Hemal Gada, MD on not letting the powers that be determine patient care.

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Does Value Based Care Improve Cardiology?

Casting doubt on value based cardiac care, a JAMA study found that outpatient cardiology practices enrolled in an accountable care organization (ACO) through the Medicare Shared Savings Program (MSSP) don’t offer better care than non-ACO practices.

• MSSP was introduced in 2012 to improve care quality and lower Medicare costs by having ACOs assume responsibility for Medicare beneficiaries’ costs and care quality.
• As an incentive, Medicare then makes fee-for-service payments and shares the savings with ACOs if cost and care quality benchmarks are met.

Evaluating the ACO incentives, researchers compared care quality data from the ACC’s NCDR PINNACLE Registry before and 6-12 months after MSSP participation at 83 ACO outpatient cardiology practices versus 332 non-ACO practices and found…

• MSSP ACO participation made no difference in coronary artery disease, HF, AFib, or hypertension outcomes.
• No changes in CVD drug prescriptions, LDL profiles, or smoking cessation.
• However, using a 24 month follow-up revealed increased beta-blocker use for HF (aOR: 1.23) as well as fewer patients with LDL profiles <100 mg/dL (0.71).

These results fly in the face of value based care’s promise to deliver better care, but the sub-analysis’ increased follow-up could suggest some benefits take longer to appear.

While their cardiac care benefits might not be clear, it’s worth remembering that ACOs are also intended to help save care costs.

• One AHA study back in 2019 found that annual spending for Medicare beneficiaries with CVD was ≈$200 lower when cared for by ACO cardiologists, without sacrificing quality.

The Takeaway

While cardiology practices might not get better through joining an ACO, they do seem to get more cost effective. Maybe that’s not such a bad deal considering the U.S.’s annual health care costs for cardiovascular conditions are projected to almost quadruple to $1.5T by 2050.

Innovating AFib Care

The first manifestation of AFib is often stroke, but many hospitals aren’t set up to coordinate these patients’ post-stroke care. See how UCSD is leveraging Viz.ai’s Viz Connect solution to simplify neuro and EP collaboration in this HRX 2024 interview.

Discover Innovation in Intervention

Explore how the AGENT™ Drug-Coated Balloon from Boston Scientific is advancing U.S.-based treatment options for patients with coronary artery disease. Rx Only. (Sponsored by Boston Scientific)

Automated and Intelligent EP Reporting

EP ablation procedures are difficult, but your EP reporting process shouldn’t be. See how GE HealthCare’s Centricity EP Structured Reporting allows for quick, accurate, and complete reporting in as few steps as possible.

The Wire

• Puzzle’s New Funds: Medtech startup Puzzle Medical closed $30M ($43M CAD) in funding to develop a percutaneous heart pump that supports cardiac and renal function in patients with advanced HF. The funds will help refine Puzzle’s heart pump that uses 4mm-pumps anchored in the descending aorta, and advance its clinical studies, while scaling the company. This raise is now one of the largest medical device funding rounds in Canada over the past two years and brings Puzzle to $55M ($78M CAD) raised so far.

• RINVOQ for GCA: The European Commission granted marketing authorization to AbbVie’s JAK inhibitor, RINVOQ (upadacitinib), for treating giant cell arteritis (autoimmune inflammation of the temporal artery, aorta, and other blood vessels). The EC approval stems from the Phase 3 SELECT-GCA trial, which found that 46.4% of patients on RINVOQ 15mg in combination with a 26-week steroid regimen achieved sustained remission at week 52, compared with 29.0% of patients on placebo and steroids.

• A Smart Pill Box: Hello Heart introduced Hello Heart Pill Box, a smart pill box designed to improve medication adherence by offering users reminders through a paired app and long term trend tracking. Pill Box comes with the Hello Heart smartphone app to send notifications for dosing times while also monitoring adherence trends and providing reports for clinicians. The company hopes Pill Box will help the ~50% of adults with hypertension who don’t take their medications as prescribed (potentially doubling their risk of heart attack and stroke). 

• HeartFlow AI Reduces Cardiac Testing: Implementation of HeartFlow’s FFR-CT AI software in the U.K. reduced follow-up testing without a statistically significant difference in clinical outcomes. In a new paper in Nature Medicine, researchers compared FFR-CT to conventional CCTA for working up 98k patients with suspected CAD at 27 hospitals. FFR-CT reduced the rate of invasive coronary angiography (14.9% vs. 16%) and of noninvasive cardiac tests (17% vs. 19%) without differences in all-cause or cardiovascular mortality.

• The World’s Smallest Pacemaker: Northwestern University engineers have developed a pacemaker that can fit inside a syringe tip and be non-invasively injected into the body. Outlined in a Nature study, the pacemaker works for any size heart, but has extra potential for newborn babies with congenital heart defects. Northwestern’s pacemaker is designed for temporary pacemaking and safely dissolves into the body after it’s no longer needed.

• EPNS for AVR: Electronic provider notifications (EPNs) could help increase aortic valve replacement in patients found to have symptomatic severe aortic stenosis in echo exams. A recent AHA study randomized 285 healthcare providers to receive EPNs or usual care for each of their patients with AS, finding that AV replacement rates at one year were 48.2% with EPNs versus 37.2% with usual care. This EPN-driven valve replacement increase led to a longer mean survival in all patients (+12 days), especially symptomatic patients (+23 days).

• Venus MedTech’s New Valve: Cardiologists performed the first AV replacement using Venus MedTech’s new self-expanding and retrievable Venus-PowerX TAVR valve with encouraging early safety and clinical outcomes. Published in AJC, the first-in-human study found that 100% of TAVR procedures (n=25) using the Venus-PowerX were successful, while valve recapture at 80% partial deployment was attempted in eight patients and was successful each time. Recapture at 100% was attempted in two patients and successful both times.

• BSCI Buys Bolt, FDA Clears its IVL: Boston Scientific finalized its acquisition of Bolt Medical and gained FDA clearance for Bolt’s intravascular lithotripsy system. The FDA officially cleared the Bolt IVL System based on data from the RESTORE ATK clinical trial which met its efficacy endpoint in 100% of patients. The fresh clearance brings Boston Scientific into contention with Johnson & Johnson MedTech’s Shockwave IVL.

• CMS Proposes T-TEER for TR: CMS proposed Medicare coverage for the use of tricuspid transcatheter edge-to-edge repair (T-TEER) to treat symptomatic tricuspid regurgitation (TR). The update comes just weeks after CMS finalized its decision to cover transcatheter tricuspid valve replacement for TR. However, the new proposal only covers patients with symptomatic TR despite optimal medical therapy and who have had T-TEER recommended by an “extensive” heart care team (including a cardiac surgeon, interventional cardiologist, HF cardiologist, EP, imaging specialists and an interventional echocardiographer).

• New Echo Contrast Moves Ahead: Ultrasound contrast developer Agitated Solutions is set to start a Phase 3 clinical study of its ASI-02 echo microbubble agent after getting an FDA IND clearance. The trial will assess ASI-02’s safety and efficacy in up to 300 patients in the U.S. and Canada getting transthoracic echo exams. Unlike other echo agents, ASI-02 is designed for right heart exams and can be administered by a single sonographer, improving practice efficiency.

• Cardiac CT AI Earns CPT Codes: The AMA approved new Category III CPT codes for AI-assisted perivascular fat analysis from cardiac CT scans using software like Caristo Diagnostics’ CaRi-Heart solution. Such algorithms detect signs of coronary inflammation that can destabilize plaque and trigger cardiac events, supporting proactive, AI-based CVD risk assessments. Code X409T and add-on code X434T will be published in July and will be effective in January 2026. Caristo’s CaRi-Plaque algorithm was cleared earlier this year.

Making Cardiovascular Data Work for You

Today, cloud-native analytics can automate data acquisition and synthesize complex data. Discover what Optum’s technology can do to facilitate future advancements in cardiovascular data and analytics.

Plaque Analysis Now Covered by Medicare

HeartFlow’s Plaque Analysis is now reimbursable thanks to Medicare’s new coverage for AI-enabled plaque analysis of eligible patients with coronary artery disease.

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.

The Resource Wire

• 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 All in One Cardiac Imaging Solution: Ready for an all-in-one solution that supports all of your MR and CT needs? See how Circle Cardiovascular Imaging’s cvi42 can streamline your core reading and reporting workflows within a single, customizable platform.

• AI Analysis of ATTR-CM: ATTR-CM is a progressive and fatal cardiomyopathy with a rising number of diagnoses and a highly variable clinical course. See how Us2.ai’s fully automated machine learning algorithm analyzes echocardiographic DICOM images without human interaction to improve tracking ATTR-CM progression and treatment responses.

• Monebo’s Customers Lead the Way: Monebo’s customers span across the globe, and range from local cardiac monitoring companies to major ECG OEMs. See what they all have in common, and how the Monebo monitoring advantage might help your business.

• 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

• 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.

• 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.

The Industry Wire

1. Digital health funding jumps in Q1.
2. Medical device group asks for tariff exemption.
3. Immigration crackdown may impact medical staffing.
4. Google funds anti-cancer AI alliance. 
5. Walgreens beats expectations with $2.9B loss.
6. Fetterman touts access to weight-loss drugs.
7. A guide to AI agents in healthcare. 
8. CareSource buys Massachusetts provider. 
9. Poor Internet access affects rural healthcare.
10. What’s the best company name in healthcare?