ESC 2022: In conversation with Philips CMO Alexandra Gonçalves on cardiac imaging

This year’s annual meeting of the European Society of Cardiology, set in Barcelona, Spain, carried a special spotlight on the growing power of cardiac imaging. Handheld ultrasounds, CT and MRI scans are offering new ways to see the heart’s inner workings. They are helping change the way clinicians track down cardiovascular disease and ultimately treat patients—whether they’re in the same room or not. 

We spoke with Alexandra Gonçalves, a cardiologist and Philips’ chief medical officer for precision diagnosis, on how tomorrow’s technologies are providing a new view into the leading cause of death worldwide.  

Conor Hale: With cardiac imaging being one of your areas of expertise, what have you been looking forward to most at the conference this year, or which studies have been a highlight to you personally so far?  

Alexandra Gonçalves: I have to say that this ESC has been very special to me, in what relates to Philips and me personally, because I'm a cardiologist and a cardiac imager and a believer in the power of the image to improve the way we treat our patients. And this year, we are getting more proof of the value of cardiac imaging in the journey of any given patient.  

Ultrasound, as an example, has been growing as the tool that can serve as the eyes of the cardiologist—and any given patient that undergoes a cardiology evaluation has an ultrasound these days. But having that in print, said loud and really understood as the way it should puts us at a different level, and it creates this demand of being able to provide quality ultrasounds for any patient, independently of the location.  

For us at Philips, that has been part of our focus, of our mantra, of our ambition to improve accessibility to this care, and one of the launches that we are showcasing here is Collaboration Live, which connects clinicians with an expert when using ultrasound, wherever you are in the world. 

CH: So how is the field changing, especially since the COVID-19 pandemic is now approaching three years? How hard has it been to train new clinicians in the field, especially in cardiac imaging, where a lot of heart exams—even if it's just a stethoscope—have largely relied on being in the room with the patient. 

AG: It's definitely changing, and these past two years have presented us with the opportunity to accelerate on that. It's not that physicians or the industry were not thinking of it or working towards it—there were too many barriers, and those barriers have not been totally overcome yet—but suddenly the circumstances showed the world that it was possible to do things differently. 

But there's a lot of different factors happening here. The patients are becoming more complex—cardiovascular patients are thankfully living longer, but they are living longer with greater complexities in their disease.  

Then, during the pandemic, people also understood they could have great quality of care even if they were not physically present with their physician.  

And third, the healthcare professionals are tired, right? The problem of the great resignation affects all sectors, and cardiology is not an exception. Healthcare personnel have more stress on them, even after these two years of incredible demand. 

That lines up with how we can help. There's a greater appetite for telemedicine, and there's a greater appetite for AI solutions that enable people to be more effective. One of the studies presented here at ESC was a proof point validating AI for ejection fraction assessment using echocardiography, which actually showed better results than an experienced sonographer.

So if we start with these mundane tasks that are repetitive, that are tiring and add on to everyone's daily routine—and if we show that we can do them more effectively—we can enable a better quality of care.  

That's part of what I'm seeing here. Three years ago, some people would look at us funny when we were describing that a patient might not need to come to the hospital, or that you might be able to communicate using a FaceTime-like tool to assess how a study is going.  

But we have this now for ultrasound, as well as CT and MR, to help the technologists have a better understanding of what's happening remotely. It's an enormous step forward, and it adds to the excitement that’s in cardiology today. 

CH: Do you think there will be a major difference in the next generation of medical residents that are now being trained in telemedicine and tele-ultrasound? Are they being trained how to respond to what they see on a screen, instead of how to deal directly with patients?  

AG: I think we have to do both, but I think you're raising a great point. The training has changed, and it has to change even further.  

It has to be mindful in how we communicate with patients because we are sensitive to body language. There’s all this indirect data that a healthcare provider or a doctor sees as the patient walks through the door, and it would be a risk to miss it. So that training has to incorporate that mindset: What are we missing when we are not face-to-face?  

And patients can be missing out as well, by missing that touch, or that pat on the back, or that engagement with a team conversation. The doctor-patient relationship is unique in that sense. But there's also so much the patient can be empowered to do when telemedicine enables the patient to do it at home, and while healthcare providers can be there to coach and support. The training of new residents has to bring in that understanding. It's not just understanding statistics, it's understanding the opportunities that data can bring.  

Ultimately, there's another factor that I think we have to be mindful of for this younger generation, which is the ability to balance personal life and professional life. I think it's more of a priority these days than it used to be in older generations for whom the career was life.  

I think we need to understand that the younger generation has more of a mindfulness on what quality of life is, so they are more open to pushing those mundane, everyday tasks onto technology. Because ultimately we are all human, but there are some expectations for healthcare providers to be a superman or superwoman, and that's very hard to achieve especially in a sustainable manner.  

CH: The ESC put out cardiovascular guidelines designed for patients for the first time this year focused on estimating personal risks and prevention, but it didn't go as far as recommending screenings before disease symptoms occur, such as with echocardiograms being performed at a certain age or risk level. But it still expressed the need for earlier diagnoses. Do you see the industry working towards some kind of age-based screening regimen in cardiovascular disease, perhaps similar to what is done in cancer with mammograms or colonoscopies? 

AG: That's an excellent point, and that's a point where there is an expectation that imaging will play a much greater role. 

So first, when we talk about age—I have been in different talks today when that point was discussed, in the sense of what does age really mean? Because there's the biologic age and there's the age on our identity card. 

A lot of us by age 70 may have better abilities than others at age 50, while some of us are building up atherosclerosis as teenagers. So how can we go beyond the description of age on an identity card, and instead get better at identifying who is at risk or who is protected, so we can intervene in a more personalized way.  

The trend we are seeing—and the evidence that is adding up—is relying on early assessments using imaging for cardiovascular risk. And CT has gained great adoption in recent years, and we are here presenting spectral CT for greater use in cardiology, so it complements our portfolio there as well.   

At the same time, you have ultrasound for assessing atherosclerotic plaque in the carotid or femoral artery as the first sign of atherosclerosis. I think we are approaching that level of sensitivity, but in this industry, what really matters is the accessibility of the tools.  

Cardiac CT, at the moment, is available if you pass certain gated points, but how could we make that more accessible earlier? Ultrasound will most likely be the prime diagnostic tool because of its portability and accessibility, and we are working on making it so easy that non-experts can implement it on a population level. 

That will help us have a more accurate assessment of our risks instead of calculating our age, our smoking or non-smoking status, our diabetes and our body weight. The genetics seems to be too complicated for cardiovascular disease—not as simple as in cancer, unfortunately, but that can be an opportunity as well. But imaging has the hope that we can do better.  

CH: Do you see scalability as the main potential for point-of-care ultrasound or handheld devices? Because before they were advertised as something you can carry around the hospital in your pocket, but without largely touching on scalability.  

AG: That's my vision. I think moving them around the hospital is a convenience, and it helps make the hospital workflow more efficient.  

But using the handheld device in a scalable manner outside of the hospital doors...even if we expand first to the outpatient clinic and then further to where people are—not necessarily patients, but people—that’s the ultimate vision of using a handheld device at its maximum level. Now it will take time to get there because it takes time to change practices... 

Yesterday someone put forward the question of how many more studies do we need to show the benefits. And one of the experts said, “Do you also need a study to show you that using Google Maps helps you arrive faster?” 

That’s one sort of reaction, but my reaction is that in today's world, we need to have proof points. I can agree that on one side there’s the voice of the person doing the experiments. But on the other side, there are the beliefs of the adopter who has never tried the technology before.  

And they won’t just try it out—to give it the time and attention we need, we need to have those proof points. Studies of cardiac imaging have to follow more of the rules set by drug therapies and interventional devices; they can apply to the diagnostic side as well. 

CH: So what is one of the main targets that you're looking to tackle in the next year? What's on the whiteboard for your team at Phillips?  

AG: One is to improve the overall workflow experience at the hospital level by having more intertwined connectivity and by maximizing the usage of the data we are collecting.

That can be described as improving the overall healthcare provider experience but also aiming to improve the outcomes—and that brings us to the introduction of artificial intelligence, with the goal of eliminating mundane tasks from the day-to-day overload. So that's the main scope of the year to come... 

Also, our ability to continue with the patient after they leave the hospital is an area of great potential, great interest and where we are interested in doing more. The healthcare journey starts at early diagnosis until the symptoms come and we treat it in the most efficient manner, but then the process continues.  

But in cardiovascular disease, the likelihood is that the cycle returns again. It's a disease that tends to cause a more permanent risk of having to come back to the hospital. How do we minimize the likelihood of a patient having to come back to the hospital—which is something no one wants, but we all need.

Editor's note: This transcript has been edited for length and clarity.