Dr. Paddy Barrett.

Pharmaceuticals

Questioning Beta-Blocker Interruption After Heart Attack

Results from the ABYSS trial surprised many at ESC 2024, finding that patients who continue beta-blocker therapy after heart attacks have better long-term outcomes than patients who stop taking the drugs, and they don’t experience the quality of life downsides that some might expect. 

• Roughly 2M people in the United States and Europe have an acute MI every year, often followed by beta-blocker prescriptions.
• Due to a lack of consensus on the optimal duration of beta-blocker therapy, these drugs are often prescribed for life, making them among the world’s most prolific medications.

In the ABYSS trial of 3,698 post-MI patients (LVEF ≥40%) who were already on beta-blockers, researchers randomly assigned participants to either continue or stop taking the medication.

After a median of 3 years the patients who continued beta-blockers had a 2.8% lower risk of experiencing a composite primary endpoint (21.1% vs. 23.8%; death, nonfatal MI, nonfatal stroke, or CV hospitalization), giving beta-blocker interruption a 1.16 hazard ratio.

• However, the continuation group’s lower primary endpoint risks were almost completely driven by its lower rate of cardiovascular hospitalizations (16.6% vs. 18.9%).
• In fact, the two groups had nearly identical rates of all-cause death (4% vs. 4.1%), MI (2.4% vs. 2.5%), and stroke (1% vs. 1%).

Very notable given the motivations for stopping beta-blockers, the continuation and interruption groups also had similar quality of life scores, despite hopes that discontinuing the medication might reduce side effects and enhance day-to-day wellbeing.

These ABYSS results add new fuel to the debate over long-term beta-blocker use…

• They seem to contradict the 2023 U.S. Chronic Coronary Disease guidelines that no longer recommend beta-blocker therapy beyond one year after MI.
• They also seem to contradict the recent REDUCE-AMI trial that found long-term beta-blocker usage didn’t reduce the composite of deaths or MIs (even though the new ABYSS trial also didn’t show meaningful reductions in MI or deaths).

Overall, these conflicting results and guidelines seem to support the new 2024 ESC guidelines, which note that “the duration of beta-blocker therapy, in the long run, is a matter of debate,” and suggest that more research is needed. 

The Takeaway

While the appropriate length of beta-blocker treatment after MI remains an open question, the ABYSS trial serves as one key vote in favor of continuing long-term beta-blocker treatment in post-MI patients. However, it will take more conclusive results to know for sure.

The Post-Acute Stroke Game Changer

See how Viz Connect solution can optimize your post-acute stroke pathway. The Viz.ai solution allows the cardiology team to promptly receive Neurology referrals to evaluate patients with suspected AFib for cardiac monitoring and reduce their risk of secondary stroke.

A New Era of Precision and Efficiency

Ready to enhance your cardiovascular imaging precision and efficiency? See how Circle Cardiovascular Imaging’s new cvi42 6.1 platform is bringing CT and MR imaging under a single platform.

AI Algorithms in Cardiology: Navigating the Path from Research to Practice

Join Tempus on Tuesday, September 24 for an in-depth webinar exploring the transformative power of cardiology AI algorithms. Learn from leading experts, including Cedars Sinai’s Dr. David Ouyang and Tempus’ senior cardiology team Dr. Brandon Fornwalt and Dr. John Pfeifer, about how cardiology AI algorithms are unlocking new possibilities for diagnosis, treatment, and patient outcomes. Secure your spot now to be part of this pivotal discussion.

The Wire

• AccurKardia AI Detects AS: A new Heart Rhythm study suggests that ECG AI might become a valuable tool for aortic stenosis screening, potentially leading to earlier diagnoses and more procedures. Researchers used AccurKardia’s AS model to screen ECGs from 3,662 participants (126 mild, 16 moderate/severe AS), predicting moderate/severe AS with 0.75 sensitivity, 0.77 specificity, and a 0.99 NPV. Notably, patients with false positive results had a 5-times higher risk of developing moderate/severe AS within five years. 

• iRhythm & BioIntelliSense’s Sensor Alliance: iRhythm took a big step beyond ECG monitoring, licensing a range of BioIntelliSense’s multiparameter sensor technologies for pulse oximetry, accelerometry, and non-invasive blood pressure. iRhythm will use this new tech to enhance its ambulatory cardiac monitoring platform and expand into adjacent areas (e.g. obstructive sleep apnea). In exchange, BioIntelliSense will receive upfront payments, royalties, and future compensation based on technology validation and regulatory milestones.

• Stopping Anticoagulants During TAVR: It might be easier for patients to continue taking anticoagulants during TAVR procedures, but the POPular PAUSE TAVI study supports stopping them. In 858 randomized patients, patients who continued anticoagulants during TAVR procedures had higher rates of the composite endpoint (16.5% vs. 14.8%; CV death, stroke, major vascular complications, major bleeding) and higher bleeding rates (31.1% vs. 21.3%) within 30 days post-procedure. 

• The Benefits of TAVR + PCI: Results from the NOTION-3 trial suggest that patients with coronary artery disease and aortic stenosis might be better off getting both TAVR and PCI. Among 455 randomized patients, those who received TAVR and PCI had a significantly lower composite MACE rate (all cause death, MI, or urgent revascularization) than patients who only underwent TAVR over a median of two years (26% vs. 36%), although the TAVR + PCR group did have more bleeding events (28% vs. 20%).

• Medera SPAC: After quite a hiatus, cardiovascular SPAC mergers are back. Biotech startup Medera will be listed on the NASDAQ through a SPAC merger with Keen Vision Acquisition Corporation, giving it at least $40M in cash and an enterprise value of $622.6M to support its clinical and preclinical programs. Medera uses gene- and cell-based approaches to develop cardiovascular therapies. Its most advanced drugs target heart failure and Duchenne muscular dystrophy cardiomyopathy.

• Elderly Revascularization: Complete revascularization of culprit-only lesions could achieve better longer term results than PCI among older STEMI patients with multivessel disease. A meta-analysis of seven RCTs with 1,733 patients over age 75 found that rates of primary composite events (death, MI, ischemia-driven revascularization) were 22% lower with complete revascularization up to four years post-procedure. With the longest follow-ups, complete revascularization was not superior for the primary event rate but did achieve lower rates of CV death and MI (11.5% vs. 15.1%). 

• Hamlin Returns: Buffalo Bills safety Damar Hamlin started an NFL game for the first time yesterday, 19 months after he suffered cardiac arrest in a playoff game. Hamlin brought significant attention to athletic cardiac arrest, both at the time of the event and through his public awareness efforts during recovery, while the news has had a constant flow of high profile athletic cardiac arrest events since then.

• A Case for Edoxaban Monotherapy: Results from the EPIC-CAD trial adds more support for anticoagulation monotherapy among patients with AFib and stable coronary artery disease, versus taking both anticoagulants and antiplatelet meds. Researchers randomized 1,038 patients with high-risk AF and CAD to take either edoxaban monotherapy (Daiichi’s DOAC Savaysa) or edoxaban plus aspirin or a P2Y12 inhibitor. After 12 months, far fewer patients in the edoxaban monotherapy group experienced a primary adverse event (34 vs. 79) or a bleeding event (23 vs. 70).

• Whole Body Heart Scans: The whole-body scanning segment gained momentum last week with the opening of London’s first Neko Health clinic, following two in Sweden. The £299 hour-long exams combine a 360-degree body scan, ultrasound, sensors, and blood tests to collect 50M AI-analyzed data points. Although the exams also check for skin cancer, many of the tests focus on cardiovascular and metabolic diseases, suggesting that clinics like Neko’s might become a new source of cardiovascular-related diagnoses (or over diagnoses).

• TAVR RHEIAlly Benefits Women with AS: The RHEIA trial suggests that women with severe AS may do better with TAVR than surgery, at least with the Sapien 3 or Ultra valves. In 443 women, the TAVR group had fewer rehospitalizations (4.8% vs. 11.4%) and shorter stays (4 vs. 9 days) than the surgery group at 1 year, with similar rates of death and stroke. However, TAVI patients had a higher chance of needing a pacemaker (8.8% vs 2.9%), and longer-term outcomes would be required to understand TAVR’s true benefits or shortcomings.

• Mobile Phones & CVD: Compulsive mobile phone usage might be associated with future CVD issues. That’s the takeaway from a widely-covered study that analyzed 12-year outcomes from 444k individuals, finding that regular mobile phone users had a higher risk of incident CVD (HR: 1.04) and increased carotid artery wall thickness (odds ratio: 1.11). Although phones don’t technically cause CVD, high phone usage was associated with disrupted sleep, psychological distress, and neuroticism.

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.

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.

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.

The Resource Wire

• Where to Go for Cardio AI? TeraRecon’s Cardio Suite is a collection of hand-selected, vendor-neutral Cardiology AI algorithms that aid in the analysis and interpretation of echocardiograms and chest CTs. Learn about TeraRecon’s AI offering and how they improve efficiency and accuracy here.

• 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.

• 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!

• 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.

• 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.

• 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.

• Tracking Your Post-Treatment Plaque: Tune-in to this on-demand Cleerly webinar where preventative cardiologist John Osborne, MD, PhD, FACC, FNLA explores how to use CTA to track plaque progression and identify residual risk post-treatment.

• Coordinate Care with an Integrated CVIS: See how Optum’s CVIS allows you to tell each patient’s unique story with an enterprise cardiology platform that uses your EHR and VNA to provide a complete cardiovascular record.

The Industry Wire

1. Memorial Hermann opens healthcare high school.
2. Patient safety goals at US News’ top hospitals.
3. Biotech buildings quickly turning into office space.
4. Northwestern Medicine CIO on where ambient AI goes next.
5. Rite Aid picks insider CEO as it emerges from bankruptcy.
6. Inside Providence’s $600M first half operating turnaround.
7. Judge ponders house arrest for indicted ADHD telemedicine CEO.
8. Dana-Farber CEO to step down.
9. Jefferson Health inks NFL jersey contract.
10. NYC Health and Hospitals tell PCPs to slash appointment times.