Yashaswini Singh, PhD on the rise of cardiology practice private equity acquisitions.

Cardiology Practices

The Rise of Private Equity Cardiology Practice Acquisitions

New research in JAMA highlighted the rapid growth of private equity-backed cardiology practice acquisitions, while revealing some interesting geographic factors driving this growth.

The PE acquisition trend started slowly, with just one PE-backed acquisition of a seven-location cardiology practice in 2019, followed by an acquisition of another small practice in 2020. 

• Subsequent years brought more and larger acquisitions, culminating in 2023 when PE platforms acquired 35 practices with roughly 220 combined locations.
• All together, PE firms acquired 50 practices with 320 locations between 2019 and 2023.

This run of cardiology practice acquisitions spanned 22 states, but largely targeted practices in Florida (80), Texas (76), and Arizona (29) due to those states’ size, demographics (e.g older patients), and regulatory environments (e.g. rules for opening new ASCs). 

• In fact, there’s now seven states where PE-acquired practices account for more than 10% of all cardiology practices, including Rhode Island (13 of 35), Nevada (14 of 53), Louisiana (21 of 89), Arizona (29 of 165), Oklahoma (13 of 82), Texas (76 of 675), and Florida (80 of 798).
• Those geographic trends were largely driven by the two largest PE-backed platforms –  Cardiovascular Associates of America and US Heart & Vascular – which operate all PE practices in seven states (AZ, GA, IA, KS, NJ, RI, SC) and over 60% of PE-acquired practices in Florida, Georgia, and Texas.

Despite PE’s momentum, these acquisitions represent just 3.9% of cardiology practice locations in the US (330 of 8,223), and there’s reason to believe that 2023’s acquisition pace might not continue going forward.

• So far in 2024 we’ve only identified four PE acquisitions, with three from CVAUSA, and just one by Cardiovascular Logistics… although it’s likely that other unannounced acquisitions happened this year.
• Additionally, many cardiology practices have already consolidated into hospital or corporate-owned groups, leaving just 10k of the US’ 33k cardiologists within independent practices (80% of them working in practices with under 10 physicians).

That creates a very different acquisition environment than seen with specialties that underwent major private equity consolidations (e.g. radiology or dermatology), and will likely force PE platforms to target both private and hospital-employed groups.

The Takeaway

Private equity’s massive expansion across US healthcare largely skipped cardiology before 2021, but recent trends suggest that PE will have a much greater influence within cardiology going forward — especially in PE-friendly states.

Can AI Prevent Heart Disease Progression?

Tune in to Cleerly’s on-demand webinar where study leaders will discuss how the landmark TRANSFORM randomized controlled trial will test whether an AI-personalized care strategy can outperform traditional risk factor management and prevent cardiovascular events.

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.

The Wire

• Initial Success for Nickel-less MiRus Valve: The MiRus Siegel 8-Fr TAVR valve showed promising results in a trial of 5 patients with severe aortic stenosis. At 30 days, there were no deaths, strokes, or major complications, and the average echo gradient was 6.7 mmHg. Notably, 4 patients had no peri-valvular leaks, and none of the patients required a permanent pacemaker. Made from Rhenium alloys instead of nickel, the valve allows for broader access to patients who may suffer from nickel allergy.

• Intra-Aortic Balloon Recall: Teleflex and its Arrow International subsidiary recalled their Arrow FiberOptix and UltraFlex Intra-Aortic Balloon (IAB) Catheter Kits due to a manufacturing issue that may cause the balloon to become over-twisted, preventing full balloon inflation. The Class I recall has been associated with 322 complaints, 31 reported injuries, and three deaths, although the recall is only positioned as a correction – not a product removal.

• PREVENT Response: Last week’s paper suggesting that the AHA’s new PREVENT risk equations might slash statin eligibility drew a reaction from one prominent preventive cardiologist. BWH’s Christopher Cannon, MD countered that it might be incorrect to evaluate the PREVENT equations based on the current risk thresholds since they are based on the previous PCE calculator. Instead, Dr. Cannon suggests that PREVENT should be tested in clinical trials to see what new risk score thresholds provide the greatest statin benefits, and then adjust the guidelines accordingly. 

• Simplifying Metabolic Disease Management: The DCRM Task Force released new multispecialty guidelines for the management of diabetes, cardiorenal, and metabolic diseases, placing a focus on diagnosis, lifestyle, and medical management. The Diabetes, Cardiorenal and Metabolism (DCRM) Diseases Multispecialty Practice Recommendations 2.0 emphasize easy-to-follow practices for non-expert clinicians including using validated apps and wearables as well as new treatment options for obesity (using GLP-1s), hypertension (targeting BP <130/80), and HF (using SGLT2is).

• Wynn Hospital Restarts Structural Heart: After pausing most cardiovascular procedures in early May, upstate New York’s Wynn Hospital announced plans to resume structural heart procedures. Wynn hasn’t revealed plans for open-heart surgeries, which have been paused since receiving an “immediate jeopardy” notice from state health inspectors. Wynn is still reviewing its open-heart surgery program, and previously suggested that firing its two cardiac surgeons is “definitely a possibility.”

• Explaining Wegovy’s HF Impact: April’s STEP-HFpEF trial added heart failure to the growing list of diseases that GLP-1s can help, and new secondary analysis suggests that it’s largely due to semaglutide’s impact on NT-proBNP (rather than merely weight loss benefits). The study of 1,145 randomized HFpEF patients revealed that Wegovy-takers with high baseline NTproBNP levels had greater HF symptom improvements than Wegovy-takers with lower baseline NTproBNP, even though weight loss was similar across patients with all NTproBNP levels.

• Quitting GLP-1s Too Soon: The steady supply of good news for GLP-1s was interrupted by a BCBS study that found 58% of patients discontinue the drugs before reaching a clinically meaningful benefit. The largest-ever study of its kind analyzed data from ~170k GLP-1 patients since the first weight-loss approval in 2014, revealing that 30% discontinued use within the first month. Adherence was especially poor among patients with prescriptions from their PCP as opposed to an endocrinologist or obesity specialist, likely due to the lack of an effective strategy for mitigating gastrointestinal side effects.

• SGLT2is Fill Gap in ATTR-CM: New data support a role for SGLT2 inhibitors in patients with transthyretin cardiomyopathy (ATTR-CM), who currently have limited treatment options. In the study of 2,356 ATTR-CM patients, a group on SGLT2is (n=220) had significantly lower rates of all-cause mortality (-43%), CV mortality (-59%), HF hospitalization (-43%) and a composite of CV mortality/HF hospitalization (-43%). The SGLT2 inhibitor group’s dropout rate was also low, at 4.5%, suggesting good tolerability.

• GE’s Imaging Overhaul: GE HealthCare updated its imaging leadership and business structure, naming a new Imaging unit head and combining its Ultrasound and Image Guided Therapies businesses. GE tapped former Ultrasound unit CEO Roland Rott to lead its Imaging business, replacing Jan Makela who is leaving GE to become president and CEO of WS Audiology. IGT leader Philip Rackliffe will now lead the newly-combined Ultrasound/IGT unit. 

• HCM Stem Cells: The Seattle-based nonprofit Allen Institute for Cell Science released six stem cell line collections for use in researching treatments for genetically caused hypertrophic cardiomyopathy (HCM). Developed in collaboration with scientists at the University of Washington, Stanford University, and the University of California Santa Barbara, the cell lines were reprogrammed with gene editing tools to have six different mutations that can be targeted by researchers and used to improve the understanding of HCM disease progression.

• US Health Spending Accelerates: US healthcare spending accelerated in 2023, growing 7.5% for the year with total expenditures of $4.8T. The latest CMS figures show healthcare’s percentage of US GDP growing to 17.6%, from 17.3% in 2022. CMS projects spending from 2023-2032 to grow 5.6% annually, bringing healthcare to 19.7% of GDP by 2032. On the positive side, the insured share of the population hit 93.1% in 2023 due to gains in Medicare and Medicaid enrollment.

TeraRecon’s Structural Heart Enhancements

Detecting and addressing mitral valve and LAA conditions can be challenging. Check out TeraRecon’s Structural Heart white paper and discover how improving workflow and pretreatment planning can streamline these processes and potentially improve patient outcomes.

Diagnosis Beyond the Hospital

It’s increasingly clear that healthcare is expanding beyond hospital walls, and recent evidence from Us2.ai suggests that AI-enabled cardiac ultrasound could help drive that expansion. Read these editorials by Izabella Uchmanowicz, RN, PhD and Prof. Blanche J Cupido, MBChB to see how Us2.ai-enabled and nurse-operated mobile ultrasound might both improve and expand heart failure diagnosis.

The Resource Wire

• The Bunkerhill Blueprint: Advancing an AI solution from concept to clinic used to take years, but Bunkerhill Health is closing that gap at lightning speed. See how Bunkerhill is streamlining AI training, validation, approval, and commercialization to get better AI tools into clinical practice, faster.

• ECG Data You Can Trust: Noise and artifacts can make automated ECG analysis less reliable than what’s required for the exacting standards of cardiac safety trials. Monebo’s Kinetic Intervals ECG Algorithm provides precise interval measurements between any two points on the ECG waveform, allowing clinicians to utilize data they can trust.

• Experience the future of learning: Medtronic Academy 2.0 is here! Unlock your ultimate destination for structural heart medical education with the newly redesigned Medtronic Academy 2.0. Gain access to expert-led courses, webinars, and a wealth of resources to stay ahead in cardiovascular care. Visit now!

• Merge Cardiology is Best in KLAS: Merge Cardio and Merge Hemo continued their KLAS hot streak, ranking Best in KLAS 2024 for Cardiology and Hemodynamics for the 9th and 12th years. The Merge by Merative cardiology solutions further expanded their KLAS score leads this year, with Merge Cardio scoring 82.8 (up from 82.7 last year) and Merge Hemo surging to 91.5 (from 85.7 in 2023).

• The First Step to Coronary Artery Disease Diagnosis: HeartFlow’s new RoadMap Analysis solution allows CT readers to accurately, efficiently, and consistently identify stenoses in the coronary arteries. See how RoadMap Analysis’ visual and quantitative insights into the narrowing of all major coronary arteries helps readers evaluate coronary CT angiograms before determining the need for an FFRCT.