William F. Parker, MD, PhD, on the debate around the EchoNext AI launch.

Quite the variety of stories in today’s issue. From advanced practice providers to LLMs and ECG AIs, cardiology is changing every day.

Wonder what the field will look like by the next World Cup.

Cheers,

Vik

Cardiology Practices

APPs are Growing in Compensation and Relevance in Cardiology

Advanced practice providers have long been viewed as support staff in cardiology, but MedAxiom’s new 2025 APP Compensation and Utilization Report suggests they’ve moved well beyond that role.

• The sixth annual MedAxiom APP report drew responses from 104 cardiovascular organizations (+16% since 2024) across all major U.S. regions.
• For the first time, the survey asked whether APPs hold formal administrative roles, with over half responding “yes.”

To track how APP roles are evolving, MedAxiom benchmarked deployment, compensation, scheduling, and productivity across care settings, finding that…

• Ambulatory cardiology remains the most common setting, reported by nearly 90% of programs.
• Meanwhile 96% of programs reported independent APP scheduling.
• Beyond scheduling, 76% of programs used APPs in clinics without a physician present.

The report also found that APP deployment is shifting toward procedural subspecialties. 

• The share of programs deploying APPs in electrophysiology rose from 82% to 87%.
• Structural heart climbed from 62% to 73%.
• Heart failure fell from 83% to 70%
• Prevention dropped from 42% to 35%.

When it comes to compensation, programs trended toward productivity-based models for paying their APPs.

• Programs using productivity-based incentives nearly doubled, rising from 37% in 2022 to 64% in 2025.
• Median total compensation for cardiology APPs reached $131,883 in 2024, with the largest pay increases in procedural specialties.

But compensation hasn’t fully caught up with specialization. 

• Despite increased training requirements for APPs in prevention and lipid clinics, more than 95% of programs reported no pay differential for that subspecialty expertise.

The Takeaway

From responsibilities to compensation, the latest MedAxiom APP report reveals that advanced practice providers are becoming increasingly central to the way cardiology organizations operate. What that means for cardiologists and their patients is still up to debate.

From Fetal to Adult Cardiovascular Ultrasound

Continuity of care is critical when it comes to a patient’s cardiovascular health. That’s why cardiologists across America are picking Fujifilm’s Lisendo 880 cardiovascular ultrasound for its versatility and precise imaging starting at a patient’s fetal development to adulthood.

Redefining Cardiac Analytics

More data doesn’t equal deeper insight. There’s a fundamental difference between measuring the timing of heart beats and understanding how the heart recovers electrically after each beat. Monebo is using that distinction to define the next frontier of cardiac analytics.

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.

The Wire

• A $89M Testing Scheme: Jason Finkelstein, a board-certified cardiologist, was charged by indictment with healthcare fraud and conspiracy in connection with an $89M cardiovascular testing scheme. As alleged, Finkelstein served as medical director of a company that tested student athletes on school campuses nationwide, using two companies he owned to submit roughly $89M in false claims, of which about $13.1M was paid. He was the sole ordering provider yet conducted no clinical exams while fabricating diagnoses.

• Heart Failure Ages the Genome: A study drawing on the MyoVasc and Gutenberg Health cohorts examined DNA methylation patterns in heart failure, finding that the condition leads to accelerated genetic aging. Across 2.1k individuals and over 767k DNA sites, HF was associated with an average 19-year increase in epigenetic age and an overall methylation decrease (OR: 1.33), with the strongest differences in DNA regions right outside methylation sites. Notably, epigenetic aging strongly predicted worsening HF and mortality.

• A Modern Benchmark for the Ross: Long-term data from a single high-volume medical center now supports broader use of the Ross procedure in carefully selected adults with aortic valve disease. Among 455 consecutive adults (mean age 47) followed for a median of 9 years with 98% completeness, operative mortality was just 0.4% and 12-year survival matched the age- and sex-matched general population. Reintervention rates were also low, with 1.1% for the autograft intervention and 3.5% for any cardiac reintervention at 12 years.

• An ECG Screen for Hidden Heart Disease: Pathway Labs launched EchoNext, billed as the first FDA-approved AI tool that reads standard 12-lead ECGs to flag high-risk structural heart diseases. The software comes with  six indications including HF, valve disease, and pulmonary hypertension. Trained on over 700k ECG-echo pairs, a Nature paper and press release claimed it outperforms cardiologists, even those using AI. EchoNext will be available through the widely-used OpenEvidence platform to bring physicians ad-supported, point-of-care ECG analysis.

• Cardiologists Respond to EchoNext: However, the EchoNext Nature case study wasn’t well received by some members of the cardiology community who claim that the use case of an AI interpreting ECG for valve disease is unnecessary. One physician broke down the Nature piece by saying “I’m deeply suspicious the clinical note is dishonest about physical exam findings.” Meanwhile, another prominent voice in the cardiac space clarified that “any cardiologist should be able to look at the ECG and predict serious cardiomyopathy.”

• Ochsner’s Expanding Heart Center: Ochsner Children’s expanded its pediatric cardiology and heart surgery program with a wave of specialized hires across cardiac surgery, cardiology, and intensive care. The program now spans more than 20 pediatric heart physicians, 38 specialized nurses, and 13 advanced practice providers, with STS data ranking it among the nation’s top performers. Ochsner is also building a 343k sqft children’s hospital to accommodate this growth.

• Defective Diuretics: The FDA recalled a batch of Inventia Healthcare’s water pills for failing to dissolve properly, which could impact the drug’s efficacy and leave patients with higher blood pressure. An FDA notice says the drugmaker will voluntarily pull more than 11k bottles of 25mg chlorthalidone across the U.S. The affected medication came in 100- and 1,000-count bottles with an April 2027 expiration date and batch number of RISB24002.

• Hone Adds Heart Care: Hone Health, a longevity-focused telemedicine platform, says its new heart health biomarker tests can identify CVD risk earlier than a standard lipid panel. The expanded panel measures ApoB and neutrophil to lymphocyte ratios as well as the usual suspects, like LDL and total cholesterol. Patients then meet virtually with a doctor, who may prescribe rosuvastatin, colchicine, and metformin (CV supplements are also for sale). The program seizes on a rising recognition that arterial disease can emerge without high LDL. 

• $6M Medical Malpractice Settlement: Failing to act on a troubling coronary calcium scan has landed Cardiovascular Group in Georgia on the wrong side of a $6M settlement. However, due to insurance limits, the practice owes just a portion of the $18.3M originally awarded to the family of a 64-year-old man who died after a post colon-surgery heart attack. The clinic that performed the elective colon surgery without cardiac clearance settled privately.

• Cardiovascular Mortality Inequalities Persist: Per a new progress report from JACC, the cardiovascular mortality gap between Black and white Americans still hovers around what it was a decade ago. Annually, there are more than 1 million years of potential life lost for Black Americans because of the various “structural, clinical, and policy factors” which produce this inequality. While overall excess cardiac mortality rates decreased nearly 3% from 2023 to 2024, the disparity in HF mortality has continued to widen despite key developments in care.

• Murj Software Spreads Overseas: Murj will soon expand its cardiac device management software offerings into Australia and New Zealand. The Oceanic expansion comes at a time when local health systems are moving away from on-site tools toward cloud-based work systems. Murj has already established their presence in the U.S. market, supporting more than 1,000 clinics which collectively provide monitoring of cardiac implantable electronic devices to 900k patients nationwide.

• LLM Pitfalls: An incisive JAMA viewpoint warned LLMs could offer lousy advice based on errors, biases, and outdated information baked into EHRs. The piece raises the example of a patient once diagnosed with panic attacks who was later found to have heart issues. If chest pain strikes, will an LLM take it seriously or downplay it as anxiety? The authors also argue for stronger patient privacy protections and greater data transparency when it comes to LLMs.

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.

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 Benefits of Outsourced Post-Processing

Using an outsourced cardiac image post-processing solution doesn’t have to mean sacrificing control of the results. Discover how PIA’s customizable post-processing workflow can help you get the most out of your images.

The Resource Wire

• Merge Cardio 12.5 is Officially Available! From AI-generated echo measurements to upgraded UI and reports, Merge Cardio 12.5 brings a long list of new innovations to the table. Find out more about how Merge Cardio’s latest version streamlines workflows to make your cardiovascular service line more cost-effective and patient-centered. 

• State-of-the-Art Cardiac Monitoring at Scale: Cleared for 13 different heart rhythm interpretations, AccurKardia’s AccurECG 2.0 shortens the time from an arrhythmia incident to clinical intervention. Watch here to find out how AccurKardia and Specialized Medical are teaming up to bring the AccurECG 2.0 technology to clinicians across the U.S. 

• 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.

• The Unified Cardiac Workflow: Cardiovascular disease remains the leading cause of global mortality, yet diagnostic workflows remain fragmented. That’s why it’s so important that Circle Cardiovascular Imaging’s cvi42 is the industry’s first unified platform for reading Cardiac MRI and Cardiac CT, and PCAT analysis within a single application.

• How Automated MRI Software Transformed Radiology Regional: Radiology Regional recently integrated automated MRI scanning software into their imaging practice imaging. Hear from their team how automating CMR scans transformed their practice and enhanced patient care.

• CathWorks is now part of Medtronic. The CathWorks FFRangio™ system is the new standard in coronary physiology. Learn more. Source: Fearon WF, Jeremias A, Witberg G, et al. Angiography-Derived Fractional Flow Reserve to Guide PCI. NEJM 2026. doi: 10.1056/NEJMoa2600949

The Industry Wire

1. Blocked COVID-19 vaccine study published in JAMA journal.
2. U.S. provides experimental Ebola drug to Congo.
3. Where did Ebola come from?
4. Indiana turns to price controls to limit rising healthcare costs. 
5. Telehealth circumvents federal abortion pill ban. 
6. Top 10 nonprofit health systems by operating revenue.
7. Medicare’s WISeR AI preapproval pilot may delay care.
8. A healthcare attorney’s guide to scaling clinical AI. 
9. Exposure to daylight linked to lower dementia risk. 
10. Many candidates in FDA’s ‘breakthrough’ program don’t get approved.