Your Heart Health: Telemedicine & Wearables’ Impact

Dr. Jeff Wessler

Thank you, Joel, it’s nice to be here.

Joel Kahn, MD, FACC

Thank you. We have a variety of people we’re interviewing and presenting on nutrition and heart disease and reversing with a plant-based approach, predominantly using technology like CT angiography and calcium scoring, and we’ve got people who are experts in diabetes, people who are fitness experts, and people who are experts in stress management. all the real pillars of cardiovascular health, but a lot of it is getting people to somebody who knows what they’re doing. You’re the expert at connecting because not everybody knows where to go. Not everybody knows a cardiologist. Not everybody wants to park and wait in a waiting room and deal with all of that and find out that their appointment got canceled and how the realities of day-to-day office life. Where along the way did you become so focused and then start up a company on what we usually call telemedicine, telehealth, or digital health? Where did that happen?

Dr. Jeff Wessler

So the right place to start here is back in 2017, which was a few years pandemic. I, like many other cardiologists who were starting to get this itch, thought that there was a different way to do early preventive care for cardiovascular disease. I took sort of this fundamental view that access and connectivity to the right care were one of these capital problems to solve. But each step of the way, our big answer was, let’s make it easier for patients and people who are at risk for heart disease to get the care that’s needed to both diagnose and then manage that early heart disease. So in the early days, that was it—a more modern cardiology practice. But now since pandemic and for the last three years, that has squarely been a virtual cardiology practice that uses telemedicine to have doctors and cardiologists connect with patients to give them that care wherever they are from their home without having to necessarily schedule and come in until that’s necessary.

Joel Kahn, MD, FACC

You are currently with a real company. You have real doctors. People are listening to this discussion who are interested in connecting with a cardiologist. I’d like to see everybody in America, but I can do it no matter how much. Let me ask you: first of all, there are physicians. How many cardiologists are there right now? I’m sure it’s growing, but they are involved with Heartbeat Health.

Dr. Jeff Wessler

We’ve now got about 100 cardiologists from across the country. I should make a note. We are not a direct-patient practice. We made the choice a few years ago to work through health plans and provider groups that were taking risks, which means predominantly the Medicare Advantage and Medicare space. It’s not a practice that if you’re a patient interested in signing up unless you do it in a few areas or a few regions across the US, you can do that. Yes, but that’s a big area that we’re thinking about and planning to move into in the next few years.

Joel Kahn, MD, FACC

So be driven more by an ACO and as it’s called, a health plan like the ones you mentioned, you’ve contracted with these bigger organizations.

Dr. Jeff Wessler

That’s exactly right.

Joel Kahn, MD, FACC

Is there a focus again we are on on Reversing Heart Disease Naturally Summit? Is there a focus on early and preventive care? What are some of those conditions as our highest priority?

Dr. Jeff Wessler

Big time for us. We’ve taken a fairly targeted approach to so-called early preventive cardiology, reversing heart disease. I’ll talk briefly about three conditions that we’ve seen work well for this. The first is arrhythmia. Most people at this point have heard of something called atrial fibrillation, or Afib, which is the most common arrhythmia. It turns out we now have amazing tools to detect that early and people who are at risk for it, everything from watches that you’re wearing to a patch that you can put on for a couple of weeks. We’re gathering a lot of data now that shows that if you find Afib early, then you can initiate the right therapy to get it under control and hopefully prevent those downstream. very devastating events like strokes, heart failure, and significant cardiac issues. That’s number one: atrial fibrillation arrhythmias. The second is structural heart disease, which is more commonly talked about as heart failure. We run what’s called a stage B heart failure program, which is the exact pathway we find. We take people who are at risk for heart failure through a diagnostic test to see if they have structural heart disease. That’s called an echocardiogram. then if they do get them on guideline-directed medical therapy, that prevents the progression of that disease, which in the case of heart failure can also be quite devastating for ten to 20 years of someone’s life when they have it, so early prevention or early therapy matters a lot.

Joel Kahn, MD, FACC

What are those groups that qualify for inquiry if they have structural heart disease? Weak hearts are on our charts. Flappy valves for people listening. What gives your panel of cardiologists a clue, if just a couple of examples?

Dr. Jeff Wessler

It tracks your common risk factors like high blood pressure, high cholesterol, metabolic syndrome, obesity, and family history. But then, importantly, there’s another test, a blood test that can be done in between that echo and it’s called the BNP. That is an early sign of a stretched-out or weak heart, and a combination of those risk factors plus that blood test qualifies you to get an echocardiogram.

Joel Kahn, MD, FACC

This is happening with a video interaction between a cardiologist and a patient who’s in one of these insurance programs.

Dr. Jeff Wessler

Everything starts with an analysis of your data, either via your medical records and the notes that you’ve had in the past or lab tests that you’ve had. Then you get a proactive outreach that says you might qualify for this program. Then you get on a video call with a cardiologist who walks through what is going on, what the options are, and why this might be relevant for you. Then, if you qualify, yes, you get an echocardiogram. The results are read and discussed via video call, and then the treatment has started being televised too. It’s, in many ways, in perfect condition. The early management of heart failure means that you can stay out of the so-called terrestrial cardiologist’s office for a lot longer if you get things diagnosed and started early.

Joel Kahn, MD, FACC

Now that I’ve been involved, I’ve done lots and lots of telemedicine, cardiology consults, and many other things. You and your team have done many things. But there’s always a skeptic. I do want to get back to A-fib heart failure and keep on going with the high-profile cardiovascular conditions you and Heartbeat Health are focusing on. People criticize you, but you’re not sitting face-to-face. What do you do with blood pressure measurements? There is no stethoscope. How do you address the skeptics who say this is cheapening the relationship, or maybe it’s inaccurate or something like that?

Dr. Jeff Wessler

There are three things to say about that. You’re right. This is why the skeptic is right to be skeptical because challenging new care models is important to make sure we get them right. My three points are, number one, that the tools have improved a lot. We can reliably check blood pressure from home. We can reliably get a rhythm strep from home. We can reliably see and hear a patient, and vice versa. The patient can hear and see a clinician now using the right video technologies, and we can transmit data. That has gone a long way to ensure that this is not an anonymous-to-anonymous note where you can’t see or hear what’s going on. The second is that experience matters a lot. One of the things we have found is that our best cardiologists are those who have been in practice for decades. This is where I wrongly went out with the hypothesis seven years ago that our clinical team would be staffed by these fresh out-of-fellowship cardiologists who were app users and very proficient with the technology. The opposite was true. Our best clinicians were those who’ve been in practice for 30, or 40 years, and now we’ve got this love of cardiology and massive experience managing patients. That translates to being able to quickly develop a relationship with a patient, understand their needs and goals, determine whether they are sick or not, and ask the right questions. of all the care relationships. The third thing, very briefly, is that physical care and traditional terrestrial care will always be very important and are always going to be here. We don’t discount that at all. Often, we will say, You do need to get in person to see a cardiologist for a physical exam or some specialized tests. that’s never going away. If nothing more, we provide this valuable service before that so that the people we do end up preferring for physical cardiology care are those who need it the most. That’s important for a system that is overburdened and understaffed for cardiology.

Joel Kahn, MD, FACC

I did it to sort of derail you, and I didn’t mean to do it. We mentioned that atrial fibrillation is a good clinical setup to potentially use Heartbeat Health and virtual cardiology. Then we got to people suspected of having a risk of congestive heart failure and applied an echocardiogram, BNP, or anything else on the list you’d want to say that you were moving.

Dr. Jeff Wessler

The third one I would just mention briefly is coronary heart disease. Coronary disease, the precursor to heart attacks, has so many exciting early diagnostics and early therapeutics in the pipeline that it is. Most everybody would agree that this will be the largest area of preventive cardiology over the next decade. This includes everything from the cardiometabolic side of the field with all of the new diabetic drugs that are proven to have amazing cardiovascular outcomes to some of the new diets that are transforming the way we think of early cardiovascular management. then on the diagnostic side, things like CCTAs or these advanced CAT scans that have AI algorithms on top of them that can examine directly for coronary disease decades before we would have otherwise. Then, not to mention lab tests that advance lipid panels like lipoprotein A and ApoB are fundamental for how we understand early precursors to coronary disease in a new way than we’ve ever done in the past. That’s an emerging program for us and one that will be growing rapidly over the next few years.

Joel Kahn, MD, FACC

All right. I know some people in your space who look for self-insured companies because they’re taking some or all of the risk. But is that who you identify with or it’s traditional insurance companies themselves or both?

Dr. Jeff Wessler

It’s a good question. We have stayed away from self-insured, which tends to map toward employers in the employer space. That’s been a business decision of Heartbeat Health, which is to say that we decided to start with the group that had the highest prevalence and highest need for cardiovascular disease, and that was the Medicare Advantage space. The commercial space, which is where most of your self-insured employers are, still has a high need, but a much lower need comparatively. That age skews lower. The general co-morbidities skew a lot lower. We see that as stage two, along with a direct-to-patient model over the next few years.

Joel Kahn, MD, FACC

Interesting. Is there any advantage? I know you’ve published a very interesting randomized clinical study of people discharged from the hospital with a cardiovascular diagnosis and being assigned to virtual cardiology follow-up and assess the impact that has on getting readmitted to the hospital, which is not what we want. We’re trying to reduce readmissions for the right reason: people are healthier. Is there some quicker assignment of a patient after discharge to a virtual cardiologist as opposed to an office for some reason that’s more efficient and speedy?

Dr. Jeff Wessler

The answer is yes. The main reason is that if you took the next thousand patients who were hospitalized for heart failure, and then tried to get them there, outpacing their normal outpatient cardiology appointments, half of them wouldn’t get that appointment within a week. Some of them wouldn’t get it within two weeks, and some would be months out. It’s a simple access issue that there are not enough cardiologists to see those patients. When you put on top of that a virtual care model that says we can staff that with a cardiologist in a different state or, doing something, working in an area that can take a visit now and again, then all of a sudden you open up the access and we can get people appointments the next day. That alone makes a huge difference to the outcomes over the next three months after you’ve been released from the hospital and whether you’re likely to come back or not.

Joel Kahn, MD, FACC

Maybe listeners don’t know that officially, you’re supposed to be licensed in the state. you’re caring for a patient. I’m practicing in Michigan. I need to be licensed in Michigan. People started calling all over the United States years ago and you’re having the same situation with Heartbeat Health. I am a typical cardiologist working for you. How many people can get licensed, and there are only a few licensed in 50 states? That’s a hard job. But what’s a typical number of states? Number one, do you cover all 50 states with Heartbeat Health, or not yet?

Dr. Jeff Wessler

We do, we cover all 50 states. We have a handful of super-licensed people like myself. I have 48 states right now. But the majority of our clinicians and our cardiologists have a regional strategy where they’ll have five states in a cluster, and another group will have another five states. That allows us to be a little bit more efficient about how we do this licensing process, which is administratively tough if you don’t have a strategy around it.

Joel Kahn, MD, FACC

I agree, it is tough; it’s expensive. There’s a lot of paperwork, and you have to do it all over again. When it comes time to reapply, I’ll tell you what: this has been fascinating. I want to go a little deeper with you on a couple more topics. But we want to say to our general audience that you’ve now heard from a cardiologist, Dr. Jeff Wessler, who’s leading the field in the United States in telemedicine for cardiology care, working with insurance companies. You heard that I happen to be a rather experienced cardiologist in the telemedicine space, doing it a little bit differently because all different models are going to come up. 

But they do afford just a tremendous opportunity to get the right patient with the right doctor, even if they’re not in the right city, as long as there is the licensing, the proper precautions, the insurance requirements, and the rest. There’s been a great quest there. Don’t go anywhere. I’m going to keep you here for a few more minutes for our general audience. Thank you very much for now. Being very educated in telemedicine. Before we go, please go over to heartbeathealth.com and look around a little bit. You might find out if you’re employed. Maybe your employer wants to associate with heartbeat health.com through their insurance provider. Again, we learned it’s not a self-insured company, and maybe some people listening are already aware of Heartbeat Health and are getting care through it. But thanks, Jeff. Don’t go anywhere.

Dr. Jeff Wessler

Sounds great. Thank you.

Joel Kahn, MD, FACC

All right. We’re back with Dr. Wessler from heartbeathealth.com. At this point, Jeff, this is your 100% activity in cardiology. You don’t have a separate practice in Long Island or the city of Manhattan.

Dr. Jeff Wessler

That’s right. I’m on the faculty at Northwell Health, where I keep my cardiology and in-patient cardiology skills up with that nice, good, good group there that we have. But I’ve dropped my private practice in New York in favor of Heartbeat Health activities.

Joel Kahn, MD, FACC

Excellent. That’s great. I just want to explore for a few minutes. We’ve not chatted with anybody at this Reversing Heart Disease Summit about wearables and technology. We talked a little bit about it last year with somebody I interviewed. What are your favorites? What do you use? What do you think will be most exciting in the future? And for those listening, that is a term for wearables. Whoops, Fitbits, Garmin’s, or Oura rings and Zio patches and cardios. Some of you don’t know what all those are, but let’s Dr. Jeff Wessler tell us what he’s using for Heartbeat Health.

Dr. Jeff Wessler

Let me start with a very brief overview of what wearables mean. I like to think of three classes of wearables. The first are consumer devices without any clinical approvals or clearances. These are things like activity trackers. Woohp is a good example. They do a nice job, and people seem to like using them, but they don’t come with any clinical studies demonstrating a clinical correlation to any outcomes or any clinical grade data. The second is consumer devices, meaning devices you can buy off of a website or in a store that does come with clinical relevance and clinical data. This has to do with their FDA clearances, which are based on studies that usually have either a clinical outcome or a clinical correlation to a medically prescribed device. The best examples of this are the Apple watches, the Withings Watch, which is a particularly strong line, and Fitbit, which now has one too. Samsung has one, too. 

The third is your clinically prescribed devices, which are also wearables, but you cannot buy them over-the-counter or temporarily at a pharmacy. You have to get those prescribed by a doctor. You mentioned one, the Zio Patch, which is a good example of an arrhythmia detection device that is probably the best in class right now for detecting arrhythmias. But you have to get that through a prescription, and it has to be sent to you. I should say that I’ve gone from being a real skeptic of the value of these consumer devices to now using them almost every day with our patients. The reason is that they are fantastic at motivating and providing a sort of self-motivation for your goals. When we were recommending an exercise plan for somebody who is at risk for heart disease and needs to change their habits around routine exercise, weight loss, or diet, these wearables were a very nice counterpart. They give you an objective measure that you can use. Patients will come to their visits, showing their results and watching their trends over time. It helps you validate what they’re saying about their exercise habits and then it also helps the patient know what to track week over week, rather than just a viewpoint that the doctor had said. I am neither commercially affiliated with any of these groups nor have a strong preference. I will tell you that the Apple Watch, the new Fitbit Watch, and the Withings Watch are probably my three favorites and the ones that patients like the most. They have the added benefit of having an EKG attached to them, which we seldom use clinically, but it provides a lot of reassurance when a patient can see that EKG and send it to us and say, I was feeling palpitations, so I took this. What do you think of it?

Joel Kahn, MD, FACC

My 91-year-old mother in Boca Raton is a whiz with her Apple Watch, and she can catch SVT and get a fast heartbeat on her Apple Watch like no other. She doesn’t need anything. If she can do it, anybody can do it. She’s pretty tech-savvy, but she learned nothing when she was 14 years old. as skills required, vital kind of area. We interviewed a top-notch sleep doctor specialist, Audrey Wells, and home sleep studies are certainly exploding. Is that something you’ve incorporated into Heartbeat Health? Do you have a favorite vendor, and what are you learning clinically from that?

Dr. Jeff Wessler

Yes, we’ve personally learned a ton about sleep and how important it is to diagnose and manage sleep. If you’re going to effectively manage cardiac disease, We will now routinely order home sleep tests on anyone with arrhythmias or heart failure, and vice versa. We will get positive sleep apnea tests being referred for heart failure evaluation and arrhythmia evaluation. I now think that these three conditions are all part of a similar spectrum. So they need to be managed together and diagnosed together. The world of sleep is a little different in that the technology is, I’d say, somewhat in its infancy compared to, for example, rhythm monitoring. The home sleep test devices are getting a lot better very quickly. There is also a whole new set of rings coming out that will probably be the gold standard in the next few years and replace a lot of the other devices. But right now, getting a home sleep test if you’re able to, meaning if it’s covered and you are capable of doing it, is so important if you’ve got a coexisting cardiac disease.

Joel Kahn, MD, FACC

Good. You are using them quite regularly. Any particular vendor brand that.

Dr. Jeff Wessler

You asked about that. What I meant to say is also different than cardiac: payers have their preferred vendor. We don’t have any over the vendor right now. That again will be changing as they onboard more and more vendors and more devices there.

Joel Kahn, MD, FACC

We’re very similar and aligned with what we’re doing, and you’re just doing it on a much larger scale and expanding, like typical cardiologists working with Heartbeat Health, like you 100% affiliated, or some of them have hybrids, or they still have their foot in their previous practice and hospital practice.

Dr. Jeff Wessler

Right now, the majority are hybrids. We have a core group of about a dozen people, and this is their majority gig. Then the 50 to 60 are hybrids who do part-time. Then we have another few dozen who are what I would call moonlights, who will read studies for us or do occasional night and weekend hours. But they still have a full-time other role.

Joel Kahn, MD, FACC

Good. It’s very exciting. You’re a real innovator. You’re creating something that’s going to change health care and is changing health care and can advance it because we got to get the right patient to the right doctor, and technology has allowed that to leapfrog, a waiting room. One of the greatest things my patients tell me is that I have 60, 70% live patients, but 30, 40% telemedicine, and those just love that. They’re never in a waiting room. Maybe they’re in the video waiting room for 30 seconds until you get them in. But they’re such a whole new thing. It’s much more efficient. They don’t have to leave work. Even I think that’s a little odd. We’re doing medical care when people are sitting in their cars on a break from work.

Dr. Jeff Wessler

We’ve seen quite a few bizarre television locations that are expected.

Joel Kahn, MD, FACC

There you go. I kind of like it. heartbeathealth.com. Everybody go over there and check it out. Dr. Jeff Wessler, thank you for your time. It’s a recording made this late in the day for both of us. We both probably had a pretty full day. Thank you for taking the time and educating us. That’s an exciting field.

Dr. Jeff Wessler

Thank you. I appreciate it. This is a fun conversation.

Joel Kahn, MD, FACC

Thank you.