A tweet from Dr. Glaucomflecken, an ophthalmologist and comedian. 

Cardiology Guidelines

Rosuvastatin, Kidney Risks, and a Clinical Takeaway

New research from Johns Hopkins further confirms that rosuvastatin use may increase the risk of kidney damage, especially at higher doses. 

Researchers gathered data from 152k patients taking rosuvastatin and nearly 800k on atorvastatin over eight years (3.1-year median follow-up) and found that: 

• Users of rosuvastatin had an 8% higher risk for hematuria (blood in the urine), a 17% higher risk for proteinuria (protein in the urine), and a 15% higher risk for kidney failure requiring replacement therapy.
• The risk for hematuria and proteinuria in patients with chronic kidney disease (CKD) increased as rosuvastatin dose increased.
• The two groups avoided myocardial infarction and stroke to similar extents.

Clinical trials and observational studies linked rosuvastatin to signs of kidney damage when the FDA first approved the drug in 2003, which is why the FDA capped the recommended dosage for people with severe CKD at 10mg/day. 

But the Johns Hopkins researchers found that 44% of patients with advanced kidney disease were prescribed a daily dose exceeding the recommended maximum, suggesting that many clinicians are unaware of rosuvastatin’s dosing recommendations. 

The Takeaway

This study reinforces early reports that rosuvastatin may predispose individuals with advanced CKD to kidney toxicity, and reveals that some clinicians prescribe rosuvastatin at excessive doses. As you might expect, the authors suggested it may be wise to reduce the dosage or discontinue rosuvastatin for these patients.  

Automating Echo AI

Check out this Imaging Wire Show featuring Us2.ai’s co-founders, James Hare and Carolyn Lam MBBS, PhD, detailing Us2.ai’s unique origins, impressive capabilities, and big goals to automate echocardiography reporting across the world.

Transformation Through Structured Reporting

Ready to realize the benefits of cardiovascular imaging structured reporting? Check out these quick and powerful Change Healthcare videos detailing the efficiency gains provided by structured reporting and what it takes to drive adoption.

The Wire

• Cleerly’s $192M Funding Round: Coronary CTA AI startup Cleerly just closed a colossal $192M Series C round, quadrupling its Series B efforts and catapulting its total funding to $249.5M. Armed with the new investment, Cleerly plans to build out its team, expand the software’s commercial reach, and support over a dozen ongoing clinical trials. The massive VC backing is a testament to Cleerly’s potential to identify early-stage and asymptomatic heart disease. 

• Provocative Testing Safety: A new JACC meta-analysis confirmed that provocative spasm testing with intracoronary acetylcholine is safe. Across 16 studies (12.5k patients), the major complications incident estimate from IC Ach testing was 0.5% (no reports of death) and was significantly lower in Western populations. The rate of positive epicardial spasm and the incidence of major complications were similar between provocation protocols using ACh doses of 100 μg and 200 μg.

• Ultromics’ Consistency Advantage: A new JASE study showed that AI-based echocardiography measurements can be used to predict COVID patient mortality, but manual measurements cannot. The researchers utilized Ultromics’ EchoGo Core AI solution and a team of expert readers to measure left ventricular ejection fraction (LVEF) and LV longitudinal strain (LVLS) in 870 echocardiograms from hospitalized COVID patients. They then applied the measurements to mortality prediction models and found that the AI-based measurements were less variable and could significantly predict patient mortality (LVEF: odds ratio, 0.974; LVLS: OR, 1.060), while the manual measurements could not. 

• AI Analysis of Limited Echos: In other Ultromics AI news, a second study highlighted the diagnostic potential of Ultromics’ EchoGo Core AI solution when used with limited echocardiograms (shorter acquisition protocol echo exams). The authors compared automated assessments of 558 limited echocardiograms from patients hospitalized w/ COVID against clinical findings, echocardiographic findings, and patient outcomes. The echo AI solution was feasible for left ventricular ejection fraction (LVEF) and LV longitudinal in 87.5% of the exams, while AI and clinical values were largely consistent for LVEF, LS, end-diastolic volume, and end-systolic volume (ICCs:  0.72, 0.74, 0.87, 0.91).

• Patients Want Access: A new PocketHealth report (N=242 patients) shared evidence that patients benefit from better access to their healthcare information. Before the respondents had access to their medical records, only 27% were able to see their imaging, and of those, 52% had difficulty sharing images with their care teams. But after the patients gained record access, 77% found image access easier and 27% found image sharing easier. Patients also felt more informed, engaged, and had greater peace of mind (75%, 61%, >50%).

• iRhythm FDA Clearance: iRhythm Technologies received a second FDA 510(k) approval for its ZEUS (Zio ECG Utilization Software) System that works alongside a clinical-grade Zio Watch to detect and characterize AFib. Developed in partnership with Verily, the ZEUS System’s latest clearance is for an AI algorithm that provides context into how much AFib a patient is experiencing over time before generating automated reports to aid in diagnosis. 

• Childcare Stress Drives Burnout: Childcare stress (CCS) during the COVID pandemic has devastated health care workers. In a survey of 58k US health care employees, researchers found those with high CCS were 80% more likely to feel burnt out, 115% more likely to have anxiety or depression, 91% more likely to intend to reduce work hours, and 28% more likely to plan to quit their job. The authors note that programs to reduce CCS are imperative for both workers and health systems. 

• Vizient Adds Mpirik: Group purchasing organization Vizient announced a partnership with cloud-based cardiac care startup Mpirik. Under the agreement, participating Vizient health systems will have access to Mpirik’s algorithm-based services, including automatic identification of at-risk cardiac patients (based on diagnostic results and clinician notes) and real-time aggregate reporting dashboards to derive insights from patient populations (like quality/data outliers, therapy outcomes, heat maps of populations by zip code, and more). 

• Apple Spotlights Heart Health: For the first time ever, Apple disclosed a complete overview of its healthcare strategy, and it placed cardiology care at the forefront. The high-profile report spotlighted an increasing number of heart health-related apps — including Qardio heart health, Withings Health Mate, and Apple’s own ECG app — that use Apple-connected accessories to help users track and monitor their health.

• New-Onset HF & Fatty Liver Disease: A new meta-analysis published in BMJ further confirms an association between non-alcoholic fatty liver disease (NAFLD) and increased risk of new-onset heart failure. Researchers pooled data from 11M middle-aged individuals (98k cases of incident HF over 10 years) and found that NAFLD was associated with a 1.5-fold higher long-term risk of new-onset HF regardless of the presence of diabetes, hypertension, or other common CV risk factors. 

• Top Cardiology Hospitals: U.S. News and World Report published its annual list of the country’s top 25 hospitals for cardiology and heart surgery based on patient outcomes, patient experience, breadth of patient services, and physician surveys. This is the third consecutive year that the top four hospitals have been exactly the same: 1) Cleveland Clinic, 2) Mayo Clinic, 3) Cedars-Sinai Medical Center, and 4) New York-Presbyterian Hospital-Columbia and Cornell.

Lighting New Population Health Pathways

See how Nanox AI’s population health solutions are helping health systems and payers to improve the quality and cost of care through early disease detection.

A New Standard of Heart Care

Open to a more personalized and proactive approach to cardiovascular care? Check out this video detailing Cleerly’s unique approach to heart disease risk assessments and care.