Sakowitz et al.

Administrative friction is one of cardiology’s biggest bottlenecks, and StackAI is equipping providers with the AI tools they need to break through it. Check out StackAI’s exclusive profile in Digital Health Wire to see how you can build and deploy AI agents that automate complex workflows – from patient outreach to prior authorizations – without writing a single line of code.

Surgeries & Interventions

Market Competition Drives TAVR Overutilization

Whether or not a patient receives TAVR over SAVR might be more influenced by market forces than clinical evidence, after a recent study found that the more competitive the hospital market, the higher the TAVR likelihood, regardless of guideline recommendations.

• TAVR is widely considered equivalent to surgery in short-term outcomes, but durability concerns have begun to emerge as the technology matures.
• As a result, the 2020 ACC/AHA guidelines maintain Class 1A recommendations for surgical valve replacement in younger patients (≤65 years).
• Market competition has historically influenced surgical technology, with TAVR being no exception as younger patients seem more keen to accept it regardless of guidelines.

Examining 137k patients undergoing aortic valve replacement across seven states, researchers calculated hospital market competition using the Herfindahl-Hirschman Index and found that 61% of patients were treated at high-competition centers while revealing a troubling pattern.

• Treatment at a high-competition hospital conferred 68% increased relative risk of receiving TAVR versus surgery.
• Market competition effects were most pronounced among younger patients: under 50 years (aOR: 1.54) and 50-59 years (aOR: 1.30).
• Meanwhile the effects of market competition were smaller in older patient groups like 60-69 years (aOR: 1.13), 70-79 years (aOR: 1.10), and 80+ years (aOR: 1.18).
• Among patients under 50, TAVR use at competitive centers grew from 7% in 2016 to 15% in 2021.

Even with patient preference surveys showing approximately 80% of patients favor TAVR for reduced invasiveness and presumed shorter recovery, the market-driven utilization among younger patients represents a break from consensus recommendations.

• This hints at an uncomfortable, but practical reality in which surgeons and hospitals may feel compelled to offer TAVR to meet patient and market demands.

That said, it isn’t a good sign that hospital systems are willing to forgo guidelines in favor of appeasing patients when we still don’t know what TAVR reintervention rates look like beyond 20 years.

The Takeaway

This analysis exposes market competition as a powerful driver of TAVR adoption among younger patients despite lacking long-term durability evidence. It seems like the saying “the customer is always right” has found its way into aortic valve replacement, a place where it might not belong.

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.

Monebo’s Approach to Cardiac Health Monitoring

The heart works day and night, so your cardiac monitoring software should too. Learn about how Monebo’s latest innovation superimposes long-term monitoring results onto a 24-hour circadian cycle scale, creating a comprehensive map of circadian variations.

Harnessing the Power of AI to Improve Patient Care

Endeavor Health is one of the first healthcare providers in the Midwest to use AI in the echocardiography lab. Learn how they are harnessing echo AI’s tremendous potential to improve diagnoses in this page from Us2.ai.

The Wire

• New Clinical Guidelines for PE: The ACC and AHA, alongside eight other medical societies, released the first comprehensive clinical practice guidelines for acute pulmonary embolism. Central to the document is a new five-tier classification system (Categories A–E) to risk-stratify patients from asymptomatic to complete cardiopulmonary failure. The guidelines emphasize rapid diagnosis, the use of multidisciplinary PE Response Teams, and treatments ranging from anticoagulants for low-risk cases to catheter-based interventions and surgery for severe instability.

• Less Plaque Still Risky for Women: Women typically have less arterial plaque than men, but their cardiovascular risk starts at lower plaque levels. That’s according to a new study that assessed CT-derived plaque levels in 4.2k adults, and found that women were less likely to have coronary plaque (55% vs. 75%) with lower median plaque volume (78 mm3 vs. 156 mm3). But they had similar adverse event rates and their cardiovascular risk began rising at lower levels of plaque burden (20% vs. 28%). These results echo findings from Cleerly’s CONFIRM2 trial.

• Gaps in Statin Acceptance: A study in JAMA Internal Medicine reveals a significant disconnect between clinical guidelines and patient willingness to take statins for primary prevention. While statins typically provide a 25% relative risk reduction, surveyed adults required a 50–75% reduction to find the treatment acceptable. At a 10% baseline cardiovascular risk, only about a quarter of respondents were willing to start therapy. These findings highlight the urgent need for absolute risk communication and structured decision aids to align medical recommendations with patient preferences.

• DurAVR’s Early Hemodynamic Results: Just a few weeks after successfully courting investment from Medtronic, Anteris Technologies unveiled encouraging new data at EAPCI for its DurAVR TAVR valve. The study used CMR to follow 141 patients, 46 of which received the valve and found that it helped restore ascending aortic flow towards native physiology.  This was also accompanied by positive left ventricular reverse remodelling at six months (-18%) and improved systolic FFR. These results make DurAVR seem like a strong TAVR contender, with further trials still needed.

• Efficacy of Lithotripsy in PCI: An international RCT of 200 patients suggests that adding intravascular lithotripsy to conventional lesion preparation significantly improves outcomes for severely calcified coronary arteries. The study’s primary composite endpoint (procedural failure or target vessel failure at one year) occurred in 35% of the IVL group compared to 52% in the conventional group. This improvement was largely driven by a reduction in residual area stenosis, confirming that IVL effectively fractures calcium to ensure better stent expansion without increasing safety risks.

• Optimizing HFpEF Diagnosis: In an effort to optimize ultrasound HF detection, a study of 511 patients evaluated the impact of integrating the 2025 ASE diastolic function guidelines with the H2FPEF score to diagnose HFpEF. While the H2FPEF score alone effectively excludes HFpEF when the probability is below 30%, adding contemporary echocardiographic measurements significantly improved diagnostic accuracy for all other patients. This combined approach demonstrated a net reclassification improvement of 1.38, providing a more precise estimation of mean left atrial pressure in intermediate-to-high-risk cases.

• AI Advancements in Interventional Cardiology: Experts highlighted AI’s developing role in preprocedural planning and intravascular imaging at the 2026 EAPCI Summit. Key highlights include how machine learning identified gamma-glutamyl transferase as a surprise 10-year mortality predictor and AI’s ability to characterize high-risk plaques via IVUS and OCT. However, researchers warned of growing issues in interventional cardiology AI including lack of software concordance and the need for robust outcome studies before AI can supplement expert clinical judgment.

• Pregnancy Biomarkers for CVD Prediction: Pregnancy health and future CVD risk could be even more connected than we thought after a Danish cohort study found that third-trimester biomarkers can independently predict long-term cardiovascular disease in women. Among the study’s 38k women, higher concentrations of high-sensitivity troponin I and soluble fms-like tyrosine kinase-1 (sFlt-1) at 29 weeks were associated with higher CVD risk over 11.9 years of follow-up. Using sFlt-1 along with age also predicted heart risk better than usual methods, so pregnancy biomarkers could serve as a key screening window for women.

• CHIIP Study on Childhood Cancer Survivors: Tailored health counseling doesn’t seem to offer additional benefit over standard cardiovascular risk assessments for adult childhood cancer survivors. Researchers examined 347 cancer survivors and found no significant difference after 1 year between the study groups with 26% of intervention participants and 30% of enhanced usual care control participants having less undertreatment of cardiovascular disease risk factors. With nearly 50% of survivors facing undertreated conditions due to past cardiotoxic therapies, simple risk communication could be enough to improve long-term CV health.

• GnRH Agonists vs. Antagonists in Prostate Cancer: In more cancer-cardiovascular news, another trial revealed that the GnRH agonist leuprolide causes significantly higher coronary artery plaque progression compared to the antagonist relugolix. Over 12 months, men treated with leuprolide showed a 68.9 mm³ increase in total plaque volume and a 64.5 mm³ increase in noncalcified plaque volume. These findings suggest that the cardiovascular risks associated with androgen deprivation therapy may be driven by accelerated atherosclerosis, specifically through the accumulation of vulnerable, noncalcified plaque.

• Prognostic Value of Cardiac Damage: A study from the CURRENT AS registry-2 involving 3.3k patients confirmed that cardiac damage staging is a powerful predictor of outcomes in severe aortic stenosis. Regardless of whether patients exhibited high-gradient or low-gradient AS, the risk of death or heart failure hospitalization increased significantly with advancing stages (0–4). This prognostic value remained consistent across symptomatic and asymptomatic patients, as well as different initial treatment strategies, supporting staging as a universal tool for risk stratification.

Earlier Detection, Better Outcomes

When it comes to heart disease, early detection is crucial to a patient’s long-term health. Learn more about how Fujifilm helps clinicians achieve that with the Lisendo 880 cardiovascular ultrasound system’s unique solutions that detect early abnormalities seen in heart failure, while offering insight into cardiac functions and groundbreaking hemodynamic analysis.

Relieving The Burden of Post-Processing

With the advent of advanced imaging technologies like CCTA come added burdens to technologists and diagnostic imaging centers. See how PIA can relieve the burden of post-processing, saving you time while helping your bottom line.

Tempus Receives FDA 510(k) Clearance for Tempus ECG-Low EF

Tempus announces the expansion of its Tempus ECG-AI portfolio with Tempus ECG-Low EF, software intended for use to analyze 12-lead ECG recordings and detect signs associated with having a low left ventricular ejection fraction (LVEF less than or equal to 40%) in patients 40 years of age or older at risk of heart failure. It is not intended as a stand-alone diagnostic and positive results may suggest the need for further clinical evaluation. For Full Indications for Use, visit here.

The Resource Wire

• CMR Access Is Broken — Here’s How to Fix It​: Cardiac MRI is one of the most powerful tools for diagnosing heart disease, yet it’s still out of reach for many patients. Download Vista AI’s new infographic to see what’s holding CMR adoption back—and how AI and automation can help make gold-standard imaging more accessible than ever.

• Streamline Your Cardiology Imaging Workflows: See how cardiologists and their teams can streamline imaging workflows to make their cardiovascular service line more efficient, cost-effective, and patient-centered, using Merge’s cardiology solutions.

• 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.

• The Power of AI in Cardiovascular Imaging: Cardiac labs are under more pressure than ever to deliver more with greater speed and precision. Hear from ACUSON Origin customer, Tony Gallagher about how Siemens Healthineers’ cardiovascular ultrasound system is improving exam efficiency and showing positive impact on ROI.

• A Single Cardiac Service Line Platform: Transitioning across multiple imaging platforms is a daily reality for many cardiologists, but it doesn’t have to be. See how three leading cardiac imagers are leveraging Circle CVI’s unified multi-modal software across their diverse caseloads, without switching to other platforms.

The Industry Wire

1. Trump tariff fallout could affect medical industry. 
2. White House taps NIH chief to lead beleaguered CDC. 
3. Grail’s cancer blood test falls short in massive U.K. study. 
4. When is it unethical to not use AI?
5. RCM firms see payor rule changes as biggest threat.
6. Federal subsidies extend far beyond ACA policies.
7. United Healthcare raises bar for MA specialist referral.
8. Hims & Hers to acquire digital health firm Eucalyptus.
9. Hospital firm CHS makes progress paying down debt.
10. NYC nurse’s strike close to resolution.