Cardiologists are missing critical opportunities to improve patient care by failing to adopt readily available tools for risk assessment and diagnosis, according to a prominent expert speaking at this week’s American Heart Association Scientific Sessions. Eric Topol, MD, founder and director of Scripps Translational Research Institute, outlined several underutilized practices that could significantly enhance cardiovascular health outcomes.
Topol, who received the James B. Herrick Award of Outstanding Achievement in Clinical Cardiology, highlighted specific tools that are not being used despite their proven value. These include exercise prescriptions, genetic risk assessments, portable diagnostic technologies, and the analysis of routine medical images for cardiovascular clues.
Exercise Prescriptions Should Be Individualized
Topol emphasized the importance of exercise prescriptions, stating, We should be … taking detailed histories of each patient’s physical activity and getting a very individualized plan for that person because it is driving healthy aging and cardiovascular aging in a very favorable way.
He noted that an American College of Cardiology scientific statement on this topic was long overdue. The scientific statement on exercise prescriptions was released in October.
On genetic risk assessment, Topol pointed to polygenic risk scores as an underused tool. Polygenic risk scores [are available] for all of the cardiovascular outcomes, but especially noteworthy is coronary artery disease,
he said. I still don’t understand why every patient has not [received], as long as they’re willing, their polygenic risk scores across all common cancers, atrial fibrillation and coronary disease. It costs $20 to do a [single nucleotide polymorphism] array. Unfortunately, there are companies out there charging $300 for what should be $20. This should be widely available, and health systems should be providing this to all their patients who would like to get it.
As one example, Topol said genetic markers do a far better job determining who is at risk for aortic dissection than the standard practice of considering an aorta wider than 5 cm as high risk and one narrower than that as low risk.
Portable Diagnostic Technologies Should Be Routine
Topol questioned why portable diagnostic technologies are not standard practice. Why aren’t we doing a six-lead [ECG], which takes a few seconds in every patient, with or without taking their pulse?
he asked. Why isn’t this routine? He also advocated for handheld ultrasound, stating, I haven’t used a stethoscope to examine the heart for over a decade. This is the modern stethoscope.
When asked about reimbursement concerns from other cardiologists, Topol countered, Well, do you get reimbursed for using a stethoscope?
Topol also mentioned that routine medical images can provide valuable diagnostic information for cardiovascular conditions but are not being used to their full potential.
