Interventional cardiologist Shariq Shamim, MD’s opinion on ABIM’s MOC.

Cardiology Pharmaceuticals

Lilly Shows Tirzepatide Superiority in SURMOUNT-3 and 4

Results from Eli Lilly’s SURMOUNT-3 and SURMOUNT-4 trials are in, and they confirmed that its GLP-1 / GIP agonist tirzepatide (aka Mounjaro) drives significant weight loss among obese or overweight adults who don’t have type 2 diabetes. 

The latest SURMOUNT trials showed that long-term tirzepatide use allows overweight people to shed a massive 26% of their weight. 

• That’s far more than tirzepatide’s 13.4% to 15.7% reductions among people with T2D in SURMOUNT-2 and significantly more than semaglutide’s (Novo Nordisk Wegovy) 10.9% to 14.9% in previous trials.

The SURMOUNT-3 trial had 806 obese adults without T2D undergo 12 weeks of intensive lifestyle intervention, before randomizing the 579 participants who lost ≥5% of their body weight to receive either tirzepatide or a placebo. After 72 weeks, the tirzepatide group…

• Lost an additional 21.1% of their weight, while the placebo group regained 3.3%
• Lost 26.6% of their weight total, including the 12-week lifestyle intervention
• Had far more users with ≥5% weight loss than the placebo group (94.4% vs. 10.7%)

The SURMOUNT-4 trial had 783 obese adults without T2D take tirzepatide for 36 weeks (not blinded), working their way up to their maximum tolerated dose. Researchers then randomized 670 participants to take either tirzepatide or placebo for another 52 weeks (double blinded). 

• After the initial 36 weeks, participants lost 21.1% of their body weight
• After the following 52 weeks, the tirzepatide group lost another 6.7% of their body weight, while the placebo group regained 14.8%
• Through the 88-week study, the tirzepatide group lost 26% of their body weight

Tirzepatide had a similar safety profile in SURMOUNT-3 and SURMOUNT-4 as its previous trials, most commonly citing mild-moderate gastrointestinal issues. This was also similar to trials for other GLP-1s.

The new trials also strengthen the evidence that GLP-1 weight loss requires continued use, which has been a source of criticism, even though continued use is normal for most other medications for chronic diseases. 

The Takeaway
Twenty-six percent is a massive weight loss number, and suggests that Mounjaro truly might earn its reputation as the “King Kong” of GLP-1s,” assuming its FDA approval process for weight loss goes as Lilly intends.

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The Behavioral Science Behind Change Cardiology Hemo

When Change Healthcare set out to design its next-generation Cardiology Hemo monitoring system, they put behavior science at the heart of its product strategy. See how Change’s UX designers applied its behavioral science team’s findings to improve its Hemodynamics solution to help make physicians and technicians even more efficient.

The Wire

• ABIM’s Bad Week: Last week didn’t seem fun for the American Board of Internal Medicine (ABIM). It all started with a petition calling for ABIM to eliminate its Maintenance of Certification (MOC) program, garnering over 6,200 signatures and a wave of negative comments. The ABIM MOC soon became the target of a hard-hitting and hilarious Dr. Glaucomflecken video that generated nearly 200k YouTube views by Friday. And to make matters worse, some MedTwitter sleuths dug up an early July ABIM post that seemed to encourage testing while on vacation – adding “burnout” to ABIM’s list of wrongdoings.

• HeartFlow’s All-In-One Results: HeartFlow made its mark at SCCT 2023, announcing its new HeartFlow ONE all-in-one portfolio (stenosis, FFR-CT, ASCVD/plaque) and releasing a trio of studies. In the REVEALPLAQUE Study, HeartFlow’s Plaque Analysis solution achieved 95% agreement with IVUS (the gold standard) for plaque quantification and characterization. Meanwhile, the DECODE Study showed that Plaque Analysis led to care management changes in 66% of patients compared to CCTA-alone, reclassifying nearly 50% of patients with zero CAC scores. Lastly, the SMART-CT Study showed that clinicians’ CCTA reads were 25% faster and 24% more confident when using HeartFlow’s RoadMap Analysis (stenosis) solution.

• Dual Biomarkers for MI Rule-Out: A new dual biomarker heart attack test could reduce length of stay among patients who aren’t actually experiencing acute MI. In the AROMI study of 4,351 people with suspected MI, testing with copeptin prior to admission followed by high-sensitivity cardiac troponin (hs-cTn) at arrival reduced average hospital stays by 54 minutes (6.9 vs. 7.8 hours), compared to hs-cTn tests at arrival and three hours later. Thirty day MACE rates were similar with the two methods.

• Us2.ai Links with HeartLab: Echo AI leader Us2.ai further expanded its platform reach, launching a new alliance with cardiology PACS company HeartLab. The companies will showcase their integrated solutions at this week’s Cardiac Society of Australia and New Zealand (CSANZ) meeting, including how echo workflows can be streamlined with Us2.ai-automated measurements and fast reporting. Us2.ai has been rapidly expanding its AI marketplace and PACS platform alliances, including Infinitt in mid-July.

• Too Much Ad Hoc PCI?: A study of New York cardiac surgery registries suggests ad hoc PCI is being overused in stable patients with multivessel (MV) or unprotected left main (LM) disease. Among 8,196 stable PCI patients with MV/LM disease, 78.4% of procedures were ad hoc, while ad hoc PCI accounted for about 35% of revascularizations (including CABG). An associated editorial called for more heart team consultations and greater consideration of other options to help curb ad hoc PCI overuse.

• Numares LDL-p Test Cleared: Metabolic diagnostics company Numares Health announced the FDA clearance of its AXINON LDL-p Test System, which measures lipoproteins in patient blood samples. Numares asserts that measuring cholesterol is “no longer sufficient,” positioning its LDL-p tests as more accurate for cardiovascular risk assessments – especially for patients with other comorbidities.

• CVD Inequities in Cancer Survivors: A large study of 905k cancer patients in the International Journal of Epidemiology found that Black cancer survivors are more likely than White survivors to die from cardiovascular disease. That held true for all 18 cancer types studied, with hazard ratios ranging from 1.30 with lung cancer to 4.04 with brain cancer. The study authors linked the higher risk to differences in socioeconomic status and health coverage, factors that “underscore the importance of neighborhood-level interventions and equitable access to care.”

• UltraSight Echo Guidance FDA Clearance: The AI-powered cardiac ultrasound guidance segment has generated a lot of attention following Caption Health’s acquisition by GE and recent calls to expand echo access –  and it now has a new (and independent) solution available in the US. UltraSight’s echo guidance solution landed FDA clearance last week, joining its CE Mark from August 2022, and enabling medical professionals without sonography experience to acquire cardiac ultrasound exams at the point of care.

• Early Ablation with AFib HF: A real-world study from Japan showed that patients with AFib admitted for heart failure benefit from early catheter ablation. After analyzing 103 patients who had catheter ablation within 90 days of HF admission and 2,683 who didn’t, early ablation was associated with far lower risks of dying from any cause (-62%), cardiovascular death (-72%), and HF mortality (-69%). An analysis of matched cohorts (83 in each group) also showed better outcomes with early ablations.

• Virgin Pulse Homebase Moves the Needle: Employer wellness company Virgin Pulse released promising results from a year-long analysis of its Homebase for Health platform (n=90k members), finding it successful in driving behavioral changes that improve obesity, hypertension, and high blood sugar. Employers utilizing Homebase saw 8-15% fewer work absences, 10-25% less turnover, and a 5-10% reduction in workers’ compensation, as well as a return of $3.17 for every $1 invested.

• Cigna Sued Over Denial Algorithm: A lawsuit filed in California accuses Cigna of using an algorithm for claim denials rather than individually reviewing each case, which state law mandates. A ProPublica expose found that Cigna denied more than 300k requests over a two month period using a PXDX algorithm that automatically identifies discrepancies between diagnoses and its coverage. An average of 1.2 seconds for reviewing each case was enough to push patients toward a class-action suit.

HeartFlow Analysis Streamlines Care

Faced with cath lab inefficiencies and an increased reliance on stress testing, Cone Health pursued a more advanced solution. See how the HeartFlow FFRct Analysis allowed Cone Health to improve the patient journey through streamlined CAD testing.

Precision QRS Detection

QRS detection is essential for any ECG algorithm, and Monebo’s Kinetic QRS ECG Algorithm sets the standard for accuracy. Kinetic QRS accurately detects the QRS complex, no matter the amplitude, waveform, or noise levels.

The Resource Wire

• Check out our 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.

• For years, world-renowned prevention expert Dr. Arthur Agatston, author of The South Beach Diet and developer of the “Agatston Score,” had been looking for technology that could accurately identify all types of plaque in the heart. Then, he was introduced to Cleerly. Hear from Dr. Agatston on why he believes “Cleerly really is the holy grail of prevention.”

• Advanced cardiac imaging often calls for a time-consuming post-processing step, requiring costly software, hardware, and training. See how PIA provides this post-processing at lower cost, improved consistency, and greater efficiency.