A tweet from John Mandrola, MD.

Guidelines

Challenging the Salt Restriction Norm

It is common practice to restrict dietary salt to alleviate or prevent “volume overload” in patients with acute decompensated heart failure (ADHF). But a new study reveals that this standard may be unnecessary. 

This double-blind randomized controlled trial investigated whether taking salt pills may actually benefit patients with ADHF undergoing intensive diuresis. Turns out, the approach made no difference to weight loss on diuresis (a proxy for volume reduction) or serum creatine levels in ADHF patients receiving high-dose IV diuretic therapy. 

The Cleveland Clinic researchers instructed 65 patients hospitalized with ADHF to take either placebo or 6mg salt per day (approximately equivalent to six servings of fast-food french fries) during diuresis for up to 96 hours. The primary endpoint was change in creatinine and weight at 96 hours.

• The authors found that change in weight (–4 vs. –4.6 kg) and creatine (0.04 vs. 0.15 mg/dL) was comparable between the salt-ingesters and the placebo group. 

• The authors also noted a smaller decrease in serum sodium (–0.03 vs. –2.6) and a smaller mean increase in blood urea nitrogen (3.1 vs. 11 mEq/L) in salt-ingesters versus the placebo group.
  
• The trial was not powered to detect differences in serious adverse events, but the researchers reported that they observed none.

The Takeaway

These results challenge the routine practice of restricting salt consumption in ADHF cases. Nothing catastrophic happened when patients ingested salt in bulk; weight and creatine levels were similar between the experimental and control groups. 

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). 

HeartFlow Analysis Streamlines Care

Faced with cath lab inefficiencies and an increased reliance on stress testing, Cone Health pursued a more advanced solution. See how the HeartFlow FFRct Analysis allowed Cone Health to improve the patient journey through streamlined CAD testing.

The Wire

• $37M for Stroke Prevention: Northwestern and Johns Hopkins were awarded $37M from the NIH to study a new stroke prevention strategy in patients with AFib. The funding will go toward a 7-year randomized trial that aims to disband the “one-size-fits-all” practice of prescribing lifelong blood thinners to everyone with AFib. The trial will utilize the Apple Watch to notify patients when they’re entering an episode, prompting patients to take blood thinners for a few weeks during the high-risk stroke window, then discontinue if they do not have another episode. 

• COVID Damages DNA in Heart: A study in Immunology asserts that COVID causes DNA damage to the heart, in stark contrast to the flu. The study looked at the cardiac tissue of patients who died from COVID (n=7), the flu (n=2), and other causes (n=6). The authors found that, in contrast to flu hearts, COVID hearts showed signals of inflammation suppression and markers for DNA damage. While the clinical implications are unclear, the work does underscore biological differences between COVID and the flu.

• Detecting HF Events through Speech: Cardio Medical presented data at HFS 2022 showing that their speech analysis smartphone app HearO could reliably detect impending heart failure more than three weeks before the event. In the study, 253 HF patients completed five voice recordings per day for 2 years. The HearO system predicted about 80% of HF events on average 22.5 days before the events occurred, significantly outperforming current standards like weight and oxygen saturation (35% & 25%). 

• AI Research’s RCT Gap: Out of over 28k healthcare AI studies performed from 2012 to 2021, only 41 were randomized clinical trials (RCTs), and none adhered to the CONSORT-AI reporting guidelines. The good news is AI RCTs are becoming more common (36 of the 41 were from 2019-2021) and most of the RCTs had a low risk of bias, although only 11 of the trials reported race/ethnic data. The study and some passionate online conversations blamed AI’s research-to-clinic translation gap on this lack of RCTs.

• Retinal Imaging Predicts CVD Events: A study in BMJ revealed that AI-powered imaging of the retinal vascular (RV) network can predict CVD and death. Models were developed on 65k UK Biobank participants (followed for ~7.7 years) and validated in 5.9k EPIC-Norfolk participants (followed for ~9.1 years). Compared with a standard risk score, the RV models captured 5% and 8% more stroke cases in UK Biobank men and women, and 3% more cases in EPIC-Norfolk men, but nearly 2% fewer cases in EPIC-Norfolk women. 

• Rock Health’s Q3 Slowdown: Rock Health confirmed that Q3 2022 brought a significant slowdown in digital health venture funding, falling 48% to $2.2B (the lowest since Q4 2019), due to a drastic decline in large late-stage rounds. Cardiology played a larger role than usual in Rock Health’s quarterly report, as cardiac CT AI company Cleerly scored the largest funding round ($223M), and cardiovascular startups raised the third most funding overall ($900M). If you’re interested in this story and didn’t catch our full write-up in Digital Health Wire, you’re missing out.

• Ballooned Aorta Increases Tear Risk: A JAMA-published study (N=6.4k) found that nonsyndromic patients with a thoracic aortic aneurysm (TAA) under 6 cm were at low risk of developing an aortic dissection (a tear in the inner lining of the aorta), although risk sharply increased when the TAA surpassed 6 cm. Five-year risk increased gradually from TAA sizes 4 to 5.9 cm (0.3% to 3.6%), and then increased sharply at over 6cm (10.5%).  

• Genetesis’ $17.5M Series C: Medical imaging startup Genetesis recently closed a $17.5M Series C round, bringing its total funding to over $40M. The funds will go toward clinical trials for the company’s CardioFlux magnetocardiography system, which measures the heart’s magnetic fields to quickly detect ischemic heart disease. The CardioFlux already has Breakthrough Device Designation and is expected to gain FDA approval by early next year.

• Earlier Diabetes Means Worse Outcomes: A study of 36k adults aged 50+ revealed that the risk for stroke, disability, heart disease, and mortality among diabetic adults was lower for adults diagnosed at an older age. Those diagnosed at 50-59 years were more likely to experience incident heart disease (hazard ratio: 1.66), stroke (HR: 1.64), disability (HR: 2.08), cognitive impairment (HR: 1.30), and mortality (HR: 1.49) compared with matched controls who never developed diabetes. Meanwhile, respondents with diabetes diagnosed at 70+ only showed (slight) elevated mortality (HR: 1.08).

• August Hospital Margins: Hospitals appear likely to end the year in the red despite margin improvements in August, according to Kauffman Hall’s latest National Hospital Flash Report. Margins improved by a median of 4.2 percentage points over July due to higher outpatient volume and an increase in elective procedures, but the report calls out new market entrants like urgent care centers and standalone surgery centers as “chipping away” at hospital revenues.

• LAAO vs. NOACs: An analysis of 562k patients with AFib directly compared clinical outcomes of left atrial appendage occlusion (LAAO) to the first-line stroke prevention therapy, non-vitamin K antagonist oral anticoagulants (NOACs). They found that both groups were just as likely to experience the composite endpoint of ischemic stroke, major bleeding, and mortality compared with NOACs. Interestingly, LAAO was associated with a lower risk of mortality (hazard ratio: 0.73) but a higher risk for major bleeding (HR: 1.22).

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.

Personalized Care Pathway for Heart Attack Prevention

More than 50% of patients who suffer a heart attack are considered “low risk” based on symptoms, but in fact do have plaque build up. Cleerly tackles the matter head-on in their 5-step care pathway for early diagnosis, informed decision making, and personalized treatment.