A tweet from Andrew Sauer, MD

Cardiology Pharmaceuticals

Polypill’s Simplicity Advantage

A study in NEJM found that heart attack patients who took a “polypill” (a 3-part cocktail of aspirin, ramipril, and atorvastatin) had a lower risk of major CV events. But findings from the SECURE trial also left some docs scratching their heads. 

The authors randomized 2.5k patients who had experienced a heart attack within the last six months into a “polypill” group or “usual-care” group. Patients in both groups typically received aspirin, statin, and ACE inhibitor, but the polypill group only took one combo tablet, while the usual-care group took each medication separately. 

• Over a three-year follow-up period, patients who took the polypill were 24% less likely to experience cardiovascular death, myocardial infarction, stroke, or urgent revascularization.
  
• The polypill advantage likely came down to adherence. Patients who received the polypill were more likely to have a high level of adherence at two years (74.1% vs. 63.2%). 

The Twist: While the polypill seemed to protect against cardiovascular events, it did not produce meaningful changes in blood pressure or lipid levels. 

• The polypill and usual-care groups had nearly identical systolic (135.2 vs. 135.5 mmHg) and diastolic (74.8 vs. 74.9 mmHg) blood pressure at two years.
  
• LDL-cholesterol levels were also similar (67.7 vs. 67.2 mg/dL).

The authors speculate that greater adherence may have prompted positive effects that simply did not influence lipid and blood pressure measurements. 

The Takeaway

The study underscores that convenience is often the key to compliance. Treatments won’t work unless they are consistently utilized, and the polypill was the patient-friendly solution some needed to stick to their prescribed regimen.

Protecting Your Cardiovascular Imaging Data

Are you sure about your cardiovascular imaging data security? Tune-in to this Change Healthcare webinar discussing how hospital systems and healthcare providers can strategically improve their data security.

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. 

The Wire

• Medtronic and BioIntelliSense’s RPM Partnership: Medtronic and BioIntelliSense inked a partnership, giving Medtronic access to BioIntelliSense’s continuous remote patient monitoring device BioButton. With the addition of the BioButton wearable to its HealthCast portfolio, Medtronic can offer general care patients access to BioButton both in-hospital and post-discharge. BioButton can take 1,440 vital sign measurements per day, including heart rate, respiratory rate, and skin temperature. 

• Pulmonary Arterial Hypertension Biomarker: NIH researchers found that the amount of cell-free DNA (cfDNA) in the blood can predict survival among patients with pulmonary arterial hypertension (PAH). In a prospective study of 209 PAH patients, researchers found that those with higher levels of cfDNA were sicker and less likely to survive. In fact, patients with the greatest concentrations of cfDNA had a nearly 4-fold greater risk of death or need for lung transplantation than those with the lowest concentration.

• Vektor’s Heart Mapping Validation: Circulation published data validating Vektor Medical’s heart mapping technology vMap. Designed to reduce procedure time and increase ablation success, the FDA-cleared system uses standard 12-lead ECG data to map arrhythmias and locate cardiac “hot spots.” The new study found that vMap’s regional accuracy for ventricular tachycardia and ventricular complexes in patients without significant structural heart disease (n=75) was 98.7%, and it completed the entire mapping process in a median of 0.8 minutes. 

• Congestive Heart Failure Victory: MaineGeneral Health used a remote patient monitoring program to reduce their congestive heart failure readmission rate, and it worked. A spokesperson reported that the overall CHF readmission rate hit 0% in four of the last nine months, and the CMS-CHF readmission rate in June 2022 was 0% compared to 26.7% in the same month the previous year. The 90-day RPM program includes personalized education, at-home care-team visits, a data-enabled tablet, as well as a Bluetooth scale, pulse exomiter, and heart-rate monitor. 

• AliveCor and BIOTRONIK’s Heart Rhythm Alliance: The companies will connect BIOTRONIK’s BIOMONITOR implantable cardiac monitor with AliveCor’s KardiaMobile personal ECG system. Healthcare providers will be able to access relevant heart rhythm analyses, identify underlying arrhythmias, and drive improvements in care. 

• Artificial Sweeteners Increase Risk: Data from 100k Europeans indicate that consuming artificial sweeteners may increase the risk of cardiovascular disease by 9%. The study authors broke down the observed risk of specific sweeteners; Aspartame sweeteners like Equal and NutraSweet were tied to a 17% increased risk for cerebrovascular events. Acesulfame potassium (Sunett, Sweet One) and sucralose (Splenda) were linked to a 40% increased risk for coronary heart disease. In short, artificial sweeteners should not be considered a healthy alternative to sugar. 

• Echo AI Detects AS: A team of Australian researchers developed an echo AI solution that accurately assessed patients’ aortic stenosis (AS) severity levels. The researchers trained the AI model using over 1M routine echocardiograms and tested it with 179k echo exams, detecting 2,606 patients with moderate-to-severe AS and 4,622 with severe AS (1.4% & 2.5%). The AI-detected moderate-to-severe and severe AS patients had 56.2% and 67.9% five-year mortality rates, far above patients with less severe AS (22.9%).

• Flurpiridaz PET MPI’s CAD Evidence: GE Healthcare and Lantheus’s [18F]flurpiridaz Phase III Trial showed that the PET radiotracer could accurately detect coronary artery disease while achieving “higher diagnostic efficiency” and image quality than SPECT MPI (n = >600). Noting [18F]flurpiridaz’s 2-hour half-life (12x longer than current cardiac PET radiotracers) and the wide use of SPECT MPI (6M exams/year in the US), the radiotracer’s potential FDA approval could significantly expand PET MPI use. GE funded [18F]flurpiridaz’s development and would be its exclusive global distributor if approved.

• Healthcare Employment Gains: New data from the Bureau of Labor Statistics indicated that the healthcare sector added 48k jobs in August, led by gains in physician offices (+15k), hospitals (+15k), and nursing facilities (+12k). Home health services were the only subsector to lose jobs (-1.8k). Despite this year’s gains now totaling 412k jobs, healthcare hasn’t fully recovered losses from the beginning of the pandemic, with employment trailing 37k jobs (-0.2%) behind February 2020 levels.

• Fixed C-Arm Demand: A IMV Medical survey revealed that the broad use of fixed C-arms is driving procedure and unit demand. Fixed C-arm units were spread across hospitals’ cardiology (42%), radiology (35%), and surgery departments (23%) during 2022, especially in larger hospitals (73%-85% have C-arms in multiple departments). IMV forecasts that fixed C-arm procedure volumes will increase by 16% year-over-year, prompting 62% of hospitals to consider buying new fixed C-arm systems through 2025.

• Cleveland Clinic Plan of Care: Becker’s published a conversation with Cleveland Clinic’s Associate Chief Experience Officer Judith Welsh, MD, on the health system’s plan of care visits, which she called “a total disruptor to how we do business.” Plan of care visits bring nurses and physicians to patient bedsides to ensure everyone understands the care plan and pre-discharge milestones. The visits have been so successful that Cleveland Clinic now tracks them over other experience scores like patient likelihood to recommend, and Dr. Welsch’s discussion makes them seem like a valuable blueprint for other organizations.

A New Standard of Cardiovascular Care

Heart disease is the leading cause of death, so it might be time to change how we think about heart attack prevention. Read Cleerly’s manifesto on why our current approach is unsustainable, how Cleerly’s AI-based platform can transform care, and what it will take to change today’s unacceptable heart disease statistics.

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).