Edward J Schloss, MD with some initial skepticism about the cardiology societies’ plans to form a new CV medicine board.

Cardiology

Cardiovascular Societies Seek A Board of Their Own

After months of growing cardiologist backlash against the American Board of Internal Medicine’s Maintenance of Certification program, four leading cardiovascular societies collectively announced plans to create a new cardiology board to replace it. 

The consortium initially includes the ACC, HRS, HFSA, and SCAI (others including the AHA are evaluating), who will apply for permission to create a new independent board for cardiovascular medicine. 

Although details are limited, the proposed CV board will reportedly …

• Follow a new “competency-based approach to continuous certification” 
• De-emphasize timed, high stakes performance exams
• Focus on learning assessments to identify knowledge/skill gaps, and then make CME learning recommendations to help close those gaps
• Be developed and overseen by cardiovascular physicians

So how did the ABIM get to the brink of losing cardiology? Gradually, then suddenly…

• Some vocal cardiologists have pushed back against ABIM MOCs for years
• More cardiologists started calling for a change in April when the ABIM began listing cardiologists as “not certified” if they hadn’t paid their MOC fees, even if they did pay for and passed their certification exams
• The heat intensified in July with a petition to eliminate the ABIM MOC (now at >20k votes), followed by a hard-hitting Dr. Glaucomflecken video (now at 269k views), and some serious online outrage after an ABIM tweet seemed to encourage testing while on vacation
• The ABIM backlash became more formal in August when cardiology societies started calling for an end to its MOC process

It seems like there’s never been a better time to launch a cardiologist-led alternative to the ABIM MOCs, but it’s not that straightforward. 

• The consortium’s ABMS application process should take a few months, and then several additional months to launch its programs.

• Plus, many folks on CardioTwitter don’t seem ready to welcome the new board. Some are holding off until they see more details, some question the societies’ motives, and others are asking why they don’t just follow state license rules or support the National Board of Physicians and Surgeons.

The Takeaway
It would be hard to find a cardiologist who wants to stick with the ABIM or its MOC process, and most see a benefit in a cardiologist-led CV board, but the societies still have a lot to prove before cardiologists also view it as “a board of [their] own.”

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The Wire

• Second Pig Heart Transplant: University of Maryland surgeons performed the world’s second genetically altered pig heart transplant, this time in a 58 year-old man with terminal heart failure. Noting that the first transplant recipient had traces of a pig virus in his heart when he died two months later, the new donor pig was tested for the virus and related antibodies. The pig also received 10 different genetic modifications to keep the man’s immune system from rejecting the heart.

• Jardiance’s CKD Approval: Boehringer Ingelheim and Eli Lilly’s SGLT2i Jardiance (empagliflozin) added chronic kidney disease to its list of FDA-approved conditions, joining HFrEF and type 2 diabetes (it’s approved for all three in Europe too). The new approval covers the reduced risk of kidney disease progression and cardiovascular death, which is supported by its EMPA-KIDNEY trial results. The approval gives AstraZeneca’s Farxiga a new CKD competitor, while bolstering Jardiance’s already massive business potential ($3.83B in H1 2023).

• Story & WVU’s Home HF Alliance: Story Health and the WVU Heart and Vascular Institute launched a new heart failure partnership, combining WVU’s clinical expertise with Story Health’s virtual care platform and health coaches. That combination would transfer more care to patient homes, while adding personalized support for treatment and care management, and reducing WVU’s rehospitalizations and repeat in-clinic visits. Story Health’s unique approach seems to be gaining momentum, after getting its start with ChristianaCare in 2021 and partnering with Intermountain in early 2023.

• Cardiac Imaging’s Uneven Rebound: Cardiovascular imaging volumes rebounded unevenly around the world following the declines seen during the COVID-19 pandemic. In Radiology: Cardiothoracic Imaging, researchers found that volumes in April 2021 had surpassed pre-pandemic levels in the US (+4%) and were down slightly in non-US high income countries (-6%). But volumes were still down significantly in lower-middle and low-income countries (-41% and -50%). Recovery within the US also varied by region: Midwest (+11%), Northeast (+9%), South (+1%), and West (-7%).

• Post-Stroke Statins, Even With Low LDL-C: Stroke patients might experience fewer future cardiac events if they’re administered statins, even if they already have low LDL-C levels. That’s from a new AHA study of 2,850 stroke patients with <70 mg/dL baseline LDL-C levels, including 74% who initiated statins while hospitalized. After three months, the statin group had far lower composite adverse event rates (6.7% vs. 21.5%; stroke, MI, all-cause mortality), potentially due to statins’ non-cholesterol effects (e.g. neuroprotection, improved collateral flows, and anti-inflammation).

• 2022 Sees Record Health Coverage: New US census data shows that last year’s uninsured rate dropped for the second year in a row, from 8.3% in 2021 to 7.9% in 2022. That percentage matched the historic low first reached in 2017 (7.9%), with the Census Bureau calling out the American Rescue Plan Act and Medicaid expansion as top contributors. Disclaimer: the 2022 figures don’t reflect the millions of patients who lost coverage in the wake of Medicaid unwinding, so it wouldn’t be too surprising to see a jump next year.

• Mirabegron Falls Short in HF: It’s looking unlikely that the overactive bladder drug mirabegron will find a role for heart failure treatment, after it failed to slow HF progression. In the year-long Phase IIb study of 296 adults with pre- or mild HF, the beta-3 adrenergic agonist missed two primary endpoints compared to placebo: LVMI was up by 1.3-g/m2 and LV diastolic function declined by 0.15 E/e. The rates of side effects were statistically similar. 

• Cardiologist Kickbacks: New York City cardiologist Klaus Rentrop, MD will pay $6.5M in fines and give up ownership of his practice Gramercy Cardiac Diagnostic Services after settling a False Claims Act case related to a 2010-2021 kickback scheme. Dr. Rentrop maintained kickback agreements disguised as “rental payments” with referring physician practices and other cardiologists. The practices referred “tens of thousands” of patients to the partner cardiologists, who referred those same patients to Gramercy Cardiac for cardiac imaging exams.

• Inclisiran’s Mixed Real Word Results: Researchers from a Dutch lipid clinic revealed mixed early results with inclisiran (Novartis’ Leqvio). Patients who began taking inclisiran experienced 38% average LDL-C reductions after three months (n=30), and patients who combined inclisiran with statins saw LDL-Cs fall by 45% (n=15). However, these reductions were smaller than inclisiran’s clinical trials, and patients who switched from PCSK9s to inclisiran actually experienced 4% LDL-C increases (n=20). Inclisiran did show a similar safety profile as its trials; mainly mild injection site reactions. 

• Medicare’s Virtual Care Lead: A new AHA report shows that Medicare is leading the way in virtual care coverage, while private payors and Medicaid are trailing by a significant margin. Medicare and MA plans are both reimbursing physicians for RPM, remote therapeutic monitoring, digital evaluation / management, and provider-to-provider consults. By contrast, Medicaid only covers RPM in 34 states (less with other digital health categories), and the 16 private payors evaluated in the report were all over the map between complete coverage and zero support.

• Myocarditis After COVID Vax: People who received their second COVID-19 vaccination showed higher signs of myocarditis on PET/CT scans up to 180 days after getting the shot … even if they didn’t have symptoms. Researchers found that in 1k people, those who were vaccinated had higher PET/CT FDG uptake from heart inflammation as measured by median SUVmax compared to the unvaccinated (4.8 vs. 3.3).

Making the Leap to Outsource Post-Processing

Interested in how to outsource cardiac image post-processing, but not sure where to start? PIA walks you through how to assess and compare vendors, understand pricing models and payment options, and outline your requirements to identify vendors who meet your clinical needs. 

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The Resource Wire

• Ready to realize the benefits of cardiovascular imaging structured reporting? Check out these quick and powerful Change Healthcare videos detailing the efficiency gains provided by structured reporting and what it takes to drive adoption.

• 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. 

• The expansion of remote cardiac patient monitoring is creating more care opportunities, but also new operational challenges for cardiology teams. Check out this Cardiac Wire Show, where ARTELLA Solutions’ Jacinta Fitzsimons shares how the right combination of technology and service can help physicians get the most out of their cardiac RPM programs – today and into the future.