This week’s New Yorker cartoon takes on waiting room inefficiencies.

Cardiology Pharmaceuticals

Novo Nordisk Expands Weight Loss Pipeline with Inversago Acquisition

Novo Nordisk added to its leadership position in the white hot weight loss segment, acquiring Canadian biotech Inversago Pharma for up to $1.075 billion depending on certain development and commercial milestones.

Inversago Pharma develops therapies that block cannabinoid receptor type 1 proteins (CB1) to treat obesity, diabetes, and other metabolic disorders, although Novo Nordisk appears most interested in Inversago’s lead asset: INV-202.

• INV-202 is an oral CB1 inverse agonist (a once-daily pill) that has shown promise for weight loss and appetite suppression in a Phase 1b trial, allowing users to shed an average of 7.7 pounds in 28 days (vs. 1 lb avg. gains in the placebo group)
• INV-202 has also advanced to a Phase 2 trial for diabetic kidney disease, while Inversago’s other assets target metabolic and fibrotic disorders

Novo Nordisk was sure to position Inversago’s portfolio as “next-generation CB1 receptor blocker therapies,” highlighting their unique approach of targeting CB1 receptors in peripheral tissues (e.g. GI tract, kidneys, liver, pancreas, muscles, lungs).

• That differentiation is notable given that Sanofi had to withdraw its Acomplia (rimonabant) CB1 weight loss drug in 2008 due to concerns about the psychiatric side-effects from inadvertently targeting brain tissue
• It’s also quite different from Novo Nordisk’s injectable semaglutide (Ozempic and Wegovy), which mimics the GLP-1 hormone released in the gut in response to eating, prompting the body to produce more insulin and reducing blood sugar

The acquisition also suggests that an early-stage obesity drug startup land grab might be underway, led by the two pharma giants who are already leading the weight loss segment.

• Inversago’s “up to” $1.075B acquisition price represents a nearly 10x premium over the $111M that it raised through its Series C round
• Lilly acquired cardiometabolic disease biopharma startup Versanis for up to $1.92B just a few weeks ago for well above Versanis’s $70M Series A funding

The Takeaway

Semaglutide and tirzepatide made Novo Nordisk and Eli Lilly early leaders in the emerging weight loss segment, and their recent acquisitions reveal that the companies are now filling out their weight loss pipelines to ensure continued leadership.

These acquisitions have come with hefty potential premiums, but considering that GLP-1s generated $4.5B in global revenue last quarter (with minimal payor coverage) and given that the weight loss segment could be worth $100B by 2030, Novo Nordisk and Lilly clearly view these bets as justified.

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.

AI Echo Copilot – The Future of Echocardiography

New technology from Us2ai called Us2.connect allows you to add AI automation to any echo device. Any echo machine can now have 100% automated reporting with disease detection and editable measurements – all generated in realtime as you scan.

The Wire

• Are Doctors Overpaid? A new study on physician salaries and subsequent coverage by the Washington Post (w/ over 6,100 comments so far) sparked heated debates about whether US physicians are overpaid. Using federal tax records, the study found that physicians made an average of $350k in 2017. That’s 25% higher than previously estimated, and represents about 9% of total US healthcare costs. Cardiology was well represented among top-earning subspecialties, with interventional cardiologists and cardiac surgeons earning $682k and $607k, respectively.

• Beware Beta-Blockers with HFpEF: A large registry study revealed that beta-blocker use might increase risks for HFpEF patients. Among almost 436k patients over age 65 with heart failure and EF ≥40% (66.4% taking beta blockers), patients with HFmrEF taking beta blockers had a lower risk of hospitalization and death, but HFpEF patients on beta blockers had a significantly higher risk of hospitalization (particularly with EF >60%). The authors called for randomized trials to clarify HFpEF patients’ beta blocker risks.

• Capstan’s Minimally Invasive Heart Valve Funding: Capstan Medical advanced towards its goal of allowing minimally invasive heart valve surgeries, landing $31.4M in Series B funding to further develop its suite of heart valve implants and catheter-based robotic delivery platform. Capstan now plans to expand its engineering, clinical development, and operations teams who will focus on progressing its technology towards human use.

• Poor Cardiac Care at Post-M&A Hospitals: A new report from Elevance further confirmed that patients often face higher prices and lower care quality after independent hospitals are acquired by health systems. Cardiac care patients seemed to fare particularly poorly, as they saw average commercial coverage costs jump by over 5%, while their readmission rates increased by 10% to 12% during the three years following acquisition. Check out Digital Health Wire for detailed coverage.

• Shockwave’s $650M Placement: Shockwave Medical announced plans to issue $650M in Convertible Senior Notes (plus an optional $100M). Shockwave will apply $83.5M to the cost of capped call transactions, while using the rest for general corporate purposes (sales, marketing, medical affairs, R&D, etc) and potentially for investing in or acquiring other companies. The placement comes a few months after Shockwave reportedly evaluated a number of acquisition bids that eventually fell through.

• How Underused Are Statins? Very underused, according to a recent AHA study. Among 322k ASCVD patients from 92 health systems, 76.1% were on statins and only 39.4% were taking high-intensity statins, while use of non-statins was even lower (4.4% on ezetimibe, 0.7% on PCSK9 inhibitors). Unsurprisingly, only 45.3% of patients achieved the advised LDL-C <70 mg/dL target after one year, due in part to what the authors called “therapeutic inertia.”

• Acorai’s Heart Monitor Breakthrough Designation: The FDA granted Breakthrough Device Designation to Acorai’s Heart Monitor, a non-invasive device that estimates diastolic pulmonary artery pressure in Stage C heart failure patients. Acorai’s unique intracardiac pressure monitoring device combines hardware and machine learning to identify hemodynamic congestion and support personalized heart failure treatment, with the goal of reducing hospitalizations and readmissions.

• Questioning Coronary Angio After Cardiac Arrest: It may not be necessary to immediately perform coronary angiography in some patients who experience out-of-hospital cardiac arrest (OHCA). Among 554 OHCA patients who didn’t have ST-segment elevation, patients who underwent immediate coronary angiography showed no statistically significant difference in all-cause mortality after one year than those who received delayed or selective angiography (60.8% vs. 54.3%, P=0.05).

• One-dose Colchicine Falls Short Before PCI: Longer-term follow up from the COLCHICINE-PCI study shows that one dose of colchicine before PCI dampened inflammation but still didn’t reduce cardiovascular events. Data just published in the AJC showed no significant difference in events over a 3.3-year follow-up period (32.5% vs. 34.9% placebo).

• Arineta’s CT Clearances: Arineta Cardio Imaging announced the FDA clearance of its new SpotLight and SpotLight Duo cardiovascular CT scanners. Arineta highlighted the SpotLight Duo as the world’s first dedicated cardiovascular and thoracic CT system, performing both cardiac exams and high-resolution thoracic imaging for pulmonary diseases. Like its previous generation CTs, Arineta will sell and service the scanners directly, potentially offering them with the same unique per-scan model as its previous generation (vs. per scanner). 

• Hospital Operating Margins Improve: Kaufman Hall’s June Hospital Flash Report found that median year-to-date operating margins increased to 1.4% (vs. 0.7% in May), although the gap between high-performing and struggling hospitals continues to widen. Average length of stay dropped 2% month-over-month while ED visits fell by 1%, yet the 2% uptick in operating revenue suggests that “people are continuing to shift away from inpatient settings.”

Imaging AI + Calcium Scoring for Heart Attack Prevention

See how CCTA AI combines with CAC scoring to transform preventive heart care in this on-demand 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.

The Benefits of Outsourced Post-Processing

Using an outsourced cardiac image post-processing solution doesn’t have to mean sacrificing control of the results. Discover how PIA’s customizable post-processing workflow can help you get the most out of your images.

The Resource Wire

• Unlock your ultimate destination for structural heart medical education with the newly redesigned Medtronic Academy 2.0. Gain access to expert-led courses, webinars, and a wealth of resources to stay ahead in cardiovascular care. Visit now!

• There’s plenty of short term benefits to cardiology data analytics, but it’s just as important for providers to make sure they’re ready for the future of cardiology analytics. This Change Healthcare article with Dr. Jennifer Hall, chief of data science at the American Heart Association, examines what technology leaders can do today to facilitate their future advancements in cardiovascular data and analytics.

• HeartFlow made its mark at SCCT 2023, announcing its new HeartFlow ONE all-in-one portfolio and releasing a trio of studies that highlight its ability to assess plaque, improve care decision making, and improve CCTA reading efficiency.