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Surgeries & Interventions

Cryoablation as a First-Line AFib Therapy

For people with atrial fibrillation, cryoballoon catheter ablation (cryoablation) as a first-line treatment can halt disease progression and reduce long-term burden. 

Cryoablation involves using extreme cold to kill harmful tissue in the heart and is usually reserved for patients who don’t respond to antiarrhythmic drugs. 

The authors of this NEJM-published study argue that it may be better to start with cryoablation. While AFib begins as an isolated electrical disorder, each recurring incident can cause electrical and structural changes in the heart that can lead to longer-lasting events. In contrast to drug therapies, cryoablation directly targets and destroys the tissue that initiates and perpetuates AFib, and thus can lead to longer lasting results. 

In the study, 303 patients with AFib were randomized to receive either cryoablation or antiarrhythmic drugs. After three years, patients in the cryoablation group had greater improvements than those who received initial antiarrhythmic drug therapy. Early cryoablation was associated with…

• Fewer episodes of persistent AFib (1.9% vs. 7.4%)
• Less recurrence of atrial tachyarrhythmia (56.5% vs. 77.2%)
• Fewer hospitalization events (5.2% vs. 16.8%)
• Fewer adverse events (4.5% vs. 10.1%)
• Improvements in quality of life

The Takeaway 

First-line cryoablation led to fewer episodes of persistent AFib, reduced arrhythmia recurrence, lower AFib burden, meaningful improvements in quality of life, lower rates of health care utilization, and lower rates of adverse events. In other words, cryoablation outperformed antiarrhythmic drugs as a first-line defense against AFib. 

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).

Us2.ai and EchoNous Integrate

Us2.ai’s echocardiography reporting automation solution is being integrated into the EchoNous Kosmos ultrasound platform, creating the most powerful diagnostic “power tool” ever created for the hand-carried POCUS market.

The Wire

• Anumana AI-ECG Support: A study published in Nature Medicine builds on a growing body of evidence that shows Anumana’s AI-ECG algorithms can use standard ECG recordings to provide early warnings of cardiovascular disease. In the 2.5k patient study, researchers applied an Anumana AI algorithm to Apple Watch ECG recordings, finding they could accurately detect patients with low EF (AUC: 0.88-0.89), suggesting it is as good as – or better – than a treadmill diagnostic test.  

• Baxdrostat BP Benefits: The BrigHTN study found that baxdrostat, a selective aldosterone synthase inhibitor, improves blood pressure. In the study, 248 patients with treatment-resistant hypertension were randomized to four groups. Three groups received baxdrostat at either 0.5, 1, or 2 mg dosages, and the fourth group received placebo. Those that received baxdrostat saw systolic BP fall by 12.1 mmHg, 17.5 mmHg, and 20.3 mmHg at the respective doses, while the placebo group saw only a 9.4 mmHg decrease. 

• ReCor Medical’s Renal Denervation Win: A pooled analysis of three randomized hypertension studies provides further evidence that ReCor Medical’s ultrasound renal denervation treatment consistently reduces blood pressure. The device, called Paradise, showed a consistent BP-lowering effect in all three trials at two months. ReCor stated that those blood pressure reductions  — if maintained long-term — correlate to a potential 25% reduction in cardiovascular risk.

• Medtronic’s Spyral Misses Primary Endpoint: While ReCor celebrates a renal denervation victory, Medtronic missed the primary endpoint in its renal denervation study. In the 337-person randomized trial, Medtronic’s Spyral multi-electrode catheter failed to outperform a sham treatment in reducing ambulatory systolic blood pressure. Medtronic maintains that the treatment could provide valuable clinical utility, as Spyral is safe and did yield some secondary benefits (e.g. reduction in office-based systolic BP). 

• Remote Hypertension & Lipid Program: A new study highlights that digital, remote cardiovascular programs promote equal access to care. In 10k patients with high blood pressure and/or cholesterol levels, the mean reduction in LDL-C was 35.4 and 37.5 mg/dL at 6 and 12 months. The results suggest that a standardized remote BP and cholesterol management program may help optimize guideline-directed therapy at scale, reduce cardiovascular risk, and minimize the need for in-person visits among diverse populations.

• Hello Heart’s Dot-to-Dot Program: Hello Heart announced the addition of Dot-to-Dot to its digital heart health program. Dot-to-Dot leverages AI to help people draw connections between their lifestyle choices, such as minutes walked or whether they took their medication, and their heart health. The digital therapeutic company raked in $70M in series D financing earlier this year. 

• Surgery over Endovascular Therapy in CLTI: The BEST-CLTI trial data outlines the benefits of surgical rather than endovascular revascularization for patients with chronic limb threatening ischemia (CLTI). Among patients who had an “adequate” great saphenous vein (GSV) for surgical revascularization, the incidence of amputation or death was significantly lower in the surgical group than in the endovascular group (42.6% vs. 57.4%). The authors saw similar rates of adverse events among the patients who lacked an adequate GSV (42.8% vs. 47.7%).  

• Agnostic Clinical Decision Tool: An EHR-based decision support tool led to more appropriate prophylaxis and significantly cut 30-day thromboembolism rates in a 10k patient, five-year RCT. The EHR-agnostic IMPROVE-DD digital VTE risk score, which adds D-dimer as a recognized risk factor to the standard IMPROVE score, boosted appropriate inpatient and outpatient thrombophylaxis by a relative 52% and 93%. The intervention reduced the incidence of thromboembolic events by 29% during hospitalization and through 30 days. 

• Cardiac Arrest Racial Disparities: New research presented at AHA showed that Black patients were the only racial group that has not recently experienced a drop in cardiac arrest deaths, highlighting the ongoing need to address racial health disparities. Overall cardiac arrest deaths fell by more than 40% from 1999 to 2020 (7.7 to 4.4 deaths per 100k people), while Black communities saw a higher death rate (8.7) with no significant change over the time period.

• Cardiology Awards Favor White Males: Cardiology societies give awards to men and white individuals to a disproportionate extent. Authors of this JACC-published study looked at honors given by seven different societies (including ACC, AHA, and ESC) between 2000 and 2021, finding that 75.2% of awardees were white and 76.2% were male. Recognition for women increased over the two decade period, with 7.7% of women awardees in 2000 to 31.2% in 2021. 

• Questioning BACs and CAD: Despite the growing buzz about using breast arterial calcifications (BACs) in mammograms to detect coronary artery disease, an EJR study found no link between BACs and CAD severity. Among 183 postmenopausal women (39 w/ BAC) who underwent invasive coronary angiography, there was no difference in the number of affected vessels in women with or without BACs (p = 0.683). After adjusting for variables (age, time since menopause, smoking), BACs still weren’t linked to having more affected vessels (odds ratio: 1.07).

Cardiovascular Structured Reporting Adoption Benefits

Check out this Change Healthcare report detailing the benefits of cardiovascular structured reporting, and how to drive structured reporting adoption in your own organization.

HeartFlow FFRct’s Clinical Data Foundation

HeartFlow FFRct Analysis’ widespread payor support and adoption by 80% of the top 50 US heart hospitals is built on a deep foundation of peer-reviewed clinical research. See how HeartFlow FFRct has consistently proven to reduce unnecessary angiograms and the cost of care, making it a “game changer” for its users.