A tweet from Asif Qasim, an interventional cardiologist, on exercising during London’s heatwave. 

Cardiovascular Disease

Race and Cardiovascular Health

Two Circulation-published papers revealed considerable gaps in cardiovascular mortality between Black and White adults, despite improving trends overall. 

Authors of one paper analyzed CDC data from the past two decades and found that CVD-linked deaths dropped among both Black and White adults. Over the twenty-year period, mortality rates declined by:  

• 42% for Black women (602 to 352 per 100,000 people).
• 41% for White women (447 to 268 per 100,000 people).
• 36% for Black men (824 to 527 per 100,000 people).
• 38% for White men (638 to 396 per 100,000 people).

Despite this progress, the death rate for Black adults was still disproportionately high. In 2019, the mortality rate exceeded that of their White counterparts by 30-40%. Disparities were greatest in rural or segregated areas. 

Younger Black women (<65 years) were over twice as likely as younger White women to die of cardiovascular causes. The authors note that this parallels well-documented racial disparities in maternal health outcomes, for which CVD is the leading cause of death in the US. 

A second Circulation paper detailed similar trends and directly tied the rate differences to individuals’ socioeconomic status. When researchers analyzed CVD mortality data from nearly 7,000 adults over 15 years, they found that Black participants had a 34% greater risk of death than their White peers.

Common social determinants of health– such as income, education, access to care, and neighborhood wealth– served as independent predictors for death. 

The Takeaway

Cardiovascular mortality rates across the US have shown encouraging declines, but Black adults still face a much greater risk. Both papers emphasized the need for coordinated initiatives focused on disease screening, prevention, and treatment in Black communities. 

A New Cardiac Population Health Pathway

Nanox.ai’s cardiac solution analyzes already-existing non-gated CT scans and quantifies each patient’s CAC, giving clinicians a valuable tool for detecting cardiovascular disease and predicting future cardiovascular events.

When it’s Good to Find Something Bad

When Cleerly’s own quality director, Terry Schemmel, underwent a CCTA with Cleerly analysis he didn’t have any reason to believe there was anything wrong with his heart. However, Terry’s Cleerly analysis identified a 95% blockage in his left anterior descending artery, allowing him to get the proactive and personalized care.

The Wire

• Deep Vein Thrombosis Insights: A JAMA-published analysis revealed that patients with isolated distal deep vein thrombosis (IDDVT) generally have significantly better outcomes than patients with proximal DVT. Analyzing data from almost 34k patients with DVT (200 centers spanning five continents), researchers found that patients with IDDVT had a lower risk of 90-day mortality (odds ratio, 0.47), stroke within one year (OR, 0.52), and 1-year VTE deterioration (OR, 0.83) compared to those with proximal DVT.

• SCCT & AvoMD Partnership: Clinical decision support platform AvoMD is partnering with the Society of Cardiovascular Computed Tomography (SCCT) to ensure physicians can easily access the current cardiovascular imaging guidelines. AvoMD’s cloud-based solution will assimilate SCCT’s guidelines and expert consensus documents, like CAD-RADS 2.0, into its Point-of-Care App to provide clinicians with real-time decision support.

• Tirzepatide for Obesity: Clinicians may be able to address multiple adiposity-based conditions with one powerful drug that treats the underlying issue– obesity. The authors of this NEJM-published study administered tirzepatide (5mg, 10mg, or 15mg) or a placebo once weekly to ~2,500 overweight, non-diabetic patients for 72 weeks. Tirzepatide takers lost 15-20% of their body weight (weight loss increased as the dose increased), while the placebo group lost only 3%. Tirzepatide recently gained FDA approval for type 2 diabetes treatment.

• Novartis & Anumana Partnership: Mayo Clinic spinout Anumana teamed up with Novartis to develop an ECG-reading AI tool that detects left ventricular dysfunction. The alliance builds on Anumana’s efforts to construct AI-powered software that detects otherwise missed cardiovascular disease, and could create a patient treatment pipeline for Novartis’ CVD therapies. Beyond the ECG-reading algorithm, the two companies also plan to develop a digital solution to guide clinicians through the optimal treatment plan.

• HF Therapeutic Targets: A Nature-published study highlighted potential therapeutic targets for heart failure. Researchers identified molecular alterations in failing hearts by sequencing RNA from 600k nuclei in left ventricle samples (26 failing hearts and 16 healthy hearts). They paired this data with results from a CRISPR-knockout screen to identify novel state transitions in end-stage heart failure patients. The authors anticipate that these targets will be the basis for future therapies. 

• FDA Backs Novavax: The FDA authorized Novavax’s COVID vaccine for emergency use, making it the fourth available coronavirus vaccine in the US, and reigniting debates over vaccines’ myocarditis risks. The FDA noted that researchers did identify cases of myocarditis/pericarditis, but Novaax explained that the rate of myocarditis was similar between the vaccine and placebo arms (0.007% vs. 0.005%; N > 50,000). 

• Cardiologists’ High Starting Salaries: A new 2021-2022 compensation report from AMN Healthcare reveals that cardiologists take home some of the highest starting salaries of all healthcare professionals. The average starting salary is $527k for interventional cardiologists and $484k for noninvasive cardiologists, positioning both specialties among the top 5 highest starting salaries in healthcare.   

• Early Follow-Up Boosts Outcomes: New research suggests that following up with heart failure patients earlier could improve their long-term outcomes. Researchers analyzed readmission rates among 450k patients hospitalized with acute myocardial infarction (AMI), congestive heart failure (CHF), or chronic obstructive pulmonary disease (COPD). Early follow-up visits were linked to lower 90-day readmission rates among CHF patients (28% vs. 30%) and COPD patients (22% vs. 23%), but there was no significant difference among AMI patients. 

• ACTA AI Contrast Reduction: A new European Radiology study detailed an AI reconstruction approach that could allow aortic CT angiography using ultra-low contrast volumes (30% of a standard dose). The researchers trained an Au-CycleGAN algorithm using ultra-low-dose and low-dose ACTA exams from 100 patients with suspected aortic disease. They then used the algorithm to reconstruct 50 ultra-low-dose ACTAs. The AI-reconstructed ultra-low-dose ACTAs scored better image quality than the unenhanced images from both groups (except for image noise), while producing images with no significant diagnostic differences. 

• NYP & Cornell’s AI Partnership: NewYork-Presbyterian and Cornell launched a three-year cardiac AI partnership that will combine NYP’s physicians, patient data, and funding ($15M), with Cornell’s AI and ML expertise. The researchers will use AI to examine multi-modal data to detect patterns that might predict who will develop heart failure, inform care decisions, and tailor patient treatment plans. 

• Improving Adverse Event Rates: The authors of a JAMA-published study found that the rate of in-hospital adverse events (common examples are infections, drug reactions, and falls) decreased from 2010 to 2019. Using data from 244k adult patients, the researchers found that adverse event rates lessened for patients admitted for acute myocardial infarction (relative risk, 0.94) and heart failure (RR, 0.95), roughly matching adverse event rates for non-cardiology hospitalizations. However, researchers noted that adverse events remained “unacceptably frequent.” 

Automating the Fight Against Heart Disease

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User Experience and Cardiovascular Imaging Transformation

Check out this Change Healthcare video discussing the importance of user experience in the adoption of structured reporting, and how it can lead to improvements in imaging speed, quality, and cardiologist workflow.