Michael Albert, MD on a recent aspartame study out of China.

Despite improving outcomes in patients with heart failure (HF), renin-angiotensin-aldosterone

system inhibitor (RAASi) therapy is often underutilized due to hyperkalemia (HK). In this article

for Cardiac Wire by Dr. Ravi Dhingra, learn why managing HK in patients with HF matters and

how healthcare providers can consider a potassium binder to treat HK in patients with HF.

Cardiology Pharmaceuticals

The Coming ATTR-CM Competition

Competition breeds innovation, and that’s good news for ATTR-CM patients who could have three different drugs to choose from: Vyndaqel (Pfizer), Attruby/Beyonttra (BridgeBio), and Amvuttra (Alnylam). 

• ATTR-CM affects more than 120k Americans with 5-7k new cases each year, but underdiagnosis means there could be even more.
• The disease occurs when misfolded proteins build up in the heart and stiffen the heart muscle, leading to heart failure.
• With diagnostics and awareness improving, analysts now estimate the ATTR-CM treatment could become a $15-20B market.

The reigning ATTR-CM drug is Pfizer’s Vyndaqel (tafamidis), which entered the scene unchallenged in 2019, and although it was first, new research has suggested it might not be the best.

• In the study, patients on Vyndaqel had a survival probability of only 54.1% after 65 months. 
• Those who received Vyndaqel within six months of ATTR-CM diagnosis had even worse results (49.6% at 65 months).
• Even so, Pfizer raked in $5.4B in Vyndaqel sales last year, speaking to the drug’s advantage as a lone contender with a $268k list price per year.

Entering the race as a fresh challenger, BridgeBio’s Attruby (acoramidis) hit the U.S. market in December of 2024 and is rapidly gaining momentum thanks to its broader label advantage and similar mechanism to Vyndaqel.

• Attruby already has 1,000 unique prescriptions since launch, leading analysts to predict it will easily surpass its current $86M sales prediction for 2025.
• Though gaining prescription popularity, Attruby is barely cheaper ($244k per year) and works the same way as Vyndaqel, so time will tell if it leads to better outcomes.

Appearing as a wild card pick, Alnylam’s Amvuttra (vutrisiran) is currently waiting for the March 23rd verdict of an ATTR-CM label expansion filed last October following its impressive HELIOS-B trial results.

• As a monotherapy, Amvuttra reduced CV death risk by 33%, while pairing it with Vyndaqel led to a 41% reduction (so it might help instead of hinder Pfizer).
• Alnylam’s Amvuttra already treats ATTR related nerve damage and is a member of the siRNA drug class, setting it apart from Pfizer and BridgeBio’s ATTR options.

The Takeaway

It’s pretty remarkable that just six years ago we had no pharmaceutical options for treating ATTR-CM and now we have two (with a potential third coming). While that brings hope for patients suffering from this rare disease, providers will likely have to weigh the drugs’ exorbitant costs with their long-term benefits.

Uncover Cleerly’s Clinical Success

Interested in learning more about the science behind Cleerly’s suite of medical technologies that are revolutionizing cardiac imaging? Click here for all of Cleerly’s recently published clinical studies.

A Better Way to Coordinate Post-Stroke Care

Think your EHR messaging system might be holding back your post-stroke care? See how UC San Diego Medical Center streamlined its neuro and EP teams’ post-stroke workflow with Viz Connect, and the impact it had on cardiac monitor placements in inpatient and outpatient settings.

How to Overcome Cardiovascular Data Challenges

Managing cardiovascular data is a complex and confusing process. Head over to Optum’s article on best practices like aggregating multisource data to prevail over common issues related to cardiology data and analytics.

The Wire

• Aspartame’s Insulin Effects: Consuming too much aspartame could lead to higher insulin levels, fatty plaques, and inflammation. According to a mouse study out of China, consumption of aspartame (0.15% concentration) led to significantly increased insulin secretion and aggravated atherosclerotic plaque. For context, you would have to drink 100 Diet Cokes per day to reach the dose used in the study.

• Us2.ai’s MR Grading AI: A recent JACC study suggests Us2.ai’s automated AI for MR severity grading could help streamline the currently subjective diagnostic pathways we use to identify the disease. Researchers used the AI to develop a new echocardiography workflow for MR grading and found that it achieved an accuracy of 0.80, and could distinguish significant versus nonsignificant MR with a sensitivity of 0.96 and specificity of 0.98.

• New Athlete CVD Guidelines: The ACC/AHA updated its guidelines for sports cardiology using new research to help cardiologists better determine which CV conditions benefit from exercise and which could be exasperated. Some examples of new guidelines include removing restrictions for vigorous exercise in patients with HCM, increasing imaging for patients with dextro-transposition of the great arteries before letting them compete, and more careful evaluation of patients with telltale signs of Marfan’s syndrome due to greater genetic risk for aortic dissection.

• Bunkerhill’s Automated Follow-Up: Bunkerhill Health launched Careblocks, a new AI-powered platform for automating patient follow-ups. Careblocks is based on vision and large language models and analyzes medical images to identify findings that might require follow-up. It then communicates with EHRs to select the patients who need immediate follow-up for conditions like CAC and aortic and mitral stenosis based on medical history, ongoing treatments, and existing specialist visits while reducing unnecessary alerts. 

• HDP Increases AFib Risk: It’s well known that hypertensive disorders of pregnancy (HDP) are a major cause of maternal mortality, acute cardiac events, and CVD later in life, but little is known about its AFib risks. A study in Circulation followed 771k women discharged after delivering their first baby, including approximately 8% who were diagnosed with HDP. Of the women with HDP, 0.3% developed AFib with more severe HDP leading to a 1.5 to 2.2x higher cause-specific rate of AFib.

• Karoo + Zing: Value-based care tech company Karoo Health and Medicare Advantage insurer Zing Health partnered to bring cardiac centered VBC to six new states. The duo aims to improve cardiovascular care by combining Karoo’s 700-plus cardiology provider partners, AI-powered technology, and innovative model of care with Zing’s insurance model for underserved seniors with chronic conditions. Karoo’s services will now be available to Zing’s Medicare Advantage members in Illinois, Indiana, Michigan, Mississippi, Ohio, and Tennessee.

• CFT Safety for Angina: New research suggests invasive coronary function tests (CFT) could be safe to perform on all patients with angina and no obstructive coronary artery disease. Researchers studied 1.2k patients with clinical indications for CFT and found that the tests had an overall complication rate of only 1.7% while offering a high diagnostic yield (78% of patients tested had abnormal CFT results).

• AS Worse for Men? Myocardial fibrosis from aortic stenosis might not affect men and women the same, which could help physicians plan care better depending on patient sex. A new JAMA study compared men (n=368) and women (n=302) with similar AS severity and found that the two groups had similar extracellular volume fraction but men showed more late gadolinium enhancement (LGE) in cardiac MRI scans, while patients with higher LGE had higher higher cardiovascular mortality risk (HR: 2.68).

• AI Compares LAAO to DOAC: AI algorithms could help identify AFib patients who may benefit from left atrial appendage occlusion (LAAO) instead of the usual DOAC regimen. Researchers developed an algorithm using data from 29k patients who received LAAO and determined that two years after the treatment, 30.1% potentially benefitted, 69.7% experienced neutral effects, and only 1.4% were potentially harmed. These results were validated by comparing matched pair outcomes from similar patients who underwent DOAC therapy.

• J&J Impella Recall: Continuing a recent trend, the FDA announced that Johnson & Johnson MedTech (formerly Abiomed) is recalling its Impella RP with SmartAssist and Impella RP Flex with SmartAssist heart pumps over ongoing safety concerns. The recall won’t remove any heart pumps from the market and is rather intended to bring attention to updated device instructions on problems that could occur while inserting, manipulating, or removing concomitant devices.

• SGLTis Improve AS Prognosis? Even though AS currently has no medical treatments to slow its progression, researchers now think  SGLT2is could be the answer. The results of a recent JACC study seem to suggest so, with patients prescribed SGLT2i having progressively lower chances of developing severe AS depending on how long they took the drug (three, six, and 12 months regimens led to HRs of 0.54, 0.48, and 0.27, respectively).

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.

Addressing Coronary Artery Disease

Learn how the AGENT™ Drug-Coated Balloon provides a new treatment option for in-stent restenosis in the U.S. Rx Only. (Sponsored by Boston Scientific)

Automating and Simplifying CMR Imaging

Watch Vista.ai’s demo on how their intelligent software automates and simplifies image acquisition so all technologists can perform a CMR scan with quality, consistency, and efficiency, increasing throughput and improving patient access.

The Resource Wire

• Merge and Duly Health Streamline Cardiology Reporting: Over the last 10 years, Dr. Sujith Kalathiveetil of Duly Health and Care has seen a significant evolution in cardiovascular imaging and experienced a similar evolution with Merge’s cardiology solutions. See how Merge Cardio has helped make cardiology reporting more consistent, accurate, and easier to obtain for Dr. Kalathiveetil and his colleagues.

• 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!

• Us2.ai’s Echo Automation Impact: Improving clinician efficiency and quality is the goal for most AI solutions, but we rarely see AI achieve both. See how the AI-ECHO RCT used Us2.ai to achieve both of those goals, while reducing sonographer fatigue in the process.

• Explore Vitrea Advanced Visualization: Discover Canon Medical Healthcare IT’s suite of advanced imaging workflows designed to increase efficiency in cardiovascular imaging, and facilitate the assessment, diagnosis, and treatment of cardiovascular diseases. These cutting-edge tools support the delivery of faster, more accurate care while integrating seamlessly into clinical workflow

• The Efficiency of the Kinetic Rhythms ECG Algorithm: See how you can interpret up to twenty-nine distinct rhythms by embedding the Kinetic Rhythms ECG Algorithm on your device or software suite. Ensure precise ECG interpretations regardless of whether they’re taken at the bedside or in an ambulatory setting.

• A Universal View of Your Patient: Think you’re getting the most out of your viewer? See how GE HealthCare’s Centricity Cardio Enterprise Universal Viewer allows you to quickly review exams, access and compare prior studies, and perform measurements in this 60-second video.

• New Horizons in Structural Heart: TAVR and TMVR rates are rising rapidly, placing more pressure on interventional planning. Tune into this Circle CVI and Radcliffe Cardiology breakout detailing how to leverage modern CT workflows to produce efficient and accurate pre-procedural plans.

• Cardiology AI: From Research to Clinical Practice: Explore how AI algorithms are reshaping cardiology with insights from Tempus’ recent webinar, featuring Dr. David Ouyang of UCLA and Cedars-Sinai, alongside Tempus’ Dr. John Pfeifer and Dr. Brandon Fornwalt. This expert panel dives into how AI can bridge diagnostic gaps, enhance patient outcomes, and streamline workflows for conditions like AFib and pulmonary hypertension. Read the full recap to glimpse the future of AI-driven cardiology.

• HeartFlow Evidence: With 500+ peer-reviewed publications, HeartFlow has shown its commitment to clinical research, and validated its potential to transform the diagnosis and management of coronary artery disease worldwide. 

The Industry Wire

1. UCLA predicts U.S. hospital occupancy to reach 85% in 7 years.
2. UnitedHealthcare looks to cut ~30k jobs.
3. Ed DeVaney named President of CVS Caremark.
4. Sutter Health invests $1B in regional expansion.
5. BCBS Michigan to charge hospitals for repeated claims denial appeals.
6. 800 Geisinger nurses strike: 5 things to know.
7. Cedars-Sinai cancer director stepping down.
8. Epic plans large campus expansion.
9. Emory Healthcare hires Mayo Clinic marketing leader.
10. NYC Health + Hospitals releases new documentary.