Marla Miller 0:00

Welcome back to Open Minded Healing. Today we'll be talking about how you can incorporate rapidly advancing AI technology and hybrid care in order to become a better health advocate for yourself. We will also discuss why chronic disease should be managed at home rather than at the doctor's office or emergency room. My guest today, Dr. Ami Bhatt, is a board-certified cardiologist, as well as the chair of the FDA Digital Health Advisory Committee and the Chief Innovation Officer at the American College of Cardiology. She will be helping to translate dense science into everyday terms and sharing how digital tools and trustworthy AI can work for people who have struggled to either access, understand, or fully trust the healthcare system with a special focus on women's cardiovascular health. So if you want to take real steps toward better heart health and also become a better health advocate for yourself, you'll want to hear everything that Dr. Bhatt has to share today. Welcome, Dr. Bhatt. Thank you for having me. Well, I'm glad we're having this conversation because I'm probably one of those people that need to become more literate in the AI technology that is rapidly advancing. A lot of people are using this AI technology. Like through through Chat GPT or different ways regarding their health.

Dr. Ami Bhatt 1:39

Absolutely. For those who used to watch the show Friends at all, people often used to ask each other, you know, what do you do for a living? I find I get that question a lot. Like, what do you actually do all day? So I'm glad you started with that. Um let's just start with the the chief innovation officer for the American Cartilage of Cardiology. So I was a practicing cardiologist for many years. And uh one of the things that I noticed in my own practice is I was oftentimes really bringing patients to come and see me, either quite a long distance or quite an inconvenience, even if you lived a few blocks away. I remember there was one, she's a grandmother, and she lived right in Beacon Hill near Mass General Hospital. But getting down the hill in February, I mean, that was treacherous. The last thing she wanted was to break a hip, slip on the ice. And so even though she lived within walking distance of the hospital, for her, the idea of staying in her home and getting care, it was really safer, right? It was both more convenient, but actually better for her. And then take somebody who lives in Maine, somebody who lives in New York, somebody who lives in Western Massachusetts and has three kids and a dog and you know needs to do all the things that need to be done at home. And so I think the reason I go back to that is we talk about AI as if it is like some, it is new, right? But it's something like brand new and it's going to change everything. And I will say that our march towards AI started years ago when we really came back to the fact that going to someone's home with a kind of a black bag as a doctor is the way we started medicine. And then because we got so good at treating really complex diseases, it became a hospital-based profession. And we finally, over the past decade, have extricated ourselves from the idea that only good care happens in the hospital to recognizing that actually we need to start the first mile of health care in the home where people live. So video visits, which became, you know, very popular during COVID for obvious reasons and have stuck around. And then thinking about, well, what's the data that you can have at your own fingertips? Right? Do you have your own data? And do you have it from the hospital because you have a portal? Do you have it because you're wearing wearables and you know things about certain days I sleep better than others, right? What's happening to me? Or do you go to your local CBS and get a blood pressure? And do you keep a log for that? And how do you keep track? So there's so much that happens to you in your life, in your home, related to your health, your well-being, your mental health, right? Behavioral health. What else is going on? Do you have enough money to go to Whole Foods? I mean, sometimes nobody does, right? One of my friends calls it whole paycheck. But anyway, this is right. So, like what is happening in your life that is affecting your health? And so we're not suddenly upon AI. The idea of giving care in the community, of patient data being really important, of using that data to care for yourself and of picking up on when you're not at your own baseline and recognizing that then you might need care. We've been moving towards that steadily. And so that's that first part of AI, which is you and I have different blood pressures, most likely. And my blood pressure may not be normal for you, and yours may not be normal for me. And we'll give a number, as the American College of Cardiology or the American Art Association, you know, we'll all give numbers. But at the end of the day, if you did a little run-in of blood pressure on me for two weeks and you for two weeks, we'd know our baseline blood pressure. And then if we kept measuring, we'd know when we're out of range and we'd say, hey, I'm out of range, and by the way, I'm really exhausted or I have headaches. Like this all tracks. Should I go get attention? And so that is the first use of AI and data, which is knowing how you're doing a baseline and identifying when you need care. It's pushing all of the care back to the Black Bank document at home. And I think that's so important. The second part of AI is now what do you do? How do you understand what's wrong with you or if there's something wrong and who you need to go see? And from a clinician or a doctor or nurse standpoint, can I really take all the data that's out there in the world that's applicable to you, Marla Miller, in the next 15 minutes and give you the best care possible? No, because there's too much data now. There didn't used to be this much information or knowledge or research. And now there is. The human brain can't actually take all of that. So computers can. AI can. It can go through all the data and say, hey, for someone like Marla, with all of these things I see about her, here are the things that are probably most relevant in her care that you want to know, Dr. Bhatt. And then I take that and I say, okay, what will I do with this? So the computers aren't meant to replace anyone, but they're meant to give patients a sense of agency and empowerment. I know my numbers, I know when my numbers are off, I know when I need help. And then give both the patients and whoever the caregiver is, whether it's a community health worker, a pharmacist, or a doctor, the information that says, if Marla's coming with this kind of a thing, here's some things I want to make sure you don't miss. It may not be comprehensive because you and your experience may know things that I don't. But let me tell you the most common things. And so I think that's that's the magic of AI. And that's kind of what I work on, study, work with companies on, do systems. And that's what my team works on is how can we really create an infrastructure, create a fabric where that's something that everybody can understand and use?

Marla Miller 7:01

Yeah, I just like that idea of it gives you a lot of direction, you know, pinpoint some specific things that could be checked by the doctor instead of going in and I would imagine it would save a lot of time, like filling out all the forms and absolutely. It might help the doctor a lot to have that free information.

Dr. Ami Bhatt 7:24

And it might help us because I don't I don't know about you, Marla, or our listeners, but how many times have we gone to a hospital and we've given them the same information and filled out the same form like five times? And so connecting those data systems, right? Like that kind of stuff, the background stuff that we don't even need to know engineer AI. Like we need the practices to learn that stuff, right? And hook up that information and make it available when we need it. And so a lot of that, that back office administrative stuff, so important for us to be able to use AI for that.

Marla Miller 7:57

Yeah, I think that would be so helpful. Yeah. So, with the work you do, you're helping to create these devices as you see a need, or yeah, what is your work?

Dr. Ami Bhatt 8:09

It's a great question. My real focus and this overlaps between the FDA role for digital health and my ACC role and just my belief as a doctor. There are so many great technologies. And because we're all so busy and science move so fast, a lot of technologies end up just sitting on the shelf and not getting used because we can't figure out where they fit. How do you educate people about them? Both the doctors, the patients, right? The systems. And so most of my work actually is taking really good technologies, generally ones that are kind of FDA approved or on that road, and figuring out who's gonna best benefit from this. How do we find those people and get these technologies matched with those people? And then how do you educate both the clinicians, the doctors or the patients, doctors or the nurses, and the patients about the new technologies? Because that's scary. None of us are, you know, I don't have a degree in AI, and most of us don't. Um, maybe the next generation will, but the majority of us don't know a lot about this. But the nice thing is, as long as the scientists who know about it are designing it well, what we need to know is how do you use the tool? And so we used to watch videos on VCR. Then we learned how to use Blockbuster and, you know, get things and return them. And now we have Netflix and we figured out technology in regular life. We all started to use different things. And so we're just trying to do the same thing in healthcare. What are the right technologies for the right people? And then how do you teach people? Really give them both health literacy, like learn about your disease, especially cardiovascular disease, because it's preventable, number one killer of Americans, and it is preventable cardiovascular disease. And then how do you teach them some digital literacy? Um, and a lot of that is not you need to be expert in AI. It's, oh, look, this is like a new system. Here's how I log in, here's how I use it, here's where it is. And it's more of that.

Marla Miller 10:10

So, what are some of these different technologies that you're speaking of, like the wearables and different things?

Dr. Ami Bhatt 10:17

Yeah. So I have a lot of favorite things, and I won't mention companies per se. So I think, you know, being able to wear something that helps you figure out your steps, um, what it's like when you exercise, being able to measure things like your heart rate, um, measure your sleep overnight, you know, I think that's all really helpful. It doesn't have to be the exact number. I always feel this strongly. It's not the exact number, but it's your trend when you're at baseline and when you feel off. Because one of the biggest things about life and health and anxiety about health, which many people have, right, is I feel off and am I just exhausted or something really wrong, right? Or I feel off and look, my wearable tells me I am a little off today. Okay. Like I feel justified that for whatever reason, like I am not my perfect self today, and that's okay, because clearly there's something really physically going on, and tomorrow I may be better. Or gee, this is continuing to get worse. I should probably call somebody, right? This is going the wrong direction. So I like the idea of if you're somebody who likes to measure, getting to know your own self and your body and your own symptoms that correlate with it. I don't want people to be numbers people. Hey, my numbers this today, my numbers that. I want people to say, hey, I'm in my range, I feel good, or I'm out of my range. I wonder what I did to feel better, I wonder what I can do to make myself feel better. So I love wearables in general. Then a second area that I think is really interesting is this voice-to-text technology, which is if you and I are having this conversation, someone can actually write a note based on it. And I love that for the doctor-patient encounter because I am tired of facing away from my patient and typing on a computer. Like that is not why I went into medicine. I went into medicine for eye content, right? I want to be there with my patient. And I don't want to be with a computer, and then my patient is an afterthought. And so I think that voice-to-text technology of being in the office and and you have to make sure that it's private, HIPAA secure. But generally, if you ask your doctor's office and if they've put into place, they've probably done all that homework already, but it's worth asking that your information remains private. It just about always does in a good system. And so that really enables you and the doctors and nurses to have good conversations and let all the paperwork get done in the background. So I love it for that. And then the other is what you started with talking about large language models, right? This ChatGPT. Now there's Chat GPT Health, there's Claud Health, there's all these different things. There's health-specific ones, by the way, that actually are built on medical knowledge that are private instances where if your doctor uses it and puts information in there, your private information is not going anywhere. So there are health-specific models out there for doctors and nurses and pharmacists and others to use. And I think some of those will, you know, eventually come to the doctor-patient encounter. The thing I say about it is this.

Marla Miller 13:09

Are you saying, I'm sorry, are you saying there's a health-specific chat GPT correct that people can use in general?

Dr. Ami Bhatt 13:18

There are chats, there are health-specific chat GPTs that are private, that are safe, that clinicians use. So you have to be a doctor or a nurse or a pharmacist to use it. I think eventually there will be models where you can use it along with your patient. I'm sure people will move in that direction. And so it's important to know that we're building models. Like ChatGPT Health and the others are trying to create an environment for patients to directly ask for information. But what I don't want to do is I don't want to disintermediate or separate the patient gaining information from the doctor who needs to treat them, right? I want to keep those two together. I want to use large language models to help bring patients and clinicians closer rather than drive them apart. And so that's really a key focus. I like large language models, but I want them to be used to do more what we call shared decision making. Like here, I can help you better understand something. Maybe I'm a good teacher. I think I'm a good teacher, but Chat GPT could make me, and I use that word to just mean large language model simply because you did. But large language models could maybe help me explain it a little better, right? And maybe it could make a picture if I'm not a great artist and show it to you with an infographic because maybe you learn visually and not by listening to me, or maybe you need to read it. And so I think there's such an opportunity for us together as patients who want information and clinicians who want to get the right information to patients to use large language models to help that discussion. And I think that's the direction we need to go in now. We're at an inflection point where we risk patients running in one direction with, you know, we used to say Dr. Google, now we say Dr. Ted GPT or whatever, right? And then clinicians going in a different direction, using it for all sorts of really complex things. And what I want to do is I want to bring everyone back towards the middle. How does a large language model help you and your clinicians and your team and your family and your caregivers better understand what's going on and talk about together? And I think that's the opportunity that I'm most excited about.

Marla Miller 15:23

Yeah, that would be great to bring them together, but give a lot of power to the patient so they understand even what questions they want to ask the doctor when they go in.

Dr. Ami Bhatt 15:35

That's right. That's right.

Marla Miller 15:37

And then to have the doctor be on your side and be able to help you implement because chat GPT can tell you some things to do. Say it said take a supplement or something, you know, and you take it, but you need someone also there monitoring maybe the effects or seeing things that you don't see.

Dr. Ami Bhatt 15:57

I think there's um, there's like three key things I think about when I think about AI, right? Which is the context of what else is going on. Like what is going on with Marla Miller, other than the one question she's asking a computer. Like that's not something that an AI knows, but that's something that another human in discussing with you could help you suss out, right? I think the second part is um a little bit of the nuance. Like you may say something, and large language models are simply, hey, this word usually goes with this word. And so if you have dog, you pick puppy. But actually, no, I was looking for dog and cat, or I was looking for puppy and kitten, right? But that's not what came up. And so it may send you in the wrong direction. If you don't know exactly what you're looking for, you may come up with answers that are right, but not right for you. And so that's again where you need to be having a conversation with your clinician about, you know, what is right for me. And then the last one is edge cases. What large language models do is they say, most frequently we see blank. Not everybody is most frequent. Sure, most frequent means like, you know, there's a bell curve and 50% of people or whatever fit in the middle of it. But there's a good number of people who are a little bit different. My disease is a little different, my symptom is a little different. We don't want to miss a woman who thinks she has bad heartburn who's actually having a heart attack because she's not a man with typical squeezing chest pain, left arm weakness, and tingling, because that's the thing that's all over the internet. And so that's the thing that the internet pulls up on, and they say, oh, well, the woman probably ate something spicy, right? Or maybe she has some anxiety and all those kind of things that also exist, unfortunately, in our data. Those kinds of stories exist. There's been some bias as to women's symptoms of heart attacks being not classic like men's and being missed. Well, the large language model is just learning based on what's already been done. And we haven't been doing a great job because cardiovascular disease is still the number one killer of women. So the data that it's based on is a little bit skewed. Maybe a lot skewed in certain cases. So I think it just brings me back to I love the idea of thinking about it not as consumerism, but as patient agency. I'm gonna wear the wearables, I'm gonna use the Chat GPT, I'm gonna do the other things, right? But I'm gonna do it in the context of recognizing that I'm trying to improve my own knowledge base to help me have a conversation with somebody who can then help me do the next step. And for part of that, my job is to go to the clinicians and say, hey, which of these things do you like the best? What works the best? What's giving us the best knowledge? Because let's direct our patients to the wearables we like the best. Let's direct them to the version of a large language model that, you know, is really creating the best relationship between us. And so that's the next job for us. We call it collaborative intelligence, which is clinicians and patients really testing out these things and not being like, oh my God, this is so great, but rather saying, hey, this was wrong. We got to do something about that. If you want me to use your thing, if you want advertisers to pay you, I demand more from you. And I think it's time for us to kind of really interact with the tech industry and demand.

Marla Miller 19:12

Yeah. Well, we talked about the wearable that monitors your steps and maybe heart rate, things like that. Are there any other devices that you found are helpful?

Dr. Ami Bhatt 19:23

So there's quite a few. So maybe I'll just name some, not because I'm trying to advertise for them, but just because for the audience they might be familiar, right? So the Apple Watch has FDA clearance for finding something called atrial fibrillation. It's an abnormal heart rhythm. It can be a risk for stroke. We ended up creating a guide for the Apple Watch. And the reason we did it is a lot of people just started recording things all the time and bringing them to their doctors. And the doctors were like, This is too much paper. And the patient said, Is any of it dangerous? And so finally we create a guide like, hey, if you're going to use your data from the Apple Watch, please bring it in this form to your doc, right? Like, please think about these things. Or to the doctors, here's the scientific research behind a couple of these features, and here's the other stuff that it does, but you know, maybe it's not yet FDA approved or they're moving towards it. And so we really tried to clarify what that wearable does because people were already using it so much that it was coming up. I think similarly, there's a lot of other things people use. There's a lot of people who love the whoop band. And so people will use whoop and it'll tell you things about your heart rate. It'll tell you things about your sleep, about your exercise, recovery. And so you see a lot of people wearing that and talking about, and again, that's really great for what is my baseline? And when am I off baseline and what activities are there? And I think they do a good job of education too. At the same time, they give you numbers. Why are we measuring this? What can you do? What are your habits? There's some that are like the Aura Ring. I was on a panel with Tom Hale, the CEO of Aura, and that's a little bit different, but also similar. It also gives you heart rate stuff. It can do some sleeve stuff. And so there are all these different things out there. Some have FDA approval for some elements, not for others. There's a new actual device that you could put on your wrist that tells you your real blood pressure all day long. Real blood pressure all day long. This, I think, is a new era of remote monitoring and wearables, which is giving you not just trends, how you're doing, do you have something diagnosis or not, go follow it up? But hey, I have you on a blood pressure medicine, and now you wear this. And does it accurately tell me if my blood pressure medicines are working for you, if I need to increase or decrease them? That's the next round of studies that are coming. Is can you use some of these things when you actually have a chronic disease? And you know who's done it is diabetes. Right. So the chronic glucose monitoring, you see people sometimes wearing them on their arm, the little white thing tells you your glucose. So there's a lot of things that we can measure. There's temperature socks, this really cool thing. Some people are what we call peripheral arterial. Disease, not enough blood flow down to their legs. You can actually end up getting ulcers in your legs. And some people can even get amputated from peripheral arterial disease. And these temperature socks can actually feel the temperature in your skin dropping when the blood flow decreases somewhere and know that you're at risk of developing an ulcer. So the technologies, there are so many, Marla. But the key for us is which are the areas of population health that are the most dangerous? Blood pressure is high in one out of two Americans during their lifetime. We've got to attack blood pressure, right? Atrial fibrillation can give you stroke. Now I'm a cardiologist, so of course I'm a little biased in the things I'm saying. But let's say asthma, right? Really important to think about. And so what are the more common diseases and can we get some of these technologies out into patients' hands and help them learn how to use them so that they can help themselves? And I think that's what I'm excited about. So there's a ton of cool things, but I think at some point we also need to focus on the right population for the right thing. So we shouldn't sell temperature socks to everyone. Makes no sense. But if you're somebody with peripheral arterial disease, and if you're potentially on the road towards ulcers or something else, then that kind of estate may be good for you. And by the way, I don't actually remember what this company was, but I just saw it and I thought it was kind of interesting. I haven't really read the research on it in depth yet. But there's a lot. There's a lot out there. And I think if you find something you think it's interesting, deep diving it, not a bad idea. You could ask one of your large language models, what do you know about this company? And if you're going to do that, please ask the large language model to be tough. So large language models love to be nice to you. They're built to be nice to you. They'll be really sweet. And so I always start with my large language model. If I'm typing something into ChatGPT, I say, hey, be really strict with me about this. Tell me the things that I could be missing. Um, don't make this sound like an awesome idea. Tell me what I could miss. And then I say, I heard about this new technology, blah, blah, blah. Here's a website. And then just see what it says. And then maybe bring that information if you think it's relevant to you, to your next visit. Um, and the thing I always tell people is if you're going to bring that kind of information from Chat GPT or Dropback or Claude or Gemini or whatever, um, please give your team a heads up in the patient portal. Hey, I have a visit coming up in two weeks, and I've been looking up this stuff using this large language model. Um, I realize that we don't have a lot of time, and you probably have actual health things you want to cover with me. But if someone in your team can talk to me about this, it would be great. That's a good idea. Just give us a heads up. Then we don't feel blindsided by, oh my God, another person looking at Chat GPT and asking me a question. And I have to manage her diabetes and her asthma right now. I don't have time for it, right? We don't want to set up that kind of relationship. We want to preempt it with this is something I'm interested in. Could we find time either at that visit or offline, or do you have somebody else who could talk to me about it? And that's really helpful to us.

Marla Miller 24:54

Yeah, that's good. I can imagine you have a lot of people coming in with Chat GPT ideas, um, which, like you have said, you know, can be helpful, but yeah, could overwhelm the system. Yeah, I guess with the limited time that people generally have with their doctor.

Dr. Ami Bhatt 25:13

And if you do have, if you know you have some anxiety, and if you do know you have health-related anxiety, then be careful what you're asking, right? Like be aware of what you're asking. Um, be aware of what you're measuring, right? Because we don't want to ask things that are not relevant to us and then go down the deep dark hole of like this is terrifying. And this was true with search engines as well, right? It's no different now. It's maybe feels a little bit easier with ChatGPT, like you're talking to someone and they're giving you information, and maybe they're getting more information than the typical search engine did. But the idea is no different. When we first started to, you know, Google for things that became a verb somewhere around the along the way. That was the same thing as, oh gosh, like I have a cough. What could this be? And all of a sudden you think you have lung cancer, and in fact, you have a little bit of asthma or you have postnasal drip. Right. And so just be careful when you're looking at a field that's not your own, because a lot of us have health-related anxiety. It's really very common in the population today. Anxiety is rampant in the United States. So just try not to make yourself feel worse if you know that you're headed in that direction. And seek health, force, please.

Marla Miller 26:23

Yeah, that's a very good point. Yeah. Well, so I want to talk about two different things, but one would be heart health and how people can really look out in the best way for their heart health. And the other I want to get to is the chronic illness. Yes. When someone has a long-term ongoing illness, how can that be better managed?

Dr. Ami Bhatt 26:46

Yeah. Let's start with heart health. Um, so the most important thing about heart health is kind of knowing your numbers. So it's important to know your blood pressure. Um, it's important to know your cholesterol levels. Um, it's important to know your glucose or hemoglobin A1C or whether or not, you know, you're where you are on the range of no diabetes, prediabetes, diabetes. So the numbers are important. Managing your weight is important, right? Because we know that higher weight will oftentimes relate to more likely to have blood pressure, more likely to have diabetes. And so watching your body mass index over 25 is overweight, over 30 is obese, is kind of important to recognize. And with some people, as we grow older too, truncal obesity, the size of your belly actually matters. So even if your body mass index is low and you have a big round belly, that is a place where adipose tissue and fat can set your body off a little bit. So I would say know your numbers is never what? Check those things. And that's one place where you can actually go online, look at American College of Cardiology, American Heart Association. They'll tell you what ranges are normal. Now remember, all of us probably have a slightly different range, but at least you have an idea. Like, do I fall into a safe range or do I fall into a range where like this might be a problem? I should bring it to my primary care. So that's number one, know your numbers. Number two is know your family history. So please ask around. And I know sometimes families are strange, people are adopted, but if you have family that you know of, just find out. Those people who had heart attacks at a young age, you know, younger than age 50 and strokes. Um, there tend to be a couple genetic things that run in families that can give you a higher risk of cardiac disease. And so just know your family history. That's helpful, right? What are those things? And so some types of cholesterol that can be high actually run in families. And so that's probably the most important one. Other things, blood pressure sometimes starts earlier in one generation, then earlier in the second generation. And then aside from that family history, your personal history is important. So no smoking, please. And if you have a history of smoking, just note that that might be still a risk factor for you. Like don't pick it up again. And then pregnancy is an interesting time. If you've had high blood pressure pregnancy, if you had diabetes in pregnancy, if you had pre-eclampsia, which is a complication of pregnancy, that's a risk factor for you developing atherosclerotic heart disease or plaques in your arteries over time. And so you have to remember that, know that, and tell that to your doctors, because they'll tick that off on the list of, oh, slightly higher risk. Let's keep a closer eye on that cholesterol, let's keep a closer eye on that blood pressure. Um, and so that's really important too. So those are some of the things that start with. And then in terms of activity, what I would say is if you already have activities that you love, that's great. Keep doing that. But if you are somebody that is not terribly active, doesn't consider themselves an athlete at this point in life, whether they once were or not, just get moving. Like walking is the best first thing you can do. Now, if you want to do a couch to five together stuff, great, right? Depending on your physical activity level. But just start walking, like at a minimum, get those steps in. And that's where I say if you feel like you're a bit of a couch potato, get some sort of thing on your wrist that measures or carry your phone with you, whatever it might be. Start measuring those steps, give yourself a goal. If you notice that you only walk a thousand steps a day, give yourself a goal of 3,000 each day next week, right? And then move it up. It really is so good for heart health. Like you don't have to be an interval exercise person. You don't have to do some significant sports each week. And if you do, that's great, sometimes even better. But the walking is really all we need. So just start to get those steps in. Don't forget about a little bit of gentle weightlifting. You can even just be against your own body weight because we do want your muscles to continue to be strong as you get older. And then for women, I would say please find somebody who knows something about perimenopause as you get older. There are not a lot of clinicians who are board-certified in menopause yet. There's an increasing number, but your risk of heart disease, which is again the number one killer of women, goes up during those perimenopausal years. So you really need to have somebody help you not only manage symptoms and think about, you know, your overall health, but also recognize that there are other kinds of risk factors, keep your cardiac risk factors in check. And so try and find yourself someone because hormone replacement therapy may in fact be a protective thing for for you from a number of reasons. Um, and I say this because just yesterday at the Whoop offices, we had a showing of the M Factor, which is a movie that came out about perimenopause and menopause two years ago in 2024. And it was great. And there's just so much more that we need to research and study about women in midlife, because the one thing that we know is every single woman in the world will go through menopause. You can't not, right? That it you just will, uh, assuming a normal lifespan. And so uh we really have understudied it, and that time of life uh does increase your risk for heart disease.

Marla Miller 32:05

So does it increase your risk for heart disease specifically during those years? I mean, what about beyond those years? Like after you get it.

Dr. Ami Bhatt 32:13

Yeah, sorry, during during and beyond. The research is venable during and beyond, as your estrogen levels decline, your risks will increase. Um and so that's just something to keep an eye on.

Marla Miller 32:25

Yeah, and I know they they used to be afraid of hormone replacement therapy because of the, what was it, the estrogen? But now the research shows if you start it within 10 years, right? Of your Yeah.

Dr. Ami Bhatt 32:38

So the women's health initiative published papers way back in the early 2000s that suggested that home-replacement therapy was not good. And there's a black box warning on it, actually. And our FDA actually just announced last year that, like, that's not a thing. There is no black box warning, and everybody should consider it. And if anybody watches this movie, the the M Factor, there is a well-respected breast oncologist, like breast cancer guy, talking about how, depending on who the patient is, there are even some patients with cancer where it's not relevant to estrogen. And therefore, it is okay for them to take estrogen during menopause. And so um, there's a lot more information that needs to come out. There's a lot more research that needs to be done for anybody who's thinking about volunteering for research. If you're in that perimenopausal phase, um, please see if there's research studies that you could kind of volunteer for. They're not necessarily things that are like take this medicine, do this thing. It's oftentimes just report your symptoms, tell us what's going on so we understand it better. But we need women to volunteer to be studied so that we can understand it better. So that's that's a real movement in the country right now.

Marla Miller 33:48

So is there a thing if you start it within 10 years of menopause? Yeah, it's good.

Dr. Ami Bhatt 33:54

But beyond that, it's no. So I would not take any hard numbers right now because there is so much more research that we need to do. So for each individual person, what I say is if somebody, if you see a doctor and they say I don't know much about it, say, could you please find me someone who does? And you please search your network and find me someone who does. And actually, your clinician will thank you for it. Because the minute they find somebody who's good at this, all the other women in their practice who ask about it, they have someone to refer to. They feel really good about themselves, like of being knowing somebody who knows this that they can forward somebody to. Um, but I would not at all say to anybody, hey, you have to do it now, you have to do it. Then we don't know enough for you and for each individual, it may be a little bit different.

Marla Miller 34:40

Okay, that's good to know. So um before we switch to the chronic illnesses, is there anything else you want to say to help people with their heart health?

Dr. Ami Bhatt 34:53

Listen to your symptoms. If you are not feeling well, if you feel impending doom, if you have not typical chest pain, but middle of the back pain, if you have worsening reflux type feelings that aren't going away, right? Um, if you're short of breath on a walk that you're always able to do, and now you're short of breath in your driveway, listen to your body. And um, when you go in to be seen, recognize our healthcare system is a little overwhelmed right now. So people might be moving quickly. And if you know something's wrong with you, you need to stand there and keep saying, no, I'm pretty sure something is wrong with me. And so advocating for yourself, I think is really important. Especially women do not advocate for themselves well enough, especially in the setting of actually having angina or a heart attack. So I would say, you know, really advocating for yourself is important. And that's true for any subspecialty, but specifically since heart disease is the number one killer, and especially in women who under-report, um, I would say please, please pay attention and report that because it's really important. And for people who are younger, I think one important thing about hormones in general is to talk to your clinicians, right? Because we use birth control and different mechanisms. One of them are pills, and just to have those conversations with your primary care, your gynecologist about what are the side effects, what do I use it for, what do I watch for, and what's my personal history? Um, I think you can start those conversations early. And then just remember that it's not only through the fertility period. Keep having those conversations after you have a baby, keep having them through the potential perimenopausal period into post-menopause. That conversation should continue for a lifetime.

Marla Miller 36:29

Now, what about chronic illness, something you know people deal with all the time?

Dr. Ami Bhatt 36:33

Yeah.

Marla Miller 36:34

Why do you think that's better handled from home? Say gosh.

Dr. Ami Bhatt 36:39

Any chronic disease. It doesn't even have to be autoimmune alone, chronic GI disease, pulmonary disease, people who suffer from diabetes for a long time, different cardiac diseases or heart failure, the rheumatoid arthritis, which is also like, you know, lupus and those things again, autoimmune, but we live with them our whole life. They are chronic. They are part of who we are. You can't manage that outside your home all the time. It is exhausting. And it is decreasing quality of life for us to expect to be able to manage chronic disease by always going to somebody else, to someplace else. And so that is the model. Chronic disease is where we need to learn how do we monitor our own symptoms at home? How do we log those? How do we communicate those to people who can help me keep track of it? What are the measures that I need, right? So do I need to measure a heart rate? Do I need to measure my headache journal for half of your diseases or a majority of them? Your oxygen level is just not changing. It is irrelevant. And it's probably just picking it up wrong. And so you're freaking out and it has nothing to do with you. And so it's different if you're in a pulmonary population or a lung disease population. Sure, then they may ask you. So I think the reason chronic disease needs to be managed at home is we are living with it for a lifetime. And it needs to be a normal part of just who we are, right? It's part of who we are. We want it to be in the background. And if we can figure out what are the important things that we can manage on our own at home and communicate that remotely, remote monitoring through portals with your clinicians, it would be really great to just be able to stay in your community, in your home where you live, because your quality of life in general, and we see this from all sorts of quality of life questionnaires of patients. When we do patient-reported outcome measures, patients prefer to be in the comfort of their own home and their own community, but then still expect to get scientifically rigorous, exquisite care. And that's our right as individuals. So we need to design for it. And that's really where I'm pushing digital health. That's where I'm pushing this data monitoring that then leads to predictive mechanisms, that then leads to AI, which is if you know everything about yourself in the home where you live, ranging from habits to a really holistic approach to health. And we can capture that data safely in a private way and look at trends, we can probably help you stay home most of the time, because we can catch things early, address them, and just have you stay in the community where you live. And I think we really have to move back to that bringing the black bag to the patient's home and out of the ivory tower massive hospital in the city feeling. Of course, we will always need the tertiary care, the complicated care, the patients who need a transplant or a surgery or a hospital stay or acute care. But we'll probably need less of it if we do a better job managing chronic disease in the community. And we'll probably need less of it if we do more preventative care, like we talked about before. If you keep track of the risk factors and you manage them, you won't get the disease. If you happen to have the disease but you keep close track of it, you won't get a flare. And then when you do get a flare, by the way, the hospital is going to have the time and space to take you. You're not going to sit in an ER in the future for 18 hours waiting for a bed in the hospital because you have a flare of something. Because all the people who didn't need to be there are going to be happily being taken care of at home.

Marla Miller 40:14

Yeah, that's a nice vision for the future to have everyone being cared for in the comfort of their own home and not waiting, like you said, in the ER for hours and hours, which is typical. That's great. And to get better care when you do go in because the doctor has time for you. Well, is there anything else that you want to add? Should everyone go out and buy a wearable today? What are the priorities for people?

Dr. Ami Bhatt 40:42

I think the first is to recognize a lot of the things that happen to us as we get older in terms of diseases. A lot of them are preventable and specifically cardiovascular disease. And so paying a little bit of attention to knowing those numbers would be great. And if I had to tell everybody to do one thing, I'd say, hey, can you go check a blood pressure? Just check it, get on the website, see what our numbers are, make sure it's okay. Different numbers are different for different people. And I'm going to push the audience just a little bit because let's say you check it and your number says 125 over 70. And you think, oh, that's in the normal range. But it turns out that you actually run 90 over 60. And so I used to say, hey, just check it once. And now I'm pushing listeners to get in the habit of finding out your ranges. Figure out your heart rate range. Figure out how many hours you sleep a night. Figure out your blood pressure and what your ranges you're usually in. And then start noticing what do I do in my life? If I have a glass of alcohol, what happens to these things? If I go for a walk with a friend, what happens? If I take a day off on a weekend and just say, you know what, I want a couple hours to read a book. What happens to my blood pressure? Right. And so I would say start noticing. Start measuring and noticing. And that's like step one. And if everybody could do that, all of a sudden, right then, you already feel agency over yourself. I'm going to go to my doctor and say, I know there are things you need to cover with me. There's one or two things I need to cover with you. And now you become a partner with your clinicians. And so I'd say that's probably step one. And then the other two things I'll say is if you can afford and like the idea of a wearable and don't think it'll make you anxious, it's fun to try one. And I think it helps you get that sense of agency. And then the last thing I'll say is it's okay to play with large language models. Like it's okay to use the free versions, but don't use them for your health first. Use them for things you know. Use them for a recipe, use them for directions and how to best get somewhere, use them about whatever you do for a living or raising your kids or whatever else. And watch where it makes mistakes and where it does things right and how you can ask questions differently. If you use a large language model like a ChatGPT for something you know well and really just start pushing it around, then you'll know how much you can maybe trust it with something you don't know. So before you ever ask a health question, ask it things that you know a lot about. It doesn't matter. Like if you love birding, ask it about birds and see where it goes wrong. And then you'll start to understand, okay, I can trust her for these kind of things, but not those. And then after you do that, if you want to think about your health, talk to your clinicians, find out, and hopefully soon we will be able to have a really good way for clinicians and patients together to ask those kind of questions and communicate so that we're bringing patients and clinicians closer together using large language models.

Marla Miller 43:35

So, where can people find you and learn more about the work you're doing?

Dr. Ami Bhatt 43:39

Oh, I would love that. So I'm at dramibhattt.com, dr a m i b-h-a-t-t.com. And they can also find me on LinkedIn as well as on Instagram and Facebook.

Marla Miller 43:53

Thank you so much for the work you're doing in these AI times and with all the advancing technology. And really trying to help people get a better understanding of the technology, but also the ways it can help them specifically to manage their own health in a better way. So I appreciate everything you've shared today.

Dr. Ami Bhatt 44:14

Well, thank you for having me.