David Bessman, MD, agreeing with conclusions from the recent JAMA paper.

Cardiology Pharmaceuticals

Deprescribing Aspirin

For people on warfarin, discontinuing aspirin use may significantly reduce bleeding events without compromising thrombotic risks. 

Michigan-based researchers identified 6.7k adults receiving warfarin for AFib and/or venous thromboembolism and who were also taking aspirin unnecessarily. They then studied the effects of an aspirin deprescribing intervention—which was as simple as communicating to the primary care clinician that there isn’t a clear reason to give aspirin along with warfarin. 

In the two-year pre-intervention period there was a slight decline in aspirin use (29.4% to 27.1%). Within the two years after the intervention: 

• Aspirin use rates plummeted from 27.1% to 15.7%
• Bleeding rates declined from 0.31% to 0.21%  
• Thrombotic risks did not change

The Takeaway

Most people who are receiving long-term anticoagulation therapy like warfarin probably don’t need to be taking aspirin if they have not had a recent stroke, heart attack or cardiac procedure. This study provides randomized real-world results to support that recommendation and shows that a systematic approach to deprescribing aspirin could really help. 

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.

Pivoting to Population Health AI

Check out this interview with Nanox AI strategy leader, Dr. Orit Wimpfheimer, where she discusses building an international telerad practice, what’s wrong with triage AI, and pivoting to population health AI.

The Wire

• Rivus Raises $132M to Advance Obesity Drug: Rivus Pharmaceuticals locked in $132M in Series B funding to advance its lead cardiometabolic drug candidate HU6. The candidate promotes weight loss by making energy production less efficient, forcing the body to rev up metabolism to maintain homeostasis. The deadly diet pill of the 1930s, DNP, acted through the same pathway but was abandoned because it famously ‘cooked internal organs.’ Rivus is obviously working to address these safety concerns and released promising Phase 2a trial results earlier this year. 

• Fluid Dynamics to Risk-Stratify ACS Patients: Japan-based researchers found that optical coherence tomography-derived fractional flow reserve (OCT-FFR) measurements may help risk-stratify acute coronary syndrome patients after a PCI procedure. In an analysis of 364 ACS patients undergoing OCT-guided PCI, the authors found that the incidence of target vessel failure was 9.9 times higher in vessels with OCT-FFR under 0.90.

• Shockwave’s Female Only Study: Shockwave Medical is launching the first-ever coronary intervention study consisting of all female patients. The company’s first-to-market technology – called intravascular lithotripsy – uses angioplasty balloon catheters to deliver sound waves that break up calcified coronary lesions *without* harming soft tissue. The company will follow about 400 female patients with ischemic heart disease over three years. 

• Hypertension Fuels ED Visits: Researchers analyzed 20.6M cardiovascular emergency department visits in the US and found that about one-third of these cases were related to high blood pressure. Within this third, hypertension alone (i.e. hypertension not connected to a different health condition) fueled 16% of women’s and 10.8% of men’s cardiovascular ED visits. The findings underscore the importance of hypertension management. 

• Rocket Acquires Renovacor: Rocket Pharmaceuticals is set to absorb Renovacor in a $53M all-stock deal that adds to Rocket’s cardiac gene therapy ambitions. The acquisition will give Rocket control of Renovacor’s preclinical heart disease drug candidate REN-001 as well as add $38M to its cash reserves. REN-001 is designed to target mutations in the BAG3 gene that lead to dilated cardiomyopathy. 

• Left Ventricular MRI Signatures Predict Risk: Machine learning-based cardiac MRI left ventricular (LV) shape signatures could help identify higher-risk atherosclerosis patients. Among 4.6k patients with atherosclerosis, combining LV shape signatures with clinical risk factors was more accurate than standard cardiac MRI metrics for predicting heart failure (AUCs: 0.83 vs. 0.81), coronary heart disease (0.77 vs. 0.75), and CVD (0.78 vs. 0.76) over 10 years. Patients identified as “high risk” by the LV signatures had far lower survival rates than “low risk” patients (56% vs. 95%).

• Medtronic Cardiac Monitor’s Pediatric Indication: The FDA has granted Medtronic a pediatric indication for its LINQ II insertable cardiac monitor (ICM). According to Medtronic, LINQ II is the first-and-only ICM to receive 510(k) clearance for use in pediatric patients over two years old who have heart rhythm abnormalities and require long-term, continuous monitoring. The small, wireless ICM system (which includes the AccuRhythm AI algorithms) received FDA clearance for adults in 2020.

• Looming Medicare Cuts: The ACC and over 120 other medical societies have joined the American Medical Association in a letter urging Congress to stop 2023 Medicare payment cuts. The letter highlights that Medicare physician payments have been reduced by 20% (adjusted for inflation) from 2001-2021. Docked doc pay isn’t their only concern; the letter argues that the current plan incentivizes ongoing healthcare market consolidation and disincentivizes value-based care. 

• InfoBionic Remote Cardiac Monitoring: Virtual telemetry company InfoBionic debuted its MoMe ARC advanced remote cardiology platform to streamline the transition from hospital to home care. The cloud-based MoMe ARC Platform is designed to replicate hospital care by capturing continuous cardiac data, alerting clinicians of cardiac events and providing AI-assisted diagnosis of up to 30 arrhythmias.

• Accelerating 4D Flow: UK-based researchers demonstrated a new cardiac MRI reconstruction technique (Kat-ARC) that can reduce 4D flow CMR exams from 20 minutes to 8 minutes, while still accurately quantifying transvalvular flow. In the GE and Pie Medical-supported study (n = 35), the Kat-ARC technique produced comparable 4D flow mitral net flow and aortic net flow measurements (60 mL vs. 63 mL), while achieving similar peak aortic valve velocity as doppler ultrasound (1.46 m/s vs. 1.40 m/s).

Stress Less with AI-Powered CCTA

Stress tests are today’s go-to method for detecting coronary artery disease, but should they be? Join experts from Cleerly and George Washington University on October 6th for a discussion exploring how we can improve CAD detection with AI-enabled CCTA.

Us2.ai Brings Clarity to Cardiac Imaging

Learn about how Us2.ai is bringing simplicity and clarity to the world of cardiac ultrasound, on the latest episode of The Bleeding Edge of Digital Health featuring Us2.ai’s founders, James Hare and Dr. Carolyn Lam.