John M. Mandrola, MD, celebrating the humility, logic, and rigor that went into the FRAIL-AF trial, calling it the “most important study” at ESC 2023.

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Artificial Intelligence

The State of Cardiology AI

There’s generally more healthcare AI buzz than actual real world clinical use, and that’s probably true within cardiology too. However, the cardiology AI segment is showing more clinical and commercial promise than just about any AI segment in healthcare outside of radiology, and its rapid evolution is worth our attention. 

Because of that, we’re taking a deep dive into the state of cardiology AI and the key trends driving its growth.

The cardiac CT AI segment has a lot going for it, including two of the highest funded startups in all of imaging AI (Cleerly ~$280M, HeartFlow ~$793M), the strongest reimbursement in healthcare AI (FFR-CT & plaque), and a unique level of guideline support (chest pain). It’s also home to a number of promising trends, including:

• A growing wave of new and innovative cardiac CT AI startups 
• More vendors expanding to comprehensive CCTA AI portfolios
• Momentum towards using routine chest CTs for incidental CVD detection

The echo AI segment remains extremely active, including a pair of high-profile startup acquisitions (DiA Image Analysis by Philips, and Caption Heath by GE), growing momentum towards reimbursements (user guidance and HF detection), and a long list of complementary macro factors (sonographer shortages, home/remote care growth, improving HF treatments). Other key echo AI segment drivers include:

• Diverse workflow integration options (ultrasound devices, AI platforms, PACS workflows, etc.)
• Leadership from OEM-backed and well funded echo AI companies
• New innovations from a growing list of emerging echo AI startups

The ECG AI segment doesn’t get as much attention as CT or echo, but it’s arguably the most diverse cardiology AI segment and could prove to be the most impactful, driven by its broad range of use cases and its support by some of the most influential organizations in healthcare. ECG AI is also seeing a number of notable trends, including:

• AI amplifying current ECG processes and creating completely new use cases
• Pharma companies actively backing ECG AI startups to find more treatable patients
• Big data AI firms and medtech OEMs acquiring ECG AI companies

The cardiac MRI AI segment has historically lagged behind other cardiac modalities, which isn’t surprising given CMRI’s complexity, low exam volumes, and small reimbursements. Still, the CMRI AI segment includes a solid array of post-processing solutions that automate key measurements and workflows. We’re also seeing some emerging trends that could drive future CMRI AI momentum:

• Deep learning-based MR image reconstruction solutions expanding to CMRI
• CMRI AI solutions becoming well represented on multi-vendor AI platforms
• AI growth in other cardiac modalities could help drive CMRI AI innovation and adoption

The Takeaway

If you assess the typical cardiology news cycle or take a look at the booths and presentations at the major cardiology conferences, it’s clear that cardiology AI is in its very early stages. However, that relatively low level of cardiology AI attention makes this early momentum even more remarkable, and could suggest that this segment is poised for far more growth in the coming years.

Upcoming master class: Multimodality imaging for cardiac interventions

Join Dr. Nicolo Piazza for a five-session master class delving into chamber views, projection curves, and advanced imaging. The first session kicks off on September 18 at 7:30 p.m. ET. Don’t miss it!

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

• Another Novo Nordisk Weight Loss Acquisition: Novo Nordisk further added to its weight loss segment leadership, acquiring Danish startup Embark Biotech for $16M upfront and another $489M in milestone-based payments. Although early-stage, Embark Biotech has made progress developing a number of potential obesity treatments, and adds more candidates to Novo Nordisk’s weight loss pipeline after its recent acquisition of Canadian biotech Inversago Pharma for up to $1.075B.

• Obesity-Related CVD Deaths: All these obesity drug investments could have major CVD mortality implications. New research in JAHA shows that obesity-related CVD deaths tripled in the U.S. between 1999 and 2020, rising from 2.2 to 6.6 deaths per 100k people. Black Americans had the highest obesity-related CVD death rates, especially Black women and Blacks living in urban neighborhoods, even though men and rural populations had the most obesity-related CVD deaths within other racial groups.

• FRAIL-AF Cautions NOAC Switching in Frail Patients: Hailed as “the most important study from ESC 2023,” the FRAIL-AF trial showed that frail elderly patients with Afib who are doing well on vitamin K antagonists (VKAs) usually shouldn’t switch to a non-vitamin K oral anticoagulant (NOAC). Researchers randomized 1,323 patients (83yr avg age) to either stay on VKAs or switch to NOACs, but halted the trial early after finding that patients who switched to NOACs had far higher rates of major and/or clinically relevant bleeding (15.3% vs 9.4%). Previous studies on VKA-to-NOAC switching focused on non-frail elderly patients.

• CVD Drugs on Medicare Negotiation List: The long-awaited list of the first 10 medications up for Medicare pricing negotiations in 2026 has finally been released. Seven of the drugs were either directly or adjacently associated with cardiovascular conditions, including two blood thinners (BMS’s Eliquis, Janssen’s Xarelto), three heart failure meds (Novartis’ Entresto, Boehringer Ingelheim and Eli Lilly’s Jardiance, and AstraZeneca’s Farxiga), and four diabetes drugs (two that also treat HF).

• CVD Drugs Might Reduce Medicare Spending: Speaking of Medicare spending, the New York Times found that Medicare spending leveled out in 2011 at $13,159 per beneficiary and fell to $12,459 per beneficiary in 2023. The NYT suggests that the impact of cholesterol-lowering drugs and blood pressure medication might have contributed to these declines, in addition to larger efforts like Obamacare and budget cuts.

• Plaque Regression and MACE: In a new study in JAMA Cardiology, researchers performed a meta-analysis of 7.4k patients from 23 studies to highlight the link between lipid-lowering therapies, plaque regression, and rates of major adverse cardiac events. Intravascular ultrasound measurements of percent atheroma volume showed that every 1% reduction in plaque volume was associated with 17% lower odds of MACE.

• Radiaction Raises $13M: Israeli radiation protection company Radiaction Medical raised $12.6M in Series C2 funding to drive its entry into the US market. The company’s FDA-cleared Radiaction Shield System blocks over 90% of scatter radiation from X-ray fluoroscopy systems used in cath labs. 

• UPFs and CVD: A pair of ESC studies explored the ultra-high CVD risks that come from consuming ultra-processed foods (UPFs). A 15-year study of 10k Australian women found that participants who consumed the highest levels of UPFs were 39% more likely to develop high blood pressure, even after adjusting for salt, sugar, and fat (so processing alone might drive BP increases). Meanwhile, a meta-analysis of 325k men and women found that people with the highest UPF consumption had a 24% greater risk of experiencing a major cardiovascular event.

• Qoros Health Acquires CFCG: Florida continued to serve as America’s private equity-backed cardiology practice acquisition battleground state, following Qoros Health’s partnership with Central Florida Cardiology Group (5 physicians, 5 NPs, founded in 1948). The acquisition is Qoros’ first in Florida after accumulating 7 practices in Texas since forming in March 2022. It also follows six Florida practice acquisitions by CVAUSA, which has openly named the sunshine state as its main practice acquisition target.

• Hard Water’s CVD Benefits: A meta-analysis in the Foods Journal found that drinking “hard” water could reduce cardiovascular disease and mortality rates, especially water at the high end of WHO’s suggested 50 to 500 mg/L CaCO3 range. Among the 25 global studies, 17 showed a significant association between drinking water hardness and reduced CVD mortality. Among those, one showed that water hardness and magnesium content was associated with lower CVD risks and two showed that calcium content is associated with lower MI and ischemic heart disease risks.

• Hospital Margins Fall, Remain Positive: Kaufman Hall’s latest Hospital Flash Report showed that median hospital operating margins declined for the first time since March, but managed to remain in positive territory at 1.3%. The data depicts a larger pullback in volume on the outpatient side, which the report attributed to patients opting not to pursue elective procedures during the summer. Hospitals are also continuing to feel the effects of Medicaid redeterminations, with over 30 states disenrolling previous members through the June / July reporting period.

HeartFlow’s FFRCT’s Nationwide Improvements

What happens when HeartFlow’s FFRCT Analysis is adopted nationwide? See how the NHS’ nationwide implementation of HeartFlow’s FFRCT solution led to significant reductions in cardiovascular and all-cause mortality, plus solid efficiency gains.

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.

The Resource Wire

• The University College London National Amyloidosis Centre is the world’s largest cardiac amyloidosis care provider, making their echo assessments both crucial and high-labor. See how UCL researchers used Us2.ai’s AI echo software to accurately analyze echos from 1,200 patients with ATTR Amyloidosis in 24 hours, without requiring human interaction.

• How can AI help physicians “see” beyond conventional lipid profiles? Tune in to this upcoming webinar, examining how Cleerly’s AI-QCT solution complements conventional approaches to evaluating heart disease risk factors, and improve coronary artery disease diagnosis and heart attack risk assessments. Reserve your spot today in order to join live on September 21st.

• 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.