Solving hypertension with Dr. Jay Shah from Aktiia

Hypertension affects almost half of all American adults and over 1 billion people globally. 

Dr. Jay Shah is Chief Medical Officer of Aktiia, a transformative company empowering providers and patients to greatly improve the diagnosis, monitoring, and treatment of hypertension.

Jay joined us to share how he plans to tackle this massive problem in public health. 

More about Dr. Jay Shah
Dr.  Shah has 15+ years of medical expertise and 11+ years of leadership experience.  He has brought his experience and expertise to the Swiss startup Aktiia, to change the paradigm of how the world’s most common disease – hypertension – is understood and managed.  Also an angel investor and advisor, he is passionate about applying technology to solve practical problems in medicine and believes strongly in the power of positive thinking and collaboration.

Website: www.aktiia.com

 Social media: @aktiiaglobal

 LinkedIn: linkedin.com/in/jshahmd

Qualio website:
https://www.qualio.com/

Previous episodes:
https://www.qualio.com/from-lab-to-launch-podcast

Apply to be on the show:
https://forms.gle/uUH2YtCFxJHrVGeL8

Music by keldez

Transcript

Kelly Stanton: 0:17

Hello everyone and welcome to From Lab to Launch by Qualio I'm Kelly from Qualio and I'm your host today. We're glad you're here. Before we jump in, just a reminder to please rate the show and share it with any of your science nerd friends. We know you have some. Also check out the show notes if you have a story or product you would like to share with us. We're grateful for all the interest this podcast has had. Today, we've got Dr. Jay Shah, chief Medical Officer from Aktiia with us. Dr. Shah is a seasoned physician leader with over 15 years of progressive and diverse experience in the medical. He's worked in various academic, clinical, and teaching environments, as well as building medical businesses and service lines as the chief medical officer of Aktiia. He's part of a transformative company that empowers providers and patients to greatly improve the diagnosis, monitoring and treatment of hypertension, which affects almost ha almo, uh, which affects almost half of all American adults and over 1 billion people globally. Let's jump into how they're addressing this massive problem in public health. Thanks for joining us today, Jay. I really appreciate your time.

Dr. Jay Shah: 1:23

Thanks very much for having me, Kelly. I appreciate it. Good to be.

Kelly Stanton: 1:27

All right. Well, to get us started, tell us a little bit about your background and how that landed you at Aktiia.

Dr. Jay Shah: 1:33

Sure. Well, I, I started like, I think a lot of doctors, you know, I sort of grew up imagining wanting to be a doctor and, and then ended up going to medical school at, uh, university of Missouri and Kansas City, which is like a city general hospital. So, you know, as far away from my, you know, relatively tame upbringing that, that you could get, you know, I. Places like Compton or South Central LA or South Side Chicago. This was like sort of the environment, which was an amazing place to be a medical student, um, by the way, because it had a lot of responsibility because they were so, you know, chronically understaffed. Um, after doing that, I ended up getting a residency spot through Luck, Chan, you know, um, and, and or hard work at Massachusetts General Hospital and in Boston. And so there it was a completely. Different view of medicine and I just, my lens was so much broadened by my colleagues. In my residency class, I was, you know, a senior resident and my junior resident was, let's say, someone who had run a W H O, you know, uh, funded N G O in Africa for the last five years. And another one would've been someone who had developed some molecule and sold it to some pharmaceutical company and was on the fast track to being sort of the leader of one of the global pharmaceutical companies in the, in the world. And so these were the sort of counterparts I was with. And so that was an amazing experience. Um, I did my general cardiology fellowship at Washington University in St. Louis, which is a tremendously academic, but huge hospital, over 1100 beds with a like a. Eight state catchment area. So it's an incredibly rich clinical experience. I really learned how to sort of be a really good and thorough clinical, you know, cardiologist. And then after doing all those sort of things at these academic places, I ended up winning, going out, and after fellowship I went and started my own practice from scratch, you know, just me and a medical assistant and two E K G machines. Wow. So there I learned about all the business aspects of starting a medical practice, you know, negotiating equipment purchases and cost effective analyses and par level for, you know, syringes and. You know, machines and all kinds of software. And so we, you know, I set that up and, and grew that into a very busy practice, which was a totally different but great experience. And then for the last three years, I've been the medical director at Mayo Clinic and I started a program for aortic diseases. So looking at people who had aortic aneurysms and kind of treating them in a very, um, you know, advanced way. So sort of a very diverse clinical experience and, and academic experience and training. But then, That led me to a place where over the last couple years I started thinking, well, how could I now take all this knowledge and experience in real world clinical practice and apply it in a different way, maybe in a broader way to help more than just one patient at a time, but help, you know, um, have a broader impact. And so that led me to sort of a search of. A number of things, but a, a very explor exploratory process. And it ended up leading me down, um, the road of looking at medical device or MedTech startups, digital health startups, and, you know, just by chance really stumbled upon Acia and have now been with the company over a year and a half as a chief medical officer. So that was sort of my journey in less than five minutes.

Kelly Stanton: 4:59

Nice, nice. I that's a, I love though that you're bringing such a broad base of experience. To a medical device setting though, that, that feels like such a good, uh, well, a great benefit to the company and to the patients for sure. Um, so what, as you explored, um, Acia and their wearable blood pressure monitoring devices, what drew you to that? What makes that innovative in your.

Dr. Jay Shah: 5:27

You know, we, I, so coming up from the background of a clinical cardiologist, I am generally taking care of patients that have had some event or are having some symptoms of some problem, a heart attack or stroke, or heart failure or arrhythmias or, you know, any number of cardiac problems. Um, and almost always after we take care of the urgent issue and they come back to my office and they sit there and they say, they'll say like, okay. Why did I have this? You know, I try to eat well. I try to exercise, I try not to do what I know and I'm not supposed to do, but why did I have this? And almost always the answer is there's not usually just one thing. But there was probably a confluence of many things that have gone on for probably decades before your event happened that many of. Are modifiable and the most common of which, and the most impactful of which is high blood pressure or hypertension. And so as you kind of mentioned in the intro, I mean hypertension affects, it's the most common chronic disease worldwide period by far. And despite lots of knowledge about how to treat it, lots of chief medications. We have existing blood pressure machines. Despite all those things, the global control rates for hypertension is 20. That means o only 20% of people who have the disease actually are treated well and treated to target control rates. In the US it's not much different. It's 26%. Hmm. So despite all that knowledge and all these things that are relatively widely available, cheap and effective, um, we're really bad at it. We're really bad at managing hypertension on a broad population level. So the idea with AIA or one of the many sort of, um, Gaps that we try to, you know, fill. And what we think about is that how can we bring a a, a product slash device, but really it's a product to the market that enables and empowers people that. To, to allow them to be more aware, allow them to be more educated about high blood pressure, allow them to be more personalized about their, their, um, interactive, you know, their interaction with their own health. That allows them to then hopefully live a better, happier, healthier life. And for them not to sit in my office one day saying, how did this happen to me?

Kelly Stanton: 7:54

How did this happen? Yeah. How did we get here? Well, and that leads very nicely into my next question about wearables in general. Uh, feels like, you know, that's definitely putting some power back in the hands of, you know, the Joe General public Right, right. To, to kind of monitor our own. Um, and so I guess, how are you seeing that change the healthcare industry? Recent years, but then going forward, um, you think we'll see more and more of that. How, how do you, how do you see that changing?

Dr. Jay Shah: 8:23

I think the, I'll answer the second question first. I think yes, we're gonna see more and more of it. I mean, the, the genie's way out of the bottle, there's no way to put it back in, like Yeah. You know, and so the, the, and it's a trick because it's, it's a tricky thing because most wearables are not medical. They are not regulated, they are not tested, they are not validated. Most of them aren't. So while they do sort of dabble play, imply that they have health benefits or say that they, there's some health application, there's a, a, a significant amount of caution. And I think distrust is probably too strong of a word, but essentially that's what it is from the medical community at looking at data from those devices. So, you know, cardiologists, so people come in and they say, oh my, this watch, or this device says this or that, or you know, don't you think I need to look at something? And then you look at the, the data behind it. There's almost, generally speaking, there's very, very little data to support, very little evidence to support using that data for medical decision making. So one of the difference with ACTA is that we have, we have. Gone down a very rigorous and stringent sort of, uh, regulatory pathway proving the science behind our technology and, you know, going through the regulatory steps to make it a class two medical device, which is what it is. And so I think that's, that's a conundrum that Digital Health Med MedTech, wearables slash and other companies have to be honest with themselves about, is that if they really wanna make a difference to he. They will have to engage with regulatory bodies to be able to gain trust with the, you know, providers and medical system in general. So I think that's the, that's sort of the second answer, but the first answer is sort of where, you know, sort of where are we going with this wearable story. And, and the truth is, I don't think most of us have much of an. Um, I think that this is where, at sort of an inflection point where these devices are gonna be more and more, uh, available to people and as you mentioned, really putting pe people, patients in from a medical center, but people in charge of their health. You know, people don't come to see me as a physician. Because they want some procedure or they want some test, or they want something done. That's not generally why people show up in the office. Mm-hmm. They showing up because they want knowledge. That is the true thing that people are seeking when they go to a specialist or a physician's office. They want. Knowledge, I have this problem, or I think I have this problem. Give me the knowledge to help me decide how best to go forward with my own healthcare. And that is the true potential power of digital health is giving that knowledge to people irrespective of where you are in the world. Of how much money you have, of how much access to care you have, because the technology will far outstrip healthcare systems' ability to be widely available. And so that, that sort of near ubiquitous, you know, source of knowledge, internet devices, connected devices, et cetera, it's really trying to bring that expert medical knowledge to the world. And that's, that's really the potential power of digital health. Um, And then of course, it's all in the details about how that actually happens.

Kelly Stanton: 12:06

Sure, sure. Yeah, yeah, definitely, definitely. Well, and, and it's interesting, you know, I mean, you're, so, you're a physician who's trying to solve a problem with a medical device, and that's, honestly, that's a, a very common path for, um, for medical device innovation and those kinds of things. But, you know, as you were talking about it, it feels like we're still maybe. Early in that tipping point of people really starting to trust, um, the digital transformation of healthcare and how, you know, can we, can we dive into that a little bit more? Because, you know, obviously yourself, like you're seeing a great opportunity here and a need and a way to put that power back in the patient's hands, but then there's resistance maybe on the doctors as you were talking about, they don't trust the data. Right. How do we, how do we keep moving that forward? How do you see physicians leading, um, leading this digital transformation in the healthcare space?

Dr. Jay Shah: 13:01

I think patients are gonna lead it. I don't think physicians are gonna be the primary leaders of it. They'll help. Interesting. They'll support, they will be, they will be there. They will provide their input and they'll provide their expertise and their, their knowledge in the ways that they, they can, and they're able to. But I think. Um, I think that patients are the ones who want this at this point in time, who want this more. You know, they are the one we, not they, there's not really, all providers are patients too, right? Right, right. So, you know, the thing is, is that medical systems are designed in a very reactive way, right? You go when there's a. Generally speaking, you know, 75% of all healthcare dollars in the US are spent on, you know, reactions to some chronic disease that has led to some event. 3% of healthcare dollars are spent on preventive care. So it is just designed, all incentives are aligned. The rails are driven in such a way that we're really, you know, most of healthcare is designed for re. React to some issue. And in between those visits, let's just say you have a primary care physician and you go once a year or you go six months every six months, which is pretty frequent for a primary care physician. And, and that's assuming you have one by the way. Mm-hmm. Which a lot of people don't. Right. Um, so in between those 15 to 30 minutes a year, what is the interaction with healthcare that most of us have? Unless you have a problem, right? Mm-hmm. But that, that is the vast majority of the time in your life, and that's the vast majority of the, uh, and, and that's where chronic diseases really have the most impact, is in that time. Right? And so, you know, the. What we see and what we see in our own sort of commercial activities that the earliest, quickest and fastest adopters are people, patients. They are the ones who want this information. They are the ones who want to be more empowered. They're the ones who really want to say, I want to be a more active participant. I'm not sure how to do that yet. You know, but I want to be more active participant. I want to be more empowered. I want to be more knowledgeable. And so that's, that's sort of the need. And then I. Digital health companies are trying to fill that need, and that's why you see so many of them are focused on patients primarily. Um, one because they're the earliest sort of adopters and they're the most excited about, about new technologies that could potentially help them. And two, there's just less barriers to entry and that's really where the tricks of working with healthcare systems and regulated in a regulated space really becomes exceedingly cumbersome from, for. Or you know, early stage small companies that are trying to do something innovative. And so that's really sort of the balance that digital health companies have to strike. Yes, you can. You need to appeal to patients cuz that's your primary adopter. That's your primary sort of person who might interface with your product. But at the same time, to be legitimately seen by healthcare systems, you do need to go through those big hurdles of relu regulatory, uh, approvals, as well as, you know, interfacing with the healthcare system. Um, and so that's really, that's the, that's the struggle and I think many digital health companies have done the former. Interfacing with people but haven't really pushed through the ladder, which is much more difficult, costly, and challenging.

Kelly Stanton: 16:38

Definitely. Yeah, definitely. And having spent some time in that startup space myself, it, it is sort of a, a, a balance of, well, we really need to get revenue, but you have to get your regulatory clearance right. Yeah. And it costs money to do those things. Yeah. Yeah. Um, were you involved in that or did that happen before you joined Acia?

Dr. Jay Shah: 16:56

No, no. Was I'm, yeah. Very much involved in regulatory. Space as well as commercialization.

Kelly Stanton: 17:02

Ah, gotcha. Okay. So, so then has it been a challenge there, um, to, to have the company do that focus or has that. They were pretty on board with, Nope, this is the regulatory pathway. We're gonna go that

Dr. Jay Shah: 17:14

way first. So I think at Aktiia, no, we, we were, we have, even before I came on, um, in my role, there was always, uh, an acceptance and a knowledge that to really make an impact, the impact that we want to make. We, we will and, and have gone through our regulatory, uh, approvals in as many of the markets as we can. Um, it. Also acknowledge that it is a tremendous amount of resources that are required to do that, and it's far easier to, to build a non-regulated product than it is a regulated product. Right? Right. Um, but that's the reality of the world. And if you want to be a regulated medical device, that's, there's nothing that's gonna change in that regard. So, um, I think it's just a matter of accepting that and being able to, um, walk that sometimes tightrope between the.

Kelly Stanton: 18:05

Definitely, definitely. Well, and yeah, certainly, uh, also maybe helping a little bit as, you know, as you said, it's, you know, patient demand, but we want our physicians to, uh, you know, to get on board with that. Then, you know, there's a, there's a credibility that comes with as, as anybody who knows anything about that process, right? You know, that the device has been through the rigors to prove that it really is safe and effective. It's not just my Apple watch telling me my blood pressure's high.

Dr. Jay Shah: 18:37

Right. That's, yeah, that is the, that is the trick. And so, yeah, I mean, there's a lot of other hurdles to adoption by healthcare systems, but that, that is certainly one of the biggest.

Kelly Stanton: 18:46

So, um, to dive in a little bit more into, um, your product specifically, is there a software component to the hardware? Does it integrate with other healthcare systems? Uh, tell me about how, um, the Acti device actually works for a.

Dr. Jay Shah: 19:01

Yeah, so I mean, I think the, the first thing is probably to sort of revisit for all the listeners, like how the fundamental sort of data capture that we, that we take is blood pressure and heart rate measurements. Um, And, and we build a very complex data set around, you know, based on those. But, so it's important to kind of realize like, where are we today with, with measurements of let's say blood pressure and blood pressure for the last 50 years. You measure it with an upper arm cuff. People are probably generally familiar with that. They're sort of nearly ubiquitous technology. They've existed. As I said, for the hun, the technology's actually 110 years old and it's really just automated 50 years. It hasn't really changed since. Um, you have to sit in a very prescribed position. You have to take it, you have to put your, you know, self in a quiet place and you know, feet on the floor back against a chair. You have to breathe for five minutes. You can't have eaten or drink, or you have to have an empty bladder. You have to have no clothing on your arm. You have to not children around. So all these things, right? That's how you take a blood pressure measurement, which in practice, who actually does that? I would challenge us even in a physician's office. That's not happening generally. No. So, you know, but that's how blood pressures are taken and have historically been taken. And one of the, one of the major gaps, another major gap in hypertension care is that generally there's just a, a lack of data to even look at, because it's very difficult to get people to routinely measure their blood pressure. Um, and, and so, but that's how cuffs, that's how, that's the only technology we've had. And so you get these episodic readings occasionally. And so what you really get with that data, even if you get it, so generally many patients don't check their blood pressure at all. And so we really have no data and we're operating in a complete data vacuum as physicians and as we try to look at blood pressure and manage it. But even if you get some, remember that blood pressure is a continuously changing parameter. So your blood pressure fluctuates day in, day out, hour by hour, day by day. And what if you only take your blood pressure at. Point in time, then you're only getting that measurement at that one instant and you don't really know what's happening the rest of the time. That's why all guidelines suggest that you have to take your blood pressure measurements very frequently, usually several times a day, or at least two times a day to even have a reasonable sense of your blood pressure patterns, which very few people do. So, uh, founders, the co-founders at IEA, developed a technology that works by optical sensors that are sort of worn. Worn on, you know, using a device that's worn on the wrist like this one, and basically using those optical sensors. It is, and there's a complex sort of algorithm behind it, which probably don't have enough time to explain in this point, but is to basically deliver back blood pressure readings without you having to do anything. So all you have to do is wear it and about, you know, 27 times a day, a blood pressure measurement will be taken, whether you're seated, standing, lying down, sitting. Any position other than exercise, we don't measure it when something you're moving actively. So that gives people about 800 measurements a month, uh, or 200 a week. And so you get a much clearer sense of overall patterns, trends, and you get this really nice complex dataset and then you, it allows you to actually get, um, sort of feedback from your blood pressure. That's another gap that people have. We don't feel blood pressure. You don't know when it's higher. You don't know when it's better. You don't know when you're stressed and it's higher, or you've drank more alcohol and it's higher. You don't know any of those things cuz you can't feel it. So you can start to get these feedback loops that are built. Based on the, based on the readings to say that, okay, my blood pressure, I went through dry, dry January, let's say, and look at what happened with my blood pressure after that intervention, where I started this exercise program. And oh, look at, look at what happened over the next several weeks because I see this pattern changing. And so you can really get constant and continual feedback. With your blood pressure based on like the sort of dataset that, that we create. So that is the primary sort of core technology. And then around that, we wrap layers of software to start to allow people to say, not only annotate their dataset, look at their intera, look at their, um, interventions and see what happened. And then we're starting the process of actually partnering with research organizations and healthcare systems to, to start pulling in health outcome data into these patterns. So that we can start to be even more predictive about what those patterns mean, what these specific blood pressure patterns mean and why. As an example, two people would both would have a blood pressure of, let's say 140 over 85 in my office of the same age. One of them has a stroke and dies at age 60, and the other one lives to 90. Why does that happen? We have currently no idea. Yeah. And so we can start to unlock some of those insights, hopefully from these blood pressure patterns by, by collecting this sort of vast amount of data from different sources and really looking at it in a different way than historically has been

Kelly Stanton: 24:21

done. That's, I love that. There's, it's interesting, we've had a few other guests on the show along the way who are trying to do clinical things with mining, lots of big data. And so, uh, yeah, this, there's a common theme there, and, and I love that because I do think you're, I well, I agree with you as far as putting the power back with the patient. The more we know, the better choices that we can make, hopefully correct. But uh, at the same time too, uh, you know, sometimes, uh, you know, blood pressure is an interesting one for sure, because yeah, you don't feel it, I guess, unless it's really, really high and you have like this massive pounding headache or something. Right. Then yeah, then you are aware.

Dr. Jay Shah: 25:01

Yeah, yeah, yeah. It's pretty rare that people actually feel it.

Kelly Stanton: 25:05

Interesting. All right, well, switching gears just a little bit, if you could go back in time and tell yourself something at the start of your career, what would that be?

Dr. Jay Shah: 25:15

Take more risk. And I guess I've taken some, you know, um, like even in a clinical context, like I trained at Mass General in Washington University, and then I went out and started my own practice. That was a risk, you know, in a different way. Most of my mentors and people who I knew were like, are you crazy? Why would you do that? At the same, because that was at the same time that the vast majority of physicians are joining employed groups and, you know, being part of larger healthcare systems. So, But I did as an example, and I, and I've done a couple other times, like joining Aktiia, maybe as you know, after Mayo Clinic. Um, may, some people might see that as a, as a sort of risky move. But the truth is, is that every time I've done that, I've learned so much and I've grown so much as a person and as a physician, as a, as a father, as everything, you know, I've just grown as a person and, um, I've never really regretted it, even if, even if it didn't work out, even if the end result was not as favorable as I thought it could be or should be or, or might be. Um, I've, I've only regretted the times when I've stayed too long in a certain place cuz it was safe. So yeah, I would've told myself, take more risk, be a little bit more aggressive. Um, and in the end, I think don't, the other part is that I don't look at any step of your journey as like, useless or failing, or I should have done that differently. Or you might have, you might, you could have said, well, I, maybe I could have done that differently. But, but the, but my, in my opinion, in my experience, that every step has led me to this point. And we've heard that. You've probably heard that a lot, but it's true and it's. There was nothing that I did that hasn't been used in some way, um, with what I'm doing now. And so I, I think those would be the two things that I would say to my younger self. Yeah,

Kelly Stanton: 27:27

I love that. Definitely. And I, I agree with that too, for sure. Last fun question for you. If I walked into a bookstore like Barnes and Noble, what section, where would I find you? Mysteries? Mysteries. Yeah. All right. Yeah. Yeah. Any mystery? Got a, got a favorite at

Dr. Jay Shah: 27:45

this point, or, well, in a classic Sherlock Holmes, the two volumes, uh, that's, that's really my favorite. Um, I'll always love those stories, but yeah, that, that would be my, Mysteries.

Kelly Stanton: 27:57

Nice, nice. Uh, sort of keeping in the theme with, uh, well, it's healthcare, right. Giant mystery to be solved. Yeah. Oh, well, thank you so much for your time today, Jay. It's been a real pleasure. Um, where can folks go to learn more about Aktiia and connect with you? Sure.

Dr. Jay Shah: 28:17

So on our website, www.Aktiia.com, you can get on our, uh, website. You can see everything that's there, all our publications, the device, how it works, et cetera, our story. Um, but you can also sign up for updates as we, as we push out new, um, updates and new things. Um, you can go all our social channels, it's for every website. It's, or every social, uh, channel. It's at Aktiia Global. Um, and then on LinkedIn, you can always find me. You know, I'm, I'm available on LinkedIn and, um, we can have those in the show notes probably, but those would be the places.

Kelly Stanton: 28:51

Great. All right. Well, thanks again. It's been a real pleasure chatting with you today.

Dr. Jay Shah: 28:55

Thank you so much, Kelly. It's great being here.