Conceived in early 2021 to address the rapidly growing area of cardiovascular digital health, the inaugural HRX2022 meeting was held September 8-10, 2022, in San Diego and delivered its promise to be an "intentionally unconventional experience." Attendees, which included health care professionals, executives from industry, members of regulatory agencies, and others with an interest in cardiovascular digital health, participated together in an immersive experience that took place in a single room. Ultimately, over 500 attendees heard from nearly 100 speakers, listened to abstract presentations, enjoyed several fireside chats, and participated in a very engaging pitch competition.

The meeting was divided into three content streams; these included Health Tech: Digital and Beyond; Health Data: Acquisition and Management; and Digital Health Boot Camp. Rapid fire discussions and debate facilitated a thoughtful discourse between the speakers and attendees about the new developments occurring at lightning speed in cardiovascular digital health. A unique aspect of the meeting was that the streams were presented in a "silent disco" format, which allowed attendees to use headphones to access any stream without leaving their seat. The format facilitated collaborative discourse within a communal environment of stakeholders.

Specifics of these content streams include:

1. Health Tech: Digital and Beyond stream synthesized the current state of the digital heath industry with focus on available devices and technologies, regulatory insights, and operability. The speakers acknowledged that despite the technology currently available and large amount of information generated, the best approach to transform information into actionable data for efficient healthcare delivery remains undefined. The need for standardization, development of gold standards, and methods to evaluate the reliability of new products, especially those being sold directly to consumers, was recognized by both healthcare providers and regulators. Most importantly, the stream highlighted the huge disparity in the accessibility to these leading-edge technologies driven by economic status, gender and race and the need to proactively seek measures to address and mitigate this problem.
2. Health Data: Acquisition and Management stream emphasized the strengths and pitfalls of the vast amount of data being generated. Starting from the 1990's, remote device monitoring has grown exponentially with data showing increased convenience and reduced patient morbidity and mortality. However, this comes at the expense of data deluge, which strains healthcare systems and providers. The emergence and role of specialized companies to help triage data into actionable information was explored in depth. The wealth of data emanating from consumer wearable devices has only worsened the data deluge. This raised the need for reimbursement for the additional time imposed on physicians for data review and management as well as the need for setting up clear expectations from patients and providers. A fundamental question asked was "Whose data is it anyway?" and the consensus was co-ownership between practitioner and patient.
3. Digital Health Bootcamp stream provided a glimpse of future technologies and hands-on experience on what it takes to be part in this technological revolution. The emphasis was put on how to integrate artificial intelligence (AI) into the lives of patients to induce behavioral change, to help providers with clinical work and research, and to help make the electronic medical record more efficient and actionable. AI represents a welcome addition to clinician expertise alone. Many ideas were proposed for how best to incorporate AI into clinical practice and how to mitigate issues such as bias that may lead to inappropriate conclusions.

HRX2022 uniquely brought clinicians, researchers, engineers, and entrepreneurs together in a forum allowing close collaboration to explore and illuminate the past, present, and future challenges of medicine with an eye to how digital health technologies will drive further innovation and transform healthcare. This goal of exploration and transformation was further exemplified by the series of three fireside chats, pitch competition, and abstract sessions.

The fireside chats gave intimate and personal thoughts on digital transformation in healthcare from several perspectives. Omar Carter first courageously shared his journey as a star collegiate athlete and survivor of sudden cardiac arrest that prompted him to start his eponymous foundation with a mission to raise awareness and promote health equity by facilitating screening and teaching athletes about cardiopulmonary resuscitation (CPR) and use of automatic external defibrillators.¹ We then heard from Dr. Siddhartha Mukherjee, physician scientist and Pulitzer Prize winning author, on his views and insights on how data science and machine learning will revolutionize cardiovascular care delivery as well as a reading from his new book The Song of the Cell: An Exploration of Medicine and the New Human.²

Finally, Dr. Sumbul Desai, Apple Vice President of Health, discussed how to break down barriers between consumers and their health information with health care providers and researchers to better deliver personalized care with wearable technologies.³ In an engaging conversation Dr. Desai and Dr. Rod Passman, Professor of Medicine at Northwestern University, discussed the upcoming Rhythm Evaluation for AntiCoagulaTion (REACT-AF) trial, which will study the role of "pill-in-pocket" strategy for oral anticoagulation to prevent stroke in patients with atrial fibrillation (AF). The study, funded by the National Institutes of Health and supported by Apple, will use the Apple Watch to assess for the presence of AF in these patients. In response to a prolonged episode of AF, patients will be instructed to use oral anticoagulation for a limited period only, to mitigate the complications inherent to long-term use of these medications.

The first of its kind pitch competition allowed several early-stage digital health companies to present their innovations on using digital health technologies to promote education, AI to identify biomarkers of disease, and telehealth solutions to a panel of judges from industry and academia as well as the wider audience.⁴ The star and winner of the competition was Relay Response, a New York based start-up that provides phone- or smartwatch- based solutions to learn, practice, and enhance efficacy of real-time CPR for individuals and health systems.

An international group of researchers from basic science, clinical medicine, and industry presented 56 abstracts on topics including AI and machine learning, innovative wearable technologies, augmented or virtual reality, interoperability, and new care models facilitated by digital health tools.⁵ This amalgamation of the different stakeholders brought together at HRX2022 uniquely fosters a highly dynamic atmosphere that will cultivate new avenues of research, innovation, and collaboration.

The first HRX2022 was a resounding success. Plans have already been made to hold another meeting in 2023. HRX2023 will be held September 21-23, 2023, in Seattle.

References

1. Sudden Cardiac Arrest: A Survivor's Journey. Presented by Dr. Omar Carter at the Heart Rhythm Society Scientific Session (HRX 2022), September 8, 2022.
2. The Intersection of Cancer, Cardiology, and the Evolving World of Digital Health. Presented by Dr. Siddhartha Mukherhee at the Heart Rhythm Society Scientific Session (HRX 2022), September 10, 2022.
3. How Do We Empower People to Live at the Center of Their Health? Presented by Dr. Sumbal Desai at the Heart Rhythm Society Scientific Session (HRX 2022), September 9, 2022.
4. HRX Pitch Competition. Moderated by Dr. G Stuart Mendenhall at the Heart Rhythm Society Scientific Session (HRX 2022), September 9, 2022.
5. AbstracX Sessions at the Heart Rhythm Society Scientific Session (HRX 2022), September 8 and 10, 2022.

Clinical Topics: Anticoagulation Management, Arrhythmias and Clinical EP, Cardiovascular Care Team, Anticoagulation Management and Atrial Fibrillation, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias

Keywords: Artificial Intelligence, Atrial Fibrillation, Consensus, Data Science, Economic Status, Electronic Health Records, Health Promotion, Reproducibility of Results, Telemedicine, Technology, Wearable Electronic Devices, Biomarkers, Cardiopulmonary Resuscitation, National Institutes of Health (U.S.), Health Personnel, Defibrillators, Death, Sudden, Cardiac, Clinical Medicine, Machine Learning, Anticoagulants, Reference Standards, Virtual Reality, Physicians, Stroke

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