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Cardiology Deserts | Farapulse Safety
July 11, 2024
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Together with
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“I had no backup. I had no colleague I could call. I remember just knowing that the people who I was seeing had nowhere else to turn, that they were entirely dependent on me to be at my best.”
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Haider J. Warraich, MD on his experience serving as the only cardiologist in his county.
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Cardiology news doesn’t happen in a vacuum. That’s why we’re excited to announce the launch of Cardiac Wire’s new “Industry Wire” section, which provides a quick snapshot of the major healthcare stories that are happening outside of cardiology. You can find the Industry Wire at the bottom of each newsletter issue going forward, so scroll on down and get caught up.
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If it seems like your patients are coming from a lot further away these days, that might because nearly half of U.S. counties don’t have a single cardiologist working there.
Researchers from Brigham and Women’s Hospital teamed up with GoodRx to analyze data from all 3,143 counties in the US, finding that 46.3% of U.S. counties don’t have a single cardiologist, and this regional cardiologist imbalance often results in…
- Much Longer Patient Drives – The 22M people who live in these “cardiology desert” counties have to drive an average of 87.1 miles round trip to see their cardiologist, versus just 16.3 miles for patients who live in counties with cardiologists.
- Exacerbated Inequalities – Unsurprisingly, 86.2% of those cardiologist-less counties are rural, where patients tend to be poorer and sicker. In fact, patients in no-cardiologist counties had 31% higher CV risk index scores (2.8 vs. 2.1) and worse access to healthy foods (7.2 vs. 7.6 scores).
- Urban Physician Density – Counties with cardiologists have an average of 24 local cardiologists, although 10% of those counties had just one cardiologist (who is likely overworked).
- PCP Pressure – The rural cardiologist shortage also places more responsibility on primary care physicians, although cardiologist-less counties also have far fewer PCPs than counties with cardiologists (40.8 vs. 63.2 per 100k residents).
The authors believe that cardiology care’s rural/urban divide is growing wider, and clearly show that it’s having a major impact on outcomes, since cardiologist-less counties had higher age-adjusted cardiovascular mortality rates versus counties with cardiologists (281 vs. 269 per 100k adults) and one year shorter life expectancy.
The solution? The authors highlight digital health’s potential to bridge geographic gaps to cardiovascular care, but also endorse incentivizing more clinicians to practice in rural areas, and better integrating cardiovascular care with primary care (especially regarding CVD prevention and risk modification).
The Takeaway
This is far from the first time that we’ve covered rural America’s problems with cardiovascular care and access, and identifying a problem is a key step towards solving it. However, this latest data suggests that big changes will have to happen before we see meaningful improvements to rural cardiovascular care.
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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 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.
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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.
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TeraRecon’s Mitral Valve Workflow
Are your mitral valve planning workflows ready for higher procedure volumes? Take this step-by-step tour of TeraRecon’s Mitral Valve Workflow to see how it gives imagers the tools to evaluate the mitral valve and support TMVR treatment planning.
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- Farapulse’s Stellar PFA Safety Data: A large real-world safety study accentuated the robust safety profile of Boston Scientific’s Farapulse pulsed field ablation catheter in patients with AFib. In the study of 17,642 consecutive patients undergoing PFA with Farapulse at 106 sites, there were zero reports of key adverse events (esophageal complications, pulmonary vein thrombosis, or persistent phrenic palsy). Major complications were rare, including pericardial tamponade (.36%), vascular events (.30%), stroke (.12%), and death (.03%).
- Octagos’ AI Monitoring Funding: Cardiac device monitoring startup Octagos Health scored a $43M Series B round (total funding now ~$52M) that it will use to accelerate its commercial growth in the US and expand to new cardiac monitoring segments (ambulatory monitors, consumer wearables, and sleep). Octagos Health’s AI-driven platform combines continuous cardiac device monitoring and data analysis, with bi-directional EHR integration and custom reporting.
- Questioning Stress Tests’ Post-PCI Value: A South Korean study questioned the value of routine stress testing after PCI. Among 1,706 post-PCI patients, major event rates after two years (composite of all-cause death, MI, and hospitalization for angina) were statistically similar among high-risk ACS patients who had stress testing after 12 months and those who received standard care (6.6% vs. 8.5%). Two-year event rates were also similar in patients without ACS (5.1% vs. 4.9%).
- Diagnostic Cardiology to Hit $5.4B: Signify Research forecasts that the global diagnostic cardiology market will maintain a robust 7% CAGR through 2028 when it hits $5.4B. This growth will primarily be driven by ambulatory use cases, specifically ambulatory ECGs and implantable cardiac monitors, while the traditional ECG segment remains largely flat. The diagnostic cardiology market will continue to be dominated by the Americas, which remains significantly larger and faster growing than the EMEA and Asia Pacific regions.
- Mounjaro’s Weight Loss Advantage: Novo Nordisk’s semaglutide might be the hottest medication on the planet, but new research in JAMA suggests that it’s not the most effective weight loss drug. Analysis of 18,386 matched patients taking semaglutide or Lilly’s tirzepatide (aka Mounjaro) showed that tirzepatide-takers were far more likely to achieve ≥5%, ≥10%, and ≥15% weight loss within one year (HRs: 1.76, 2.54, 3.24). They also achieved this weight loss far faster. It’s still unproven whether tirzepatide can meet or beat semaglutide’s cardiovascular advantages, but Lilly is working to prove that too.
- Pulse Biosciences’ nsPFA Breakthrough: Pulse Biosciences announced that its Nanosecond Pulsed Field Ablation (nsPFA) Cardiac Surgery System landed FDA Breakthrough Device Designation for AFib treatment, and the company is now setting its sights on two major trials, its premarket approval, and a US commercial launch. To fund those endeavors, Pulse Biosciences also raised another $83M on the Nasdaq. The nsPFA Cardiac Surgery System would be used during other open heart surgeries, treating AFib with a total application time of under two seconds.
- Surging ASCVD Costs: In a study of 28k U.S. patients with ASCVD, individual care costs jumped by 30% between 2008-2009 and 2018-2019 ($14,713 to $19,145), with 1.5-times higher costs in patients who also had diabetes. With the introduction of new drug treatment classes like GLP-1s and SGLT2is, prescription costs increased by 37% overall and by 45% among patients with ASCVD and diabetes.
- NYU’s Florida Expansion: NYU Langone Health further expanded its cardiology presence in Florida, acquiring small Atlantis/Lake Worth practice Florida Cardiology Group (two physicians, two AAPs). The newly acquired practice will now operate as NYU Langone Cardiology Associates—Atlantis/Lake Worth, and will soon add interventional cardiology capabilities. The acquisition adds to NYU’s small but growing Florida presence, which also includes the Julia Koch Family Ambulatory Care Center in West Palm Beach and NYU Langone Medical Associates in Delray Beach.
- Lerodalcibep’s PCSK9i Prowess: A randomized trial showed that lerodalcibep, a new anti-PCSK9 protein, cuts LDL cholesterol by an average of 56% in patients with cardiovascular disease. Of 922 participants, 90% hit guideline targets and at least a 50% reduction in LDL levels. Adverse events were similar to placebo, making lerodalcibep a viable long-term LDL-lowering treatment for those not adequately managed by statins.
- Patients Open to Hospital-at-Home: Perhaps in light of the healthcare access challenges highlighted in today’s top story, a Vivalink survey found that 84% of patients over age 40 would be willing to participate in hospital-at-home programs, with that percentage jumping to 95% among those with three or more hospitalizations in the last year. Among patients who had already participated in an HaH program, 84% had a positive experience and 49% found the technology to be easy to use.
- Physicians Support Home Testing: In related news, a ixlayer survey of 140 physicians found that 83% believe at-home testing can help accelerate the path to diagnosis, while 80% felt it would also enhance their existing workflows. Nearly all of the physicians reported they’d be willing to provide at-home diagnostic kits to their patients (91%), a surprisingly large share considering only 63% think home tests are reliable.
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Echo AI for HFpEF
New research comparing Us2.ai to gold-standard invasive hemodynamic measurement showed that in patients with HFpEF, echo AI measurements are interchangeable with manual core-lab measures to diagnose increased filling pressures – and could improve HFpEF detection.
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Planning Your Move to The Cloud
There’s a long list of advantages to transitioning your enterprise imaging to the cloud, but you have to plan that move first. This Optum e-book details what health IT and imaging leaders need to know before moving their enterprise medical imaging to the cloud.
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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.
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- Accurately Measuring Heart Rate Variability: Heart rate variability measurement and analysis involves two critical elements – the ability to accurately discern the R wave in noisy environments, and using the correct analysis method for a given application. Check out how Monebo’s Kinetic HRV ECG Algorithm excels at both of these essential tasks.
- Cardiology’s Path to Enterprise Imaging: By connecting healthcare teams through every image, every scan and every report, we can reveal the full picture of a patient’s story. Check out this GE HealthCare Cardiology Coffee Break and see how enterprise imaging seamlessly integrates with existing technology infrastructures, ensuring compatibility across systems and platforms, enhances workflow efficiency, and more.
- 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!
- Your Cardiology Data is Valuable. Put it To Work. See how one major Midwest health system’s decision to implement Merge Cardio transformed physician and staff workflows, improved data entry speed and accuracy, and increased cost savings.
- 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.
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