There’s a phrase in cardiology: ‘Time is muscle.” The longer a heart attack victim has to wait for treatment, the more heart tissue dies.
Heart disease is the leading cause of death in America, according to the Centers for Disease Control and Prevention. Care for heart problems could soon be easier to get for people in rural states like Montana. Researchers are now testing a device that could allow physicians to remotely perform cardiac procedures using a robot and the internet.
“Rarely a day goes by that we don’t have someone in our emergency room that we’re at least evaluating for a potential cardiac problem. Often those turn out to be exactly what they have," says Dr. Greg Hanson, president and CEO of the 16-bed Clark Fork Valley Hospital in Plains. It’s one of the 48 Critical Access hospitals serving rural Montana.
“So the treatment folks would usually get in our emergency room if they’re in the middle of a heart attack is to use the so-called clot-buster agents as we prepare for them to be transported, most commonly by helicopter if weather cooperates, to one of the other centers where they can then see cardiologists and they can set a plan in place to finish doing the care that’s necessary.”
But in a rural western Montana community like Plains, time and distance are daily facts of life. Local ambulances are operated by volunteers who have to drop what they’re doing before they can jump on duty. Long distances are common and locating rural addresses can sometimes get tricky.
Throw in a crippling Montana blizzard and suddenly a lot of time has elapsed before a cardiac patient receives treatment.
"You look at the American Heart Association guidelines and they really want patients to hit a cath lab in under an hour as their target time after onset,” says Walter Panzirer, a trustee of the Leona M. and Harry B. Helmsley Charitable Trust.
The Helmsley Trust supports health initiatives in seven upper Midwest states and Montana. It’s granted over $3 million dollars to the Mayo Clinic to test a new robotic device that would allow a cardiac specialist to remotely treat a patient from hundreds of miles away.
“If you have a heart attack in, say, eastern Montana and you need a procedure like this, you would have to go to Billings, or Minot – this could be a game changer," says Panzirer.
Boston-based Corindus Vascular Robotics is developing the equipment, which relies on the internet.
“It allows endless miles between the operator and the patient," says Panzirer. "In theory, you could have the patient up in the space station and the physician operator down on Earth. It’s all done via the internet. It’s all done with very little latency. It’s just amazing how far technology has come to allow this to happen.”
Dan Spoon is the Director of Clinical Research and an interventional cardiologist at the International Heart Institute in Missoula, Montana, and he has hands-on experience with an early version of this equipment.
Spoon specializes in diagnosing and treating cardiovascular diseases using procedures including angioplasty and stenting.
“I actually know Corindus well. I was involved in using their equipment while I was at the Mayo Clinic in kind of a trial basis. When we did it we were in a corner of the same room doing the procedure using the robot.”
Spoon points out an angioplasty is made up of many moving pieces, including complex pre and post-surgery procedures that, for the foreseeable future, can only be performed by experienced physicians and nurses.
“Just like what we carried around for an iPhone or phone 10 years ago compared to what we have now is wildly different, I think this is just another step that, if we look at the benefits, if we try to use the strengths of the technology and put a system in place to use it effectively, it could be a very nice technology for patient care in more rural areas, absolutely."
How well would a device so reliant on high speed internet function in rural settings where service isn’t always particularly robust?
Spoon says, “It would be a very difficult time if in the middle of a procedure the communication stopped, and I think that’s something that needs to be taken into account when and if people are thinking about rolling out this technology.”
The Helmsley Trust’s Walter Panzirer confirms that redundancy question is actively being discussed. “Part of what’s going on with the FDA trials right now is determining what is needed for physicians and training nurses on the patient end where it's going to be remote. This is to be answered by the FDA and the Corindus company; they’re working on those issues,” says Panzirer.
Missoula’s Dr. Dan Spoon doesn’t seem worried that robotic surgeons will replace humans or disrupt the industry’s business model anytime soon.
“The business model of health care is a long and complex discussion that may need disrupting. If it could be disruptive in some way, to the benefit of patients and the community, I’m all for that.”
Helmsley’s Walter Panzirer predicts physicians will embrace this technology.
“There are shortages of physicians that can do this kind of procedure," says Panzirer. "There are shortages of cath labs, especially when you look at eastern Montana. There are none in eastern Montana. This isn’t going to replace physicians; this is going to save lives.”
There are still many unanswered questions surrounding this remote, robotic cardiac surgery program: equipment cost, which clinics would get them, the expense of the procedure and how, or even if, insurance would help cover the expense.
There’s still plenty of time to figure all that out. Preliminary tests at the Mayo Clinic should be complete by next year. More human testing comes after that and could take at least five additional years.
There are no guarantees it will ever make it to market, but Walter Panzirer believes the potential impact on rural health care is too tremendous to ignore.
“This is going to level the playing field. At Helmsley Charitable Trust we truly believe that it does not matter where you choose to call home," says Panzirer. "Whether it’s an urban city or a rural farm or ranch, everyone deserves access to equal quality health care and that’s what this new technology will do.”