**Podcast Episode: "EP402: Remote Monitoring Menopause and Much More - Mark Goddard"**
**Dr. Auric Bishop:** Welcome, my name's Dr. Auric Bishop. I'm a cardiologist, I'm an author, and a keynote speaker. I'm the CEO of the Healthy Heart Network. I'm all about trying to help people live as well as possible for as long as possible. Heart disease is huge in Australia. Every 20 minutes, someone suffers a heart attack. Most of these could probably have been avoided if only we knew what to do. This podcast is all about helping you understand blood pressure, weight, and cholesterol for better health. If you enjoy this podcast, I would be honoured for a five-star review. You can share it with your family and friends. It may well save someone you love.
G'day and welcome to my podcast and videocast station. Thank you for tuning in. Today, I've got all the way from the United States, Mark Goddard, joining me, and this is going to be a cracker, so stay tuned. Welcome, Mark. How are you?
**Mark Goddard:** Dr. Bishop, it's a pleasure. Thanks for having me. I appreciate it.
**Dr. Bishop:** You can call me Dr. Warwick like everyone else.
**Mark Goddard:** Okay. Dr. Warwick, sorry about that.
For those listening, Mark is based in the US. He's on the eastern border, in northeast Maryland. His training is as a registered nurse, but he's trained up specifically in devices—implantable devices. He's been doing that for about 20 odd years, and he's in that space where, as anyone who knows anything about these devices is aware, the technology is rolling along with greater and greater sophistication. One of those aspects of sophistication is the way we can remote monitor, and now Mark is intimately involved as Vice President of Clinical Services for an organization called Infobionic, which delivers monitoring equipment in the US and also in Australia. Did I get that right, Mark?
**Mark Goddard:** You got it absolutely right. That's correct. Yep.
**Dr. Bishop:** So just in very simple terms, for those listening, when we talk about devices, we talk about things like pacemakers and defibrillators. When we're talking about how they're remotely monitored, just give us a very quick potted history on what you've seen over those 20 years.
**Mark Goddard:** For those particular devices, the patient will be provided with a monitor once they have the implant, and they'll go home with it from the hospital. From there, that device is able to transmit information at any time. Some of them have to be used manually; some happen automatically. But either way, it's a really cool way to keep track of these devices. Defibrillators and pacemakers specifically have measured information that needs to stay within a normal range related to the function of the device. But it also provides the doctor with diagnostics related to heart rhythm as well. So it's been a revolution. My first 10 years of practice, we didn't have that technology. At that time in the US, we'd have the patient come in every three months, run those tests, and check for arrhythmias. But we wouldn't know what would happen in between those 91 days. Now, you know immediately, which is awesome, especially with certain arrhythmias that need to be addressed quickly to stave off anything that would be untoward.
**Dr. Bishop:** Well, I'm certainly seeing that the device companies—the big businesses that build these devices—seem to put in place remote monitoring systems. Certainly in my own practice, I'm now getting information telling me if someone's had atrial fibrillation or a pause. If I've got a device in for monitoring rhythm only, rather than delivering electrical charge, I'm getting all sorts of information that comes through. What does your company Infobionic do in that space?
**Mark Goddard:** Infobionic is a little bit different in that regard in that they're not implanted devices. We have one device that's a wearable. The patient will wear it for anywhere from one day to 30 days. That device will transmit near real-time electrocardiographic information, or like an ECG, at all times. So from the time the patient puts it on until they take it off, they're being monitored. The great thing about that compared to previous monitoring techniques is that real-time aspect. In the late 90s and through the 2000s, it was a device that you would carry with you; you would make a recording, but you had to upload it to get it reviewed. And it wasn't timely at all. So things have really changed in that regard.
**Dr. Bishop:** Well, I can see the significance and the value in a device like that because we'll often see people who have a moment in time. They might be 40, 50, 60, or 70 years of age, and one event has led to them blacking out. In all that time—70 years—they haven't had a single problem. So to put on a device, our standard Holter monitor for 24 hours, it's a one in 365 chance that we'll get the day that the event happens. But let alone you multiply that by the number of years. So something that's got a 30-day monitoring ability sounds like it really increases your chances of picking up.
**Mark Goddard:** I think it does. And then quite often, if, like you mentioned, you monitor, if our device doesn't detect anything in those 30 days, quite often the patient will get an implanted device that can be managed long-term, and you would get that data every day for a couple of years instead of just 30 days.
**Dr. Bishop:** Yeah, those little implantable devices that Mark's alluding to are tiny. They came out initially as the size of a USB memory stick, and they've got smaller and smaller. They're smaller than your finger these days, thinner than your finger, and you can literally inject them under the skin. They can sit there for up to three years recording rhythm, which is just amazing.
So we'll wrap it up on Infobionic, but I will mention to those listening, there is a website, so feel free to check that out. It's available right across the US, and I believe it's also available in Australia.
**Mark Goddard:** Yes.
**Dr. Bishop:** Also, from what I understand, it's a cardiological test device that your cardiologist needs to request. So be aware of it, and if you have had any funny turns or palpitations that need to be diagnosed, have a chat with your cardiologist about it. Does that cover it, Mark?
**Mark Goddard:** I think that's great advice. Yeah, absolutely. And in the end, there are multiple companies that provide similar technology no matter where you are in the world. So, yeah, if you're having symptoms, get checked out; it's important.
Now, I wanted to wrap that component of the monitoring up because what I'm really interested in is one of the other things that you've got an interest in, which is the impact of hormonal change on cardiovascular risk. Would you like to lead us into that? Because we're all changing; our ages are changing, and we're all aware our hormones are changing. This is one for the ladies as well as the men, so lead on.
**Mark Goddard:** It is, and it may be more impactful for the ladies, actually. They go through a different type of change as they get older than we do, and it impacts hormones quite a bit. The amount of estrogen they had, even when they were younger, is no longer really there. And estrogen, in the end, is cardioprotective. So once you lose that traditional level, it can impact your cardiac health. The other thing to mention is if you had early menopause, those patients generally are at higher risk for cardiac issues. So if you had a very early menopause, it's just something to make sure that you're not having those issues. Get assessed by a clinician and get a baseline of where you're at so that as time goes on, you can manage those things. There are hormone replacements and things you can do, but they haven't necessarily been proven to improve that cardiac risk that much and sometimes actually impacted negatively. You know, assessment by a cardiologist is vital, but also recognizing if you're one of these folks that may have early menopause, it's important to identify that.
**Dr. Bishop:** I think this is a super important point. And for those listening, Mark, I'll bring their attention. If you're interested, actually, I've got a series of podcasts. We're probably in the early 400s in this particular episode, but I've had the chance to speak with a colleague here in Sydney called Dr. Fiona Fu. So for those listening who want to know more about those changes and specific female-related cardiovascular issues, please have a look for my podcasts where I've interviewed Dr. Fiona Fu because she touches on exactly what you're talking about, Mark—the early menopause, the complex pregnancies with high blood pressure, proteinuria, preeclampsia, and polycystic ovary syndrome. These sort of are markers of potential increased risk in the future for those individuals. And nicely, she touched on some of that hormone replacement therapy, which I think you've also alluded to. It's super important. My understanding from her sharing was if you can get that on board soon after menopause or at the time of menopause, you can potentially have some benefit in that space. But if you leave it 10 years or more, it could be detrimental. So a super important area.
Mark, with your monitoring, have you seen changes for women as they go through that time of life or not really?
**Mark Goddard:** Oh, I mean, we see more arrhythmias as they get older, for sure. We don't know where they stand as far as that goes. But, you know, men and women, as they get beyond, say, 50 years old, we tend to see more of just, you know, simple premature beats in folks, but also atrial fibrillation, which becomes more common. And yeah, just as you get older, it's impacted. So we don't have it broken down like that. I think it really needs to be addressed at the clinician level. I think that a cardiologist needs to be engaged when things are recognized. And even if they're not, by the time you're 50, you know, you should be checked out. Get that baseline; see what that looks like.
**Dr. Bishop:** So for those listening, you know, I claim to be a preventative cardiologist. I think Mark's talking about that exactly. And look, I think I'm a bit of a nerd. I do all these exciting things around blood pressure and cholesterol, and people don't feel any different. I get very excited when nothing happens. When people come back year after year and grizzle about taking their tablets, I say, well, it's those tablets that have made sure that nothing has happened and has allowed you to come and grizzle to me. So I'm so aligned with that.
One of the things in that preventative space that I haven't quite got my head around, Mark, I'd be interested in your thoughts, is we know as people get older, that risk of atrial fibrillation increases. So in your experience or in your ideal world, how would you be thinking about trying to use, say, the monitoring devices that you guys have to reduce the risk of atrial fibrillation or improve the identification of atrial fibrillation?
**Mark Goddard:** Yeah, we're pretty good at identifying it right now. So your doctor would know within 15 minutes of you developing atrial fibrillation if you were wearing our device. In an ideal world where I would like to be is to be able to put a device on a patient, use AI to understand certain nuances within the cardiac waveforms that may indicate a patient would have a propensity for atrial fibrillation, and maybe be able to get ahead of the game, right? And prevent it from ever happening if that would be possible. To me, that's like the nirvana state, right? Where you can understand what might be coming without it actually coming. So that's where I would love to be. And that's kind of where we're working. We work with an AI team that's partnered with the Mayo Clinic, and that's one of the things we're striving to do—be able to preemptively identify certain nuances in that cardiac waveform to identify things that may be to come.
**Dr. Bishop:** So actually, I'll come back to that because I may have made a significant error here. So for those listening, keep listening because I may have got this wrong. The device that you're putting on people is a waveform device, not an electrical device?
**Mark Goddard:** Well, it provides cardiac waveforms from electrical assessment or from electrodes.
**Dr. Bishop:** Yeah, from electrodes. It would look like a standard 12-lead presentation, although we only provide six of them. And the device goes on with dots on the chest?
**Mark Goddard:** Yeah, button electrodes.
**Dr. Bishop:** Okay. But we're incorporating these AI algorithms, and hopefully that'll be one of them. The first one we're going to deploy will be the ability to analyze whether a patient's EF is normal or suboptimal. It won't give you a number, but it's going to let you know yes or no. And Mayo has vetted that; it's got FDA approval now, and they actually have a billing code for it in the US. We're deploying that probably in the next six months.
**Dr. Bishop:** Okay, so this is a skin electrode monitoring device that can give us, say, QRS variants to try and ascertain what's going on?
**Mark Goddard:** Is that exactly right?
**Dr. Bishop:** Yeah, okay. Look, I think this space is amazing. In my own practice, and for those listening who understand a little bit about hearts, I completely agree with what Mark said about trying to identify those people who could be at risk. My own cohort of those people who might have had a bad function with their heart for some reason—so stiff heart or a baggy heart—who have had long-term high blood pressure, who are getting elderly, who are overweight. We look at the size of the atrial chambers of the heart. If they're enlarged and the person's in normal rhythm, those enlarged chambers really probably put those people at risk. So my own practice is to often do some monitoring and just see if we can pick some stuff up. I do incidental or opportunistic ECGs on pretty well all my patients 65 years of age and older. But I think there will be a role for this sort of monitoring that you're talking about and the likes of Apple Watches, wearable devices that will help us with that sort of space. So it's really interesting.
Mark, just tell us about the service that's delivered in Australia. How would someone get hold of that, or even in the States?
**Mark Goddard:** In the States, you would have to go to your cardiologist who happens to cooperate with us or be partnered with us at Infobionic. Any cardiologist you went to in the States would have a similar type monitor. It wouldn't be as nice as ours, but they would have that technology. In Australia, you know what? I can't remember the name of the group that uses it. Could it be HeartBug? I think it is.
**Dr. Bishop:** Because I use a service called HeartBug out here and can put on the device for 30 odd days. Fantastic service. And for those listening, any thoughts about rhythm problems, funny thumps and bumps, these devices work really, really well.
So look, I think I'll wrap it up there just in the interest of time. We've done our 10 to 15 minutes, which has been fantastic, Mark. I really appreciate that. For those listening, I always appreciate the fact that you've decided to use your valuable time to listen in. I don't take that for granted because I know how valuable our time is. I hope you've learned something today. I certainly have. It's fantastic to be speaking with you, Mark, from the other side of the world simultaneously and learning more about how we can make a difference. Mark, thank you once again for joining us.
**Mark Goddard:** Thank you. I really appreciate it. It's a pleasure, Dr. Warwick.
**Dr. Bishop:** Yeah, my pleasure as well. And I'm sure the pleasure of those listening in. For those listening, if you've got any queries or questions, drop us a note. I do appreciate that. If you've got any suggestions for future podcasts, you can let me know as well. Other than that, I do hope you live as well as possible for as long as possible. Take care and bye for now.
**Outro:** Hi. Ever wondered what your risk of heart attack is? You should. It's the single biggest killer in the Western world. We're talking one death less than every 30 minutes in Australia. One death less than every 60 seconds in the United States. Nine million deaths globally per annum. Well, how do you check your risk? You can go to www.virtualheartcheck.com.au. You'll find out about your risk and what can be done beyond that to be even more precise.
