Cleerly CTO Nick Nieslanik, on changing the heart disease standard of care. 

Cardiac Imaging

Cleerly’s Proxy Solution

Big data analytics and advanced imaging modalities have the potential to transform care for patients with cardiovascular disease. And yet transferring colossal data files remains a huge challenge for hospitals and providers, impeding cardiologists’ workflow and patient care. 

We sat down with Cleerly CTO Nick Nieslanik to learn about how Cleerly is tackling the image transfer problem with their new solution, Proxy.  

Highlights from the conversation include: 

• What is Cleerly – Cleerly’s goal is to prevent heart attacks by establishing a new standard of heart disease care. Their machine-learning algorithms analyze CT angiography scans and generate a comprehensive report of a patient’s coronary artery disease.
  
• Proxy Workflow Solution – Proxy helps Cleerly take in coronary CTA exams, and then send back insights and analyses to cardiology and radiology teams. A single Cleerly Proxy installation can be used as an endpoint to receive CCTA scans from one or more scanners, PACS, or vendor-neutral archives. Each scan can then be uploaded into the Cleerly service for providers to review and share with patients.
  
• Physician Impact – Proxy aims to be seamless, so in large part, it will be invisible to the physician. It is designed to be integrated seamlessly with providers’ existing workflow, ensuring that the Cleerly insights are easily available when providers need them. This will help providers make quick, comprehensive, informed treatment decisions. 

Our full conversation with Nick Nieslanik is available online and filled with insights for anyone interested in Cleerly’s image transfer solution. For more information on Cleerly Proxy, visit www.cleerlyhealth.com/heart-disease-technology

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. 

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.

The Wire

• Narrative-Based Education for AMI Patients: A narrative-based education approach may better prepare acute myocardial infarction (AMI) survivors to respond to AMI symptoms. Researchers randomized 608 AMI patients to either a narrative-based psychoeducation group (an 8-week intervention focused on complex decision-making and behavioral changes) or a didactic education group. The psychoeducational intervention group reported greater positive changes than the control group in their attitudes and beliefs toward care-seeking at the six-month and 12-month follow-ups. 

• Common Drugs Tied to AFib: An observational study of 23.5M California residents found that people who use opioids, cocaine, cannabis, or methamphetamines are more likely to develop AFib in the future, even after adjusting for other cardiovascular risk factors. At the end of the decade-long study period, methamphetamines increased risk the most (86%), followed by opiates (74%), cocaine (61%), and cannabis (35%). These risks were on par with those seen for tobacco use (32%) and alcohol abuse (99%) in the same adjusted analysis. 

• Predicting Ischemia in ACS Patients: Researchers developed a new model to identify acute coronary syndrome (ACS) patients most at risk for CV death and myocardial infarction. The score, dubbed ABC-ACS, was created based on data from 10.7k ACS patients and incorporates patients’ age (A), biomarkers (B), and clinical characteristics (C). In a validation cohort of 3.5k people, the model achieved “good” discriminatory ability for the 1-year risk of CV death or MI in both cohorts (C-indices: 0.71 & 0.72), modestly outperforming the standard GRACE 2.0 score. The ABC-ACS ischemia score still needs to be validated in a real-world population.  

• Bridging the TTE Critical Care Gap: New research out of the UK showed that DiA Imaging Analysis’ AI-driven LViVO cardiac ultrasound software can help critical care departments bridge the transthoracic echocardiography (TTE) skill and subjectivity gap. The authors used LViVO to analyze TTE exams from 50 critically ill patients that were performed by a TTE specialist, finding that the software could run a full LV analysis with 52% of the images and RV analysis with 64% of the images. 

• Bayhealth Cuts HF Readmissions by 75%: Delaware’s Bayhealth health system cut heart failure readmissions by 67% through a pilot program that focuses on social determinants of health. The program uses a CMS-recommended screening questionnaire to connect patients with resources for food, transportation, and other needs. 

• Lotus Matches CoreValve/EvolutR: A new 5-year follow-up analysis suggests that Boston Scientific’s Lotus valve is a safe and effective treatment for patients undergoing TAVR. After examining rates of stroke, mortality, aortic gradient, valve area, paravalvular leak, and other post-TAVR complications, the authors determined that patients who received the Lotus valve (n=581) had “comparable outcomes” to those who received Medtronic’s CoreValve/EvolutR (n=285). 

• Post-VTE Anticoagulant Regimens: A Michigan-based quality improvement initiative suggests most patients with provoked venous thromboembolism (VTE) receive anticoagulation therapy for longer than the recommended three months. The median length of treatment for patients taking warfarin was 142 days and for direct oral anticoagulants was 180 days. The authors note that the findings highlight an opportunity to improve care and reduce anticoagulant-associated bleeding risks for VTE patients. 

• Virtual Reality TAVR Planning: A Spain-based study highlighted virtual reality imaging’s potential to help cardiac surgeons plan TAVR procedures, providing a more immersive way to evaluate pre-procedure multidetector CT exams. The authors used their self-developed VR system with 11 TAVR patients, finding that VR provided adequate image quality for segmentation, led to implant strategy changes in 5 cases (45%), improved the team’s confidence for all cases, and led to good outcomes with no complications. 

• Underprescribing OACs in Black Patients: A cohort study including 70k patients hospitalized with AFib found that providers were less likely to prescribe oral anticoagulants (OACs) to Black patients than White patients, and Black patients experienced significantly higher rates of adverse events one year later. At discharge, 77% of Black patients and 81% of White patients were prescribed OACs. Among the 16.3k individuals with one-year follow-up data, Black patients were at a two-fold higher risk of experiencing bleeding or stroke, and at a 20% increased risk of mortality. 

• 23andMe Cholesterol Medication Insights: The FDA has expanded its clearance for one of 23andMe’s genetic reports, allowing the company to give test-takers an idea of how they’ll respond to the cholesterol medication simvastatin. The new clearance modifies the labeling of the previously authorized 23andMe SLCO1B1 Drug Transport report, removing the need for confirmatory testing and allowing the company to provide interpretive drug information based on genetic factors for simvastatin.

• ML-Powered CCTA Score Predicts Ischemia & Blood Flow: Researchers developed a machine learning algorithm that analyzes plaque in coronary CTA exams to identify patients with ischemia and impaired myocardial blood flow (MBF). Trained on invasive FFR data from 484 vessels and tested on 581 vessels from CCTA, the CCTA ML model predicted FFR-defined ischemia more accurately than standard CCTA evaluations (AUCs: 0.92 vs. 0.84), performed comparably to FFR-CT assessments (AUCs: 0.92 vs. 0.93), and predicted PET-based impaired MBF more accurately than standard CCTA (AUCs: 0.80 vs. 0.74) and FFR-CT (AUCs: 0.80 vs. 0.77) assessments. 

Us2.ai Automates the Fight Against Heart Disease

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A New Standard of Heart Care

Open to a more personalized and proactive approach to cardiovascular care? Check out this video detailing Cleerly’s unique approach to heart disease risk assessments and care.