Celina Gorre, CEO of WomenHeart, on the fall of Roe V. Wade.

Cardiology Policy

Roe v. Wade’s Cardiology Impact

The fall of Roe V. Wade garnered reactions from cardiologists across the country, many emphasizing the burden pregnancy places on the heart– literally– and how the Supreme Court’s decision may endanger patients.

Cardiovascular disease is the leading cause of pregnancy-related death in the US, making cardiologists a key part of at-risk pregnant patients’ care teams. Cardiologists may discuss these patients’ CV health risks, the risks to the fetus, and the relative safety of continuing the pregnancy versus undergoing pregnancy termination.

Now, state lawmakers have the power to restrict the scope of these discussions. While most state abortion bans provide exceptions for pregnancies threatening the mother’s life, experts say the definition of “lifesaving” is murky. 

• Georgetown University law professor, Lawrence Gostin, explained how the vague language leaves cardiologists and other physicians’ criminal liability up in the air. “At best, it will make physicians hesitate to save the life of a woman; at worst, outright refuse to.”

The Consequences for cardiologists and other clinicians who breach abortion bans also vary widely by state, ranging from losing a medical license to life in prison.  

Cardiology societies widely criticized the SCOTUS ruling, citing concerns about the integrity of patient-physician relationships, including this statement by The American College of Cardiology:

“The College is deeply concerned about the potential implications of the Supreme Court decision regarding Roe v. Wade on the ability of patients and clinicians to engage in important shared discussions about maternal health, or to remove previously available health care options, especially given the alarming maternal health crisis in the U.S.”

​​The Takeaway

Cardiology leaders made it clear that the decision to overturn the landmark ruling will have downstream consequences for cardiologists. Exactly what those consequences will look like will vary by state, and are still shrouded in ambiguity.

The Wire

• AHA Creates ‘Essential 8’: Life’s Simple 7 became Life’s Essential 8 last Wednesday when the American Heart Association declared sleep duration essential for ideal heart and brain health. The eight features include four health behaviors (diet, physical activity, nicotine exposure, and now sleep) and four health factors (BMI, cholesterol levels, blood sugar, and blood pressure). This was the first time AHA has updated the list in 12 years. 

• Earlier Cardiac Rehab: UK-based researchers found that patients who undergo median sternotomy can start cardiac rehab (CR) exercises as early as two weeks post-op, as opposed to the standard six weeks. Researchers evaluated 118 patients who began CR either two or six weeks post-op and found that, after eight weeks of rehab, early starters performed comparably to the late starters in the 6-minute walk test (early starters walked 28m further). There was also no significant difference in secondary outcomes like safety, functional fitness, and quality of life. 

• Nicotine Cap: Aiming to hamper cigarette addictions and diseases brought on by smoking, the U.S. government proposed a rule that would allow the FDA to set maximum nicotine levels in cigarettes and other tobacco products. The proposal is on theme with other tobacco limiting maneuvers, like banning Juul Labs, the maker of e-cigarettes, from the US market.

• Pregnancy-Related Hypertension: UPenn researchers found that hypertensive disorders of pregnancy (HDP) more than double the risk of acquiring chronic hypertension (CHTN) a decade later. Researchers evaluated 135 patients ten years postpartum (58 with and 35 without a history of HDP), finding that a history of HDP increased the risk of developing stage 2 CHTN by 2.4-fold. Exploratory analysis revealed that patients with CHTN, regardless of HDP history, demonstrated worse diastolic function, higher LV wall thickness, and more abnormal longitudinal strain, suggesting that CHTN may be primarily responsible for CV risk in patients who developed HDP.

• Protecting Health Workers: Amid increasing violent attacks against healthcare workers, the American College of Cardiology expressed support for the SAVE Act. The bill would provide federal protections for health workers facing violence and intimidation in the workplace. In a letter to the representatives that proposed the bill, ACC president Edward T. A. Fry, MD, FACC, stated “Violence against health workers is unacceptable, and is a national problem that requires a national response.” 

• Caption’s Home Echo Service: Ultrasound AI startup Caption Health unveiled its new Caption Care service, which provides in-home cardiac wellness assessments through a partnership with major home care company Portamedic. The Caption Care service will allow Portamedic technicians (who probably aren’t sonographers) to perform AI-guided echo exams in patient homes across America. This is the first nationwide home echo service we’ve seen, but it isn’t completely unexpected given the advancements in ultrasound accessibility (portability, cost, AI guidance/reporting, connectivity) and healthcare’s continued shift towards patient homes.

• 4D Flow Validation: UK-based researchers published a study validating their four-dimensional flow cardiovascular MRI technology (4D flow CMR), developed in collaboration with Pie Medical Imaging. Researchers assessed 50 patients with suspected heart failure using both echocardiography and 4D flow CMR, finding that the two techniques produced comparable peak E-wave inflow velocity, median A-wave peak velocity, and E/A ratio measurements. 4D flow CMR also demonstrated “excellent” intra/inter-observer reproducibility across all parameters.

• Cardiologs AFib Prediction: The European Heart Journal published a new study finding that Cardiologs’ AI-based atrial fibrillation detection algorithm can successfully predict whether AFib would occur in the next 15 days. Using only the first 24 hours of a Holter recording, the algorithm could discriminate future AFib with 76% sensitivity and 69% specificity (AUC: 79.4%), outperforming models using ECGs to make similar predictions. Applying the model to an external dataset achieved 78% sensitivity and 58% specificity (AUC: 75.8%).

• Epigenetics & CVD: Northwestern University researchers found that midlife epigenetic markers reveal information about past cardiovascular health and predict future cardiovascular disease risk. Researchers analyzed DNA methylation (epigenetic changes that regulate gene expression) in 1,085 participants. They found that 45 methylation markers reflected past exposure to factors like obesity, elevated blood pressure, blood sugar, and cholesterol. The researchers also determined that a higher methylation risk score was associated with increased calcium buildup in heart artery walls five to 10 years later. 

• Social Responsibility Flop: This year’s Lown Institute Hospital Index for Social Responsibility gave less than 2% of hospitals top marks across health equity, value, and outcome categories. After analyzing hospital performance using information from Medicare claims, CMS hospital cost reports, IRS 990 forms, the non-partisan think tank found that only 66 of 3,600 hospitals achieved an “A” rating in at least three categories.

• Atlas & MedAxiom’s CV Solution: Ambulatory surgery center (ASC) management company Atlas Healthcare Partners and MedAxiom are teaming up to form a cardiovascular-focused ASC company. Atlas will lead ASC development and management, while MedAxiom– a company dedicated to cardiovascular operational performance improvement– will oversee clinical and functional outcomes. 

• Apple Patent Dispute: An International Trade Commission judge found Apple guilty of infringing on AliveCor’s patented personal ECG technology. AliveCor filed the complaint against Apple in April 2021, alleging that the Apple Watch’s arrhythmia detection software infringes on their Kardiaband technology patent. The ruling sets up an October vote for the full ITC to affirm the verdict, which could result in an exclusion order banning further Apple Watch imports to the US.