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Cardiology in 50 Years | Genomics’ Lipid Impact September 18, 2023
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Together with
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“Almost nothing that we view as modern cardiology was available 50 years ago. It is likely that cardiology will change as much in the next 50 years as it has in the last 50 years.”
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Rick Stouffer, MD, Chief of Cardiology at UNC Health
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Most of today’s cardiology procedures, technologies, and medications were unknown or in their very early stages fifty years ago, and a new Becker’s Viewpoint by UNC cardiology chief Rick Stouffer, MD forecasts that “cardiology will change as much in the next 50 years.”
Here’s the ten core areas where he expects these changes to take place:
Personalized Medicine – Although very different patients are treated with the same medications today, unique patient characteristics (especially genetics) will play a far greater role in future medication decisions.
De-Emphasized RTCs – Randomized controlled trials might be the current gold standard for cardiology science, but improvements in EHR data will pave the way for real-time “pragmatic trials” that avoid RCTs’ delays, costs, and hassles.
Environmental Focus – We’ll see a far greater population health-level focus on addressing environmental contributors to CVD (e.g. toxins in water, air pollution, chemicals in food).
Nutrition Focus – Nutrition will become a major research focus area, noting that nutrition could have a far larger impact on overall CVD health than the CVD drugs that get most of the research attention (and funding).
Cardiomyopathy Progress – There’s currently limited options for heart failure, but the future will bring new therapies that “will recruit myocytes to the failing heart (e.g. stem cell infusions) to replace those irreversibly damaged.”
Specialist Access – The expansion of telehealth will give patients far more access to subspecialist cardiologists, while general cardiologists will lower their thresholds for subspecialist referrals.
Chronic Interventions – We’ll see more chronic diseases treated with interventional procedures, starting with renal denervation for hypertension, and followed by future interventions for “diabetes, heart failure, arrhythmias, etc.”
Family Ties – We’ll better understand family transmission of cardiovascular disease, as future research into genetic, epigenetic, and environmental factors allow us to identify and treat people with greater inherited risks.
Better and Fewer Procedures – Cardiac procedure and surgery outcomes will continue to improve due to technological and technique advances, but they will “be used less frequently as the focus turns to prevention rather than treatment.”
Preventative Weight Loss – Weight loss will become a primary focus for CVD risk management, with weight loss drugs becoming an early addition to obese patients’ CVD regimens.
What won’t change?
- Exercise will still be prescribed but rarely followed
- Cheap, non-nutritious foods will continue to be widely available
- Patients will continue to engage in behaviors that are detrimental to their health
- People will still die from heart disease
The Takeaway
Although some of these predictions might be hard to envision (people have far more faith in RTCs than EHR data), they all make a lot of sense. And recent Cardiac Wire issues suggest that some of these trends are already underway.
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The True Measure of Cardiac Risk
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.
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PIA’s Post-Processing Solution
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.
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- Genomics’ Complex Lipid Impact: A new Cell Journal study revealed the complex influence that genome sequence variants have on lipid levels and cardiovascular disease. The study gives plenty of details for genomics buffs to dig into. Some interesting examples for the rest of us include: 1) Trp154Ter in FUT2 protects against CAD among people with A1 blood type, but increases CAD risks with others, 2) People with His48Arg in ADH1B don’t see the typical LDL-C increases from drinking alcohol, 3) People with some TM6SF2 variants receive far greater apoB lowering benefits if they don’t eat oily fish.
- Attune’s Esophageal Temp Approval: Attune Medical announced the FDA De Novo Approval of its ensoETM device, which uses temperature regulation to reduce esophageal injuries during RF ablation procedures. The approval was supported by two studies that found that ensoETM cut esophageal injuries by up to 83%, while significantly reducing atrioesophageal fistula complications. The FDA appears particularly focused on AFib ablation esophageal safety recently, granting S4 Medical a similar De Novo approval last week.
- Private Equity Comes For Cardiology: Just days after STAT detailed the overuse risks created by private equity’s cardiology expansion, an ACSH editorial shared similar concerns. The editorial acknowledged the business logic behind PE’s sudden focus on cardiology (outpatient reimbursements, potential to scale volume and control costs) and even noted why cardiologists might be interested in PE employment (equity, more autonomy versus hospital employment). However, it noted that PE expansions in other specialties have driven troubling volume and price increases, and it’s less clear whether their outcomes similarly improved.
- Lead’s Heavy Impact: New research in Lancet Planetary Health revealed the massive impact that lead exposure is having on CVD rates, IQ scores, and the global economy. The authors estimate that 5.54M adults died from lead-caused CVD in 2019 – six times higher than previous estimates – while lead exposure caused children under 5 years-old to lose 765M IQ points. Over 90% of lead’s CVD and IQ impacts occurred in poor countries, but it still delivered an unbelievable $6T burden on the overall global economy (… that’s 6.9% of global GDP).
- Supine Blood Pressure Signals Risk: An analysis of long-term ARIC study data found that supine BP measurements could help predict long-term CVD risks. In the study of 11,369 adults, 16% had high BP while lying down but not while seated and 74% had high BP in both positions. Those with high BP in both positions were at higher risk for CHD (1.6 times higher), heart failure (1.83x), stroke (1.86x), and CVD death (2.18x), while those who only had high BP while lying down had similar risks.
- Providers Up IT Investment: A Bain & Company and KLAS survey of 200 provider executives suggests that we might have finally passed the low point of the investment downturn, with 80% of health systems reporting that they “materially increased” spending on software and IT in the past year. Most of the findings echo trends we’ve seen before (point solutions = bad, EHR integration = good), but there were some good insights on how AI strategy is moving from IT departments to the C-suite as the expected impact grows.
- Generic Access Gaps: A study of low-cost generic drug programs in the US highlighted gaps in access to medications, including some generics for cardiovascular diseases. The analysis of major programs found that some CVD drug classes had high availability (ACE inhibitors, beta blockers, thiazides, moderate-intensity statins), but antiplatelets and antiarrhythmics were less available. Coverage and choices for atrial fibrillation and heart failure drugs were also limited.
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Elevate Your Imaging Skills: Don’t miss Dr. Nicolo Piazza’s exclusive master class series
Gain in-depth knowledge of fluoroscopic anatomy and cutting-edge imaging techniques with renowned expert, Dr. Nicolo Piazza. This five-session master class is happening now through November. Register now!
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Overcoming Cardiovascular Data Challenges
Aggregating multisource cardiology data is a worthy mission, but it’s often thwarted by confusion and complexity. This Change Healthcare article with Dr. Jennifer Hall, chief of data science at the American Heart Association, outlines best practices to help you overcome your cardiology data challenges and start leveraging deeper insights.
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- 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.
- Monebo’s Kinitec Rhythms ECG Algorithm separates true ECG signals from background noise, leading to more accurate diagnoses and improved operator efficiency. See for yourself how the algorithm measured up to a gold standard.
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