William Castelli, MD from JACC’s cardiology quote archive

Cardiology Business

Cardiac Tests & Procedures Cost Variability

A new JAMA study found substantial cost variations in common cardiovascular tests and procedures across top US hospitals. 

Boston-based researchers capitalized on the CMS Hospital Price Transparency rule (effective Jan 2021), which requires hospitals to publicly post projected out-of-pocket expenses, as well as payer-specific negotiated rates, for standard care services. 

The investigators gathered data from the 20 highest-ranking US hospitals (including Cleveland Clinic, Cedars-Sinai Medical Center, and Brigham and Women’s Hospital) and identified the following median payer-negotiated ranges across the hospitals:

• Echocardiogram: $204 to $2,588
• Stress test: $463 to $3,230
• Right heart catheterization: $2,821 to $9,382
• Coronary angiogram: $2,868 to $9,203
• PCI: $657 to $25,521
• Pacemaker implantation: $506 to $20,002

Costs varied widely even for the same procedure within a single hospital, depending on the payer. Here are the largest payer-specific interquartile ranges (the spread of the middle 50% of data) the researchers saw within the hospitals: 

• Echocardiogram: $470 to $3,022 
• Stress test: $776 to $3,473
• RHC: $3,143 to $12,926 
• Coronary angiogram: $4,011 to $14,486
• PCI: $11,325 to $23,392
• Pacemaker implantation: $8,474 to $22,694

The Takeaway

This study exposed huge hospital-level price variations for routine CV tests and procedures, which don’t seem to reflect differences in quality-of-care. The authors suggested that the variations “may instead reflect which stakeholder—hospital or insurance company—has stronger negotiating power in the boardroom, which is often dictated by market dynamics.”

Staging Coronary Artery Disease

Believe it or not, there’s been no clinically relevant atherosclerosis staging system used to characterize heart disease — until now. Check out Cleerly’s four-stage system for evaluating atherosclerotic plaque burden, which is the direct cause of coronary artery disease (CAD).

Us2.ai Launches Globally

Us2.ai recently announced the global launch of its flagship echocardiography AI solution, leveraging a new $15M Series A round, and its unique abilities to completely automate echo reporting (complete editable/explainable reports in 2 minutes) and analyze every chamber of the heart (vs. just left ventricle with some vendors).

The Wire

• Two COVID Myocarditis Types: A retrospective analysis revealed there may be at least two different COVID-associated myocarditis phenotypes, each with distinct manifestations and clinical outcomes. Of 38 adults with COVID and sudden-onset myocarditis, those with multisystem inflammatory syndrome (MIS) were less sick and recovered more quickly than those without MIS. Further, the MIS-negative patients were more likely to undergo VA-ECMO (92% vs. 16%), had higher ICU mortality (31% vs. 4%), and had lower 3-month cumulative probability of survival (68% vs. 96%) compared with MIS-positive patients.

• No Long-Term COVID-Associated CVD (some good news!): Piggy-backing off the above story, this study found that the increased cardiovascular risks associated with COVID are usually short-lived. Researchers analyzed electronic records from 429k COVID patients who were matched with 429k control patients, finding that CVD diagnoses declined from 4 to 12 weeks after COVID, and then returned to baseline levels or below.

• Caption Health’s CE Mark: Caption Health received a European CE Mark for its Caption AI platform, which uses AI guidance to allow untrained clinicians to perform cardiac ultrasound exams (vs. only sonographers), and could significantly expand access to echo exams. Caption AI gained FDA clearance in 2020 and has since generated solid US momentum, including a high-profile alliance with Butterfly Network and a rare NTAP reimbursement.

• Ezetimibe + Moderate Statin: Results from the RACING study suggest a combination of ezetimibe and a moderate-intensity statin may be a good alternative to high-intensity statin monotherapy in patients with atherosclerotic CVD. Over three years, the rate of CV death, major CV events, or nonfatal stroke were similar in the dual therapy and monotherapy groups (9.1% vs. 9.9%, N=3,780). However, the ezetimibe-based combo achieved superior LDL cholesterol reduction and was associated with better tolerability.

• Nurse Mental Health: A Trusted Health survey of over 2,500 nurses uncovered some harsh trends related to frontline worker well-being. Nurses rate their current mental health at an average of just 5.8 out of 10 (vs. 7.8 pre-pandemic), and although this is a well-documented issue, 71% of nurses feel that their mental health isn’t a priority for the healthcare industry. As a result, 64% report being less committed to the profession than they were prior to the pandemic. 

• TricValve Safe & Effective: P+F’s TricValve System (CE marked, FDA pending) achieved high procedural success and strong outcomes in patients with severe tricuspid regurgitation (TR). In a JACC study, the system demonstrated a 94% procedural success rate (35 TR patients) and improved patient quality of life six months post-op. The device features two self-expanding valves that physicians can implant without disturbing the native tricuspid valve.

• CMRI Hypertension Biomarkers: Singapore-based researchers found that nonischemic myocardial fibrosis is associated with harmful cardiac remodeling among patients with hypertension. Researchers evaluated cardiac MRIs from 786 hypertensive patients and found that 18% had nonischemic late gadolinium enhancement (LGE). These nonischemic LGE patients had a higher risk of future adverse outcomes (acute coronary syndrome, heart failure hospitalization, strokes, and cardiovascular mortality) within a 39-month median follow-up period (hazard ratio: 6.69). 

• CardioFocus’ PFA Technology: CardioFocus highlighted its progress toward developing a pulse field ablation (PFA) AFib treatment, including filing key patents, completing pre-clinical studies, and forming a Clinical Advisory Board. The company is leveraging its FDA-approved pulmonary vein isolation technology, HeartLight X3 System, to develop its novel PFA device. 

• Salt Restrictions Backfire: Data analysis from over 1,700 patients with HF w/ preserved ejection fraction revealed that excessive salt restriction may actually be harmful for this population. The study demonstrated that those who ingested the least salt (based on a self-reported “cooking salt score”) had a greater risk of HF hospitalization. This relationship between the ultra-strict salt ingesters and poor CV outcomes was more common among patients under 70 years and patients who were not White.

• Radialis’ Organ-Targeted PET: Radialis announced the FDA clearance of its unique Radialis PET Imager, which images a range of specific organs and anatomy (including the heart) and is highlighted by its high image quality, support for any PET radiotracer, and its small size (6×2.5×4.5 ft). Radialis positions its new organ-targeted PET as a complement to traditional PET/CT systems within nuclear medicine fleets.

• Reconstructing Dynamic CTP: Deep learning image reconstruction (DLR) may improve upon key challenges associated with dynamic CT perfusion. A team of Japan-based researchers applied DLR to 30 dynamic CTP scans and found that the algorithm reduced image noise by 20% (compared to iterative reconstruction dynamic CTP methods) while still accurately capturing myocardial blood flow. This is notable given that dynamic CTP exposes patients to more radiation than static CTP, and thus a safer approach (that is just as accurate as iterative reconstructed dynamic CTP) would be welcomed.

Cardiovascular Structured Reporting Adoption Benefits

Check out this Change Healthcare report detailing the benefits of cardiovascular structured reporting, and how to drive structured reporting adoption in your own organization.

Nanox AI’s CPT III Codes

The American Medical Association added new CPT III codes for quantitative CT tissue characterization, paving the way for more health systems to adopt Nanox AI’s HealthCCSng CAC scoring population health solution.