Nicklas Vinter, MD, PhD to TCTMD after finding that four out of every ten people with AFib will develop heart failure, while two out of every ten will go on to suffer a stroke.

Atrial Fibrillation

Atrial Fibrillation’s Downstream Consequences

A BMJ study out of Denmark provided alarming new insights into atrial fibrillation’s impact on patients’ future cardiovascular health, while highlighting the need to improve post-AFib heart failure and stroke prevention.

The researchers analyzed 2000-2022 data from 3.5M Danish people who didn’t have AFib at baseline (45-95yrs, 48yr avg, 51.7% women), including 362k people who experienced AFib during the study period:

• Lifetime AFib risk was 27.7% overall, increasing from 24.2% in 2000-2010 to 30.9% in 2011-2022.
• Heart failure was the most frequent post-AFib complication with a 41.2% lifetime risk, which remained stable at 42.9% and 42.1%.
• Stroke was the second most common post-AFib complication with a 21% lifetime risk, falling from 22.4% to 19.9% during the two periods.
• Post-AFib myocardial infarction was the third most common at 12%, with MI rates falling from 13.7% to 9.8%

The study’s startlingly-high heart failure risks post-AFib drove the most headlines, suggesting that HF prevention deserves far more attention in AFib guidelines and treatment development.

However, the fact that post-AFib stroke rates remain around 20% despite the common use of anticoagulants in AFib patients is a sign that greater stroke prevention improvements are also needed.

The Takeaway

This study got the most buzz for highlighting the surprisingly high connection between AFib and heart failure, and the lagging role of HF prevention in AFib care. However, it is perhaps most notable for underscoring AFib’s broad cardiovascular impact and the overall need to improve AFib prevention, detection, and treatment in order to reduce these sobering post-AFib event rates.

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The Wire

• IVUS Beats Angiography Again: A new Lancet study added to intravascular ultrasound’s growing advantage over angiography. Analysis of 3,500 randomized patients showed that IVUS guidance led to a 1-year target vessel failure rate of 4%, well below angiography’s 7.3% failure rate. This decrease was primarily due to fewer incidences of target vessel MI and revascularization, with no notable variations observed in all-cause death or stent thrombosis.

• Shifting Away from Private Practice: A PAI-Avalere report on physician employment trends between 2019 and 2023 wrapped some new numbers around how large the shift has been away from private practice. Nearly four of five physicians (77.6%) are now employed by health systems or other corporate entities, up 5.1% in the last year alone. The biggest driver unsurprisingly has been the arms race to acquire practices, which resulted in 58.5% of physician practices now falling under hospital or corporate ownership.

• Exercise Benefits: A new MGB Biobank analysis highlighted how exercise can reduce both stress and cardiovascular risks. Among 744 patients who underwent brian PET/CT exams, participants who commonly exercised displayed lower levels of stress-related brain activity in their scans, and had 20% fewer cardiovascular events over 10 years. Across the entire 48k-person MGB biobank, people who met or exceeded exercise recommendations had 23% lower risks of cardiovascular events, and those CV event improvements were two times greater among people with pre-existing depression.

• Annoviant’s NIH Grant: Soft tissue healing startup Annoviant scored a $2.99M NIH grant to support the development and commercialization of its TxGuard pulmonary-valved conduit, which is used to treat pediatric congenital heart disease. The TxGuard aims to overcome the shortcomings of other materials used for valve and conduit replacement procedures, including issues with thrombogenicity, durability, susceptibility to infection, and lack of growth potential. Annoviant was previously awarded a $1.85M NIH grant in 2021.

• Barostim’s HFrEF Symptom Impact: Data from the post-market BeAT-HF study of 323 patients shows that while CVRx’s carotid baroreflex activation therapy, Barostim, missed primary CV mortality and HF mortality endpoints, it did achieve long-term safety and symptom improvements. The Barostim group achieved a 97% event-free rate for the trial duration, plus lasting symptom improvements in quality of life, the six-minute walk test, and NYHA class. Barostim’s FDA labeling was revised at the end of 2023 in light of these study results.  

• AskBio’s CHF Fast Track: Bayer subsidiary AskBio announced that its AB-1002 gene therapy program achieved FDA Fast Track Designation for the treatment of congestive heart failure, helping to accelerate its development and regulatory review. AB-1002 is an investigational one-time gene therapy that’s administered to the heart with the goal of blocking the action of protein phosphatase 1, which is linked to congestive heart failure and could have a therapeutic impact.

• Mating HM3 and Apixaban for Anticoagulation: A new AHA study highlighted apixaban’s promising results when used in patients with the Abbott HeartMate 3 (HM3) LVAD system, suggesting that switching from VKAs to apixaban could be feasible for this group. The 45-patient DOT-HM3 study found that apixaban was safe, with no thromboembolism at the six-month mark. Apixaban also had minimal bleeding incidents among the six LVAD patients who received heart transplants.

• Avive’s AED Funding: Portable AED startup Avive Solutions scored $56.5M in Series B funding (total funding now >$78M) to accelerate its commercialization and expand its team. The FDA-approved Avive Connect AED is highlighted by its wireless-connected software, which “dramatically” shortens the time to deliver a life saving shock, and supports remote device maintenance and monitoring.

• Imbria’s Ninerafaxstat Phase 2 Data: Phase 2 results show that Imbria Pharmaceuticals’ ninerafaxstat, a cardiac mitotrope that targets metabolism, is safe and tolerable in patients with symptomatic nonobstructive hypertrophic cardiomyopathy (nHCM). In 67 patients with nHCM, ninerafaxstat’s serious adverse event rate was 11.8%, versus 6.1% for placebo. Secondary endpoint results were also promising, as patients on ninerafaxstat had significantly better ventilatory efficiency from baseline to 12 weeks.

• AHA Inflammation Funding: Inflammation is a known and treatable CVD risk factor, but there’s still a lot we don’t know about it. Because of that, the AHA awarded $15M to teams at Northwestern, University of Michigan, and University of Pittsburgh to study inflammation’s role in cardiac and brain diseases. Each group will have unique focus areas, with Northwestern targeting inflammation’s role in HFpEF, University of Michigan studying inflammatory process drivers, and University of Pittsburgh researching how to identify and treat interrelated brain and vascular conditions.

• Flecainide’s INSTANT AFIB Conversions: The INSTANT trial showed that FlecIH, an inhaled flecainide acetate solution, was effective in converting recent-onset symptomatic AFib to sinus rhythm. FlecIH achieved a 42.6% conversion rate within a median time of 14.6 minutes, which rose to 46.9% among patients without prior flecainide exposure. With only two cases of AFib recurrence by day five, FlecIH presents a potential first-line option for acute AFib cardioversion.

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Advancing CAD Risk Assessments

When HeartFlow used its Plaque Analysis solution to analyze more than 11,000 CCTAs in the DECODE Study, the solution achieved 95% agreement with IVUS and led to changes in two out of every three patients’ treatment plans. See how HeartFlow Plaque Analysis can help you accurately assess your patients’ CAD risks and personalize their treatment

The Resource Wire

• Advance Your Vessel Analysis: Ready to advance your EVAR planning? See how you could leverage TeraRecon’s EVAR (Vessel Analysis) package to streamline and enhance your complex aortic intervention planning.

• Us2.ai’s Next Gen AI: Us2.ai recently scored FDA clearance for Us2.v2, the newest version of its flagship software featuring 45 automated echocardiography parameters, including strain analysis. See how the new version automates echo exams and improves cardiovascular disease detection.

• A New Standard of Heart Care: Open to a more personalized and proactive approach to cardiovascular care? Check out this video detailing Cleerly’s unique approach to heart disease risk assessments and care.

• 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.