Ann Marie Navar, MD, PhD, associate editor of JAMA Cardiology in a TCTMD interview. 

Guidelines

Statin Guidelines Spark Debate

The new USPSTF statin recommendations sparked debate last week, eliciting four editorials published the same day in the JAMA journal family. 

The first editorial emphasized the limitations of the USPSTF’s ten-year risk framework, asserting that if physicians wait to prescribe statins until a person reaches an “arbitrary threshold” for ten-year CVD risk, atherosclerosis could develop unchecked for decades. 

A second editorial spelled out where the new guidelines do or don’t overlap with the 2018 ACC/AHA statin guidelines. 

• The panels agree that patients aged 40-75 with a high enough 10-year ASCVD risk score should receive statin therapy. 
• But there are also some conspicuous differences, most notably USPSTF recommends a 10-year CVD risk of 10% or greater for adults 40-75, while the ACC/AHA cites a threshold of 20% or greater.
• Unlike the USPSTF recommendations, the ACC/AHA/MS emphasizes the clinician-patient risk discussion to reach a shared decision regarding treatment. 

A third editorial posited that the USPSTF recommendations are too conservative, pointing out that statins can be effective even for individuals with very low risk. 

• The author also underlined the guidelines’ failure to provide important risk-factor nuances such as family history, metabolic syndrome, inflammatory disorders, and more. 

A fourth editorial recommended a new approach to tackling the CVD epidemic altogether, stating that it’s time to “curb our statin enthusiasm.” 

• The authors noted that the US spends $25B annually on statins, and those funds may yield greater benefits if reinvested into communities to encourage healthy lifestyles. They also expressed disappointment at the lack of sex-specific analyses, as the “risk-benefit profile for statins is less favorable for women than men.”

The Takeaway

Last week, the USPSTF updated its 2016 recommendations on the use of statins for the primary prevention of cardiovascular disease. Many physicians were dissatisfied with the new guidance. Some felt the guidelines were too conservative, while others suggested shifting our focus away from statins altogether. 

Protecting Your Cardiovascular Imaging Data

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The Wire

• UltraSight’s CE Mark: UltraSight announced the European CE Mark approval of its ultrasound AI guidance software, which allows novice clinicians to capture sonographer-level cardiac ultrasound images. This is UltraSight’s first major regulatory clearance, representing a significant milestone for the company and its flagship product. It’s also a sign that echo AI guidance could be gaining momentum in Europe, as Caption Health’s AI guidance solution just gained its CE Mark last month.

• SGLT2 Inhibitor During Chemotherapy: New evidence points toward a cardioprotective role of SGLT2 inhibitors in patients with type 2 diabetes receiving anthracyclines. The authors compared 32 patients receiving SGLT2 inhibitors during anthracycline therapy and 96 patients not taking the inhibitor and found that CV events were lower in the SGLT2 inhibitor group (3% vs. 20%). The non-SGLT2 inhibitor group had a higher rate of incident heart failure (7% vs. 0%) and sepsis (40% vs. 16%), and an increased risk of all-cause mortality (hazard ratio: 4.7). 

• KOAG’s FDA Clearance: KOAG announced that it has received FDA clearance for its Vascette HP – a topical, adhesive, single-use pad for vascular closures following cardiac catheterizations. The patent-pending technology uses hemostatic foam to control bleeding after cardiac catheterization without direct compression over the puncture site. 

• Physician Substance Use: APN’s Mental Health in Healthcare 2022 report revealed shockingly high levels of substance use among healthcare workers, with 14% of physicians admitting to drinking or using controlled substances while on the job. The survey of 1k healthcare workers found that 49% are either at their breaking point or seeking less stressful work, yet few of the respondents pursue mental healthcare due to perceived stigma and fear of getting their licenses revoked.

• Recurrent Pericarditis Advancements: A recent review from Cleveland Clinic outlined how imaging advances and targeted therapies are improving outcomes for patients with recurrent pericarditis. The authors emphasize that cardiac MRI data can augment symptom and inflammatory marker reports to provide important insights that inform the diagnosis, management, and risk stratification of recurrent pericarditis. They also highlighted evidence supporting the use of interleukin-1 blockers to treat colchicine-resistant, corticosteroid-dependent recurrent pericarditis. 

• Telemedicine for CV Disease: A recent review published in The Lancet underscored virtual medicine’s life-saving potential for patients with cardiovascular disease. Researchers analyzed 34 studies (13,269 patients) and found that remote monitoring and consultation for heart failure patients was associated with a reduced risk of CV-related mortality (risk ratio: 0.83) and hospitalization (RR: 0.71) over the short term. 

• Sudden Cardiac Death Genes: A JACC-published study suggests genetic profiling could help identify coronary artery disease patients at high risk of sudden cardiac death. Among 4.5k CAD patients, those whose genetic propensity for CAD fell in the top decile (estimated by a weighted polygenic risk score) had a significantly higher incidence of sudden death than other patients over an eight-year follow-up (8.0% vs. 4.8%). These findings point toward the use of genetic profiling as a tool to identify those who may benefit most from defibrillator therapy. 

• Health Plan Challenges: HealthEdge’s Voice of the Market Survey of 300 health plan execs found that their top two challenges are managing costs (46%) and driving operational efficiencies (41%), a dramatic jump from their fourth and fifth positions last year. Although inflation typically impacts healthcare costs later than other sectors due to the multi-year nature of payor-provider contracts, the survey indicates that more health plans are beginning to prioritize the issue by making significant investments in innovation (53%) and improving their engagement strategies (52%).

• mHealth BP Tracking: As clinicians continue working to better understand how mHealth apps can improve treatments and disease management, a study in JAMA Internal Medicine found that they do neither for reducing blood pressure. Analysis of 2.1k patients showed that self-BP measurement enhanced by a smartphone application demonstrated negligible improvements to systolic BP over 6 months compared to standard self-measurement (-10.8mm Hg vs. -10.6mm Hg).

• FFR-CT Hubbub: A recent study revealed a diverse set of opinions regarding FFR-CT’s validity. In contrast to recent favorable FFR-CT analyses, the UK-based study found that FFR-CT did not improve accuracy in a real-world dataset. Researchers pooled data from 245 patients and found that FFR-CT actually reduced the accuracy of the CAD-RADS 2-4 grade from 91% to 78.4%. The study fueled discussion for those on MedTwitter, with some commenters interpreting the results as “totally unsurprising,” while others pointed out the fallacy in comparing one grading system based on anatomy (CAD-RADS) with one based on hemodynamic flow.

• Hospital-at-Home Set to Double: The number of health systems considering hospital-at-home programs is expected to double to 38% over the next five years, according to a Chartis Group survey of 143 health system execs. One reason for the accelerated investment is new competition from nontraditional rivals, and a surprisingly high share of those surveyed (77%) believe there is a good chance that large tech companies like Amazon and Google will be their top competitors in the next five years.

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 proactive and personalized care.

Us2.ai and EchoNous Integrate

Us2.ai’s echocardiography reporting automation solution is being integrated into the EchoNous Kosmos ultrasound platform, creating the most powerful diagnostic “power tool” ever created for the hand-carried POCUS market.