S7E2 - Tackling Cardiovascular Disease: Prevention, Technology and the Path Forward

This episode of AXREM Insights focuses on cardiovascular disease as a major global health challenge and explores how advances in imaging, AI and medical technology are reshaping its detection and management. Host Sally Edgington and guest host Giulia Ginami are joined by Dr Sohaib Nazir, who shares insights from both clinical practice and academic research. The conversation highlights the growing importance of early detection and prevention, with imaging playing a central role in identifying disease before symptoms appear. Innovations in CT, MRI and ultrasound, alongside AI-driven analysis, are already improving diagnostic accuracy and efficiency, but challenges remain around adoption, funding and integrating these tools into everyday clinical pathways.

The discussion also looks at the wider system pressures facing clinicians, including administrative burden, fragmented IT systems and limited interoperability across NHS trusts, all of which can delay diagnosis and treatment. Dr Nazir emphasises the need for better use of existing data, more streamlined processes and stronger collaboration between industry, academia and healthcare providers to close the gap between innovation and patient care. Looking ahead, the episode explores the increasing complexity of patient needs, particularly with rising multi-morbidity and the intersection of conditions such as cancer and cardiovascular disease. Ultimately, the conversation calls for a more proactive, data-driven and collaborative approach to improve patient outcomes and ensure the healthcare system is equipped for the future.

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Transcript

Disclaimer: This transcript was produced using AI transcription software. It may contain errors, misspellings or inaccuracies and has not been fully edited for verbatim precision. It is intended to accompany the podcast audio and should not be relied upon as a standalone or definitive record of the discussion. 

[00:00.000 --> 00:05.600]  Welcome to AXREM Insights, the podcast where we explore the technologies, people and partnerships
[00:05.600 --> 00:10.800]  shaping the future of diagnostic imaging and healthcare innovation. This is our condition
[00:10.800 --> 00:16.800]  series and this month our focus is on cardiovascular disease. I'm Sally Edgington and I'm here with my
[00:16.800 --> 00:24.160]  guest host Giulia Ginami, AXREM future leader representative and collaboration manager at
[00:24.160 --> 00:30.640]  Siemens Health and Ears. Today we have the pleasure to be speaking to Dr Sohaib Nazir,
[00:30.640 --> 00:37.200]  clinical senior lecturer and honorary consultant cardiologist at King's College London and the
[00:37.200 --> 00:43.280]  Royal Brompton Hospital. So welcome Dr Nazir and thank you for being on our show today.
[00:43.280 --> 00:48.640]  Let's start by handing over to you to tell us a bit more about yourself and your career so far.
[00:49.040 --> 00:53.920]  Oh wonderful, so thank you Sally and Giulia for the very kind invitation. It's a real pleasure to be
[00:53.920 --> 01:01.680]  here this sunny afternoon in London. So I'm an academic cardiologist, so I practice as a clinical
[01:01.680 --> 01:08.080]  cardiologist at Royal Brompton Hospital in cardiology and imaging and I've also got a luck
[01:08.080 --> 01:13.280]  enough to have an academic post as well at King's College London where I spend half my week also
[01:13.520 --> 01:20.000]  doing academic research and innovation. My interests are very much in cardiovascular
[01:20.000 --> 01:25.440]  imaging, all types of cardiovascular imaging and also trying to look at new pathways and imaging
[01:25.440 --> 01:31.040]  technologies to improve the lives of my patients. My specific area of interest is looking after
[01:31.040 --> 01:38.400]  cancer patients with heart disease. Brilliant thank you and what kind of got you into this
[01:38.480 --> 01:42.080]  career? Was it something that you always wanted to do from a young age?
[01:43.200 --> 01:49.760]  Great question, so very much serendipity. Looking back about 10-15 years ago I never thought I'd
[01:49.760 --> 01:54.800]  be where I am at the moment in a fantastic institution supported by excellent colleagues
[01:54.800 --> 02:02.080]  and also in this field. I changed direction a few times in my junior training as a junior doctor
[02:02.080 --> 02:07.280]  but one thing led to another and then eventually I found the field of cardiology and then somehow
[02:07.280 --> 02:12.160]  I managed to do a PhD in cardiovascular imaging here actually with Giulia was a PhD student as
[02:12.160 --> 02:17.120]  well at the School of Biomedical Engineering and Imaging Science at King's College London
[02:17.920 --> 02:22.320]  and that's when I fell in love with imaging and then the career just helped to develop part of
[02:22.320 --> 02:26.160]  that. Fantastic thank you and Giulia do you just want to tell us a little bit about your career
[02:26.160 --> 02:31.200]  because it sounds like you've kind of got a similar type background? I am originally from
[02:31.200 --> 02:37.680]  Italy and I graduated there in engineering. After that I spent some time in research,
[02:37.680 --> 02:44.640]  I have a PhD and postdoctoral background in cardiovascular MRI and after a few years in
[02:44.640 --> 02:51.920]  research I joined Siemens Healthineers first in marketing for magnetic resonance where I was
[02:51.920 --> 02:57.840]  responsible for some products and their marketing production and then slightly more than a couple of
[02:57.920 --> 03:03.920]  years ago I joined our collaboration department which means I'm responsible for partnerships with
[03:04.480 --> 03:12.240]  academic realities in particular here in London with the King's Health Partners and I design and
[03:12.240 --> 03:18.880]  drive projects around innovation and clinical validation of new technologies. Wow thank you I
[03:18.880 --> 03:24.320]  have to say I'm glad I'm just the host today because I feel very under qualified. So today
[03:24.320 --> 03:28.800]  we're turning our attention to one of the most significant health challenges of our time,
[03:28.800 --> 03:34.880]  cardiovascular disease. It remains the leading cause of death globally but it's also an area
[03:34.880 --> 03:42.640]  where rapid advances in imaging AI and medical device innovations are transforming how we detect,
[03:42.640 --> 03:48.400]  diagnose and manage heart conditions. In this episode we'll be diving into the realities
[03:48.400 --> 03:54.240]  clinicians face on the ground, the breakthroughs emerging from industry and the collaborative
[03:54.240 --> 04:01.120]  efforts driving early diagnosis, more personalized care and better outcomes for patients from cutting
[04:01.120 --> 04:07.280]  edge CT and MRI technologies to the evolving role of interventional imaging and digital tools.
[04:07.280 --> 04:12.640]  We'll explore how our sector is helping to reshape cardiovascular care whether you're a
[04:12.640 --> 04:19.680]  radiographer, a clinical leader, a policy maker or part of the wider medical technology community
[04:19.760 --> 04:24.240]  this conversation is for you. It's about understanding the challenges, celebrating
[04:24.240 --> 04:28.640]  the progress and shining a light on the innovations that are saving lives every day.
[04:29.280 --> 04:35.200]  So we'll deep dive straight into the questions. Cardiovascular disease is often described as a
[04:35.200 --> 04:41.840]  silent threat. From your perspective where are the biggest opportunities to improve early detection
[04:41.840 --> 04:47.200]  and how can imaging play a more central role in reshaping patient pathways?
[04:47.200 --> 04:52.560]  Thanks Sally, that's an excellent question and I think one of the really important aspects to think
[04:52.560 --> 04:57.600]  about is what can we do for our patients now and what can do for our patients in the future.
[04:57.600 --> 05:02.080]  So there's already really well established therapies out there for patients with established
[05:02.080 --> 05:07.520]  cardiovascular disease. For as an example let's take the disease process of heart failure. Once
[05:07.520 --> 05:13.440]  it's happened there's actually quite good therapies now available but actually I think one of the
[05:13.440 --> 05:18.960]  major challenges for us and the major directions of in the future for as a silent threat is about
[05:18.960 --> 05:23.760]  trying to prevent these problems from happening in the first place. This is where imaging is as a
[05:23.760 --> 05:29.040]  non-invasive tool is really really well suited trying to detect these kind of changes early
[05:29.680 --> 05:35.280]  but the key thing is we need to use the right tools which are clinically meaningful and then
[05:35.840 --> 05:40.240]  things that we can actually action upon to prevent deterioration in the future.
[05:40.240 --> 05:45.440]  Thank you and Giulia do you have anything to add there? Yes I think it's I mean I'm perfectly
[05:45.440 --> 05:51.600]  aligned with what what Sohaib has described and I think I mean in general technology plays a
[05:51.600 --> 05:59.520]  key role and it's important to also you know look at technology not just from the technical footprint
[05:59.520 --> 06:06.160]  but also the role that it has throughout the entire pathway. So to make individual technologies
[06:06.160 --> 06:12.720]  better being it a specific imaging device or a specific interventional device but also the role
[06:12.720 --> 06:20.400]  that it has in streamlining the patient pathway throughout. We are seeing rapid advances in CT,
[06:20.400 --> 06:27.040]  in MRI, in ultrasound and in various technology also when it comes to AI driven component and
[06:27.040 --> 06:34.400]  analysis of those and from your perspective as a comprehensive clinicians when it comes to the
[06:34.400 --> 06:39.680]  cardiovascular space which innovations do you believe are genuinely moving the needle in
[06:39.680 --> 06:46.720]  cardiovascular care and what are the barriers also that you see still exist to the wider adoption
[06:46.720 --> 06:51.840]  of those? Great question Giulia and I think you know as a multimodal imager I really really
[06:51.840 --> 06:56.400]  appreciate all aspects of all the different kind of technologies you've just described. There's
[06:56.400 --> 07:00.960]  actually lots of out there that I think are really good but the ones that I think are really powerful
[07:00.960 --> 07:06.000]  in making a difference and adding incremental benefit on what we're already doing perhaps a
[07:06.000 --> 07:11.520]  few of them. So if we look at CT coronary angiography plaque-based quantification is
[07:11.520 --> 07:16.480]  really can be is changing the paradigm of how we think about our patients and how we treat them.
[07:16.480 --> 07:22.240]  MRI is it is fantastic and cardiac MRI is multi-parametric as you know so you can essentially
[07:22.240 --> 07:27.200]  take the same pitch of the heart several times using different techniques and get different
[07:27.200 --> 07:32.720]  information which is you know really really a fantastic asset to cardiac MRI and actually
[07:32.720 --> 07:37.120]  the processes and the technology and the techniques behind there as Giulia's alluded to
[07:37.120 --> 07:43.360]  have rapidly evolved so we're taking images faster we're processing them faster which means
[07:43.360 --> 07:47.840]  there's less time needed to try and understand what those images mean. Now if we just take the
[07:47.840 --> 07:54.560]  last example ultrasound so ultrasound is very much the workhorse of cardiovascular imaging so
[07:54.560 --> 08:00.000]  looking at trans thoracic echocardiography and there's been huge strides made in the field of
[08:00.000 --> 08:06.000]  echocardiography to do AI enabled assessment of the heart function for instance with ejection
[08:06.000 --> 08:09.920]  fraction and these tools are now readily available and I think they're really really developing
[08:09.920 --> 08:15.440]  further and will continue to do so over the next few years. I think that said that these tools are
[08:15.440 --> 08:20.640]  out there but I think one of the major challenges will be it is about the deployment and the
[08:20.640 --> 08:26.640]  acceptability and getting these tools made available readily for clinical use. There's
[08:26.640 --> 08:31.360]  always a long lag time and all the you know if you look at all the great work that Giulia did in the
[08:31.360 --> 08:38.960]  past in the research studies once those studies are done it there is some time for that kind of
[08:38.960 --> 08:44.720]  technology is taken up by clinicians and deployed readily but that's why you need industry and that
[08:44.720 --> 08:49.120]  kind of partnership with the academic industry and healthcare interface is the one that really
[08:49.120 --> 08:55.760]  will take and churn this way forward. Yeah and I think one of the things I hear from our members
[08:55.760 --> 09:03.200]  is it can be quite frustrating because AI is an amazing tool but obviously getting it up scaled
[09:03.200 --> 09:09.600]  and deployed is you know you can get lots of trials into trusts but actually then getting
[09:09.600 --> 09:15.520]  them to spend the money even if they see the value seems to be one of the the blockers. Do
[09:15.520 --> 09:20.880]  you experience that yourself or hear that from any of your colleagues? Yeah I think that's a
[09:20.880 --> 09:26.800]  really important point the actual deployment process and the acceptability and usability
[09:26.800 --> 09:31.920]  at the point of the interface of the healthcare trusts is a challenge but that that's where I
[09:31.920 --> 09:38.160]  think we need to as a healthcare system be a bit more adaptable flexible and dynamic to be able to
[09:38.160 --> 09:43.760]  you know take on those kind of new tools except the things you mentioned already the AI tools
[09:43.760 --> 09:50.080]  in example and you know embrace them so that we can start using them before those techniques expire
[09:50.080 --> 09:53.520]  and the next thing comes out because actually if these tools are already there we should be using
[09:53.520 --> 09:59.840]  them. I totally agree and I think I see it frustratingly because you know some of our
[09:59.840 --> 10:05.520]  members have tools that are being used in all other areas of the world yet UK patients are not
[10:06.160 --> 10:11.040]  you know seeing the benefit of them so it you know for me it's very frustrating you know
[10:11.040 --> 10:17.760]  representing industry and suppliers of all of those tools so yeah I think we definitely need
[10:17.760 --> 10:24.240]  to upscale at more rapid pace within the UK once we know that something works and that it is making
[10:24.240 --> 10:32.560]  a difference to a patient's life. I agree completely with you Tali there. Great thank you so clinicians
[10:32.560 --> 10:38.240]  are under huge pressure across the system what does the day-to-day reality look like for teams
[10:38.240 --> 10:44.720]  diagnosing and managing cardiovascular disease and how can industry better support you and your
[10:44.720 --> 10:53.440]  colleagues? Thanks Sally so just to maybe put that in context there's a lot of behind the scenes work
[10:53.440 --> 10:59.280]  that goes into seeing a patient managing them and diagnosing them appropriately and starting
[10:59.280 --> 11:04.720]  them the right therapies and if we just take a few maybe snippets I won't map out the whole pathway
[11:05.280 --> 11:11.200]  but you might get a letter in from another clinician from another doctor from another
[11:11.200 --> 11:17.520]  hospital or from a GP that then gets processed that then gets triaged some tests are done
[11:18.400 --> 11:24.000]  and then those tests are done and interpreted in perhaps a multi-disciplinary team meeting
[11:24.560 --> 11:32.560]  the patient's then seen and discussed and then a letter is generated all these points that pathway
[11:32.640 --> 11:37.200]  require time and administration so that all the behind the scenes work which are really really
[11:37.200 --> 11:42.320]  important but actually all if you just map out maybe six or seven of those processes actually
[11:42.320 --> 11:47.920]  the amount of time we actually spend with the patients is actually not that long all that time
[11:47.920 --> 11:52.480]  is taken to like let's retrieve that information get that test done there's quite a lot of
[11:52.480 --> 11:58.480]  administrative work behind the scenes that isn't always captured and probably appreciated by
[11:58.480 --> 12:02.880]  everyone in healthcare so I think one of the biggest things I think in just you could think
[12:02.880 --> 12:09.920]  about doing is trying to enhance and you know streamline those administrative processes that
[12:09.920 --> 12:13.600]  means that we can spend some more time with patients because these tools and technologies
[12:13.600 --> 12:18.880]  you mentioned Sally and we discussed so far are already out there in terms of the imaging based
[12:18.880 --> 12:24.080]  ones so actually if we're able to embed those tools already in that pathway we might be able
[12:24.160 --> 12:30.480]  improve the way our patient pathways and protocols and hopefully improve the patient experience as
[12:30.480 --> 12:35.920]  well I think to do that though there's you know we talk that simplifying process but also we need
[12:35.920 --> 12:41.280]  as clinicians we need the right kind of tools that are user-friendly and it can be deployed readily
[12:42.400 --> 12:48.320]  at scale on you know systems that we use so if it means that you need you know let's say company
[12:48.320 --> 12:54.320]  x comes up with a fantastic tool and that can solve lots of things but you need a high
[12:54.320 --> 13:00.400]  processing you know high spec computer that requires a high-end graphics processing unit
[13:00.400 --> 13:05.280]  you know that costs 10 or 15 thousand pounds and a workstation at different place that's not going
[13:05.280 --> 13:11.120]  to readily work but actually there's actually lots of innovative solutions out there but like
[13:11.120 --> 13:16.080]  using cloud-based computing that might be able to overcome those challenges so I think you know if
[13:16.080 --> 13:22.160]  we have those kind of user-friendly interfaces that can be embedded at point of care those are
[13:22.160 --> 13:28.240]  things that are going to be helpful and solve problems for patients doctors and also let us
[13:28.240 --> 13:33.360]  spend more time with our patients yeah and I think you you all become clinicians because you want to
[13:33.360 --> 13:39.200]  help patients and ultimately you want to have time to spend with patients and I always say that
[13:39.200 --> 13:44.880]  some of the innovations and technologies that AXREM members provide create those efficiencies to
[13:44.880 --> 13:50.240]  enable you to spend more time so I think we just need I bet you all of the solutions are out there
[13:50.240 --> 13:56.400]  it's just a case of you know finding them and putting them all into into one pathway
[13:57.360 --> 14:03.120]  and I think that's the the challenge and I think the other challenge is about how they all integrate
[14:03.120 --> 14:08.640]  with one another because there's so many different you know innovations and products out there so
[14:08.640 --> 14:14.640]  sometimes that can be a blocker is how they integrate and I know that when we sometimes
[14:14.640 --> 14:21.760]  speak to members an IT department within a hospital think about computers but actually
[14:21.760 --> 14:29.520]  most medtech products are connected in some way to the IT infrastructure but so there's not always
[14:29.520 --> 14:35.520]  that great understanding of how they should all integrate internally within a trust and I'm sure
[14:36.080 --> 14:41.680]  you've probably come across that at some point yeah I've had lots of challenges the past years
[14:41.680 --> 14:45.920]  but even deploying you know simple softwares potentially that might be quite helpful because
[14:45.920 --> 14:49.440]  there's a number of barriers that you know number of processes you need to get through to get into
[14:50.480 --> 14:56.960]  the very secure NHS system and deploying on healthcare records or those kind of computers
[14:58.720 --> 15:02.800]  but you know that I think what you just said really summed it up there is a lot of stuff out
[15:02.800 --> 15:09.360]  there ready a lot of tools and actually they're all as in the small pieces of a jigsaw what we
[15:09.360 --> 15:14.640]  need to just put that jigsaw together and then we need to continuously update and refine it rather
[15:14.640 --> 15:18.960]  than wait for the system to break down and they say oh well now this is a new problem we've got
[15:18.960 --> 15:23.600]  or a new diagnosis actually we need to be more disruptive and intuitive and put those jigsaws
[15:23.600 --> 15:29.360]  together dynamically and be able to move them as time goes on so it needs a bit of a rethink
[15:29.360 --> 15:32.480]  about how we do things but the tools are out there we need to get them using them
[15:33.360 --> 15:39.760]  yeah I agree and I use this term a lot we talk about one NHS but actually there's lots of
[15:39.760 --> 15:45.920]  different trusts that are all doing their own thing do you think that that is a good or bad
[15:45.920 --> 15:50.800]  thing because I wonder whether that is a blocker to some of this innovation and technology that
[15:50.800 --> 15:55.920]  could help clinicians yeah I mean I'm just reflecting when I was a medical student
[15:55.920 --> 16:04.160]  about 20 years ago Imperial and I heard about having a one national IT system dream and there
[16:04.160 --> 16:09.520]  was that was the policy that was a policy about 20 years ago and Lord Aridazi was health minister
[16:09.520 --> 16:14.320]  it was a great idea and there was going to have this NHS backbone spine and have a you know one
[16:14.320 --> 16:20.400]  system 20 years later hasn't really happened as you say people are not necessarily working in silos
[16:20.400 --> 16:24.480]  but they have partnerships so there's large organizations so we're part of King's Health
[16:24.480 --> 16:30.080]  Partners, Guy's and St Thomas's and Royal Brompton and Harefield Hospital which is fantastic we've
[16:30.080 --> 16:35.440]  got very very large infrastructure but actually we're not always connected to the rest of the
[16:35.440 --> 16:39.840]  UK so we've got a fantastic operating system what we use at the moment but actually it's
[16:39.840 --> 16:46.160]  about having those integration and having a bit more centralized way of managing these things that
[16:46.160 --> 16:51.520]  it can be rapidly deployed and if we're all using similar systems we can all communicate far better
[16:51.520 --> 16:57.760]  I think that would be the absolute ideal situation I think the reality is the NHS is such a
[16:57.760 --> 17:04.720]  I mean obviously the biggest organization in the UK so I think deploying one system for everyone
[17:04.720 --> 17:08.880]  would be such you know a huge challenge but actually it's it's one that we should be looking
[17:08.880 --> 17:13.920]  at and I think one of the other things and I don't know whether it's the same in cardiovascular
[17:13.920 --> 17:21.760]  care but one of the things I see in general diagnostic imaging is there isn't one currently
[17:21.760 --> 17:28.240]  one register that keeps all of the images so for instance my son was taken poorly in Cornwall
[17:28.240 --> 17:34.080]  and had a CT scan and when he came back home to Northamptonshire and was taken poorly a couple
[17:34.080 --> 17:41.040]  of weeks later he had to have another CT scan and to me that just seems crazy that that information
[17:41.040 --> 17:47.040]  is not shared across trusts because with a workforce shortage and obviously with the
[17:47.040 --> 17:54.160]  economic situation and funding within the NHS that would be a massive cost saving and a time
[17:54.160 --> 17:59.760]  saving and obviously help with the workforce do you see that in cardiovascular area as well
[18:00.560 --> 18:04.400]  so Sally you made an excellent example then I'm sorry to hear that your son had to have another
[18:04.400 --> 18:09.600]  CT scan because that's not what should be happening but that's a very good example where
[18:09.600 --> 18:14.560]  we can avoid duplication of resources and duplication of testing so in fact a lot of my
[18:14.560 --> 18:20.480]  time in my week in my admin time when I'm seeing or processing the patients I spend a lot of time
[18:20.480 --> 18:26.240]  actually requesting images from other hospitals because we're not on the one system or that you
[18:26.240 --> 18:32.240]  know one registry where you can be able to access and pull data because if you have all that access
[18:32.240 --> 18:38.160]  ready you don't have to you know you don't have to waste time importing that data and then you
[18:38.160 --> 18:42.080]  could use that information to guide the patient guide the management of those patients going
[18:42.080 --> 18:48.080]  forwards as well so I think having and I think the way that that needs to be done is actually
[18:48.080 --> 18:54.160]  even if we're operating on separate systems we just need to have easy accessibility to others
[18:54.160 --> 18:58.000]  electronic health care records and DICOM datasets and PACs and whatever we're using
[18:58.720 --> 19:02.320]  so that we've got all that kind of information ready to hand so we can improve the way we
[19:02.320 --> 19:07.360]  improve you know treating our patients going forwards yes I mean it's a very fascinating
[19:07.360 --> 19:12.400]  conversation and one point that came to mind while you were talking Sohaib I was thinking
[19:12.960 --> 19:19.040]  I mean someone in your position you have this very unique and in a way very interesting and
[19:19.040 --> 19:25.040]  privileged setup where you are fully embedded in the clinics through your Brampton activities
[19:25.600 --> 19:30.720]  as well as in the research right and I would imagine that you well I would imagine that you
[19:30.800 --> 19:38.320]  see a gap between what's actually available to patients these days and what we have developed
[19:38.320 --> 19:44.160]  as human beings with our thoughts and with our you know implementations and what would be possible
[19:44.160 --> 19:50.000]  for them to have my question is how from your perception when it comes to cardiovascular care
[19:50.000 --> 19:58.880]  how big do you think this gap is and also from let's say a personal perspective is it frustrating
[19:58.880 --> 20:04.560]  for you to see that you know maybe there is a certain technology available to patients while
[20:05.200 --> 20:12.000]  meanwhile something much more detailed and much more suitable perhaps has been developed and
[20:12.000 --> 20:18.560]  that's not something that you can offer to them at this point in time yeah it's a great question
[20:18.560 --> 20:24.000]  Giulia I think you know as you say I feel really privileged because I'm at the academic institution
[20:24.000 --> 20:28.160]  where it's at the cutting edge of these new technologies that Giulia and the team are developing
[20:28.480 --> 20:33.760]  at Siemens Health Nears and other industry members and then we then I see what we're doing now on the
[20:33.760 --> 20:38.720]  patient side so I think there is clearly a gap but that's where I think you know we need to have
[20:38.720 --> 20:42.560]  those kind of disruptive technologies where we are able to try and use those technologies at an
[20:42.560 --> 20:48.000]  early pace and embed them in the healthcare system sometimes it has felt frustrating we think oh this
[20:48.000 --> 20:52.400]  is clearly an answer this but it just needs it just sometimes just needs a sensible approach
[20:52.400 --> 20:57.120]  and say look what have we got what are we trying to do let's just put these tools together and put
[20:57.120 --> 21:01.760]  that jigsaw together and then the cogs will just start moving and then you'll have a very very
[21:01.760 --> 21:08.720]  rapid way of getting all these processes done and improving you know and then you know moving
[21:08.720 --> 21:13.920]  the patients forward getting more patients seen more diagnosis done and the early treatment
[21:13.920 --> 21:17.680]  initiated for the patients and that's going to be the things that can improve our healthcare system
[21:17.680 --> 21:23.120]  and I mean on the basis of all of these and in line with what we have discussed that if you
[21:24.080 --> 21:30.400]  could change one thing about how we approach cardiovascular disease in the next five years
[21:30.400 --> 21:37.680]  whether this is technology policy pathways way of collaborating what do you think would make
[21:37.680 --> 21:44.400]  the biggest difference for for patients well lots of things and if you had a blank check you could
[21:44.400 --> 21:48.000]  just think about all the lovely technologies that you might want in implementing the different
[21:48.000 --> 21:54.560]  hospitals and see how quickly that could move on and just get more diagnosed but actually I think
[21:54.560 --> 21:58.960]  you know we've got to take a bit more wider perspective on things and I think we've got
[21:58.960 --> 22:06.720]  to be really disruptive in the way we do things I mean as you know all these new techniques using
[22:06.720 --> 22:13.440]  deep learning machine learning and AI are really progressing at such a fast pace and at the same
[22:13.440 --> 22:20.080]  time there's in parallel there's lots of clinical trials being done in parallel as well they're
[22:20.080 --> 22:24.720]  moving at such a fast pace particularly when you look at the field of oncology as an example all
[22:24.720 --> 22:32.640]  these new trials rapidly being done and by the time we are able to make informed decisions about
[22:32.640 --> 22:38.720]  right this what we need to do actually that tech or those clinical trials might be out of date
[22:38.800 --> 22:43.200]  because the new studies come about or new technologies being deployed so I think what
[22:43.200 --> 22:48.160]  we need to really be thinking about is if we really want to move the needle forward
[22:48.960 --> 22:54.880]  it'd be a bit more disruptive about how we use our data and rather than wait for the data to come in
[22:54.880 --> 23:00.080]  and reflect on it and then write a guideline a few years later if we really want to be really
[23:00.080 --> 23:06.240]  dynamic I think one this might sound slightly crazy but I think what we need to do is capture
[23:06.240 --> 23:12.240]  that kind of data real time to all our patients if we're capturing that data real time at point
[23:12.240 --> 23:18.800]  of care it's integrated and then we have an iterative system where it is used to improve
[23:18.800 --> 23:24.960]  our pathways and diagnosis that's actually where we're going to see really big gains
[23:24.960 --> 23:30.720]  where we're actually capturing that data at point of care and it's being embedded and used for
[23:30.720 --> 23:36.880]  research purposes and also enhancing the clinical pathway because that doesn't need a
[23:37.680 --> 23:44.080]  brand new scanner or a brand new device it just means a sensible approach to just capturing what
[23:44.080 --> 23:51.280]  we already got which is data for free but managing that data for free is complex but then that's where
[23:51.280 --> 23:58.480]  you might have tools you know AI tools or digital twins or other novel approaches where actually you
[23:58.480 --> 24:02.880]  can capture that data and say right this is what we think is going on what can we do better with
[24:02.880 --> 24:06.880]  this data for our next patient that we've seen and before you know it in a few months time you're
[24:06.880 --> 24:12.080]  already making a difference to patients sounds slightly wild but I think that's slightly that
[24:12.080 --> 24:15.200]  that's the kind of disruptive things we need to think about in the future of our patients
[24:16.640 --> 24:21.760]  yeah and just a couple of points around that I think that as I mentioned earlier I think the
[24:22.480 --> 24:28.240]  adoption of innovation can be quite slow for various reasons and I actually have companies
[24:28.240 --> 24:33.360]  that come and speak to me about AXREM  membership where they've got an amazing innovative product
[24:33.360 --> 24:37.440]  and I'll go back to them a month later and say do you want to join and they're like we decided not
[24:37.440 --> 24:43.200]  to do business in the UK because it's just too difficult to get innovations into the NHS which
[24:43.200 --> 24:47.280]  we need to do better at that and I you know I know the Department of Health and Social Care are looking
[24:47.360 --> 24:52.480]  at innovation pathways and other things like that which is really important but I agree with the
[24:52.480 --> 24:57.840]  data we just need to work much smarter and and really maximise the use of that data because
[24:57.840 --> 25:03.520]  that's going to inform so many decisions within the NHS and I think when we were talking earlier
[25:03.520 --> 25:10.720]  about the images being transported if you like from one trust to another we see a great example
[25:10.720 --> 25:16.320]  of the NHS app working brilliantly for patients so I can log into my app and all my data is there
[25:16.320 --> 25:21.040]  I know exactly when I last went to the doctor when my last prescription was approved and
[25:21.040 --> 25:26.880]  and if we could have a system like that that you guys can use as clinicians that is much more
[25:26.880 --> 25:32.960]  informative and transferable from one trust you know one area of the country to another
[25:32.960 --> 25:39.120]  that's going to just inform your decision making so much better. Yeah no I agree and I think there's
[25:39.120 --> 25:43.040]  efforts being done to do that so we've got a really good electronic healthcare record system
[25:43.040 --> 25:46.880]  that we use at our trust and I think it's fantastic and it works really well it automates
[25:46.880 --> 25:52.960]  a lot of these tasks but there's a big role there's a huge opportunity for us to do more I think.
[25:52.960 --> 26:00.400]  Oh I agree thank you. I wanted to ask you Sohaib also again reflecting why we were talking I mean
[26:00.400 --> 26:06.320]  I think it's been amazing to see how much technology and the adoption of technology has improved in the
[26:06.320 --> 26:12.640]  last in the last few years and the main result of this is that we have also a population that lives
[26:13.280 --> 26:21.040]  longer which is in itself great right and but that also means there is more exposure to disease
[26:21.040 --> 26:27.680]  and one of the elements is also that sometimes the disease intersects and in your case I know
[26:27.680 --> 26:35.760]  you are very much working also on cardio-oncology which is basically the impact that oncology and
[26:35.760 --> 26:40.640]  that kind of disease has on the cardiovascular system of your patients please correct me if
[26:40.640 --> 26:47.200]  anything is inaccurate here but in a way this is this is adding an additional layer of
[26:47.200 --> 26:52.880]  multidisciplinary an additional layer of complexity do you think we are ready to tackle that where do
[26:52.880 --> 27:03.120]  you think we are or sort of from you know the way we collaborate industry clinicians NHS and so on
[27:03.120 --> 27:09.120]  and a general reflection from you around this. Yeah excellent point so you raise Giulia I completely
[27:09.120 --> 27:13.840]  agree with all aspects of what you said and I think we are heading to a bit of a tsunami about
[27:13.840 --> 27:18.720]  what healthcare would look like in a few years time so while cancer and cardiovascular disease
[27:18.720 --> 27:22.880]  are the two biggest causes of death worldwide actually cardiac oncology is where the fields
[27:22.880 --> 27:29.120]  collide and where you have problems at the point of cancer treatment but also the long-term
[27:29.120 --> 27:33.840]  survivors because we know a lot of these cancer survivors have a lot of cardiovascular problems
[27:33.920 --> 27:39.680]  that manifest much later in life and that's things that we need to address now because these are
[27:39.680 --> 27:46.720]  becoming more and more of a problem we don't have systems set up for cancer survivorship for
[27:46.720 --> 27:50.960]  cardiovascular care and so that's one perhaps tangible thing I think we maybe we should think
[27:50.960 --> 27:54.480]  about after this endless meeting actually what we're doing is these patients maybe there's a
[27:54.480 --> 28:01.200]  new pathway for our own local trust but actually the other point you made Giulia was also about
[28:01.200 --> 28:07.120]  complexity of disease processes so patients don't come in anymore with just well I've got
[28:07.120 --> 28:13.920]  a heart attack or I've come in having one problem my heart having a disease actually that disease
[28:13.920 --> 28:19.040]  process of a specific part of the heart might be so intricately related to lots of the disease
[28:19.040 --> 28:24.720]  process around the body and that's where the concept of multi-morbidity is going to be a real
[28:24.720 --> 28:31.920]  problem in the next decade there's a quote from one of the NHS England looking at the what the
[28:31.920 --> 28:36.960]  projection of multi-morbidity is going to be like in 10 years time and multi-morbidities where
[28:36.960 --> 28:43.520]  you've got a disease process of two or more organs so cancer and liver disease as an example so maybe
[28:43.520 --> 28:49.600]  heart and liver or kidney and brain disease whichever combination and actually it's expected
[28:49.600 --> 28:55.040]  actually more than half the population are going to be having these kind of problems in 10 years
[28:55.040 --> 28:59.600]  time the question we've got ourselves what we're doing about this what we're going to be doing and
[28:59.600 --> 29:04.800]  actually we need to not only have the right healthcare professionals to look after these
[29:04.800 --> 29:10.400]  patients but also the right technologies to deal with these complexities and it goes back to what
[29:10.400 --> 29:14.560]  we're saying if we've got that real-time AI capture or the data that's where it's going to embed in
[29:14.560 --> 29:19.120]  the future but we need to think about having tools that are going to address these complexities
[29:19.120 --> 29:24.960]  because at the moment sometimes we only look at disease processing single organ or single disease
[29:24.960 --> 29:29.680]  processes but actually it's going to be far more complex in the future and I think this is where
[29:29.680 --> 29:35.520]  we all need to work together industry needs to come together with academia and also at the
[29:35.520 --> 29:40.080]  front line of the healthcare to understand what are these challenges and what are we going to do
[29:40.080 --> 29:44.960]  to solve them because it's going to be a real problem from the healthcare system and also from
[29:44.960 --> 29:51.280]  a socio-economic burden for the the UK government how we fund this and having the right kind of
[29:51.280 --> 29:56.800]  treatments involved before all the impact takes care it takes hold on the patient's health and
[29:56.800 --> 30:02.480]  also the healthcare system yeah and you've mentioned a couple of times during the podcast
[30:02.480 --> 30:10.400]  about preventing disease so how can people prevent cardiovascular disease how can we
[30:10.400 --> 30:16.000]  lighten your workload yeah so it's a great question actually I did part of my job actually
[30:16.000 --> 30:21.920]  is that I know we talked about imaging and cardiology and multimodal imaging but actually
[30:21.920 --> 30:26.000]  I really enjoyed doing preventative medicine there's lots of things we can do from a cardiovascular
[30:26.000 --> 30:30.720]  perspective you know there's simple things like to help asking patients to stop smoking making
[30:30.720 --> 30:35.200]  sure their diabetes and cholesterol is well controlled but actually if you if we're able
[30:35.200 --> 30:42.480]  to harness that okay and personalize it for all our patients using personalized imaging things like
[30:42.480 --> 30:47.760]  coronary calcification scores and a CT scan looking at early markers of heart dysfunction
[30:47.760 --> 30:52.960]  on MRI or echo these are things that we tools that we have readily available now
[30:53.760 --> 30:59.040]  that we can use for screening of patients but also it's trying to identify which patients
[30:59.040 --> 31:02.800]  will get those problems in the future but we've got a lot of risk tools available
[31:03.600 --> 31:08.960]  and it's about actually using those a bit more widely and getting one thing we've not talked
[31:08.960 --> 31:13.680]  about sally actually said all these ideas actually wonderful and there's companies that got all these
[31:13.680 --> 31:17.920]  fantastic tools out there it's one of the major things is about the reimbursement so if there's
[31:17.920 --> 31:22.640]  no reimbursement model it's very hard to deploy technology in the UK healthcare system because
[31:22.640 --> 31:28.080]  actually that company the SME that's got a new tool is going to go bust if they just keep on working
[31:28.080 --> 31:33.600]  without any return so actually the reimbursement of those preventive tools is going to be what I
[31:33.600 --> 31:38.000]  think will be really really important because there's lots of out there already but we just
[31:38.000 --> 31:42.320]  need to apply them and also make sure there's a adequate reimbursement model for the people
[31:42.320 --> 31:47.440]  come up with these tools so that actually we can be the leaders the world leaders of innovation
[31:47.440 --> 31:54.240]  technology and when we plan that money back into R&D to the innovatives that can then go into make
[31:54.240 --> 31:59.120]  the newer tools that for the next five years the 10 years for these multiple mobility patients
[31:59.120 --> 32:02.640]  actually that's where we're going to be excelling and leading the way forward in the world I think
[32:03.600 --> 32:08.640]  yeah I totally agree and obviously we hear from the government that they want the UK to be the
[32:08.640 --> 32:16.160]  life science powerhouse by 2030 it's now 2026 like we've only got three four years to achieve
[32:16.160 --> 32:21.920]  this and so I absolutely agree with you on that point but yes I think we've all got a role to play
[32:21.920 --> 32:26.240]  you know to be more healthy live more healthy lifestyles so hopefully then that does
[32:26.240 --> 32:31.520]  reduce your workload a little but we're going to move on now and we're going to mix things up a
[32:31.520 --> 32:37.040]  bit and and be a bit more light-hearted so we always end a podcast with our quirky question
[32:37.600 --> 32:40.960]  and I know at the beginning you were slightly worried about this so I've actually thought I
[32:40.960 --> 32:47.440]  will answer the quirky question first for you to give you an idea so our quirky question today is
[32:47.440 --> 32:52.640]  if you could have a solo dinner with one person anyone in the world living today who would it be
[32:52.640 --> 32:58.240]  and why so I was just thinking about this and basically following our conversation I'd probably
[32:58.240 --> 33:06.080]  be a bit greedy and want to have a dinner with Wes Streeting and James Mackey because I would really
[33:06.080 --> 33:14.480]  really like the NHS and the government to see industry as a true partner to the NHS and it's
[33:14.560 --> 33:19.040]  very frustrating for me I write a lot of letters to ministers and to Wes Streeting
[33:19.600 --> 33:26.640]  but actually getting them to speak directly to us is quite a challenge so in my role it's probably
[33:26.640 --> 33:32.000]  my biggest frustration and I think that when the government made the pledge during their
[33:32.000 --> 33:39.600]  election campaign to double scanner capacity AXREM  represent 100% of scanner suppliers in the UK
[33:39.600 --> 33:46.480]  they've never directly came and spoke to us and it's really frustrating because it's like you said
[33:46.480 --> 33:51.120]  it's not necessarily that we need more equipment we just need to use the equipment more smartly
[33:51.120 --> 33:58.560]  and I would imagine that the OEMs the manufacturers of the equipment can show the NHS how to work
[33:58.560 --> 34:04.880]  smarter with their equipment to help capacity so mine's a very kind of worky one rather than
[34:04.960 --> 34:10.880]  a personal one but you can have Eva so we'll now go over to Dr Nazir to give us your answer who
[34:10.880 --> 34:17.520]  would you like to have a solo dinner with? So Wes Streeting was not bad I think I think that's a
[34:17.520 --> 34:21.360]  good choice I think and reflecting on that so but just maybe for the audience who are listeners we
[34:21.360 --> 34:26.320]  had a pre-meeting I just had a quick question about the person I wanted to nominate for her
[34:26.320 --> 34:32.240]  to have dinner with but he's now in prison so but he was um so I reckon maybe I'll just go back to
[34:32.240 --> 34:39.200]  that was actually it was Imran Khan who many of you may know was a famous cricketer in the 1990s
[34:39.200 --> 34:44.800]  but also led a very large successful political party to try and change and democratise parts
[34:44.800 --> 34:49.520]  of South East Asia so I think he still was probably the person to go for dinner with at the moment
[34:49.520 --> 34:55.760]  but I guess if we want to make change like through AXREM  we probably need not only just one person
[34:55.760 --> 35:00.800]  we need a round table dinner with lots of people we need clinicians on the table who are frontline
[35:00.800 --> 35:06.480]  seeing all the problems at the frontline we need academic researchers who are at the forefront of
[35:06.480 --> 35:14.320]  cutting technology to understand what is possible and that interface between healthcare and industry
[35:14.320 --> 35:19.680]  and then also industry partners just understanding what is the problem going forward because actually
[35:19.680 --> 35:23.840]  if we have those round table discussions beyond a solo dinner then actually that's where we're
[35:23.840 --> 35:28.880]  going to make change we all do it collaborative together because it sometimes sometimes we've
[35:28.880 --> 35:33.760]  gone to some events and I think I've heard a talk about a tool and I think that was a brilliant tool
[35:33.760 --> 35:39.440]  but probably doesn't have much role in a couple years time because something else is going on
[35:40.160 --> 35:45.280]  you know that that problem is going to be phased out or another company's got this going you know
[35:45.280 --> 35:50.880]  this other tool that's been developing so if we're all actually singing from the same same
[35:50.880 --> 35:55.760]  same hymn sheets at the same dinner table then we're not going to be working the silos
[35:55.760 --> 35:59.520]  and then we'll all do it together collaboratively cross institution
[36:00.720 --> 36:08.240]  cross national cross borders that's all going to make impact I think I totally agree and I'd like
[36:08.240 --> 36:14.560]  to think that AXREM m is a great platform to be able to do that in all of our work we you know
[36:14.560 --> 36:20.080]  we collaborate with the societies and royal colleges the RCR, SOR, BIR and all the other
[36:20.160 --> 36:27.040]  acronym organisations because the clinical voice is so important we have to do this together as one
[36:27.920 --> 36:33.200]  so I totally agree with you so thank you very much. Giulia same question to you so if you could
[36:33.200 --> 36:39.600]  have a solo dinner with one person anyone in the world who would it be and why? So mine is truly
[36:39.600 --> 36:47.040]  going to be lighthearted and I'm a big fan of I'm a big fan of tennis so I would say either Roger
[36:47.040 --> 36:54.080]  Federer or Serena Williams and the reason being apart from a personal passion for the sport
[36:54.880 --> 37:00.480]  I would say that when someone is for a very long time at the top of their game they are also
[37:01.200 --> 37:06.640]  you have also a lot to learn from them when it comes to handling pressure handling you know
[37:06.640 --> 37:13.440]  constant kind of scrutiny and being at the top of your performances all the time and I guess that
[37:13.440 --> 37:22.160]  there is a lot of insights and learnings that you can translate into every profession and therefore
[37:22.160 --> 37:28.800]  in that sense I think I would have a lot to learn from either of them and then I mean just to
[37:30.160 --> 37:37.040]  comment on your thoughts when it comes to changing things in our field I agree that
[37:37.600 --> 37:43.920]  rather than a solo dinner what we probably need to have is more intentional I would say
[37:44.720 --> 37:49.840]  discussions in larger rounds particularly when it comes to multidisciplinary rounds
[37:50.640 --> 37:56.800]  and I agree with you Sally that's something where AXREM is an excellent platform and there is the
[37:56.800 --> 38:02.720]  the potential to be even more so that's something that we also try to to steer with our future
[38:02.720 --> 38:09.760]  leaders council and I'm looking forward to have more of that. Dr Nazir? I've got a comment actually
[38:09.760 --> 38:14.560]  I'm really glad you said Roger Federer or Serena Williams actually I'm actually a massive tennis
[38:14.560 --> 38:19.040]  fan as well and I actually grew up in Wimbledon so I was always watching tennis when I was growing
[38:19.040 --> 38:23.360]  up but there was one really inspirational thing that I heard from Roger Federer after he retired
[38:23.360 --> 38:30.240]  and I'm sure Giulia and Sally you've heard this but he gave like a coaching talk about
[38:30.720 --> 38:34.240]  how he got coached and something I've taken away as well and I think something we should do for
[38:34.240 --> 38:38.560]  healthcare by the way as well not saying we should be throwing tennis balls around the industry or
[38:38.560 --> 38:42.880]  the hospitals that probably won't go down right but one of the things that he did is that he said
[38:43.440 --> 38:49.760]  I think as a top ranked tennis player he won about 70 to 80 percent of matches yet if you look at his
[38:49.760 --> 38:55.440]  point score his point score if you look at every ball he played actually he only won about 50% of
[38:55.440 --> 39:04.240]  them so with a 50 success rate per ball or per shot he managed to win and be one of the most
[39:04.240 --> 39:09.520]  successful tennis players in the world and the way he did that is that once he took on a task or took
[39:09.520 --> 39:15.360]  on one serve or played one ball whatever the outcome of it would be he would get about it
[39:15.360 --> 39:20.000]  and focus on to the next the next ball and the next point because actually with that with and
[39:20.000 --> 39:24.480]  then that way you don't sorry I'm slightly digressing on this one but it's a really good
[39:24.480 --> 39:28.560]  point because actually rather than gloom on one things have not gone well you just focus on the
[39:28.560 --> 39:33.120]  next one and equally once you've done really well you don't gloat about it you just go on
[39:33.120 --> 39:38.400]  and keep on trying to be persistent and consistent and that's where success begins so yeah I think
[39:38.400 --> 39:45.280]  I would also like to join you Giulia if you ever go and have a solo dinner with Roger Federer or
[39:45.280 --> 39:51.920]  Serena Williams as well if that happens so hi I'll make sure I invite you I was gonna say and if you
[39:51.920 --> 39:56.080]  insist I will be happy to join you and I think that your point there Dr Nazir is actually
[39:56.720 --> 40:03.360]  really how the NHS works you know as well like you know if something goes wrong you don't stop
[40:03.360 --> 40:10.240]  you carry on because you want to do best for your patients so you continue to you know fight barriers
[40:10.240 --> 40:16.560]  and difficulties to make sure you're always doing what's right by the patient and that's why we're
[40:16.560 --> 40:21.200]  all here and we're all doing the different jobs in the different sectors and areas but like you
[40:21.200 --> 40:26.160]  say together and collaboratively we can achieve so much and I think that's a really great point
[40:26.160 --> 40:32.240]  to actually end the podcast on so it's been great to get to know more about you Dr Nazir
[40:32.240 --> 40:38.160]  and get some further insights into cardiovascular disease a big thank you to Dr Nazir for joining
[40:38.160 --> 40:42.720]  us thank you to Giulia for being my guest host and thank you to all of our listeners