Douglas Drachman, MD, on interventional cardiology’s transition to the match system.

Surgeries & Interventions

Interventional Cardiology Joins The Match for 2025

Prospective interventional cardiology fellows can breathe a sigh of relief. Starting in 2025, three-quarters of interventional cardiology fellowship programs will transition to a voluntary match system.

“The Match” uses an algorithm to place resident and fellowship applicants into their most preferred programs that also prefer them. 

• While all other CV specialty fellowships already use a match system to place candidates, IC has been the lone exception. That will change in the 2024-2025 application cycle. 

The Society for Cardiovascular Angiography and Interventions (SCAI) initiated the change, hoping that the match system will promote “fairness, equity, and thoughtfulness.” 

• Of the 177 accredited IC training programs, 136 signed on to SCAI’s initiative in support of the match– just surpassing the 75% threshold needed to change the precedent.

The current system, which will be phased out in 2024, can be chaotic and anxiety-inducing for applicants. There is no central information hub to find out key details about available programs and positions, which prompts both the applicants and programs to waste a lot of effort.

• When a candidate is offered a position, they have a certain amount of time to either accept or decline the offer – sometimes as little as 48 hours – and often don’t have the opportunity to complete interviews at other institutions. Cardiologists have made it clear that they hate this. 

The Takeaway

The Match should help shift the decision-making power in favor of the candidate, rather than the program. In the next couple of years, candidates will have the opportunity to interview and assess the programs that might best meet their professional, personal, and logistic objectives without the pressure of an unreasonable deadline to commit.

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The Wire

• Imagen’s Aorta-CAD Receives FDA Clearance: Imagen Technologies announced the FDA clearance of its software Aorta-CAD, a deep learning tool designed to help physicians detect aortic atherosclerosis and aortic ectasia in chest X-rays. The cloud-based solution is part of Imagen’s Diagnostics as a Service platform, and can assist any physician who reads CXRs (including PCPs, cardiologists, and radiologists). 

• Heart Support Device Shortage: The FDA warned health systems that certain heart support devices might be in short supply after learning of logistics problems at Getinge. The shortage affects Getinge’s Maquet/Datascope intra-aortic balloon pump devices, including supplies of IAB catheters, new Cardiosave IABPs, and Cardiosave IABP parts. The medtech company has not said when they expect supply to meet demand.

• Heart Ultrasomics: Authors of a JACC study developed an AI model that successfully extracted cardiac ultrasonic textural features from echo images to assess LV structure and function. Developed on cardiac ultrasound images from 1.9k subjects, the “ultrasomics” model successfully predicted LV remodeling in an external dataset of 484 subjects (AUC: 0.78-0.79). The ultrasomics probability score also independently predicted MACE (HR: 8.53). The tool could potentially facilitate image triage and management, and add to the size and function measurements of standard echos. 

• Higher Copay = Higher Nonadherence: A study out of NYU found that the higher the copayment, the less likely heart failure patients were to fill their ARNI prescription. Compared with HF patients with a $0 copayment, those whose ARNI copayment was $10-$100 were nearly twice as likely to not fill the script (odds ratio: 1.93), and patients whose copayment was over $100 were over two and a half times as likely to not fill the script (OR: 2.58). 

• Pediatric Obesity Treatment: A randomized clinical trial of 54 children with obesity revealed that butyrate supplementation may be an effective treatment for pediatric obesity. According to six-month follow-up data, children taking oral butyrate in addition to standard care decreased their BMI 40% rfaster than children only receiving standard care. Children taking butyrate also showed a greater decrease in waist circumference, insulin level, and ghrelin level. 

• Empagliflozin Economic Analysis: A cost-effectiveness analysis based on the EMPEROR-Preserved trial (6k patients) suggests empagliflozin provides low economic value compared with standard of care for HFpEF, largely due to its lack of benefit on mortality and small benefit on quality of life. The authors found empagliflozin had an incremental cost-effectiveness ratio of $437k per quality-adjusted life-year gained. 

• Apple v. AliveCor: Next week is the deadline for the International Trade Commission to ban imports of the Apple Watch following AliveCor’s successful patent-infringement lawsuit, which of course means that Apple’s been hard at work making sure that no such ban takes place. On Tuesday, the US Patent Trial and Appeal Board ruled that three AliveCor patents covering ECG tech were unpatentable because they were “obvious in light of previous advances,” and as you might imagine Apple plans to submit the new ruling to the ITC swiftly. AliveCor stated that it “strongly disagrees” with the decision, so it’s looking like the import ban will have to wait until after another round of appeals.

• CAD-RADS Evidence: CAD-RADS improves coronary CTA reporting variability, even with reconstructed low-dose exams. Italy-based researchers enhanced 161 patients’ low-dose CCTAs using model-based and iterative reconstruction algorithms (MBIR & IR) and had two readers interpret the exams using CAD-RADS. The CAD-RADS assessments achieved “excellent” inter-observer agreement, even though the readers didn’t have experience with CAD-RADS and had different levels of CCTA expertise. The MBIR images also consistently produced higher image quality and image noise measurements than the IR CCTAs.

• CGM Use Cases: Continuous glucose monitor startups still have to prove their worth, or at least that’s the tagline of a recent Verge article that dove into whether or not CGMs make a real impact for consumers without diabetes. Following a recent crop of startups springing up to help everyday consumers manage their blood sugar, the author (without diabetes) and her friend (with Type 1 diabetes) documented their experiences wearing a CGM to see how they differ. It’s a well laid-out story that gives the impression that CGMs definitely aren’t a need-to-have device for non-medical use cases.

• November Jobs Report: The November Jobs Report revealed that the healthcare sector added 45k jobs last month, with ambulatory services, hospitals, and nursing and residential care facilities leading the job gains (23k, 11k, 10k). Although this month’s hiring slowed 17% from October, the Bureau of Labor Services reiterated that healthcare employment appears to be in a much better spot this year than last, adding an average of 47k new jobs each month (vs. 9k per month last year).

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.

Stress Less with AI-Powered CCTA

Stress tests are today’s go-to method for detecting coronary artery disease, but should they be? Tune-in to this Cleerly webinar exploring how we can improve CAD detection with AI-enabled CCTA.