Sheila Sahni, following Lisa Presley’s recent cardiac arrest.

Surgeries & Interventions

CAPLA: Simple Ablation is Best

The debate around AFib ablation gained clarity last week, when the CAPLA trial revealed that more aggressive treatment did not lead to better patient outcomes – but did increase procedure time. 

Some experts believe that extending ablation to the posterior wall of the left atrium may help block irregular electrical signals and restore a healthy heartbeat. But this add-on strategy has had mixed success in the literature. 

• The 2022 ERASE-AF study found that targeting the left atrium in addition to PVI effectively improved AFib suppression. But before that, several trials showed the opposite (STAR-AF-2, DECAAF-2, STABLE-SR-II).

Enter: CAPLA. The authors randomly assigned 338 patients with persistent AFib to receive either the standard PVI or PVI plus posterior left atrial wall isolation (PVI + PW). The authors found…

• No differences in AFib recurrences
• No differences in safety outcomes
• Procedural times were 20 minutes longer in the PVI + PW group

The Takeaway

There is a tendency to think “more is better” when dealing with persistent AFib. This study adds to a growing body of evidence that suggests sticking to the traditional PVI-only approach is as effective as additional ablation and cuts procedure time.

How Precision Heart Therapy Advances the Business of Healthcare

Health systems continue to face economic and regulatory pressure to reduce care costs and improve outcomes. See how Cleerly’s precision heart care approach helps enhance patient care, avoid unnecessary and high-cost procedures, and improve the patient and provider experience.

Reducing Variability in Echo Analysis

What if AI could produce echo measurements that are comparable to expert physicians, but with less variability? That’s precisely what this Nature study revealed about Us2.ai’s solution, finding that its measurements had fewer and smaller differences compared to three human experts than when the experts were compared with each other.

The Wire

• Shockwave Acquires Neovasc: Shockwave Medical agreed to acquire Neovasc’s cardiac device business for an estimated $100M. At the heart of the deal is Neovasc’s Reducer system, a small device that helps adjust the flow of blood to the heart to treat refractory chest pain. Shockwave has made a splash in the interventional cardiology waters for pioneering intravascular lithotripsy (IVL) to treat severely calcified CVD, and the Reducer system now adds to its growing pipeline of devices the company plans to introduce in the coming years. 

• Elevated Uric Acid Linked to AFib: A new study in JAHA found that increased uric acid in middle adulthood (30–60 years old) was a significant risk factor for new-onset AFib. The risk was present across those with and without other cardiovascular conditions, suggesting that these high uric acid levels may contribute directly to the onset of AFib, as opposed to simply being “a reflection of cardiometabolic burden.” 

• Bias in TAVI vs. SAVR Studies: A multidisciplinary group of academics found weaknesses in internal validity among randomized controlled trials comparing transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR). The meta-analysis of 8 RCTs including 8.8k participants found that studies comparing TAVI and SAVR show “serious methodological imbalances,” and should be considered at high risk of performance and attrition bias. 

• Viz.ai Vascular Suite: Viz.ai launched its new Viz Vascular Suite, combining the company’s trademark care coordination capabilities with its existing vascular AI tools (pulmonary embolism, right heart strain, aortic disease detection) and a new FDA-pending abdominal aortic aneurysm solution. The Viz Vascular Suite launches shortly after Viz.ai’s new Cardio Suite and Radiology, as the care coordination AI company increasingly looks to create solution packages for clinical workflows beyond neuro.

• Out-of-Pocket Costs for Recommended HFrEF Care: Last week, I covered a study that found that many acute heart failure patients are not getting the guideline-directed medical therapy (GDMT) they need. The same day that study was published, a research letter in JAMA highlighted the extreme out-of-pocket costs for brand-name drugs included in GDMT regimens (>$2,500 /yr). These high costs are primarily driven by two on-patent medications (ARNI and SGLT2i), the need for multiple medications, and the Medicare Part D coinsurance requirement in the coverage gap. 

• Kidney Transplant CHD Testing:  Despite the ubiquity of the practice, new research suggests testing for coronary heart disease before kidney transplant may not be that necessary. Among 80k first-time kidney transplant recipients, testing within 12 months before the procedure was not associated with any change in death or MI within 30 days after transplant.

• What Your Scrub Color Means to Patients: A clinician’s attire is known to influence patient confidence in them. But what do different scrub colors indicate to patients, if anything at all? Researchers presented 113 adult patients at UNC Medical Center with eight images: four each of a male and female clinician wearing different color scrubs. Black scrubs ranked worst in terms of knowledge, skill, trust, and level of caring, with some saying black scrubs were deathlike and resembled a mortician. Blue scrubs were thought to be most caring for both male and female clinicians.

• Rybelsus Approved for First-Line T2D Therapy: The FDA approved a label update for semaglutide, allowing Novo Nordisk’s medication Rybelsus to be used as a first-line treatment option for adults with type 2 diabetes. This update removes a previous use limitation that stated the medication should not be used as the initial therapy for treating T2D patients. 

• EHR Messages Don’t Burn Out Doctors: UCSD researchers recently combed through over 1.4M EHR patient messages, finding that message volume (number of messages), length (word count), and sentiment (positive, neutral, or negative) were not associated with physician burnout. In case you’re wondering the most common negative words were “cancel,” “pain,” and “no,” with “f*ck” making an appearance at #9. 

• Deprescribing Aspirin in PCI Patients: A new analysis in JACC reveals that clopidogrel monotherapy after DAPT decreased bleeding rates without increasing the risk for blood clots, even for people with diabetes. In the study, 6k PCI patients were treated with DAPT (aspirin and clopidogrel or prasugrel) for one month, and then either continued DAPT for 12 months or switched to clopidogrel monotherapy. The 1-month DAPT group had far fewer bleeding events (diabetes patients, 0.3% vs. 1.5%; nondiabetes patients, 0.6% vs. 1.2%), and their risk for CV events did not increase. 

• BioSig Provides PURE EP System to Bellin: Wisconsin-based Bellin Health System signed an agreement to purchase BioSig Technologies’ PURE EP System, a combination of hardware and software designed to capture raw EP signals, remove background noise, and boost interpretation confidence. The system is already used at places such as Mayo Clinic, Cleveland Clinic, and Kansas City Heart Rhythm Institute.

PRECISE Trial Rewrites the Patient Pathway

HeartFlow’s landmark PRECISE trial found that their precision approach for evaluating people with stable chest pain avoided unnecessary testing and improved care without putting patients at risk of a missed heart disease diagnosis.

Relieving The Burden of Post-Processing

With the advent of advanced imaging technologies like CCTA come added burdens to technologists and diagnostic imaging centers. See how PIA can relieve the burden of post-processing, saving you time while helping your bottom line.

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.