Siyab Panhwar, MD

Cardiovascular Disease

Good News and Bad News – CV Deaths Are Changing

Good news – overall heart disease deaths in the U.S. have declined significantly since 1970. The bad news? According to a recent AHA study, several complex heart conditions are becoming increasingly responsible for cardiovascular deaths.

• The number one cause of death in the U.S. has been heart disease for decades, but its share of deaths has decreased by almost half (41% in 1970 vs. 21.4% in 2022).
• Much of this improvement stems from the development of new ways to treat heart attacks and ischemic heart disease, but cardio-metabolic health is on the decline.

Searching for trends in CV mortality, Stanford researchers analyzed over 50 years of CDC data, revealing dramatic changes in cardiac mortality patterns among American adults. 

• On one hand, acute myocardial infarction deaths decreased by 89%.
• On the other, heart failure mortality rose 146%.
• Hypertensive heart disease mortality rose 106%. 
• And arrhythmia mortality rose by a whopping 450%.

So what does this mean? It’s mostly good news, since it shows the U.S. cardiovascular care community has gotten really good at ischemic heart disease management, but there are emerging challenges stemming from more complex conditions like HF and rhythm disorders.

However, there’s one critical factor to keep in mind – obesity. 

• Conditions like arrhythmias, hypertension, and heart failure are rising in parallel to the U.S. adult obesity rate which reached 40% in 2025 compared to 15% in 1970.
• While this study itself wasn’t designed to explore causality between the two, many other studies have shown the devastating effects of obesity on heart health.

Where do we go from here? The AHA’s 2025 Heart Disease and Stroke Report earlier this year already gave us insights into the solution to these emerging cardiovascular conditions and it isn’t a treatment.

• With obesity and obesity-related CV deaths on the rise in the U.S., the number one cure for conditions like arrhythmias, hypertension, and heart failure is prevention.

The Takeaway

This AHA study comfortingly confirms we’ve gotten really good at treating heart attacks and managing ischemic heart disease. Unfortunately, with the rising obesity rates in the U.S., the challenges of complex CVD might need to be addressed on the population level before the patient ever gets to a cardiologist.

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The Wire

• FARAPULSE Adds Persistent AF: Boston Scientific’s FARAPULSE landed a major FDA approval expansion covering drug-refractory, symptomatic persistent AFib treatment, following its early 2024 approval for paroxysmal AFib. FARAPULSE’s persistent AFib expansion is backed by the ADVANTAGE AF trial, which achieved an 85.3% symptomatic recurrence-free rate, with no reported strokes, pulmonary vein stenosis, or major access complications (success rate was 91.4% among experienced physicians).

• SAVR Innovation Stagnates: Two German cardiac surgeons argue in a JACC editorial that surgical heart valve innovation has stagnated over the past two decades while transcatheter technologies rapidly advanced. They attribute this slowdown to surgical valves becoming “mature technology” with strong outcomes, conservative surgical culture avoiding risk, and lack of industry investment in surgical research. 

• Prostate Cancer’s Cardiac Link: New research suggests that the systemic inflammation associated with prostate cancer might also drive higher coronary calcium and plaque burden. Analysis of the REVELUTION-1 study of 87 men with prostate cancer found that participants with high-risk cancer had 8-fold higher odds of having clinically significant CAC and 4X greater risk of having higher total plaque volume than men with low-risk prostate cancer.

• T-TEER Covered: CMS will cover tricuspid transcatheter edge-to-edge repair (T-TEER), calling overall evidence “insufficient” but “promising enough to allow coverage with evidence development (CED).” The coverage determination supports treatment of TR patients who can’t be treated with optimal medical therapy, following approval by a team of cardiac surgeons, interventional cardiologists, HF specialists, and interventional echocardiographers (not EPs or multi-modality imaging experts as previously proposed). The decision was based on the TRILUMINATE and Tri.Fr trials, which initially only showed improvements to quality of life (not mortality).

• Heart Transplant Disparities: A new study in Circulation revealed significant gender disparities in donation after circulatory death (DCD) heart transplants. The study tracked nearly 10k heart transplant candidates from 2019-2023, finding that DCD listing increased transplant likelihood for both sexes. However, while women comprised nearly 28% of traditional brain death heart transplant recipients, they accounted for only 20% of DCD transplants despite similar one-year survival rates. Women were also less likely to be listed for DCD transplants, creating inherent disadvantages in receiving these life-saving procedures.

• Is Surgery Worth it in Elderly ACS? A meta-analysis of eight randomized trials involving elderly patients with acute coronary syndromes found no mortality benefit from early invasive treatment compared to conservative management. Examining 3k ACS patients over 70, researchers found that early invasive strategy reduced recurrent heart attacks by 22% and repeat revascularization by 57%, but increased major bleeding risk by 60%. The study suggests that for elderly ACS patients, the competing risks of invasive treatment should be carefully weighed against potential benefits.

• Restore’s Transcatheter HFrEF Funding: Restore Medical closed a $23M Series B round to advance its transcatheter heart failure therapy through clinical trials. The funding will allow Restore to complete its European feasibility study, after showing promising safety and efficacy improvements, and support the launch of its U.S. trial. Restore’s novel transcatheter Pulmonary Artery Banding system is intended for HFrEF patients who remain symptomatic despite maximally tolerated GDMT, potentially creating a new treatment for patients with limited options.

• EXPANDing MTEER Criteria: Results from the EXPANDed studies suggest MTEER may benefit patients with secondary MR who fell outside COAPT trial criteria due to more advanced heart disease. Among 967 patients studied, 81 were classified as non-COAPT-like and despite having more advanced disease, non-COAPT-like patients achieved similar one-year outcomes to COAPT-like patients. This included 74% reduction in heart failure hospitalizations and 90% achieving significant mitral regurgitation reduction.

• AI for HCM-SCD Prediction: An AI model could outperform current clinical tools for predicting sudden cardiac death in hypertrophic cardiomyopathy patients. As part of a Nature study, researchers developed the MAARS deep learning system for SCD prediction using EMR and imaging data. MAARs achieved strong performance in internal and external validation (AUCs: 0.89 & 0.81), with improvements of 0.22-0.30 over existing risk calculators.

• Cardiologist Killed in Airstrike: The international medical community lost Dr. Marwan al-Sultan, a prominent cardiologist and the director of Gaza’s Indonesian hospital, in an Israeli airstrike on July 2 along with four of his family members. He was one of only two remaining cardiologists in Gaza with thousands of heart patients. Healthcare Workers Watch reported he was the 70th Palestinian healthcare worker killed in the last 50 days, highlighting the devastating effect of the Hamas-Israel War on Palestine’s healthcare system.

• Impella FDA Alert: The FDA issued an alert about detection issues with Abiomed’s Impella heart pumps and their controllers. The problem prevents proper device detection without visual alarms on the controller screen, potentially causing inadequate hemodynamic support that could be life-threatening for cardiogenic shock patients. So far, three deaths have been reported related to this issue and Abiomed sent updated instructions recommending backup controllers and specific protocols for device transfers. This alert follows a series of recalls regarding the Impella device.

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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.

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• 5,600 Ways to Improve Your Cardiac Ultrasound Workflow: AI-powered measurements can enhance the way you acquire and interpret cardiac ultrasound. Learn how AI-powered ultrasound can help you overcome everyday limitations in echo. Read Siemens Healthineers’ white paper on how its AI software provides 5,600+ automated measurements to help improve workflow efficiency, consistency, and clinical confidence.

• 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.

• 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.

• Revolutionize Your Cardiac CT Workflow — See It LIVE at SCCT 2025! Be among the first to experience next-gen CV imaging at Booth #315 during SCCT 2025. Sign up now to find out how Circle CVI’s software enables lightning-fast LAAC, TAVR, and TMVR workflows while providing more accurate heart function insights, and clinician-controlled plaque quantification.

• LVAD Therapy Receives 1A Recommendation for Inotrope-Dependent Patients: The U.S. joint societies of the AHA/ACC/HFSA have given LVAD therapy a 1A Recommendation for heart failure patients dependent on intravenous inotropes or who cannot be weaned from temporary mechanical circulatory support. As both the strongest class of recommendation and highest level of evidence, a 1A Recommendation indicates LVAD therapy is supported by strong data and the benefits far outweigh the risks.

• Vista AI Grows CMR Volume: Are your patients waiting weeks or months for cardiac MRIs? See Brigham and Women’s Hospital’s real-world results showing how Vista AI’s software for automated MRI scanning led to 50% more scan slots, without adding more scanners or staff.

The Industry Wire

1. Trump threatens 200% tariffs on pharmaceuticals.
2. Senate advances nomination of Susan Monarez for CDC director.
3. Optum Health CEO exits role.
4. Hospitals can fight cybercrime by securing billing data, not medical records.
5. Health system stadium naming agreements come under scrutiny.
6. Lawmakers introduce five-year hospital-at-home extension.
7. Justice Department interviews UnitedHealth employees about Medicare upcoding.
8. How a rural health system got Epic for just $6M.
9. Immigrant doctors offered visa support.
10. Cities with the most, fewest adults in poor health.