Notes from the Field | The Future of Hypertension Management

Dr. Karl Schwarz is the director of the University of Rochester Medical Center’s Echocardiography Laboratory. He performs routine imaging and advanced imaging studies on patients with complex cardiac disease. Dr. Schwarz completed medical school, residency, and cardiology fellowship at the University of Rochester. Dr. Schwarz then joined the faculty at the University of Rochester Medical Center, where he is now also a Professor of Medicine. Dr. Schwarz also holds a position as a Research Professor in Electrical and Biomedical Engineering at the Rochester Institute of Technology.

Please note: The following interview has been edited for length and clarity. Any claims or views expressed by Dr. Schwarz are his own and do not necessarily reflect those of the company.

--------------------

Tell us about your introduction to Casana and The Heart Seat.

I'm a cardiologist at the University of Rochester, and I'm the director of the Echocardiography Laboratory. I've been the director of the Echo Lab for a little over 30 years. My original training was in physics; I've always been keenly interested in physics, electronics, mathematics, and chemistry. I did a lot of research on the basic physics of ultrasound and that’s how I ran into David Borkholder. David shared the idea of The Heart Seat™ and I thought it was a tremendous idea. I joined the team as an advisor and co-founder to help refine The Heart Seat design, and help prove the device has value in the clinic.

What made you think, “Wow, The Heart Seat could really change how we do things”?

First, when I tell people about The Heart Seat, I start off by describing what it does. It is capable of measuring a lot of different cardiac parameters besides the usual stuff that is now becoming more commonplace, like EKG and heart rate—there are a lot of wearables that do that now. Early data shows that The Heart Seat is capable of measuring things like cardiac output and cuffless blood pressure, which is unique. No other device like this does that.

Second, in medicine, patient compliance is problematic. For patients to follow a treatment plan, even taking the correct regimen of drugs, most patients don't do it. You would think, if you were sick, you would want to do everything a doctor tells you to do but there is a high percentage of patients that don't. The cool thing about a toilet seat [as a form factor] is that everybody has to use one. If we don't use one, we don't live very long, right? You don't have to convince people to use it. And everyone knows how to use a toilet. If a device is going to be monitoring the patient—let's say you are treating high blood pressure—and you're telling the patient to check their blood pressure every day, or every two days. Guess what? They almost never do it. Compliance is poor with that kind of stuff. But with a toilet seat, compliance is 100%.

How often do you see untreated or undiagnosed hypertension prior to a patient experiencing a serious cardiac event?

A ton. Hypertension is just so rampant, so as far as the number of patients that would fit in this category, certainly every new diagnosis [of heart failure or other cardiac diseases] would.

The typical story for a hypertensive patient is they come into the hospital or the doctor's office, you take their blood pressure and it’s high. I tell the patient that they should probably start taking an anti-hypertensive drug. The patient says, “I don't really want to start that right now. You know, I'm a little overweight, I'm going to lose some weight.” I send the patient off with some exercises and say, “I'll see you in three months.” The three months go by, the patient comes back and their blood pressure is just as high, maybe even higher. I say, “I'll give you this drug and I'll see you back in three months.” Another three months go by, and the patient's blood pressure is still high. I up their dosage and say I’ll see them again in a few months. Six, nine, twelve months have gone by before we finally have that blood pressure under control.

Explain how hypertension impacts a patient’s body.

Most people don't experience the effects of hypertension on a daily basis but high blood pressure is constantly wearing the heart out, pounding on the brain; it causes all kinds of havoc. If a patient feels fine, it's hard to convince them to follow a treatment plan. So consequently, people often don't know that they have hypertension until the damage has been done.

High blood pressure wears on the blood vessels in the heart constantly, 24/7. It’s analogous to having a little leak in your sink, drip drip drip… Not much, just a really slow drip, and you may think ‘no big deal, it’s just a little drip.’ But if you measure that water over the course of a week, let alone months or years, you'll end up with a flooded floor.

How do you envision The Heart Seat can help with hypertension management?

With The Heart Seat, I envision that blood pressure control for hypertension is not going to take weeks or months. Over a week, or 10 days, I can have a patient’s blood pressure under control because their blood pressure is being checked every day, with no effort on the part of the patient.

I believe there are applications for other diseases, too, like cancer. Currently, when a patient receives a dose of chemotherapy, we don't even know what happens to the heart. We check an echocardiogram every once in a while, but if you could check the cardiac output every single day, we might realize, ‘Wow, there are huge shifts that occur in the cardiac output zone.’ And maybe that's one of the reasons why patients feel so bad after chemotherapy?

How do devices like The Heart Seat fit into clinical practice?

As I mentioned, Cardiologists typically prescribe a course of treatment for a patient and then follow up with that patient in three, six months. Of course, we have no idea what's happening to the course of treatment during that time period in between visits. Certain disorders have a very short time fuse before the clinical situation goes awry, like diabetes. You can't treat it that way.

For example, you can't treat a patient newly diagnosed with diabetes by saying, “I'm going to give you 10 units of insulin every day” and then follow up with that patient in three months. You couldn't do that because the primary disorder and the treatment have very short time fuses for disaster; the patient could easily experience glucose levels that are too low or too high. You have to constantly check the glucose and fine-tune the treatment plan on an almost daily basis in order to achieve the appropriate level of glucose control. We really should have that kind of control over other treatments, but we don't.

This is the huge advantage of The Heart Seat that is above and beyond all other devices that I’ve seen, of any kind: it opens the door to daily management of diseases like hypertension and heart failure. I call it “the glucometer of cardiology”—the glucometer measures blood glucose in patients with diabetes and tells the patient what insulin dosage to take. I envision The Heart Seat will do the same thing for patients with hypertension by measuring blood pressure. This is revolutionary.


Are you a cardiologist or other clinician who is interested in learning more about The Heart Seat? Contact us here or visit our Research page for information on ongoing clinical research at Casana.

Stay in touch for the latest news about Casana.

Sign up for updates