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What Cardiology Costs, Gut Metabolites, and Karoo’s Capital
By Viktor Zarev, Virginia Hunt
July 23, 2026
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Together with
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“We need smart, ethical physicians with common sense, critical thinking, courage, and creativity. Not moral-less mediocre lemmings willing to mindlessly follow algorithms and marching orders at the expense of individual patients’ best interests.”
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Kris Held, MD.
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Remote patient monitoring comes up a lot in cardiology and in diseases like heart failure, so keeping a constant eye on the small details matters. Check out this exclusive Cardiac Wire article in partnership with Abbott to find out how CardioMEMS helps do just that.
On a different note, at what point is the cost of something unfair?
Read below and tell me what you think.
Vik
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New price transparency data reveals how wildly insurance payments, reimbursements, and facility fees for cardiology swing across insurers and states, which underscores the complexity of U.S. healthcare costs.
- The analysis used “April 2025 Transparency in Coverage” data from America’s four largest commercial insurers: Blue Cross Blue Shield, UnitedHealthcare, Aetna, and Cigna (78% of the commercial market).
- This provided insights into roughly 6.7M professional and 104k facility price points across 32 common cardiology services, covering 51k physicians and 4k facilities.
Researchers analyzed the negotiated allowed amounts by CPT code, grouping services into diagnostic imaging, electrophysiology, interventional cardiology, and stress testing, then compared prices across payors and states.
- Facility price variation far exceeded professional fee variation (IQR: 2.56 vs. 1.78).
- That gap was starkest within imaging, with transthoracic echocardiogram facility fees seeing a 3.87 variation ratio compared to just 0.61 for the professional fee.
But beyond variability, the dollar figures on device procedures are eye-popping.
- Median facility fees for ICD placement ranged from $6.6k with Aetna to $36k with UnitedHealthcare (quite the spread).
- Pacemaker insertion showed a similar pattern, from $6.3k with Aetna to $17.6k with UnitedHealthcare.
- By contrast, these procedures’ professional fees varied far less — ICD placement professional fees spanned only $610 to $1.5k across payors.
Each insurer showed a distinct pricing personality, which the authors attribute to differing negotiation strategies.
- For reference, BCBS consistently had the highest facility prices, up to 1.31x the market average.
- Meanwhile, Aetna had the lowest across nearly all services, as little as 0.39 times the market average even for complex procedures like electrophysiology.
Geography further compounds the problem, because where a patient lives can matter as much as who insures them.
- In the case of ICA with catheterization, the median facility price was $7.6k, but it could be anywhere between $4.5k to $10k depending on the state.
The kicker to all this? Prior research has already confirmed there’s no relationship between higher prices and better care quality or efficiency, so the patients paying more aren’t necessarily getting more.
The Takeaway
This analysis opens our eyes to just how arbitrary the cost of cardiology is across the country, and with most American patients insured by an oligopoly of four payors, there’s little reason for those costs to come down. At least we know it’s not the cardiologists’ fault.
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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.
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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.
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- Implantable RPM for HF Patients: Nearly 7M Americans live with heart failure, and with that number expected to reach nearly 9M by 2030, GDMT isn’t enough. In the latest Cardiac Wire exclusive we took a look at how remote patient monitoring with Abbott’s CardioMEMS implantable pulmonary artery pressure sensors supports better therapy adjustments, identifying additional interventions, and escalating patients to more advanced heart failure therapy evaluations when needed.
- CCTA Finds Atherosclerosis in Younger Adults: Coronary CT angiography scans found a high rate of atherosclerosis in younger adults – and it’s a trend that has clinical consequences. Among 10.2k people (median age = 47) who received CCTA scans from 2006 to 2021, 29% had non-obstructive plaque and 8.7% had obstructive coronary artery disease. Over a median follow-up of 6.7 years, those with obstructive CAD had a higher risk of cardiac events (aHR = 2.6). CCTA could be used for early risk stratification and to guide preventive strategies.
- Bolton Medical’s Relay Pro Recall: The FDA has issued a Type I recall, their most serious designation, for Bolton Medical’s thoracic stent graft. The warning specifically covers Relay Pro System devices ≥32mm with a non-bare stent configuration. The grafts may be unable to unclasp from the delivery system, a malfunction which led to three deaths as of April 23. The FDA has called for a full withdrawal of affected devices from the market, and impacted customers should have received instructions from Bolton Medical.
- Gut Metabolite Implicated in AAAs: A new European Heart Journal study suggests that metabolites produced from digesting red meat, poultry, and dairy may be linked to abdominal aortic aneurysms. Plasma samples from 4.4k older adults showed that the risk of AAA was 1.73x higher for those with elevated trimethylamine N-oxide (TMAO) levels. The risk of adverse AAA events like rupture or death was even greater (146% higher risk). The findings indicate AAA may have a new biomarker — or even a new therapeutic target.
- Steerable Sheaths Steered Off Market: Yet another recall in the news, this time for Boston Scientific’s steerable sheaths used in PFA procedures. Over 750k Faradrive sheaths are included in the Type II recall, the FDA’s designation for products which could cause “temporary or medically reversible” health consequences. The products don’t need to actually be returned, but clinicians should follow updated instructions regarding device use. Last month, the company released a field safety notice highlighting low embolism risk when the device was used with correct technique.
- Burnout Hits Cardiac Imagers: New survey data found that about three in five cardiovascular imaging physicians report feeling burned out, with clinical workload and inefficient workflows cited as the top drivers. Across 248 respondents, 58% reported burnout, pointing to clinical workload (60%), inefficient workflows (52%), administrative burden and institutional culture (each 42%), and after-hours work, with more than two-thirds reporting working outside of scheduled hours and 37% working after-hours daily.
- Orphan Status for AFTX-201: Affinia Therapeutics received FDA Orphan Drug designation for AFTX-201, its one-time IV gene therapy for BAG3-associated dilated cardiomyopathy (DCM). AFTX-201 delivers a functional BAG3 transgene via viral capsid and has shown it can raise cardiac BAG3 protein, restore cardiac function, and provide a survival benefit in preclinical models. The orphan designation, which follows a recent Fast Track nod, adds development incentives for a condition estimated to account for 2.3-3.6% of DCM worldwide.
- The Cath Lab’s Carbon Problem: We don’t often think about the environment when talking about interventional cardiology, and it might be time to change that. Among 859 GREEN-CCF study respondents, (43% interventional cardiology) participants reported high personal motivation on environmental issues but low levels of knowledge and little perceived motivation from their centers. More than 70% reported discarding procedural materials like packaging, plastics, and specific supplies, and the most cited barrier to change was the difficulty of shifting professional behaviors (47%).
- Skipping Contrast in CMR: A JACC validation study suggests that AI-based virtual native enhancement (VNE) can detect myocardial scar on cardiac MRI without contrast agents. Using precontrast cine and T1 map images an Oxford team generated VNE images and scored them blinded to the late gadolinium enhancement ground truth. They found that VNE diagnosed myocardial infarction with 94.4% accuracy on “confident images” and 87.5% across all images. Applying a technology like this to CMR workflows could potentially spare many patients from gadolinium injections.
- Plozasiran Aces Its Phase 3 sHTG Studies: Arrowhead Pharmaceuticals announced positive topline results from its global Phase 3 SHASTA-3 and SHASTA-4 trials of plozasiran in patients with severe hypertriglyceridemia (sHTG). Both studies met their primary endpoint of triglyceride reduction, including a statistically significant drop in pancreatitis events. The 25mg dose, tested in both studies, drove median triglyceride reductions of 79% and 81% at month 12 versus roughly 27% for placebo. Meanwhile, a pooled analysis showed acute pancreatitis events reduced by 78% in the broad sHTG population, and a full 100% reduction in the highest-risk subset.
- $16M Series A for a Cardiac “Operating System”: Karoo Health closed a $16.2M Series A round to build what it calls an operating system for cardiovascular care. The platform aims to connect payors, providers, and patients through workflow data analysis, potentially supporting earlier risk detection and care coordination. The company will use the proceeds to further develop its AI-native platform, including predictive models and clinical signal detection, while expanding its teams and scaling payor and provider deployments.
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How AI Expands the Role of CMR Experts
If you’re an MRI technologist, AI could be the best thing that ever happened to your career. Read here to learn about the benefits of AI for CMR experts and how it can accelerate both your training and opportunities.
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Why Merge Hemo is the Cardiology Hemodynamics Leader
Thanks to feedback from its customers, Merge Hemo has been named the 2026 Best in KLAS for cardiology hemodynamics for the 14th time. Watch this on-demand virtual discussion to hear the factors behind their win and the latest innovations in hemodynamics.
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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 Tony Gallagher, Director of Noninvasive Cardiology at Baptist Health Lexington about how Siemens Healthineers’ ACUSON Origin is reshaping daily practice and transforming the future of echocardiography.
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- 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 Economics of AI-Assisted HF Diagnosis: As sonographer shortages become more common, so too are diagnostic delays and missed opportunities for early heart failure treatment. Find out how task-shifting LVEF assessment to novice operators using AI-assisted ultrasound is both clinically viable and cost-saving.
- 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.
- 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.
- A Cardiovascular Ultrasound Platform You Can Trust: Being able to provide premium diagnostic information for your pediatric patients every day, all day, is vital. Find out why cardiac imagers trust Fujifilm’s Lisendo 880, and how its premium imaging quality, efficiency tools, and reliability you can trust, have helped change workflows for clinicians and technologists alike.
- Telemedicine Isn’t About Technology. It’s About People. With temporary telehealth rules expiring, millions of Medicare patients may lose their ability to see their doctors remotely. Read why Monebo and the Alliance for Connected Care are urging Congress to make telemedicine a permanent part of the healthcare system.
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