ACC President Hadley Wilson, MD, FACC on the new American Board of Cardiovascular Medicine’s leadership intentions.

Value-Based Care

CVAUSA and InnovaCare’s Value-Based Alliance

Transitioning to value-based care is at the center of most private equity cardiology groups’ strategies, and a recently-announced alliance between Cardiovascular Associates of America (CVAUSA) and InnovaCare Health is aiming to create a new model for cardiology + primary care VBC delivery.

The alliance involves three key stakeholders…

• InnovaCare Health – Florida-based integrated care provider with a big focus on VBC
• Family Care Partners – Jacksonville-based primary care physician group, owned by InnovaCare
• First Coast Heart and Vascular Centers – Jacksonville-based cardiology group, owned by CVAUSA

The three groups will focus on “improving care quality and reducing total costs” for Family Care Partners’ patients through…

• More proactive and efficient management of chronic cardiovascular diseases 
• Improving access to timely cardiovascular care
• Improving co-management of shared patients
• And hopefully reducing hospitalizations and emergency room visits, and shifting care to the “lowest cost sites”

Although this is a “first-of-its-kind” alliance in cardiology, some might have seen it coming given the massive costs associated with low-value cardiovascular care, the benefits of improving cardiology/primary care collaboration, and the emphasis CVAUSA has placed on VBC. 

• In fact, this alliance is directly tied to CVAUSA’s acquisition of VBC-focused cardiology practice NovoCardia in April, noting that NovoCardia now appears to be spearheading its VBC strategy and First Coast Heart and Vascular was previously one of NovoCardia’s practices.

The Takeaway

Over $320B is spent on cardiovascular care in the US each year, leaving plenty of room for low-value care, and plenty of opportunities for improvements through VBC alliances like this.

Whether CVAUSA and InnovaCare significantly improve value at Family Care Partners remains to be seen, but at least for now CVUSA believes that this partnership will become a model for how cardiovascular and primary care-focused VBC alliances can operate.

If it does prove successful, CVAUSA and InnovaCare have plenty of other Florida practices to expand to.

Reducing ECG Background Noise

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.

The CCTA + FFRCT Interventional Pathway

How are interventional cardiologists using CCTA & FFRCT to guide revascularization? Tune-in to this 30-minute webinar to see how experts from Atrium Health, Yale Heart & Vascular, and St. Francis Hospital are using CCTA & FFRCT to inform their patient selection, cath lab planning, and treatment.

The Wire

• AF Ablation and HF Risks: An observational study in Heart Rhythm Open provided what might be the first evidence that Afib ablation reduces heart failure risks. The researchers analyzed 2014-2022 data from 18,492 AF patients, finding that the ablation group had a ∼57% lower risk of developing HF than patients who only took anti-arrhythmic drugs. That included far lower rates of HF incidence (18 vs. 35) and HF per 1k person years (78.88 vs. 206.31), and was consistent across patient groups, AF subtypes, and CHA2DS2-VASc scores.

• Cardiology Board Update: Two weeks after the major cardiovascular societies announced plans to create a new board to replace the ABIM, leaders of the new American Board of Cardiovascular Medicine (ABCVM) addressed cardiologists for the first time. The 51 minute discussion included plenty of reassurances and (a bit) more details, with the general themes being that the new ABCVM recertification process would be more focused on identifying and addressing knowledge/skill gaps, less burdensome, lower cost (30% to 40%), and more relevant to cardiologists’ roles. 

• Rock Health’s Q3 Report: Rock Health showed that US digital health funding might have reached a new normal in Q3 2023 with $2.5B raised across 119 rounds. That’s the second-lowest total since 2019, but the fourth of the past five quarters with funding in the $2B range. Cardiovascular startups have raised the third most funding so far in 2023 ($0.3B), which is in-line with the last four years (CV consistently 2nd, 3rd, or 4th). Check out Digital Health Wire for a deep dive on Q3’s funding trends. 

• First HCM Gene Therapy: Cleveland Clinic conducted the world’s first in-human gene therapy for hypertrophic cardiomyopathy (HCM) as part of a clinical trial using TN-201, a first-in-class adeno-associated virus-based gene therapy. The therapy aims to address the most common genetic cause of HCM, MYBPC3 gene mutations, by delivering a functional MYBPC3 gene to the heart muscle through a single infusion of TN-201. In preclinical studies, the therapy showed promise for restoring normal protein levels and reversing HCM.

• GE Adds Caption Guidance: GE HealthCare added Caption Guidance to its Venue family of point-of-care ultrasound scanners. Available as an option, Caption Guidance gives clinicians step-by-step instructions for acquiring cardiac ultrasound images, expanding the range of clinical personnel who can perform echo exams. This is GE’s first major Caption Health integration since acquiring the company earlier this year.

• Cardiac Imaging Shifts: MedAxiom’s Cardiovascular Provider Compensation and Production Report revealed continued shifts in cardiovascular imaging. CTA is enjoying the greatest growth among advanced imaging modalities since 2018 (up from 10 to 16 exams per 1k patients), while cardiac PET and CMRI remained stable (22 to 24 & 4 to 4 per 1k patients). Meanwhile cardiac imaging staples, echocardiography and nuclear SPECT, are slowly trending in different directions since 2018 (509 to 514 & 117 to 89 per 1k patients).

• Enteric-Coated Aspirin Bleeding: Enteric-coated aspirin is sometimes prescribed with the idea of minimizing bleeding risk, but a new randomized study found it doesn’t have a safety advantage over uncoated aspirin. In the ADAPTABLE study of 10.7k adults, there was no significant difference in rates of hospitalization for bleeding (AHR=0.82, p-value .46). However, enteric-coated aspirin was as effective as coated aspirin (AHR 0.94, p=.40) based on the number of events (a composite of MI, stroke hospitalization or death from any cause).

• Biome’s Echo Surveillance Manager: Biome Analytics announced the launch of its Biome Surveillance Manager, which leverages machine learning and Biome’s benchmark library to improve echo exams and downstream care. The Biome Surveillance Manager analyzes previous echo studies and calculated ejection fractions, plus other metrics, to help echo operators improve exam quality and reduce variation. The solution also helps cardiovascular teams monitor disease progression and make patient management decisions.

• Cardiac Arrest Recoveries: Athlete sudden cardiac arrest was a mainstream news story once again last week, although this time coverage focused on recoveries. Buffalo Bills safety Damar Hamlin took the field for the first time, almost nine months after he suffered cardiac arrest in a playoff game. Meanwhile, LeBron James shared that his son Bronny is “doing extremely well” following his July cardiac arrest and will play basketball again in the upcoming college season.

• Lung Cancer CAC Screening: A new study out of Italy suggests that integrating CAC scoring into CT-based lung cancer screening assessments could improve the overall predictive power of these exams. The researchers analyzed data from 6.5k heavy smokers who underwent low-dose CT screening between 2005 and 2016, using AI to assign baseline scores to each participant (15% had 101-400 CAC scores). Twelve year follow-ups showed increased all-cause mortality among patients with higher CAC scores (log-rank test, p < 0.0001).

• Hospital Performance Stabilizes: Kaufman Hall reports that year-to-date hospital operating margins stabilized at 1.1% in August, with rising revenue offsetting higher supply costs. While margins are still below historical levels, that marks six consecutive months of positive margins. One thing to keep an eye on: Medicaid redeterminations could cause a surge of patients who lost coverage just as hospitals are finding their footing.

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!

Incidental CAC Predicts Long-Term Risks

What if you could identify which of your asymptomatic patients have high risks of future cardiac events? Stanford-led researchers used Bunkerhill Health’s Incidental CAC algorithm to do just that, finding that patients with ≥100 incidental CAC scores had a 24% 10-year risk of developing ASCVD and far higher risks of major adverse events.

The Resource Wire

• 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. 

• How can AI help physicians “see” beyond conventional lipid profiles? Tune in to this on-demand webinar showcasing how Cleerly’s AI-QCT solution complements conventional approaches to evaluating heart disease risk factors, and improves coronary artery disease diagnosis and heart attack risk assessments.

• The ESC has updated its heart failure guidelines, for the first time including a guideline-directed medical therapy for heart failure with preserved ejection fraction (HFpEF). See how cardiologists are trusting echo AI to find these cases earlier in this video from Us2.ai. 

• Looking to optimize your cardiovascular imaging services, but don’t know what to measure? Check out this Change Healthcare report for insights on how to track and evaluate your cardiovascular imaging performance, assess quality, and enhance operational efficiency. Read the full article now and start measuring what matters!