Cobin Soelberg, MD, JD

The heart failure treatment landscape is changing, and recent discussions at AHA 2025 highlight important considerations especially for adults who have heart failure with a left ventricular ejection fraction (HF LVEF) of 40% or more. Watch the latest episode of The Cardiac Wire Show where we sat down with Martha Gulati, MD, to learn more about treatment options for this community – and about heart failure’s broader impact on women. #Sponsored

Heart Failure

Telemedicine’s Unintended HF Consequences

Heart failure telemedicine doesn’t seem to be lining up evidence-based care after a recent Stanford Medicine analysis revealed that remotely-managed HF patients received less diagnostic testing and saw serious dips in guideline-directed medical therapy.

• The COVID-19 pandemic changed the way we look at telemedicine, taking it from a cost-effective way to check-in to a care continuity tool.
• Earlier telemedicine studies had focused on pandemic-era care or compared telemedicine versus in-person patients, but its impact on HF was unclear.

With the rising popularity of remote patient management in cardiology, Stanford researchers decided to explore telemedicine’s HF impact by tracking 44 cardiologists who treated 7.7k HF patients while grouping them by their clinician’s telemedicine use patterns.

Researchers ultimately uncovered that patients whose clinicians favored telemedicine underwent dramatically fewer diagnostic tests the more virtual visits they attended:

• ECGs (-70% use).
• Echocardiograms (-30%). 
• Natriuretic peptide tests (-34%).
• Chemistry panels (-34%).

But the quality of care didn’t just drop in diagnostic testing, with GDMT and medication orders decreasing as well. 

• Higher telemedicine use reduced total GDMT initiation (-20%) and aldosterone antagonist prescriptions (-28%).
• New medication orders also declined across multiple drug classes including beta-blockers, RAS inhibitors, nitrates, and diuretics.

While telemedicine certainly offers access benefits, these findings allude to a potential disconnect between physicians and their patients when relying on remote check-ins.

• Researchers also think that the GDMT reduction likely stems from decreased patient data availability during telemedicine visits like real-time vitals and same-day labs.
• Without real-time blood pressure, heart rate, kidney function, and electrolyte data, clinicians may hesitate to initiate therapies.

The Takeaway

Telemedicine, just like many other newer technologies, is a fantastic tool in a physician’s overall toolbox for treating patients, but this study highlights that its use may lead to unintended consequences for complex heart failure patients if used incorrectly.

AHA Scientific Sessions Discussion: Heart Failure Treatment Developments and Impact on Women

Women with heart failure with preserved and mildly reduced ejection fraction (HFpEF and HFmrEF, respectively) often present with different symptoms than men, leading to underrecognition. Moreover, the incidence of HFpEF in women is increasing more than in men. Watch Dr. Martha Gulati discuss prevalence and changing treatment options.

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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.

The Wire

• Intuitive’s da Vinci Earns Multiple FDA Clearances: The FDA cleared Intuitive’s da Vinci 5 for several new cardiac procedures as of January 26th. The newly cleared indications include mitral valve repair/replacement, tricuspid valve repair, IMA mobilization for revascularization, PFO/ASD repair, LAA closure/occlusion, atrial myxoma excision, and epicardial pacing lead placement. The clearances will initially be using non–Force Feedback instruments, with Force Feedback clearances and cardiac-specific training/tools planned for future rollout.

• HighLife’s TMVR System Notches CE Mark: HighLife received European CE mark approval for its TMVR system to treat adults with symptomatic mitral regurgitation who can’t undergo surgery or TEER. The Paris-based company’s transfemoral, dual-component “valve-in-ring” design implants a ring and then a valve percutaneously in a two-step, beating-heart procedure. The replacement valve is then positioned to accommodate native mitral annulus sizes from 30–53 mm (currently the broadest CE mark-approved TMVR sizing range). HighLife also holds an FDA IDE and breakthrough designation.

• Stopping Statins Pre-Pregnancy: New research in JAHA seems to back up the current guidelines recommending statin discontinuation during pregnancy. In a South Korean study of 13.3k women using statins preconception, discontinuing statins was not associated with higher maternal MACCE risk (HR: 1.00). Curiously, stopping statins was also associated with lower risks of nonlive birth (RR: 0.89) and low birth weight (RR: 0.88), though authors are uncertain about these findings due to the study’s observational design.

• MAC Mitral Stenosis vs. RMS: A recent JAHA study suggests it might be possible to differentiate mitral stenosis caused by mitral annular calcification from rheumatic stenosis. Researchers compared linear, area, and volumetric measurements from 70 patients (22 normal mitral valves, 26 RMS valves, 22 MAC valves) and found that MAC-related mitral stenosis showed smaller anteroposterior dimensions, reduced valve volume, lower contractility, and higher transmitral velocities than rheumatic mitral stenosis, even when the valve opening was larger.

• A Noninvasive 3D ECG Imaging Map: A new Nature Communications paper detailed Corify Care’s physics-based ECG imaging approach that reconstructs 3D activation within the myocardium (not just the heart’s surface) using chest sensor signals plus body geometry and computational modeling. In simulation testing on four patient proof-of-concept cases the 3D ECG method more accurately localized arrhythmia origins than surface-only mapping and generally matched earlier clinical assessments. Larger studies are planned to determine whether this 3D mapping can improve procedural planning and guide treatment strategy selection.

• FOQUS Ultrasound’s First-In-Human Use: BURL Concepts reported the first-in-human use of its FOQUS transcranial ultrasound system for brain emboli detection that aims to streamline patent foramen ovale (PFO) evaluation using the standard saline bubble test. FOQUS scans the whole brain for microbubbles in ~40 seconds without sedation and is designed to be run by a single nurse in offices or diagnostic centers, potentially reducing the need for cardiologist/anesthesia support and shortening wait times. Clinicians involved said the automated “curtain” detection could help identify PFO candidates more efficiently.

• HF Societies on Integrated Health Technologies: A joint scientific statement from the HFSA and the AAHFN suggests that integrated health technologies in heart failure care like telemonitoring, mobile health remote monitoring, and implantable devices can improve quality of life and reduce hospitalizations for HF patients. The statement also flags major real-world hurdles like uneven patient engagement, digital access, and high start-up costs. While cautiously optimistic, the statement’s overall premise might be challenged by data that suggests certain telehealth approaches are detrimental to HF care quality (see top story above).

• Cytokinetics Launches MYQORZO: Cytokinetics announced that its newly FDA-approved cardiac myosin inhibitor MYQORZO (aficamten) is now available by prescription in the U.S. in 5, 10, 15, and 20 mg tablets for adults with symptomatic obstructive hypertrophic cardiomyopathy to improve functional capacity and symptoms. The company also noted its REMS program is live and distribution is running through a specialty pharmacy network. The launch now puts Cytokinetics’ cardiac myosin inhibitor in direct competition with Bristol Myers Squibb’s CAMZYOS.

• Long-Term Wildfire Exposure for Older Adults: We already know air-pollution and smoke exposure are bad for you, but a new EHJ study seems to have defined just how bad it is. In a national Medicare cohort of 25M adults, higher chronic exposure to wildfire smoke-specific PM2.5 was linked to more incident strokes (~2.9M events). Researchers also found that risk increased even more with longer exposure windows with each 1 µg/m³ increase in exposure corresponding to a 1.3% higher stroke risk.

• Compass Launches Standalone Cardiovascular ASC: Compass Surgical Partners and local physicians opened the Cardiovascular Surgical Institute of Northwest Florida, an 8,000-sq-ft outpatient center offering interventional cardiology, electrophysiology, and vascular surgery. The facility includes two fixed Philips Angio cath labs and will perform coronary diagnostics/interventions, device implants, AFib ablations, peripheral interventions, and dialysis access. This move makes CSINF the region’s only outpatient cath lab within a 100-mile radius and a lower-cost alternative to hospital-based care.

• Many Patients Don’t Monitor BP at Home: Patient-dependent at-home BP monitoring might not be useful for guiding medication therapy according to a recent JAMA study. As part of a Mass General Brigham remote hypertension program of 3.4k patients who were provided education and support, only 34.8% met “high engagement” (24–28 readings/week), while 32.7% never used the device. Nearly half of patients (47%) logged too few readings (less than 12 per week) to reliably guide med titration.

The Largest Registry on Plaque Analysis in CAD

What if 50% of your CCTA patients could benefit from an adjustment to their treatment plan? Read more about Heartflow’s DECIDE registry that demonstrates how Heartflow Plaque Analysis using its Plaque Staging software empowers physicians with clinical insights that lead to real-world impact.

A Solution for Your Entire Cardiology Service Line

The pace of change in healthcare can be dizzying, creating new and more complex challenges for cardiology departments to overcome. See how Merge Cardio and Merge Hemo can turn those challenges into opportunities for greater workflow efficiency and improved care.

PIA Medical Processes It All

Need an analysis like calcium scoring, strain or even FFR? PIA Medical began as a Core Lab and can handle creative cardiac research and clinical trials along with the full breadth of clinical analyses available today.

The Resource Wire

• Assessing CAD with Circle CVI: Did you know that Circle CVI offers a suite of cardiac CT tools for the assessment of coronary artery disease? See how Circle combines heart function segmentation, automated plaque analysis, CAC scoring, reporting, and viewing in a single dedicated Cardiac CT package.

• Identify and Treat Cardiovascular Disease: Complex care pathways make getting patients to the next step a challenge. See how Tempus Next, an AI enabled care pathway platform, helps providers identify and reduce under treatment in cardiovascular disease by adding an intelligent layer onto their routinely generated EHR data.

• RoR in the Real World with Monebo and UNCG: Strenuous exercise can significantly reduce people’s heart relaxation reserve, putting them at risk without preliminary warning signs. Find out how Monebo’s new Reserve of Relaxation technology provides a crucial tool for anyone looking to enhance their physical performance without harm.

• 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.

• How Us2.ai Improves CA Screening: Cardiac amyloidosis may not be as rare as previously thought, with early and accurate detection becoming increasingly critical for treatment. Read about how the AI-SCREEN-CA study implemented Us2.ai’s automated CA reporting and AI-based pattern recognition analysis, leading to better disease screening at scale.

The Industry Wire

1. Insurers scramble to adapt to flat 2027 Medicare Advantage rates.
2. UnitedHealthcare may lose 1.4M MA customers this year. 
3. South Carolina measles outbreak achieves dubious record.
4. Measles outbreaks also take hold in European countries. 
5. Doctors take a pass on new federal vaccine guidance. 
6. 50% of Americans may be obese by 2035.
7. FDA’s CDRH issues report on 2025 accomplishments.
8. Hospitals get more resident training slots.
9. Doctors are looking at AI scribes more positively.
10. Two-thirds of Epic EHR hospitals are using ambient AI.