A tweet from Harlan Krumholz, MD, on the Bain survey results showing 25% of clinicians are considering a switch in occupation. 

Cardiology Pharmaceuticals

COVID Drug Paxlovid Interacts with Heart Medications

A review paper in JACC warns that the COVID antiviral Paxlovid may interact with common heart medications, potentially complicating treatment options. The authors report that some cardiac patients might need to either avoid Paxlovid or temporarily discontinue their heart medication while receiving the antiviral treatment.

The study includes a detailed list of which heart disease medications have known reactions with Paxlovid. Here are the five most important ones to watch out for: 

• Antiarrhythmic agents
• Antiplatelet agents and anticoagulants
• Certain statins 
• Ranolazine
• Immunosuppressants for heart transplant patients

Paxlovid’s interactions with blood thinners can increase bleeding risk, and its interactions with some statins can be toxic to the liver. Their conclusions are based on drug-drug interactions and not on any adverse events reported.

The Takeaway

Paxlovid may lead to adverse interactions with drugs commonly prescribed to patients with heart disease. While hospitalized COVID patients face an increased risk for cardiovascular complications and could benefit from an antiviral pill, it may be best to opt for an alternative COVID therapy for those on the above medications. 

User Experience and Cardiovascular Imaging Transformation

Check out this Change Healthcare video discussing the importance of user experience in the adoption of structured reporting, and how it can lead to improvements in imaging speed, quality, and cardiologist workflow. 

Staging Coronary Artery Disease

Believe it or not, there’s been no clinically relevant atherosclerosis staging system used to characterize heart disease — until now. Check out Cleerly’s four-stage system for evaluating atherosclerotic plaque burden, which is the direct cause of coronary artery disease (CAD).

The Wire

• OpSens SavvyWire Clearance: OpSens announced the FDA clearance of SavvyWire, a guidewire for TAVR procedures. OpSens described SavvyWire as the first and only Sensor-Guided TAVR solution that supports stable aortic valve delivery and positioning and provides continuous hemodynamic measurements.

• Plaque and Sudden Cardiac Death: Findings from a new European Heart Journal study found that cardiac hypertrophy and/or fibrosis may be stronger predictors for sudden cardiac death (SCD) than acute plaque complications. Among 600 SCD victims, almost all of them (96-98%) showed signs of myocardial hypertrophy or fibrosis, while only 48% had unstable plaque. 

• Post-MI Rehospitalizations Higher in Women: New research revealed that women were more likely than men to be rehospitalized for a cardiovascular event after an acute myocardial infarction (AMI). The study of 38k patients found that one-year mortality did not differ between men and women after adjusting for baseline differences, however cardiovascular (8% vs. 10%) and all-cause (21% vs. 26%) readmission rates were significantly elevated in women. 

• ELANA Heart Bypass’ Promising Results: AMT Medical unveiled the preliminary results of its clinical trial evaluating the ELANA open heart bypass solution. Results looked promising, with all of the participants free of MACE at 30 days post-op (N=10). The trial will now expand to 65 more patients by mid-2023, with the goal of achieving European clearance. ELANA uses a clip to connect the donor vessel behind the site of the blockage – which is then opened, allowing blood to flow through the newly made path. 

• Frailty More Important than Cancer for TAVR Outcomes: Researchers in California found that frailty status should be “heavily considered” during a TAVR evaluation, as it may be a better predictor of outcomes than cancer status. Among 640 patients who underwent TAVR, increased frailty was associated with worse outcomes in the overall and non-cancer groups, and frailty (not cancer) was associated with all-cause mortality (odds ratio: 1.7). 

• ACC’s Acute Chest Pain Guidance: The ACC released new guidance for evaluating acute chest pain in EDs by outlining how to best apply AHA/ACC’s chest pain guidance released last year. The 36-page Expert Consensus document outlines recommendations at the institution level, such as high-sensitivity cardiac troponin assays with a clinical decision pathway to reduce ED crowding and limit unnecessary testing. At the individual patient level, the document provides a structure for ED chest pain evaluation to accelerate treatment. 

• Healthcare Hiring Recovery: The September Jobs Report revealed that the healthcare sector has now fully recovered the 1.4M jobs lost early in the pandemic, adding 60k jobs throughout last month. Ambulatory services and hospitals added 28k workers each, while other gains came primarily from physician offices and home healthcare services.

• Five Post-TAVR HF Hospitalization Predictors: A meta-analysis of 77k patients highlighted five key predictors of heart failure hospitalization after TAVR. Patients were at an increased risk of HF one year post-op if they had AFib (hazard ratio: 1.69), diabetes (HR: 1.39), chronic kidney disease (HR: 1.39), chronic pulmonary disease (HR: 1.33), or a high STS score (HR: 1.07). However, older age, hypertension, LVEF<50%, and NYHA class III/IV symptoms were not predictive of HF hospitalization. 

• Self-Measured BP Participation: A JAMA study revealed that only half of Americans with blood-pressure conditions regularly perform self-measured BP monitoring, even after being recommended to do so by their doctors. Among 1.2k survey respondents with hypertension or a blood pressure-related condition, 55% owned and used a home BP monitor at different frequencies, yet only half of that group shared the results with clinicians.

• Wasteful Administrative Costs: New research in Health Affairs estimates that roughly 15% of US medical spending is administrative waste ($570B!), with the authors finding that at least half of all admin cost “does not contribute to health outcomes in any discernible way.” The report makes the case that the government should standardize administrative processes such as prior authorization across public and private sectors to cut back on wasteful spending.

• iCAD and Solis CVD Alliance: Mammography AI leader, iCAD. and major breast imaging center company, Solis Mammography, announced plans to develop and commercialize AI that quantifies breast arterial calcifications (BACs) in mammograms to identify women with high cardiovascular disease (CVD) risks. The alliance comes several months after Volpara (another mammo AI company) and Microsoft also revealed plans to develop a mammography AI solution for BAC quantification, and after years of clinical evidence tying BACs to CVD.

• Microbot Acquires Nitiloop Assets: Microbot Medical announced the acquisition of Nitiloop’s assets including the FDA-cleared NovaCaross family of microcatheters for an undisclosed amount. The NovaCross device family gained FDA clearance for the placement of conventional and steerable guidewires beyond stenotic lesions, including CTO, prior to PTCA or stent intervention.

Us2.ai’s Echo Evidence

Have more echo studies than sonographers? See how Us2.ai was able to classify, segment, and annotate echocardiographic videos with similar accuracy as expert sonographers. 

ACC/AHA Chest Pain Guidelines Highlight FFRct

Coronary CTA + FFRct is now a front-line pathway in the ACC/AHA’s 2021 Chest Pain Guidelines. Check out the clinical data supporting FFRct’s positioning as a “dominant strategy” and how HeartFlowFFRct Analysis impacts patients, physicians, and administrators.