mine and yours are different, right?
And very frustrating to me.
By the way, women's heart rate variability on average is lower than men's.
I'll tell you, I feel like I'm a very healthy person.
God, I really don't like looking at my HRV.
Like I'm not happy with what it looked like.
And so you have to know your baseline, and then you have to see what are the things that affect your baseline.
And that starts to give you some agency over yourself. hey, when I exercise, this happens.
When I eat poorly, this happens.
When I don't sleep, this happens.
When I'm stressed.
And now you can start to understand your own body.
It also means that let's go back to the beginning of this conversation.
When you are having an episode, a lot of these things won't catch a heart attack.
In fact, none of them are going to catch a heart attack, but they sure are going to catch.
Wow, your heart rate is through the roof.
What is happening?
That level of discomfort you're feeling is That's real.
It's not just in your head, right?
And so even those kinds of things are helpful for you to say, you know what?
I can listen to my body.
I do know my body.
I see how it responds.
Big fan of wearables.
If you're going to bring your wearable information to your doctor or nurse, please ask them how, because what I am working on really hard right now is to create a culture change in our country where we don't consider consumerism a bad word, but rather we consider consumerism as patient agency.
So we want the doctors nurses, health systems to say patients who are constantly monitoring themselves or who find this to be interesting.
Those are the ideal patients, because they're willing to partner in their care rather than be irritated because you printed out 120 sheets of your Apple Watch tracing and brought it in.
Like, please don't do that, right?
Talk to your doctor and say, hey, I wear an Apple Watch.
Are there ways in which we do?
We actually at American Culture Cries you created.
My team helped create the Apple watch guide, which is here's how you use it.
If you're a patient, here's what to not do.
Here's what you can do.
Here's what it can do.
And we're hoping to work with kind of more and more teams in doing that for the most common wearables to help it become part of population healthcare.
So huge fan of wearables.
Yeah.
I mean, that makes a lot of sense to me.
And we'll be right back after a word from our sponsors.
We're talking about sort of like the currently available standard of care.
And we're starting to talk about like more of the, what are we pushing the edges of here?
Like what is sort of like the leading edge of how we can get data.
That's really important to us to respond to.
Wearables are one part of that.
I know you've played a really major role in also bringing cardiovascular medicine to trying to really expand it to different populations.
Maybe you don't have a cardiologist or somebody who's very skilled in understanding in like a place that would be medical desert, for example.
What's happening there these days?
Yeah, yeah.
I started doing telemedicine long before COVID and people weren't very interested.
And part of the reason was the technology was still didn't have enough money put into it to be good.
It's much better now.
But the other is we didn't have reimbursement for it.
So if you're a doctor or nurse making a living by seeing patients and nobody's going to pay you for seeing the patient who's in the middle of nowhere, most of us who did that did it kind of out of the goodness of our heart or because a hospital backstopped our pay to do it, et cetera.
Right.
Now there are payment codes for telemedicine.
We are constantly fighting to keep them.
So that is a constant battle.
But the important part is, I think we've come to the understanding that there are areas of our country and the globe, but there are areas of our country that do not have specific versions of care, in this case, cardiovascular care.
In fact, they barely have enough primary care doctors.
And we're going to have more patients who need cardiovascular care and fewer doctors and nurses moving forward.
That trend is not changing.
So, with that in mind, wouldn't it be great if the people who have no access right now at least had some access?
And that's what TELS Medicine provides.
It provides a chance for us to educate into these communities, to have people feel connected.
It's where the remote monitoring and digital health also comes in, because I can't just look at you and know things.
But if I could have, you have a remote blood pressure cuff at home, a wearable even, that tells me some heart rates oxygen, other things about you and your home, then I can start to take more comprehensive care of you.
And then there's a third part which I'm gonna kind of enter into, which is AI, which I know we're gonna get there in a minute, but I bring it up now because there are a lot of people willing to be caregivers, who may not be people who went through nursing school or medical school, but are in the community and community health workers and people willing to provide this kind of care.
And now, with the advent of some of this generative AI, We can actually help upskill them to triage locally.
So now you can actually create a system where you have people willing to offer care in low-resourced areas like rural America who can be connected to us directly.
We can connect to the patient.
We can connect to the community health worker.
We can offer them more education and the right information at the right time, using AI and to help decide.
Does that patient stay at home and we take care of them there?
Does that patient come into the big city to get care because they're sick?
And now they're not dying at home en route, not making it, presenting to an EGAR, right?
Instead, we have a really nice system because we use telemedicine and remote monitoring and digital capabilities to reach into the ears of the country, where this is largely affordable the kind of things we're talking about as long as the payment codes are made.
This is fascinating, right?
Because now we're talking about saying, okay, we've got these two things happening at once.
One is the explosion of AI.
And I think two years ago we all just looked at it as a way to make writing easier or create fun goofy pictures.
Now we all know, or we're starting to know, that this actually has profound, profound possibilities on the educational front.
And that, especially in the world of medicine, AI is something that practitioners are going to be collaborating with.
But I think you're taking it to a different level here, which I think is really fascinating, right?
Because, at the same time, the other phenomenon we're seeing is the shrinking of highly qualified healthcare practitioners in parts of the country, although in parts of the world.
If I'm getting this right.
What you're arguing is saying, like if we take these two things and we say but we do have people, maybe with a minimal amount of qualifications, but who are ready and willing and want to play a role in helping,
And we can find ways or systems or processes to partner these with intelligent AI so they can work collaboratively like an AI enabled practitioner.
We may be able to solve this problem in a different way that was available to us five years ago.
That's absolutely right.
So first of all, I'm so excited because you used all my favorite words in one sentence.
The phrase I love is collaborative intelligence.
That's what it is.
And we can use it at any level.
You can be any level of training in anything.
Many people out there are already using it, right?
I may not be the best travel agent, but I'm collaborating with the AI to tell me what kind of a nightshare I should.
I put together.
Well, I actually want more of this.
I want more of that.
It's the same idea when it comes to healthcare.
So the phrase that you hear that scares me.
I just want to start with this is clinical decision support.
AI should not be making any decisions.
What we're offering is the human brain can only hold so much, even the most talented human brain, because the amount of information about each patient their social determinants, their wearable data, their health record data, the research on their multiple diseases there's no way in 20 minutes that I can optimally get all that information, put it together and say I know the best plan for you.
So I'm giving good care.
I'm not giving care with the same scientific rigor that I would have in the 1980s.
Because there was less to know.
There was less access.
It was easier to put it all together.
It was in one chapter in a book.
So what I like to call it is navigating to knowledge, which is can you use the AI to get to the right information at the right time to make the best decision?
Can we collaborate with that AI to help us make a decision?
And if it's me in an advanced setting, I may ask for different things.
But if I'm a nurse in rural America and I am caring for couple hundred patients over a couple hundred miles, then what I need is triage level care.
I have a feeling that this person is sick.
When I put this stuff into this medically approved large language model that will have been validated by the time they use it, it will say yeah, these are the few things I think could be too.
Do you agree?
And then you use your own clinical judgment as a nurse and say, yeah, this is the thing.
And then you send that patient to Jackson to get their care. right?
Whereas the other patient you feel good about.
You can kind of backstop that with some navigating to knowledge information, figure out what to do.
And so those are the kind of models that I think we should really think of, because the option is leave people with no access to any care or try our best to build a level of triage to start getting people to the right access.
Yeah.
Being able to do this would... really level the playing field in a lot of different ways.
And especially then if you couple them with a welcome basket of wearables.
That's right.
Yes.
No, this is the welcome basket of wearables.
Why do I love that?
I may still love it.
I'll give you credit.
But yes, there are companies that for a long time, we will send you a whole kit of wearables.
Insurance companies do this.
They will send you a whole kit of monitor your blood pressure, do this, do that.
And by the way, there's some incentives tied to that, right?
Then you get $20 for the gym each month or, you know, Absolutely.
Getting the wearables into the home.
And that goes to the wearable companies, which is, please make things really easy and user-friendly.
That is what we need, because the people using the wearables are, in fact, people who specialize in different things.
They specialize in automotives.
They're taking care of kids at home.
They're a lawyer.
They may not have medical knowledge.
And so the easier they are to use, the more straightforward, the more likely people are to use the wearables.
It's not helpful to send a basket of complex stuff to somebody's house.
It's just going to be a basket of complex stuff.
Right.
So this depends in part also on the availability, the accessibility of wearables and also that AI system that you mentioned.
We're not talking about accessing your generic chatbot.
We're talking about something that is very specifically and intentionally trained for this purpose.
How far are we from that right now?
Does this exist right now?
Yeah, we have it already.
There are numerous companies that have created large language models that are based entirely on medical information.
And what we're actually, we just finished writing is, we call it a prompt generation guide.
It's a guide for doctors and nurses to understand how to ask the right questions of the large language model to get the right answer.
Because any tool is only as good as the way the person using it, right?
And if you ask a question that's non-specific, you're in a non-specific answer and then that doesn't help you and you kind of move on and you're throwing the baby out with the bathwater and that doesn't make sense.
And so we're really working on teaching Clinicians of all shapes and sizes.
How do you ask questions in a way that get you an answer that helps you care for a patient?
How do you navigate to the right knowledge?
How do you combine the right knowledge?
And then luck always stops with the doctor or nurse or clinician, right?
It's always your decision.
You can take that advice.
You could not.
You have to double check it's right.
It might make mistakes still.
It is a computer.
In some cases, computers make fewer mistakes than humans.
In other cases, they don't understand nuance. or context or edge cases.
And that's where the human is really important.
Rare things will be harder for an AI to do and better for an experienced person.
Common things that I.
So if I don't know about needs for self, I don't know anything about ortho.
I shouldn't be taking ortho care for a person.
Let's just not go like way up, but let's say I was a primary care who kind of knew something.
I could get a little more knowledge.
That would just kind of sharpen me so that I would know exactly what the next thing is to do.
And those models exist right now.
And we're working on helping people teach people how to use it.
So the second phrase you use that I loved, in addition to collaborative for collaborative intelligence, is the AI enabled clinician.
That is what we are working on at the American College of Cardiology.
That's my baby, which is how do we not create a genre of doctors who are all completely all over AI.
I just want everybody to be comfortable using a technology that we really need because there's so much information that Yeah no, that makes so much sense to me.
And if you can empower nurse practitioners PAs EMTs, if it's the appropriate person to be able to provide a level of care that just it's literally.
Is that plus AI or just nothing?
That's huge.
Absolutely.
From an access standpoint.
Yeah, let's switch a little bit here, but I want to stay on AI and, rather than AI enabled practitioners and collaborative, I'm curious how AI may be influencing diagnostic testing.
One thing that comes to my mind immediately in cardiovascular domain is a test that I've seen pop up on my radar a number of times recently clearly which, from what I understand, is certainly taking some more traditional testing, overlaying a level of AI to analyze the data very differently and give sort of like next generation insights.
Where do you see the intersection between, on the testing side, AI affecting things, moving things forward, or just what are you seeing on the testing side that exists today, that is available and that is very cutting edge?
All right.
So let me tell you the thing that really bothered me the other day.
It turns out.
There's a really nice algorithm that tells you if you have liver disease, based on an EKG.
And I was like, hold on.
I don't think I want to know that.
I don't know what to do with that as a doctor.
I don't want to know that as a patient.
It was very interesting.
Now let's back out of that to AI right now is good at a few things.
So the first is it's been around for a long time.
It is not new.
The radiologists have been using some form of automation algorithms AI, to be able to read imaging studies.
And that's largely like here, computer, learn this x-ray is a pneumonia.
This x-ray is a pneumonia.
And you show them.
You know thousands of pneumonias.
And then the x-ray, and then the computer says hey, I can identify pneumonia.
And that kind of training has been around for a long time.
And actually, it's probably in wherever you're getting care right now.
There is something pre-reading a lot of your testing, and then the doctor's confirming.
So that already has existed.
Now we're getting to the point where AI can tell us things that we wouldn't necessarily be able to confirm with our own eyes, because it gets insights from how those numbers words graphs, signals come through that we don't see.
What's happening is challenging.
You can take two approaches to it.
One is, I don't know how it works.
I don't trust it.
I'm not going to use it.
I maybe used to be that approach.
Many of us did.
I have changed my tune.
Why?
As long as you know the data that went into the AI and that it's not biased, it's appropriate, it's clean data, it's real data, right.
So transparency on what a company puts into their AI, and then you see outcomes.
I find the cancer every time.
You find the cancer as a doctor for 50% of the time.
I find it 98% of the time.
Let's take ovarian cancer as an example.
We often find it stage three or four because it's just really hard to identify.
There's symptoms, but there are AIs now that are trying to train to identify that earlier, because it sees things we don't see.
I don't know.
It's a bit of a black box in between, but if you can tell me that you can find these patients and we can save their lives, then that makes sense.
And so that's the direction AI is going in.
And it's a bit of a leap.
But it also is such an opportunity to find people in the community with diagnoses that often present too late and find those people earlier.
And we're at a point in medicine where we can do that.
And just imagine all the people, if just anybody was listening.
Think of one person in your life who presented too late with blank
And what if AI had identified them earlier?
That's where we are now.
And that's the technology that is coming.
What we have to figure out is how do you teach people to use it?
When do you deploy it?
And once you find those patients, how do you make sure to get them to the right care?
You don't want to just find them and leave them there, right?
How do you find them, get them?
So we need an infrastructure that says, if we're going to diagnose more now I need to get you to the right doctor.
By the way, we just said we don't have enough doctors.
So if we diagnose more, what does it look like?
So now we have to talk about upskilling up-training, increasing our clinical caregiving workforce, while also working on having doctors and nurses go more to school, stay in school, stay in the career, et cetera.
It's so interesting.
I hadn't really thought about that, this notion that okay.
So as technology improves, as we get new capabilities to be able to diagnose earlier and more effectively, then chances are we're going to see a lot more diagnoses, which means a lot more referrals to then healthcare and treatment.
And if the people who are qualified and available to do that is actually shrinking and not growing, we're actually exacerbating an already really tough situation.
But we don't want to say the answer is, well, don't diagnose people earlier.
The answer is, no, do it if we can.
But we've got to have somebody to hand them off to that can take the baton from that point forward.
That's right.
Now, if you look at healthcare today though, you'll realize that there are a lot of people referred in who don't need to be.
There are a lot of people who get really anxious.
Probably happen to listeners right now, where you had something you got so anxious, you had to wait so long to see a doctor and actually it was nothing.
The flip side of AI is what about reassuring you that you are normal, right?
That could happen.
You could have a telemedicine visit saying, hey, the AI really says you're normal.
There's nothing I could do on an exam that would refute that.
I could see you sooner.
I could see you faster.
The AI could tell us that you're normal.
There is that other side of the negative predictive value.
This person with chest pain is absolutely not having a heart attack, Dr. Bhatt.
It's okay.
Send them home.
Again, I want to know the data that trained that AI.
I want to trust the company that made it, right?
And I want to see the outcomes in their studies.
That tells me if I send them home.
I'm really doing the right thing.
So they have a lot to prove if they're going to be a negative company, right?
It's easier to be a positive company.
You might have this. go check.
It's harder to be a negative company.
Your patient is safe, send them home.
But those companies are going to be really important too, because I'd love to know if I'm sitting in an emergency room for 17 hours.
I didn't need to be there.
I didn't need to be there for seven.
I would love to go home in an hour.
If you had a really trustworthy negative AI system that told me you are safe.
And so people are also working on that side.
And I think that'll help balance the burden a little bit, because we'll get the right patient's, the right doctors.
And if you open up some of that space because you don't send the patients that didn't need a doctor there now you've made their life better as a patient because they're not sitting in a hospital.
The doctor has more time.
And then the other part of AI we're not going to discuss today, but that exists is the efficiencies.
If the AI can write the note for the doctor by just listening to the conversation, then that doctor can spend more time with the patient.
I mean, it's interesting.
I've had two physician visits recently where And they both walked into the office.
They opened up their desktop computer.
They set it aside and said, hey, listen, are you cool if my AI takes notes for this?
And I was like, sure.
I mean, I use an AI note taker on a lot of calls that I do.
Again, I'm comfortable.
I said, is it secure?
They said yes.
And it was really interesting because then they could just sit there and talk to me.
And they weren't spending half of their attention constantly typing and jotting down notes.
And I feel like the impact just on the provider and patient relationship changes in a really meaningful.
Even with me, for somebody who I've been seeing for like a meaningful period of time, it is a really different experience.
And then the practitioner can actually just really pay attention to you, to like the nuance, to your body language, to the nonverbal signals, in a way where I have to imagine if half of your attention is on note taking, you're missing stuff.
Absolutely.
And I will, I'm going to, take liberty speaking for all caregivers everywhere.
Gosh, that's what we want.
We miss that.
For those of us who have been practicing for 20 years, like me, we've seen that evolution of spending time and looking people in the eye and having a conversation turn into get the notes done and see patients faster and type as much as you can.
And that's not great.
That's not what you went into medicine to do.
You went into medicine to do science, but to provide that science to a human sitting across from you where it really matters and and I'm okay sitting with a human across the screen from me where it really matters if it's better for you to be in your home rather than next to me.
That was a big leap, by the way, for me, the first time I had to really have a conversation with someone.
That was hard and I had to do it over a video.
I didn't want to do it to the point where because I wanted to hold their hand right, that this is who I am to the point where, when we were done talking, they actually thanked me.
They said doctor, but I saw how hard that was for you, but I didn't need to be with you.
I need to be at home with my family because I wasn't going to have surgery any other way.
I think when we sometimes we have to accept we're very afraid technology is going to get in between us and our patients.
These are two examples.
Telemedicine, where my patient got to be at home hearing tough news, not in a sterile hospital.
And you and your doctors making eye contact again, those things are made possible by technology.
I love that.
If somebody is joining us for this conversation and they're wondering.
Okay, so I get all the basics here.
There are some really interesting things happening.
And I want to know is there something where I can go in and have a concern that exists today as a diagnostic tool or a test that is breakthrough level in your mind, that maybe it's not accessible or affordable to everybody right now, but if it is, the information it will give you is game-changing.
Does anything come to mind?
Yeah, I have a favorite and I'll use no company name so I don't get in trouble with anybody.
But we in cardiology have been all about anatomy for a long time.
Meaning like there's an obstruction in your artery.
Let's go back to the beginning, right?
Artery blocked, right?
What percent blocked?
That's very anatomic.
But it turns out that a lot of arteries that have just a little blockage, that little blockage it gets so irritated that it ruptures.
We call it plaque rupture.
And so you have a tiny blockage, but then you have a heart attack.
We now have, using AI analytic ability, to say hey, that little plaque you have, that is an unstable guy.
He may only be 20%, 40%, but boy, he is rearing to go.
And then you can affect that by using certain medications.
Change the things that you do, pay attention to it.
And so now we have an opportunity to look at the heart using physiology.
How likely are you to have a heart attack from one of these blockages rather than?
Oh, you had a blockage, in which case I mean, it's all gone right.
Or it's small or it's big, but if it's big and stable, I want to know that.
If it's small and dangerous, that's the one.
I want to know that.
And so that exists.
We call it plaque analysis.
So we talked about plaque being that thing, plaque analysis.
And that's been enabled by AI.
So there are trials and studies.
This is available in some places.
Again, I try not to use company names, but plaque analysis is what people are looking for.
It's based off a CAT scan, actually.
So it's not even invasive.
Even put a catheter in your body to find it.
It's going to be game changing because now I'm always jealous of oncology.
I know not everybody gets their colonoscopy, their mammogram.
Please get your colonoscopy mammogram.
Everybody's listening.
But they've always been ahead of like, before you get disease, we are going to start screening you.
And in cardiology, we don't say before you get coronary disease, we're going to screen you.
We importantly say, let's check all the risk factors.
And that's what we started talking about.
But now we have a technology where we can say hey, if you've gotten enough risk before you get disease, I'm going to screen you.
And now you're not finding heart disease after the fact.
You're finding it earlier.
And then you're following it to know that you've made it better with your meds.
It is a game changer in the future of heart disease.
Yeah.
So these are currently available.
To your knowledge, are they often covered by insurance or not yet?
We are getting there.
We are getting there and that is happening.
And so I think you're going to see this evolving.
Just like in 2026, you're going to start seeing things evolve.
We're getting there.
So one of the things that's popping into my mind here and that is the other thing I feel like 2025 is a year where you couldn't stop hearing about two things.
One was AI and the other is GLP-1s.
Is there a role for GLP-1s in heart health?
I'm a fan of the idea of GLP-1s.
There are clearly significant benefits.
First of all, they get a lot of the things in check that are risk factors that we talked about.
Second of all, there's increasing evidence that it's actually also good for the heart.
Having said that, that's a conversation for each individual with their clinician and Because, as all things you know, medications have side effects.
They have rebound.
They have appropriate uses.
They have not very appropriate uses.
The GLP-1 groups that are doing this work.
They recognize that one of the things was kind of lean muscle loss.
Remember we talked about muscle in the beginning?
You don't want to lose lean muscle.
That was one of the things that the original GLP-1s were causing some trouble with.
And so I think they're trying to revamp that branding so that there's less muscle loss in the newer ones coming out.
I think it's a good drug.
I think it's important in the people for whom guidelines say you should use it.
I think abuse of anything is not ideal.
So we don't want GLP-1s to become the new laxative of the 1980s, right?
Hey, look, it made me lose weight, right?
We don't want to abuse things.
At the same point, we have a real problem with diabetes, obesity, leading to heart disease.
And so I'm glad that there are new classes of drugs. that are so effective.
And I think we're going to see a lot of evolution in that field as well.
You know, it's been all the rage and kind of the word that everybody's using.
And I think as long as we continue to stick by the science of it, we'll continue to make it better.
And yeah, I think we're going to see some heart health benefits downstream.
Yeah.
I mean, it's going to be really interesting.
I think I know that the next wave, also sort of like in the final stage of trials from what I'm seeing is, Is that being available, sort of like the next generation, but also in pill format, which I think will change accessibility in a lot of different ways.
It's going to be fascinating.
Absolutely.
If we look five years, five to 10 years in the future, is there something that you're looking at, that you're tracking, that you're aware of, but it is not available now, but you see it coming and you believe that this is going to be incredible.
Yeah.
I am not a data scientist by training.
I was a, biochemical major in college.
And so I understand systems and how they work and interact.
And I'm so impressed with AI's ability right now to see relationships between different factors, leading to an outcome that you see it in finance all the time right.
What's going to move the market?
How are these things going to interact?
And so for me the kind of the holy grail that I think is feasible and I don't know if we're going to get there, but gosh, I really hope so is assuming that we don't get to a place yet where everybody controls all of their risk factors before age 50 and there's no more heart disease.
I would love for that to happen.
It's not going to happen right now, right?
While we continue to work on that lifestyle habit prevention.
Most people over age 60 have two chronic diseases, and oftentimes one of them is a cardiac disease.
Many people by age 50 and above end up on multiple medications.
It is hard to afford medication to take multiple medications.
We need to continue to work on that side as well, right?
Affordability.
Assuming that also doesn't change anytime soon.
In our capitalistic market, what AI could do is tell me hey Ami, for you, your diabetes is most likely to affect your mortality, compared to this, that and the other thing.
But Jonathan, for you, we're going to see that this other thing is most likely.
So ideally, you are going to prioritize treatment of this disease over that one, over that one right.
And so it kind of helps us help patients understand what are your biggest, strongest risk factors.
Now, ideally, you'd say, but Dr. Bout, you're a doctor.
You want me to take all 17 meds.
Yes, I do.
But I know that you may not.
In which case, if I can double down on two diseases that I know are going to kill you, I will do that with you.
Now, you may say, I don't want to know it's going to reduce my lifespan.
I
What's going to give me the greatest morbidity?
My quality of life is going to go down from which one?
And I'll say, sure, in that case, it's still this one, but now it's this one here.
And maybe you should get your knee done.
That kind of knowledge about us as an individual, I am so excited for it.
And I think it's within reach scientifically to be able to take an individual and watch them and say these are the things driving your mortality rate.
These are the things driving your quality of life.
Now let's work together to make them better.
And maybe that'll actually give me a little incentive too for the healthy lifestyle things, knowing that, getting certain numbers in check or lowering my risks of certain things,
And I can see that.
So that's what I'm really excited for.
Can people make it scientifically?
I think yes, in five years.
Can we make it, package it, sell it in an affordable way to get it to people and then have people know what to do with it?
That's maybe 15 years.
Yeah.
These days, it seems like time is moving faster and faster, so who knows, right?
That is true.
Thank you so much.
I really appreciate your insights.
So much to think about and so much to look forward to.
Thanks for having me.
It's been great.
Hey, before you leave, a quick reminder that this conversation is part of our special Future of Medicine series.
Every Monday through December, we're exploring breakthrough treatments, diagnostics and technologies transforming healthcare from cancer and heart disease to aging, pain management and more.
Next week we're bringing you two fascinating conversations that will change how you think about the future of health monitoring.
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