ACC Past President Edward Fry, MD, MACC on the non-economic factors that might be driving more cardiology practices to sell to private equity.

Structural Heart

Older Patients and Asymptomatic Valvular Heart Disease

A new study out of the UK found that over a quarter of people aged 60+ have asymptomatic valvular heart disease, and revealed that prevalence increases as patients age — potentially providing new reasons to screen older patients for VHD.

• VHD diagnosis generally involves echo exams, ordered in response to patient symptoms or abnormal cardiac auscultation.
• However, this practice leaves many older patients with undetected VHD, raising interest in using echocardiography as a large-scale VHD screening tool.

To test that theory, researchers performed echo exams on 4,237 asymptomatic 60-and-over adults between 2007 and 2016, finding that…

• A whopping 28.2% of participants had VHD
• 2.4% of the VHD cases were clinically significant, including 94 moderate cases and 7 severe cases.
• Significant VHD prevalence increased with age: 1.5% at 60-64yrs, 2.1% at 70-74yrs, 3.8% at 75-79yrs, and 10% at 85+.
• The most common VHD cases were tricuspid (13.8%), mitral (12.8%), and aortic (8.3%) regurgitation.

Perhaps most actionable, age was the only factor associated with severe VHD (odds ratio: 1.07 per year), with the number of echo scans required to diagnose one clinically significant VHD case falling from 42 scans among 60-74yr olds to 15 scans among 75-and-over patients. 

Age-targeted VHD echo screening might result in even more positive cases in the real world, noting that only 8.6% of this study’s population was ≥80 years old, and other studies have found 51% prevalence of any VHD among over-65 patients and 17% prevalence of moderate-to-severe VHD among 80-and-over patients.

The Takeaway

By 2050 the over-60 population is expected to double, while the over-80 population triples. That elderly population surge will apparently come with a similar surge in undiagnosed VHD cases, unless there’s big changes to how we screen for VHD.

Accurate and Efficient Remote Cardiac Patient Monitoring

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.

FFRCT Slashes PAD + CAD Mortality

See how adding HeartFlow’s FFRCT assessments to patient workups prior to peripheral artery disease surgeries can have a massive impact on coronary artery disease outcomes, including major reductions in long term heart attack and mortality risks.

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!

The Wire

• Private Equity’s Cardiology Expansion: JACC highlighted private equity’s growing role in cardiology, revealing that PE firms have acquired 41 outpatient cardiology practices with 342 clinic locations over the last decade – and 94% of those occurred between 2021 and 2023. The acquisitions were limited to 20 PE-friendly states, with the most acquisitions in Florida, Texas, and Arizona. As is typical for PE-owned businesses that are often bought and resold in 3-7 years, 64 of clinic sites were acquired twice. These numbers largely align with a similar JAMA study from last month.

• Novo Nordisk Scraps Ocedurenone Trial: Just eight months after acquiring ocedurenone from KBP Biosciences for $1.3B, Novo Nordisk has halted the nsMRA’s Phase 3 CLARION-CKD trial after it failed to improve hypertension, resulting in a hefty $816M impairment loss. The 652-patient 24-week trial was intended to evaluate ocedurenone’s effect on patients with uncontrolled hypertension and advanced CKD, but they shut it down after hypertension improvements didn’t show by week 12. A positive result would have positioned ocedurenone as a rival to Bayer’s nsMRA Kerendia.

• Simulating PCI Benefits: The ORBITA-STAR study suggests that verifying angina symptoms using a placebo-controlled ischemic stimulus to simulate angina can predict which patients would benefit most from PCI. In 51 patients with stable coronary artery disease (average age 63), those with higher similarity scores (comparing induced vs. usual symptoms) had a significantly greater reduction in angina frequency post-PCI (OR: 8.01) compared to those with lower scores (OR: 1.31).

• Intensive BP Lowering Benefits: A new JAMA study out of China highlighted the dramatic benefits of intensive BP lowering. Among 34k people with hypertension, those who received intensive BP control had far 4-year lower rates of CVD and all-cause mortality compared to people who received usual care (-25% CVD, -10% CV death), with even greater reductions among people under-60 years old (-36% CVD, -46% CV death). Meanwhile, the intensive-lowering and usual care groups had similar adverse event rates.

• Arrowhead All-In on Plozasiran: Arrowhead Pharmaceuticals announced that it will prioritize its cardiovascular resources to support its triglyceride-lowering RNAi therapeutic plozasiran’s upcoming Phase 3 CAPITAN outcomes trial, while seeking a partner to take over development of its LDL-lowering RNAi candidate zodasiran. The decision was driven by the positive results from plozasiran’s recent Phase 3 PALISADE study, in addition to the fact that LDL reduction has become far more competitive since Arrowhead first began development of zodasiran.

• Hypertension Blood Biomarker: A study of blood proteins found that the transforming growth factor β receptor 3 (TGFBR3) – a marker of blood pressure during acute exercise – appears to be protective against hypertension and could lower CVD risk. The researchers first identified 4,977 proteins of interest in a plasma profiling study of 681 healthy people, then in pooled analysis found that TGFBR3 was associated with a 14% lower adjusted risk for incident hypertension.

• Echo AI HFpEF Code: Ultromics announced that the AMA has issued a CPT III reimbursement code for echo AI-based HFpEF detection (0932T), including the startup’s EchoGo Heart Failure solution. The new code will go live in January 2025, replacing a previous HCPCS outpatient code (C9786), while joining a New Technology Add-on Payment code for hospital inpatient settings (XXE2X19). Although CPT III codes don’t have assigned RVUs, they can be reimbursed on a case-by-case basis and help collect data for more permanent reimbursement code decisions.

• Precision Antiplatelet Prescribing: A new AHA Scientific Statement suggests that a precision medicine approach to prescribing oral P2Y12 inhibitors could help reduce ischemic events without increasing bleeding risks. Recent trials and meta-analyses have found that prescribing ticagrelor or prasugrel for patients with CYP2C19 loss-of-function variants (and clopidogrel for all other variants) yields better outcomes. However, this strategy requires genetic testing, which is not currently recommended in guidelines.

• Amarin Resurrects Vascepa Case: A US Appeals Court decided to allow Amarin to revive its Vascepa patent infringement lawsuit against generics-maker Hikma Pharmaceuticals, noting that Hikma’s marketing has positioned its drug as “generic Vascepa,” even though its labeling doesn’t cover the same indications as Vascepa. It’s safe to say Amarin has struggled since losing its patent for the fish-oil-based heart med in 2020 (it was Amarin’s only drug), including a 95% stock value decline and the layoff of its entire US salesforce.

• MI’s Flu Association: In a Dutch registry study of 26,221 positive flu tests and 406 MI episodes, the risk of experiencing an acute MI was more than six times higher in people who had flu in the past seven days compared to people who had the flu within a year of their MI (but further than 7 days). The relative risk increase was highest in patients who hadn’t had a prior hospital admission for coronary artery disease (16.60 vs. 1.43).

• Wegovy in Women w/HFpEF: A new JACC study showed that semaglutide (Novo Nordisk’s Wegovy) drives greater weight loss in women with HFpEF, but similar HF symptom and outcome improvements as men. The study analyzed pooled data from two HF trials involving 1,145 patients with heart failure plus obesity or diabetes (STEP-HFpEF, STEP-HFpEF DM), finding that women lost more body weight than men (-9.6% vs. -7.2%), but had similar changes in KCCQ-CSS scores (+7.6 vs. +7.5 points) and other CV endpoints.

Catch up on 2024’s Cardiology Coffee Breaks

Join GE HealthCare on a journey to bridge the gaps to connected cardiovascular care with this season’s Cardiology Coffee Breaks. In the time it takes you to finish your coffee, these Coffee Breaks demonstrate how GE’s integrated solutions empower healthcare organizations to provide precision care, achieve operational efficiency, and enhance patient satisfaction.

From CPACS to CVIS

Cardiovascular imaging has come a long way from CPACS. Explore the evolution of cardiology image and data management in this Merge by Merative executive brief, and see what makes CVIS such a significant advancement.

Taking AI from Idea to the Clinic

There are few areas of healthcare with more innovation than artificial intelligence, but most of those solutions never make it past being published in a medical journal – providing no additional value to medical care or the solutions’ developers. In this Cardiac Wire Show, Bunkerhill Health CEO Nishith Khandwala discusses Bunkerhill’s unique approach to solving this problem and the impact they are having in cardiology and beyond.

The Resource Wire

• Uncover the Brain-Heart Connection: AI might be poised to transform cryptogenic stroke care, but many cardiologists and neurologists still have a lot to learn. Tune-in to this upcoming Viz.ai webinar on July 24th, where Drs. Brett Meyer and Jonathan Hsu will explore how Viz.ai’s post-acute workflow solution, Viz Connect, is being used to accelerate cryptogenic stroke diagnosis and treatment. 

• The Behavioral Science Behind Optum’s Hemo System: When Optum set out to design its next-generation Cardiology Hemodynamics monitoring system, it put behavior science at the heart of its product strategy. See how Optum’s UX designers applied its behavioral science team’s findings to improve its Hemodynamics solution to help make physicians and technicians even more efficient and user-centric.

• Cleerly at SCCT2024: Cleerly has an action packed SCCT2024 planned. Don’t miss the chance to dive into newly published evidence supporting Cleerly’s personalized AI-enabled CCTA analysis, meet with their executives, or see how their ischemia solutions stack up to traditional methods.

• 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.

• 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.

• AI-Driven Novice Heart Failure Screening: We hear a lot about AI’s potential to expand echocardiography to far more users and clinical settings, and a study using Us2.ai’s AI-automated echo analysis and reporting solution showed that echo AI might make novice-led heart failure screening possible.