Ian Meredith is a well-known figure within the field of interventional cardiology, not only for a distinguished academic and clinical career but also his six-year spell as the executive vice president and global chief medical officer at Boston Scientific.
After retiring from his role at the medtech giant earlier this year, Meredith joined the board of directors at Avertix Medical. The company, formerly known as Angel Medical Systems, is commercialising an implantable cardiac monitor and patient-warning device, the Guardian system, a device designed to detect heart attacks in real time, including silent and atypical symptomatic heart attacks, among patients with acute coronary syndromes.
Meredith spoke to Cardiovascular News to discuss his decision to collaborate with Avertix, how patient interaction is likely to shape the future of cardiovascular medicine, and the current challenges in bringing new technology to the healthcare market.
“What I brought to Boston Scientific was 25 years of caring for patients with acute and chronic ischaemic heart disease, acute and chronic heart failure, and acute and chronic valvular heart disease,” says Meredith of his time at Boston. “That experience of managing large numbers of patients in the public health system gave me a perspective of a longitudinal approach, rather than a transactional approach to care.” This translated into a strategy looking at developing care that is “parallel to the course of human disease” rather than being “intersectional”, Meredith comments.
After retiring from the post in early 2023, Meredith says that he has sought to engage with companies with whom he can “actively influence the thinking about transforming care to something that is much more longitudinal” and in parallel with patients’ needs. This means, he explains, “not simply inventing the next stent”, but developing smart diagnostics, proper surveillance of the disease process, planning for later stages of disease to minimise rehospitalisation, and delivering care in non-traditional settings, all of which will increase in importance with an ageing global population.
“When the team at Avertix asked if I would be interested, I saw that it fits the bill for the way I think about healthcare in terms of how we provide patients with smart technologies that can prevent hospitalisation, prevent readmission, prevent anxiety and allow people to live a normal life, and more importantly to empower patients to be able to be engaged and manage their own care,” he adds.
The concept of patients being engaged in their own treatment is one that Meredith sees as being important for the future of the delivery of treatment for cardiovascular disease. “I deeply believe in engaging and empowering patients in their own care. There is an abundance of evidence that patients who are involved in their own care do better and are less anxious about their condition,” he argues. “We have to invert the hierarchy in medicine, empowering patients so that we are there as the facilitators rather than sitting in the ivory tower and passing down dictums from the top.”
This approach is not without its own challenges, not least a potential resistance from healthcare providers, the need for robust evidence underpinning new models, techniques and technologies, regulatory and reimbursement hurdles, as well as the need for an engaged and educated patient population.
“You have to start with meeting the unmet needs with smart, simple, safe, sophisticated technologies that can provide that sort of surveillance, and the next step, which is a really big one, is providing meaningful evidence, and developing an evidence-generation strategy that actually allows the medical community to have comfort that you are approaching this in a sophisticated and logical way,” comments Meredith. “And then, of course, the education and training, both of the healthcare provider community and the patient community, so that the system and the solutions are used appropriately.”
Asked how he views the potential for resistance from physicians, particularly those who have been raised in a “top-down” model of care delivery, to engaging patients more closely within the delivery of care, Meredith raises several points.
“To me, the more informed you are, the easier as a patient you are to manage because you understand the subtleties and nuances in the disease process and management outcomes,” he responds. “All of the therapies we have are not perfectly personalised for each individual. They are therapies that are developed and based upon population evidence, and are largely a good thing for most, but not a perfect fit for many, and having a deep understanding of healthcare makes expectation of outcomes easier.”
With the ubiquity of smartphones and other digital technologies, Meredith says that he believes patients have greater access to data sources than they would have had in previous decades, a shift that fundamentally changes the way that they need to be treated.
“Everybody does research. Where it is hard is when people are wedded to a doctrine that it is essentially flawed because of their ascertainment bias, when they have collected information reaffirming fixed beliefs. But, I think we live in a world now where people are educating themselves on their health issues, and they are looking for a partner to be shoulder-to-shoulder with them, as opposed to somebody in a patriarchal or hierarchical relationship saying ‘you must do this’.”
The Guardian system is one such technology that Meredith sees as playing a role in a more patient-empowered treatment paradigm. The system has US Food and Drug Administration (FDA) class III indication for use in patients who have had prior acute coronary syndrome events and who remain at high risk for recurrence. It works by detecting potential ongoing events, characterised by sustained ST segment changes, and alerts the patient to seek medical attention for a potential event.
Meredith says that he expects the accumulation of data as being a core strategy in the continued commercialisation of the device, building upon insights already gathered through previous clinical study, including the ALERTS clinical trial, in which it was shown that patients implanted with the device were able to seek medical attention earlier than patients who relied purely on symptoms.
“Market expansion through thoughtful evidence generation will be the most important next step and then continuing to refine the device,” Meredith comments.
Reflecting on the wider regulatory landscape within the medtech industry, Meredith acknowledges that there have been challenges, particularly in Europe with the introduction of new requirements for medical device manufacturers, but he comments that a focus on patient safety is critical.
“The CE-mark system was certainly favourable to industry without necessarily providing the regulatory framework at a level that was ideal,” he says. “You can take it to such extremes that it makes it difficult to develop technology because you simply do not have the financial resources because the regulatory framework is so demanding. There has to be a balance between safe and effective and practical, so that we do not stifle innovation.”