Genetics and Technology for Real World Care
Episode 586

Evan Muse, Cardiologist at Scripps Research Translational Institute / Scripps Clinic

Genetics and Technology for Real World Care

In this episode, we are honored to listen to Dr. Evan Muse. Dr. Muse is the lead for cardiovascular genomics at the Scripps Research Translational Institute, and he’s a cardiologist and assistant program director for research of the Cardiovascular Disease Fellowship Program at the Scripps Clinic in La Hoya.

Today, Dr. Muse talks about leveraging existing technologies to shape the future of prevention and treatment. He discusses cardiovascular genomics and offered some specific examples of how it impacts patients and populations. He shares his thoughts on how genomics can be fully utilized, how education can enable people to find the best applications for this technology and the need for patient involvement in clinical trials. We covered some great topics in this fascinating conversation with Dr. Muse, and we hope you’ll enjoy it as much as we did.

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Genetics and Technology for Real World Care

Episode 586

About Dr. Muse

Dr. Muse is a physician-scientist with research interests that mine the transition zone of digital medicine, genomics, and cardiovascular disease. After his undergraduate studies in biochemistry at the University of North Carolina at Chapel Hill. He completed his medical and graduate studies at the Albert Einstein College of Medicine in New York following an internship and residency in internal medicine at the Columbia University Medical Center in New York-Presbyterian Hospital.

Dr. Muse completed his training in cardiology at the Johns Hopkins Hospital in Baltimore, Maryland, and Scripps Clinic in La Jolla, California, as he served as a judge for both the Qualcomm Tricorder X Prize and IBM Watson X Prize competitions. He also sits on the Strategic Advisory Board for Digital Medicine Society and as an associate editor for the nature partner journal Digital Medicine. He’s currently the lead for cardiovascular genomics at the Scripps Research Translational Institute, and he’s a cardiologist and assistant program director for research of the Cardiovascular Disease Fellowship Program at the Scripps Clinic in La Jolla.

Genetics and Technology for Real World Care with Evan Muse, Cardiologist at Scripps Research Translational Institute / Scripps Clinic transcript powered by Sonix—easily convert your audio to text with Sonix.

Genetics and Technology for Real World Care with Evan Muse, Cardiologist at Scripps Research Translational Institute / Scripps Clinic was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best audio automated transcription service in 2020. Our automated transcription algorithms works with many of the popular audio file formats.

Saul Marquez:
Welcome back to the Outcomes Rocket, this program is made possible by the sponsors of Reach, including HP, Microsoft, Smooth Podcasting and listeners like you. Reach is a global nonprofit social impact organization whose mission is to create better health care experiences for both providers and patients. Reach is focused on sustainable, large scale improvements in the delivery of care and in the health journey of all people. Advocates, public health, thought, leadership, education and innovation. Be sure to share this podcast and visit them at www.reachtl.org. That’s www.reachtl.org

Saul Marquez:
Welcome back to the podcast. Today, I have the privilege of hosting Dr. Evan Muse. Dr. Muse as a physician scientist with research interest that mine the transition zone of digital medicine, genomics and cardiovascular disease. After his undergraduate studies in biochemistry at the University of North Carolina at Chapel Hill. He completed his medical and graduate studies at the Albert Einstein College of Medicine in New York following internship and residency in internal medicine at the Columbia University Medical Center in New York Presbyterian Hospital. He completed his training in cardiology at the Johns Hopkins Hospital in Baltimore, Maryland, and Scripps Clinic in La Joya, California, as he served as a judge for both the Qualcomm Tricorder X Prize and IBM Watson X Prize competitions. He also sits on the Strategic Advisory Board for Digital Medicine Society and as an associate editor for the nature partner journal Digital Medicine. He’s currently the lead for cardiovascular genomics at the Scripps Research Translational Institute, and he’s a cardiologist and assistant program director for research of the Cardiovascular Disease Fellowship Program at the Scripps Clinic in La Hoya. Such a privilege to have had the discussion with Evan and his work with cardiovascular genomics and the impact that they can have to public health and population health overall. And so I think you’re really going to enjoy this interview with Dr. Muse. I hope you enjoy. So it’s such a privilege to have you here with us. Evan, thanks so much for joining Saul.

Dr. Muse:
Saul. It’s a real honor. It’s great to be here.

Saul Marquez:
So we’re going to dive into some really fascinating work that you’ve done and really focused around the work at Scripps Clinical Medical Group and Research Translational Institute. But before we dive into that and sort of the impact that the population health level, I’d like to hear a little bit more about what inspires your work and health care.

Dr. Muse:
Yeah, that’s I love people, Saul probably like yourself. You get to talk to people every day, know, learn new things and be inspired. And I think that that’s what is at the core of what keeps me going as a physician, you know, being able to help individuals discover things about themselves, work through his work through lows. And that then translates as a scientist in terms of trying to think, well, what tools do we have and what things do we not know yet? What’s the best way for us to set up a good trial or experiment or tap into certain data points for us to be able to achieve individual goals Right. whether that’s disease prevention or disease management. And so it’s a real, real honor to be able to have this sort of relationships that I do not only with my patients, but with the research teams and organizations that I’m a part of.

Saul Marquez:
Well, it’s certainly outstanding work that you’re up to and the drive for people. We want to have that impact. And that’s why we’ve chosen health care and so around population health. And I mean, the work that you’re doing in cardiovascular genomics is super fascinating. And the promise that that could mean for the country and the world. What would you say is the way that you guys are adding value to the health care ecosystem in that respect?

Dr. Muse:
Well, you know, you bring up cardiovascular genomics and that’s a big plus. I mean, so much has been going on in the space, but it’s not well utilized. OK, and so I think that one of the things that we’re trying to do is leverage these existing technologies that we have right now for big wins, that then we can then use those to shape the future of prevention and treatment, et cetera. So if we think of something like statins, Right., more of a statin rosuvastatin, simvastatin, a lot of folks that end up having high cholesterol or risk factors for plaques within their arteries that then go on to cause stroke and heart attack Right. take statins. Well, the number needed to treat for primary prevention, meaning how many individuals do I have to put on a certain medication to prevent? One outcome is greater than we would like it to be. Right. I think number needed to treat for primary prevention depends on the study 40 to 70 Right. treat those individuals for a period of years to be able to prevent one adverse event. So what if you’re the fifty ninth individual Right. and you’re taking this medication for ten years? That’s frustrating to know that maybe you haven’t gotten the benefit that you thought you were going to get Right.? Oh, without a doubt. I think that what we’re seeing in cardiovascular genomics, the way polygenic scores are helping us to delineate what are inborn risks are and really brilliant studies done from groups at the Brigham and elsewhere have helped us understand that stratifying individuals based on their polygenic risk for coronary disease can help us understand and actually. We move the needle in terms of the number needed to treat to reduce that amount. So if you were in the highest tier of this polygenic risk, then you would most likely receive a benefit greater than that if you’re in the lowest here. So we are embarking on several studies to utilize polygenic scores in coronary disease. I was lucky enough to do a nice study with atrial fibrillation. Polygenic risk atrial fibrillation is one of these is the most common sustained arrhythmia that we have in man. I’m sure that you’ve heard people with atrial fibrillation and blood thinners, Right. and blood thinners.

Dr. Muse:
And no one wants to be on a blood thinner if they don’t have to be in a fib Is such a debilitating disease for some folks, but it’s also somewhat preventable with certain lifestyle modifications. Right. So if I were to tell you so what, you have the highest genetic risk of getting a fib over time, meaning that you’re three times as likely as someone in the lower genetic risk. OK, and that means that you need to watch your weight, maybe get your sleep apnea under control. Moderate your alcohol consumption. Pay attention to your blood pressure and you may be more inspired Right. to really be on top of these preventative measures than you would be otherwise. At the same time, a lot of people present with atrial fibrillation to the clinic with their first event being a massive stroke Right. and with the kind of digital technologies that we have like single lead and six lead electrocardiograms that fit on our iPhones and smartphones, et cetera, maybe if you were in the highest polygenic risk and this hasn’t been studied yet, but postulated that if you’re in the highest polygenic risk of a fib, then maybe you would monitor more often for signs of atrial fibrillation. So you do not then present with a stroke as your first diagnosis.

Saul Marquez:
It becomes really promising in that way. And at the very beginning, you mentioned underutilized. And so how do we unlock that, Evan, and how do we maximize that as we look to large systems to care for populations or even employers Right. seeking to provide preventative care and the best outcomes for their employees?

Dr. Muse:
Absolutely. I think it starts by education, educating not only patients Right. that genetics can be used in informative way, especially for coronary disease. It’s been shown that even if you’re in the highest polygenic risk of coronary disease, if you have your risk factors under control, you’re not essentially doomed Right.. And so they could be empowering. And the same thing goes for helping and educating patients, but needs to go for the physicians as well. Right. most docs are overworked and now with each hour you add on a genomic component and there’s ethical considerations and risks and a certain amount of not being have that part of their core training Right.. So I think that we need to do better in terms of bringing those to the real world for not only our patients but also our docs and was and in peace as well who are on the front lines.

Saul Marquez:
And that’s a great call, is focusing on education and then enabling people to apply these powerful technologies and methods. How would you say the approach and maybe we could focus this at the research institute or perhaps the work being done at the medical group, but how are you guys doing things differently that has helped you guys get results in the populations you serve?

Dr. Muse:
Yeah, so I guess it’s trying to reach the right people and ask the right questions with the technologies that we have at hand. Right., we want to increase access, increase the amount of underrepresented individuals in research, make sure that the underserved can be a part of research and also get this information as well. That’s a big drive that we’re doing with a lot of our remote digital trials. Right. kind of moving outside of the ivory towers of academia and trying to go directly into patients in their own environment and have them be participants and active partners in the research process. Right. So I think that that’s one of our major drives, whether we’re doing it in diabetes studies, sleep studies or whatnot. It’s really trying to improve access for patients to be a part of these trials and discover their own personal risks as well.

Saul Marquez:
And so and I can really appreciate that, Right.. I mean, it is about the right people, the right questions, giving access. How do you get to that? I mean, I feel like that tends to be a challenge for a lot of us.

Dr. Muse:
Yeah, well, I don’t know if I have the answer to that right now. Right., the clinical trial space is evolving and from being OK, it’s just with a research coordinator and a face to face visit and now being able to use social media or education networks to go to. Directly to potential participants in those studies, and we have to be able to, I guess, provide a value added for them Right. oftentimes clinical trials, you’re reading the inclusion exclusion criteria and you’re going through the informed consent form and it says, well, what is this going to do for you? And the answer oftentimes is nothing Right.. And so it’s just a one way data from the patients to the scientists. But what we’re trying to do is now involve their participants as partners and make sure that we’re delivering some sort of insight at each part of a clinical research project as we can to make sure that those folks stay involved, stay engaged, and that there is value added for those folks as well. Not just us writing the papers and putting together the science, et cetera, totally adds that sensitivity.

Saul Marquez:
Right. is a two way street. One of the things that I admire about you and your work is sort of the the way that you approach patients as consumers. And I think that’s what makes you a very forward thinker and your approach more modern. How would you say maybe an example of how the methods you and your team use has improved outcomes for better business models in health care?

Dr. Muse:
Yeah, well, we’re starting to figure that out. Right. So one of those ways is, as I mentioned, having the participants be a part of the research projects, Right. having to be invested fully Right.. And so we’ll see if that plays out. We’ll see if that pays off. We all know that one of our big strengths is using digital tools and digital technologies to kind of take these things that are previously just been relegated to hospitals and specialty care clinics to now give patients access to those in their homes. Right. But just like Fitbit, which sometimes folks have wear for a couple months or any kind of activity tracker, and then they drop it only to come back to it after a couple of years or so Right.. We want to make sure that folks don’t have device fatigue, which is a real thing. All of us in this time have a little bit of zoom fatigue. Yeah, it was a nice shiny object and allowed us to really get back to productivity and meeting with folks. But now at the stage of the game, we’re a little standoffish Right.. So we have to continually rethink our approaches in terms of how do we get long term participation in studies to really then glean insights from that data right now?

Saul Marquez:
That makes a lot of sense, Evan, and just it still time will tell. But the reality is patients seek that involvement and they want to be part of it. I mean, let me just say we Right. because we’re all members of this health care space and we’d rather be engaged than just a one way data suck. So I appreciate the approach there. I think with time, we’ll probably most likely see that the results are better. If you had to identify any area where potentially there was a setback that you learned something incredibly valuable from in the efforts that you conduct. And what would you say that is?

Dr. Muse:
Well, I would say, number one, you can’t boil the ocean Right. you can’t try to do too much too quickly without understanding the ecosystem. Right. And so you don’t want to move at a snail’s pace. Right. But make sure that at each step along the way, when trying something new, that you have good the ability to feed back change and then act on those edits and see if they are successful Right. to be able to model at each step along the way. I think the second thing is building good teams. And that’s one of the things that I’m very lucky with. My colleagues at Scripps Research Translational Institute, we built a research ecosystem basically with genomics, digital medicine experts, patient engagement, A.I. Analytics, as well as our clinicians and research coordinators. So everything is together and we get to meet and discuss everyone’s perspectives to make sure that at each step along the way, we’re really uniting and bringing a specific trial or question answering it to its fullest in the most efficient and best way.

Saul Marquez:
Yeah, and you really can’t boil the ocean. And you mentioned something understanding the ecosystem. There’s a lot of technology companies entering the space that feel like they could disrupt. And the reality is it’s not that easy. And you really have to understand the ecosystem partner with physicians like Dr. MEUs and be able to build those teams to deliver results. And the neat thing is that more physicians like you, Evan, are having a front seat and what innovation looks like and how we’re transforming delivery of care. And that, to me is very exciting. But there’s a lot of exciting things happening in health care along with challenges. What would you say is one of the things you’re most excited about?

Dr. Muse:
You know, I think one of the most exciting things for me is just understanding the data, doing the right sort of analytics, getting insights from that data, and then transitioning it to a point where a patient, an individual, a company would then utilize that for improved outcomes overall. Right.. I think what we’re seeing is now that every person is producing so much data about their lives. A lot of that, even the way we swipe and talk on our cell phones, how fast our keystrokes are, what apps we use, etc. have been shown to be digital biomarkers for cognition and mental health. And so just in the background, there’s so much data that we are producing. But for me to take a paper chart and open it, then try to distill that down to an actual item, it’s previously I can’t do that. Right. And so now using better analytic methods, I and other tools, I think that we’re able to then learn from those and then act at really the highest point Right. for our patients and colleagues.

Saul Marquez:
It certainly is promising and an exciting I mean, I recently got an Apple Watch and the little things that the watch could do for you to breathe better or even understand what you’re doing is just incredible. And to your point, like keystrokes and how quickly you do things. I mean, it’s so promising and it’s just a matter of how do we use it Right.. And it’s great to have somebody like you and your team and the many across the country that are working to make this better and scalable for us to benefit from. Certainly a fascinating discussion that I know we could dive and so much deeper. And again, the discussion around how we impact populations is exciting, but we’re here at the end. And so, Dr. Mieux, what conclusion would you give us and what closing thoughts can you leave us with? And then with that, an invitation for the listeners to continue to learn more about you and the work that you’re up to?

Dr. Muse:
Well, you know, I think it’s being brave and trying new things, but also knowing that what we do affects others continually Right.. And so I think that as we evolve our clinical trials phase and start to utilize novel data sources, sensor’s genomics, et cetera, we also have to understand the power of the data and the appropriate ways to protect it, to be up front and then to use it in the right ways to benefit humanity. You know, folks can join me on Twitter at avenues, send me direct messages or on LinkedIn. Happy to start a conversation that way.

Saul Marquez:
Outstanding, Evan. Again, just want to say thank you. The polygenic scores, I mean, building strong teams and not boiling the ocean, just tip of the iceberg of all the work that you’re up to. But we really appreciate you sharing your insights here with us and definitely looking forward to staying in touch with you.

Dr. Muse:
Happy to be here. So I really enjoyed it.

Saul Marquez:
This program is made possible by the sponsors of Ritsch, including HP, Microsoft, Smooth Podcasting and listeners like You Reach is a global nonprofit social impact organization whose mission is to create better health care experiences for both providers and patients. Reach is focused on sustainable, large scale improvements in the delivery of care and in the health journey of all people. Advocates, public health, thought, leadership, education and innovation. Be sure to share this podcast and visit them at www.reachtl.com. That’s www.reachtl.com.

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Things You’ll Learn

  • Cardiovascular genomics is not well utilized. You can’t try to do too much too quickly without understanding the ecosystem.
  • Stratifying individuals based on their polygenic risk for coronary disease can help us understand and actually move the needle in terms of the number needed to treat to reduce that amount.
  • Understand the power of the data and the appropriate ways to protect it, to be upfront and then to use it in the right ways to benefit humanity

Reference:

www.reachtl.org