Wearables to predict sudden cardiac death?

Volume 9, Issue 24 | June 20, 2024

Also in This Issue 

Saliva-based diagnostic for prostate cancer risk
A wireless way to “see” inside the brain
Bird flu update
The Playbook for testing in the next pandemic 

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New and Noteworthy

Saliva-based genetic screening for prostate cancer has promise

The search for a better screening test for prostate cancer is making incremental progress, according to study results reported at this year’s conference of the American Society for Clinical Oncology. The latest step: A saliva-based test that rates people’s risk of cancer based on a group of genes. The patient’s result is delivered as a polygenic risk score (PRS).

In this study, only the folks in the highest-risk category (top 10%) underwent further testing. Of those, 40% had prostate cancer, a much higher detection rate than PSA’s typical 25%. And of those cancers, 55% were aggressive (PSA only detected 36% of these). 

In addition, the test was able to catch people that both PSA and MRI would have missed. Close to 80% of the people who had cancer had a PSA in the normal range, and 64% of biopsy-confirmed cancers weren’t caught on MRI.

A follow-up trial will compare this test’s screening ability to that of PSA and MRI in folks with all PRS levels, not just the top 10%.

Wireless, biodegradable sensor could let us “see” inside the brain 

A wireless sensor made of biodegradable gel could be used to track changes inside the brain, according to recent research published in Nature. The “sensor” is really just a sesame-seed-sized speck of hydrogel that changes shape depending on the temperature, pressure, and pH of its surroundings. Once implanted (which can be done without major surgery), it can be monitored and measured via ultrasound. In addition to what its shape tells clinicians about conditions in its location, the way it vibrates can also provide information about blood flow there. 

When implanted into rats and pigs, the sensor “performed as well or even better than conventional wired sensors,” the Tech Times reported. In subjects’ bodies, it began breaking down after five weeks (in saline solution, it was gone after four months).

Wearables may one day predict risk of sudden cardiac death

Traditionally, heart-disease risk is measured in a clinician’s office. But what if you don’t even know you’re at risk? One of the scariest things about heart disease is that its first symptom is often . . . sudden cardiac arrest. 

Researchers have developed a new tool for estimating the long-term risk of sudden cardiac death (aka death due to sudden cardiac arrest) - and the cool thing is that it could be integrated right into a wearable device like a smart watch or smart ring. The estimates are based on a new computational method of measuring heart rate variability. 

Folks whose variability was one standard deviation away from the normal were 2.5 times more likely to die from cardiac arrest over the next eight or so years. The prediction held up even when controlling for a number of other factors, including age and cardiorespiratory fitness. Commentary: So if your future smart watch tells you to go get a stress test, maybe stop what you’re doing and call your doctor.

Bird flu update: Pasteurized milk ok; we need to test more

Idaho has overtaken Michigan as the state with the largest number of affected dairy herds, as reports of affected herds continue to trickle in. 

Commercially pasteurized milk is safe to consume, despite last week’s alarming headlines referencing a research letter to NEJM. A brief and crystal-clear thread by Joe Allen of Harvard’s T.H. Chan School of Public Health explains why.

So far, no farms have signed up for voluntary bulk milk testing.

Michigan announced additional compensation for up to 20 farms with affected herds, at up to $28K per farm. The state’s public-health response to H5N1 was described by STAT News as the most robust in the nation. 

Experts continue to voice concerns about the US’s response to the cattle outbreak:

• Jennifer Nuzzo: The CDC’s test for H5N1 is the only one that’s currently authorized, but it’s only available through the CDC and some 100 public-health labs. Clinical labs (where doctors typically send tests) that have applied to use the approved test have been stymied by bureaucratic red tape, in some cases for months. 

• Kay Russo, Michelle Kromm, Carol Cardona: While it’s not yet a threat to humans other than dairy workers, the viral strain in cattle is an imminent threat to the poultry industry. The dairy industry needs to “start the kind of broad-scale influenza testing and reporting that occurs in the poultry and swine industries.”

• Zeynep Tufekci: US officials don’t know how the virus is spreading. They have guesses, but no clear evidence.

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Food for Thought

To get testing right in the next pandemic, follow the Playbook

As noted above, the H5N1 outbreak in dairy cattle doesn’t yet pose a significant health threat to the general (human) public. And the hope is that it never will. But if it does - or if another microbe shows up with pandemic-causing potential - will the US be ready? It depends on what the nation does now, during “peacetime,” according to the Testing Playbook for Biological Emergencies. 

Authored primarily by experts from the Brown University School of Public Health Pandemic Center and the Association of Public Health Laboratories (Mara is a co-author), the playbook is an effort both to prepare for the future and to avoid the mistakes that we made during the COVID pandemic. An article covering key points from the document appears in this month’s Health Affairs. 

The playbook is organized chronologically. It lays out steps that decision-makers should take and questions they should ask during each of the following time periods:

• “Peacetime,” i.e., when no health emergency exists

• The first 48 hours after the pathogen is found anywhere on Earth

• The first 48 hours after it’s found in the US, then the first week, then the first month

• Six to 12 months after it showed up in the US (ongoing response)

•  “Deceleration,” when case numbers are decreasing and no “significant” new variants are on the horizon 

The major recommendations: 

Structural: 

• Establish a permanent National Testing Lead and Federal Testing Readiness Commission now 

• Create a forum where federal, state, local, tribal, and territorial officials can all discuss issues involving testing

Functional

• Develop a portfolio of pre-vetted test protocols so that the FDA can approve tests quickly when a crisis arrives (peacetime)

• Promote rapid use of effective point-of-care and home-use tests, and involve the private sector early

• Make quality testing data accessible and useful

• Purchase standing federal testing capacity with designated commercial laboratories, academic medical centers, and test manufacturers 

• Establish a permanent program for moving tests into communities quickly, to enhance awareness, choice, and equitable access 

We hate to say it, but there will be another pandemic - the question isn’t whether, but when. Let’s not forget (deliberately or not) the lessons learned from the COVID debacle.