Mamas A. Mamas on interventional cardiology’s celebrated bullies.

Cardiology Pharmaceuticals

A Case for Antihypertensive Polypills

A new JAMA Cardiology study suggests that many hypertension patients could benefit from beginning their treatment with “polypills” featuring a combination of three or four low-dose antihypertensives, rather than starting with one or two BP-lowering agents and escalating if they don’t prove effective.

The researchers analyzed seven diverse trials with 1,918 patients (avg age: 59yrs; 38% women), including four studies testing three-component polypills and three studies testing four-component polypills. Across the trials’ 4-12 week follow-up periods, patients who took the polypills achieved…

• Greater systolic BP reductions versus monotherapy or usual care (avg: -7.4 mm Hg)
• Greater systolic BP reductions versus placebo (avg: -18.0 mm Hg)
• A higher rate of participants with BPs below 140/90 mm Hg versus with monotherapy or usual care (66% vs. 46%)
• A higher rate of participants with BPs below 140/90 mm Hg versus with placebo (54% vs. 18%)
• Consistent improvements across the seven trials, even though they all used different drugs at different doses

Polypills’ benefits appeared to improve over time. Two of the trials showed that patients in the polypill groups were also more likely to keep their BPs below 140/90 mm Hg at 6 to 12 months compared with patients in the monotherapy and usual care groups (72% vs. 59%).

The downside was polypill patients were more likely to experience dizziness than the other groups (14% vs. 11%), but there were no significant differences in other adverse reactions (e.g. edema, MSK pain, headache, major events) or treatment withdrawals.

These results might not surprise many Cardiac Wire readers, noting the results of the source studies and the general consensus that using multiple hypertensives in a single pill is more clinically and behaviorally effective, while using low doses of each component generally avoids adverse reactions. We’ve also seen similar results for other CVD polypills

The Takeaway
This study review adds to the growing field of evidence supporting the early use of antihypertensive polypills, particularly showing how well their efficacy and safety generalized across the different studies. However, as detailed in this TCTMD article, evidence is only one of the barriers to widespread BP polypill adoption, and we’ll likely need greater medication availability and more evidence regarding patient risk before we see real progress.

PIA Medical Processes It All

Need an analysis like calcium scoring, strain or even FFR? PIA Medical began as a Core Lab and can handle creative cardiac research and clinical trials along with the full breadth of clinical analyses available today.

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. 

The Holy Grail of Heart Attack Prevention

See how CCTA AI can transform preventive heart care far beyond CAC scoring, in this upcoming Cleerly webinar featuring world-renowned prevention expert Dr. Arthur Agatston (author of the South Beach Diet, creator of the Agatston score), Cleerly founder Dr. James Min, and CMO Dr. James P. Earls. Here’s where you can register today in order to join live on May 12th.

The Wire

• Beating-Heart Transplants: Stanford Medicine performed the first six beating-heart transplants from cardiac death donors, which avoid tissue injuries caused by stopping the heart a second time before implantation. Before now only hearts from brain death donors were stopped once. The team used a “heart in a box” system during transportation (perfuses heart w/ warm, oxygenated blood) and then quickly transitioned the heart to a cardiopulmonary bypass machine that was already supporting the patient, before sewing the heart into the recipient while it was still beating.

• Interventional Bullies: A powerful TCTMD editorial by Khaldoon Alaswad, MD placed a spotlight on the bullying and abuse that trainees absorb from interventional cardiology attendings and leaders, spurring passionate conversations across CardioTwitter. The editorial detailed a broad range of abuse tactics, warning that this (often ignored) behavior is hurting the mental and physical health of trainees, putting patients at risk, and driving doctors away from interventional cardiology. 

• Story & Sprinter’s Home HF Testing: Story Health and Sprinter Health launched a new partnership that will provide Sprinter Health’s mobile diagnostics services to heart failure patients in Story Health’s virtual care program. The partnership looks to eliminate the burden that in-clinic lab testing places on heart failure patients (often at the expense of GDMT compliance), by bringing testing to them via Sprinter Health, while Story Health will use the in-home lab results for treatment optimization. The partnership initially serves patients in Utah, with expansions to other regions planned for the future.

• Medtronic’s AAA Stent Graft Data: Medtronic unveiled 10-year data from its Endurant Stent Graft Natural Selection Global post-market registry (ENGAGE, 21 countries, 49 sites), showing that its abdominal aortic aneurysm (AAA) stent graft system achieved a 94.7% freedom from aneurysm-related mortality rate and a 64.1% sac regression rate. The ENGAGE registry was initiated less than a year after the Endurant AAA stent gained its CE Mark, and has evaluated over 1,200 Endurant patients, including ~400 represented in this follow-up data.

• Anticoagulation Disconnect: Results from the BOAT-AF study revealed a significant disconnect between AF patients and their physicians’ willingness to reconsider anticoagulation, underscoring the need to revisit previous anticoagulation decisions. Researchers surveyed 817 patients with AF who were not receiving oral anticoagulation and their physicians, revealing that far more patients were open to reconsidering anticoagulation (38% vs. 27%), potentially because many physicians incorrectly believed that their patients weren’t open to the treatment (24.6% of the patients who were actually “open”).

• Outcomes-Based Pharmaceutical Contracts: About 58% of payors had at least one outcomes-based contract with a PBM for prescription drugs in 2022, according to an Avalere Health survey of 46 health plans. Of the payors with outcomes-based contracts, 12% had contracts for cardiology meds (2nd most after oncology w/ 18%), and 36% had over 10 OBC contracts. The payors’ also showed a preference for using these contracts with “mostly new products,” revealing growing interest in aligning reimbursement with clinical benefit for new drugs with limited real-world evidence.

• CardioMEMS’ LVAD Potential: A study in Circulation: Heart Failure suggests that patients with left ventricular assist devices (LVADs) could benefit from using Abbott’s CardioMEMS system for pulmonary artery (PA) pressure monitoring. The nonrandomized multicenter prospective study followed 101 patients with LVADs and CardioMEMS PA Sensors for 6months, finding that patients who achieved PAD reductions saw improved 6min walk distances (266 to 322 meters, vs. no improvement), while participants who maintained PAD below 20 mmHG more than half of the time had fewer heart failure hospitalizations (12.0% vs. 38.9%).

• USHV Expands into Kansas: Private equity-backed cardiology managed service organization US Heart & Vascular continued its practice M&A spree, acquiring Wichita, Kansas-based Heartland Cardiology (~15 physicians, ~10 locations) just a week after acquiring Dallas-area practice HeartPlace. Heartland becomes the first Kansas-based cardiology practice to join USHV, which has expanded across Tennessee, Arizona, Texas, and Kansas since forming in 2021, with the goal of creating a nationwide value-based care-focused cardiology practice.

• Ozempic in Demand: A survey of 1k US adults from Tebra wrapped some numbers around diabetes and weight loss drug Ozempic’s sudden rise in popularity… and the numbers were pretty wild. Nearly a quarter of respondents had asked their doctor for an Ozempic prescription, and apparently 15% of Americans have personally used Ozempic for weight loss. The demand is making it hard for diabetes patients to source their medication, and this breakdown of Ozempic’s popularity by state makes it look especially hard to come by in the South.

• egnite Flags LAAC-Eligible AF Patients: Cardiology digital health startup egnite Health announced the addition of a new module for its flagship CardioCare solution that identifies atrial fibrillation patients with higher risks of stroke and bleeding who might be eligible for left atrial appendage closure (LAAC) therapy. The module scans over 1,700 hospital codes to identify AF patients who might have better outcomes with LAAC instead of blood thinners, allowing care teams to expedite referral and treatment.

• Costly Nurse Turnover: The 2023 NSI RN Staffing Report showed that the average turnover cost for a staff RN spiked 13.5% to $52k between 2021 and 2022. RNs in telemetry (27.1%), step down (23.7%), and the ED (21.7%) have consistently seen the highest turnover, important stats to keep an eye on considering that each percent increase in RN turnover costs the average hospital $380k per year.

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Check out this Cardiac Wire Q&A with Us2.ai president and co-founder Yoran Hummel, discussing how his career as a sonographer led him to echo AI, and how Us2.ai’s upcoming automated strain analysis feature brings the company even closer to democratizing echo.

Evolving Coronary Disease Imaging Pathways

HeartFlow’s PRECISE trial showed that their precision approach for evaluating stable chest pain avoids unnecessary testing and improves care – without risking missed heart disease diagnoses. In this Cardiac Wire Show, HeartFlow’s Chief Medical Officer Dr. Campbell Rogers dives into the PRECISE trial results and its implications for clinical practice.

Monebo’s AF ECG Algorithm

Atrial fibrillation is often difficult to characterize with an automated algorithm due to the changing waveform morphology, system, or muscle noise. This is especially true given the size constraints of ambulatory devices to detect AFib. See how Monebo’s Kinetic AF ECG Algorithm overcomes these size limitations without sacrificing accuracy.