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Specialist HF Care, Constipation & CVD, and NanoPhoria’s Peptide
October 13, 2025
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Together with
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“The concept that it’s financially beneficial to prescribe BP meds or statins only makes sense if you’ve never spent any time in clinic. It’s *way* more lucrative to skip the discussion of medications, not prescribe anything, and see another patient instead of having a risk/benefit conversation about how to treat.”
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Greg Katz, MD
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ICYMI: Cardiac Wire recently partnered with Abbott on an exclusive story about how intravascular lithotripsy could be the future of coronary artery disease treatment. Read more about Abbott’s investigational Coronary IVL System that uses high-energy acoustic pressure waves to treat calcium blockages prior to placing a stent.
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A recent study out of the U.K. suggests that multidisciplinary team management could significantly reduce death or rehospitalization risk for HF patients across the LVEF spectrum.
- Specialist heart failure care involves management by specialist nurses under direct cardiologist supervision.
- This approach is traditionally reserved primarily for HFrEF patients who have the most proven guideline-directed medical therapies available.
- However, recent studies demonstrating SGLT2i and finerenone efficacy in HFmrEF/HFpEF has expanded the therapeutic options for specialist care beyond HFrEF.
Based in a single U.K. county, the Buckinghamshire analysis examined 2.1k patients hospitalized for acute heart failure who received either specialist care or standard care over a 618-day follow-up and found some striking outcome differences…
- Specialist care reduced the composite risk of death or HF rehospitalization across all LVEF categories: HFrEF (HR 0.58), HFmrEF (HR 0.49), and HFpEF (HR 0.76).
- Despite clear benefits, only 61% of discharge survivors received specialist outpatient care, with disparities between HFrEF (79%), HFmrEF (77%), and HFpEF (53%) patients.
- Overall outcomes were concerning: 63% died and 21% were rehospitalized for acute HF over follow-up, with 68% experiencing either endpoint.
Given the expanding HF population and increasing treatment complexity, the specialist nursing capacity, both in the U.K. and U.S. could be inadequate for population needs, especially since other specialist care implementation barriers persist.
- Among those with specialist care arranged, 38% missed their first appointment, highlighting implementation challenges beyond care availability.
- The population distribution (55% HFpEF, 36% HFrEF, 9% HFmrEF) suggests that current HFrEF-focused services also miss the majority of HF patients who could benefit from specialist care.
So where do we go from here? Currently, the British Society for Heart Failure argues that at least four specialist nurses per 100k people are needed to address growing treatment complexity and aging demographics.
- Further restructuring of HF care teams and understanding that all types of HF patients benefit from specialist care will also be necessary to move the needle on practice opinions.
The Takeaway
Heart failure comes in many forms in many different types of patients, but that doesn’t mean that only one subset of the disease should receive multidisciplinary care. This small, but important study raises the point that both having enough care providers and the right approach will be critical to improving HF care in the long run.
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Changes in Heart Failure Management
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- Investors Bullish on NanoPhoria’s Peptide: Milan-based NanoPhoria Bioscience raised $96.9M (€83.5M) in Series A financing, marking Italy’s largest biotech Series A round, to fund the company’s heart failure peptide. NanoPhoria’s lead candidate, NP-MP1, is a first-in-class peptide that targets cardiac L-type calcium channels for HFrEF. So far, the drug has been through IND-enabling studies and uses NanoPhoria’s proprietary lung-to-heart nano-in-micro delivery technology, suggesting it has serious potential to address HFrEF’s root causes.
- FDA Expands Evkeeza to Children Under 5: The FDA approved Regeneron’s Evkeeza (evinacumab-dgnb) for children aged 1 to under 5 years with homozygous familial hypercholesterolemia (HoFH), extending its indication from the initial 2021 approval for ages 12+ and 2023 approval for ages 5-11. Clinical trials showed that Evkeeza lowered LDL-C by approximately 50% versus placebo when added to standard therapies. The expansion was supported by data from six pediatric patients in expanded/compassionate use programs.
- Vektor’s vMap Earns CE Mark: Vektor Medical received CE Mark approval for its vMap System that converts standard 12-lead ECG data into 3D arrhythmia source maps in under one minute. Previously U.S.-only, vMap has already been used in over 2,000 procedures for treating AFib and ventricular tachycardia, reducing procedure times and improving ablation outcomes. The new CE Mark will now enable European Union electrophysiologists to access the technology for data-driven arrhythmia treatment guidance.
- A Constipated Heart isn’t Healthy: A Japanese study of over 1.5M people without prior CVD suggests that constipation could be correlated to one’s risk of CV events and heart failure. Roughly 12.3% of participants had constipation which was significantly associated with incident CVD, particularly heart failure (HR: 1.32). Constipation ranked second after hypertension as a population risk factor across composite CVD, stroke, heart failure, and atrial fibrillation. Adding constipation to risk factor equations also modestly but significantly improved CVD prediction.
- EPS vs. ECG for MBAE Prediction: Electrophysiological studies (EPS) might be better than ECG for predicting major bradyarrhythmic events (MBAEs) in patients with myotonic dystrophy type 1 (DM1). Researchers examined 706 DM1 patients and found that EPS proved more sensitive (68.35% vs. 34.76%) and more reliable than ECG-based criteria. The study also found that lowering the his-bundle to ventricular time threshold to ≥65ms further improved sensitivity to 90.18%.
- AFib’s Genetic Components: We’re getting closer to understanding the genetic basis of AFib, thanks to a UK Biobank study that examined common, rare, and somatic genetic variants’ roles in the disease’ incidence. Multi-gene risk scores (HR: 1.65), rare mutations (HR: 1.63), and clonal hematopoiesis (HR: 1.26) all independently predicted AFib occurrence, with incidence rates doubling among people with all three genetic drivers. Researchers then combined this genetic model with clinical factors (CHARGE-AF) and achieved superior prediction (C-statistic: 0.80) with improved risk classification.
- ICE or TEE During Ablation? New study results suggest intracardiac echocardiography (ICE) could be a noninferior, safer, and a more efficient alternative to transesophageal echocardiography for AFib ablation. The study examined 1.8k patients undergoing AFib ablation and compared ICE versus TEE for thrombus screening, finding that ICE showed better outcomes overall – lower transseptal puncture bleeding (0.2% vs. 1.2%), reduced fluoroscopy time (4.2 vs. 9.3 minutes), shorter preprocedural waiting (14.4 vs. 23.6 hours), and less patient anxiety/depression (24.6% vs. 37.5%).
- More Efficient Cardiac MRI: Cardiac MRI is a powerful tool, but it’s complex and time-consuming. A JACC: Case Reports study customized CMR scanning protocols to patient pathology and implemented remote scanning, finding that the program cut scan duration 35% (61 vs. 95 minutes). This led to a 32% increase in scan volume at the main campus, a 200% increase at a satellite campus, and establishment of a CMR service at a third campus.
- An At-Home HF Drug System: The FDA approved SQ Innovation’s Lasix ONYU, a furosemide drug-device combination for adults with chronic heart failure-related edema. Lasix ONYU’s injection system uses a reusable base that holds the drug (48 treatments) and a disposable injector for safety and affordability. The approval stems from several studies that showed Lasix ONYU’s bioavailability was comparable to IV furosemide with good tolerability. This approval also follows the recent FDA approval of bumetanide nasal spray for heart failure edema, marking now the second “at-home” dosing resource for HF patients.
- A New Defibrillator Monitor: The FDA also approved Zoll’s Zenix defibrillator-monitor for EMS and hospital use. The device features a large touchscreen, automated workflows, and customizable real-time adjustments for critical care. It includes Real BVM Help technology with a ventilation quality indicator that provides real-time feedback on manual ventilation, and Real CPR Help that guides compression rate and depth through audio-visual feedback. Zenix is now one of three major defibrillator-monitors available alongside Physio-Control and Philips.
- AstraZeneca Ups U.S. Investment: AstraZeneca will increase its $4B investment to $4.5B for its new Virginia manufacturing facility near Charlottesville. The facility, which is part of AstraZeneca’s $50 billion U.S. investment, will produce drug substances for weight management, metabolic medicines, and antibody-drug conjugate cancer treatments. Analysts expect the expansion to create 3,600 direct and indirect jobs including 600 highly skilled positions once operational in 4-5 years.
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Cracking the Code of ECG Analysis with Monebo’s AI Genetic Algorithm
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Tempus Receives FDA 510(k) Clearance for Tempus ECG-Low EF
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- 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.
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- Heartflow Plaque Analysis: Accurate CAD Assessment Now Covered Across the US: 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.
- 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.
- 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.
- Us2.ai’s AI HF Now Possible with Handheld Echo: The latest research shows Us2.ai’s software can take handheld echocardiography beyond its standard applications. Read this EHJ study about how swiftly and accurately Us2.ai’s HF detection software detects LVEF, closely matching expert human analysis of standard cart based echocardiograms.
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