Category Archives: Cardiology

Cardiology

5 trends in cardiology to watch – Harvard Health

Longtime readers of the Heart Letter know that most of our stories focus on steps you can take right now to improve your heart health. But once in a while, we look ahead at what's on the horizon in this dynamic field. We consulted Dr. Eugene Braunwald, Distinguished Hersey Professor of Medicine at Harvard Medical School, where he has worked since 1972. At age 94, he continues to work and publish, adding to the more than 1,100 articles he has authored since the early 1950s. His pioneering research helped elucidate how heart attacks happen, which ushered in new ways to treat and prevent them.

Dr. Braunwald's discoveries also advanced the understanding of hypertrophic cardiomyopathy, valvular heart disease, and heart failure. (His life and research are described in Eugene Braunwald and the Rise of Modern Medicine, written by former Harvard Heart Letter editor in chief Dr. Thomas H. Lee.) The trends Dr. Braunwald is most excited about, summarized below, may one day affect heart health at every stage of life from birth to old age.

Dr. Braunwald: The future of cardiology will focus on preventing heart disease very early in life, a concept known as primordial prevention. Instead of waiting until people develop risk factors such as high blood pressure, high cholesterol, or diabetes and treating them, we will be able to identify and prevent the development of those conditions in the first place. Many of these conditions are caused not by a single gene but by many genes. We now have specialized genetic tests to create polygenic risk scores that help predict cardiovascular risk [see "Genetic profiling for heart disease: An update" in the October 2023 Heart Letter]. In the future, these tests will become more accurate and less expensive, so I foresee doing these tests in newborns.

For example, if a baby has genes linked to the development of high blood pressure by age 30, you could modify that child's diet to prevent the problem. Focusing on prevention very early in life could make a huge difference in reducing cardiovascular disease, which remains the most common cause of death in adults worldwide.

Dr. Braunwald: For people who already have heart disease, medications that lower blood pressure and cholesterol are an important part of avoiding future heart problems. Until recently, however, there haven't been any drugs to address inflammation, which ignites the artery-damaging process that leads to a heart attack. But in June 2023, the FDA approved the anti-inflammatory drug colchicine [Lodoco] for people who have or are at high risk for heart disease. The drug, which has been used for many years to treat gout, can lower the risk of heart attack and related problems by about 30%. Investigators and the pharmaceutical industry are now looking very closely at this category of medications. Going forward, I predict there will be a whole battery of new anti-inflammatory drugs. It will be similar to the current situation with high blood pressure, where we have many different drugs that doctors can use to treat this common problem.

Dr. Braunwald: A heart attack cuts off blood flow to part of the heart's muscle, creating damage that scars the heart. Over time, especially in people with repeat heart attacks, this can impair the heart's ability to function normally, leading to heart failure. For more than two decades, scientists have tried to repair damaged hearts using cardiac cell therapy, also known as stem cell therapy. The original concept was to infuse large numbers of stem cells derived from bone marrow into the heart to regenerate heart muscle cells. While the initial results appeared promising, these cells aren't incorporated into the heart muscle, and they quickly disappear. Now, several other techniques are being explored, including isolating the substances released from transplanted cells that appear to be responsible for their benefits. By making these substances which include factors that encourage blood vessel growth in the lab, we might be able to provide "cell therapy without cells." I'm also excited about the promise of pluripotent stem cells, a discovery based on technology that was awarded the 2012 Nobel Prize in Medicine and Physiology. These are cells that have been reprogrammed into their embryonic state and can therefore be directed to generate any type of adult cells, including heart muscle cells.

Dr. Braunwald: Despite steady progress in heart transplantation, many hundreds of people die each year waiting for a heart transplant [see "An advance in heart transplantation" in the July 2020 Heart Letter]. Over the years, there have been a number of successful interspecies transplants known as xenotransplantation including in non-human primates. In the past two years, two men with end-stage heart failure received transplants using genetically modified pig hearts. [One survived for six weeks, the other for two months]. Pigs are a logical choice because their hearts are similar in size to a human's. In both cases, several genes in the donor pig were inactivated and human genes were inserted into the pig's genome to stop the recipient from rejecting the new organ. These early studies have paved the way for further advances in xenotransplantation.

Dr. Braunwald: A left ventricular assist device, or LVAD, is a small pump implanted in the chest to help a greatly weakened, failing heart deliver blood to the body. In addition to becoming smaller, more powerful, and less expensive, LVADs will undergo other improvements in the coming years. Current devices use a driveline, a cable that passes through the skin to connect the pump to a battery and control system worn outside the body. In the future, devices will be charged through the skin without requiring a driveline, which is a common place for infections. Another potential advance is the use of biocompatible materials in the pump, which means patients might not need to take anti-clotting drugs. People with advanced heart failure may receive an LVAD temporarily while waiting for a heart transplant, or even instead of a transplant, in what we call "destination therapy."

Image: Westend61/Getty Images

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5 trends in cardiology to watch - Harvard Health

Cardiology

Top Policy and Practice News for Cardiologists in 2023 – TCTMD

***SPOILER ALERT: The following includes some solutions to our 2023 Cardiology Crossword Challenge***

Cardiology, like the world as a whole, had more headspace for introspection and growth in 2023 as the COVID-19 pandemic officially ended, allowing for shifts in practice and public policy.

Perhaps most on the minds of cardiologists is the momentum to create a new, independent medical board. The move comes after years of friction over the American Board of Internal Medicine (ABIM; 6 Down) mandate that midcareer physicians must pursue Maintenance of Certification (MOC) to show their competencya process that many cardiologists have argued is time-consuming and expensive. Application for the new board to the American Board of Medical Specialties is imminent, TCTMD reported this month.

Also gaining steam in 2023 have been debates over what constitutes the right credentials for managing patients with heart disease. Highlighting the tensions over scope of practice was the furor kicked off when Glenfield Hospitals cardiology X (formerly Twitter) account congratulated an advanced nurse practitioner (ANP; 44 Down) for performing a TAVI case as first operator. The resulting firestorm focused on safety concerns as well as worries that physician trainees might be missing out on chances to learn structural heart skills.

TCTMD spoke with Cathleen Biga, MSN, RN, president and CEO of Cardiovascular Management of Illinois and president-elect of the American College of Cardiology (CATHLEEN; 30 Down), who observed that its been a year of evolutions in team-based care and scope of practice that are important to both applaud and watch carefully.

This year marked the second for in-person meetings in the postpandemic era, with many dropping the option of live remote attendance, which in turn led to more discussion about how to balance work and life commitments against the fear of missing out (FOMO; 5 Down). For years, Twitter has been the place to keep up with live meeting updates, but many cardiologists have soured on the new X platform and a few have quit altogether.

But if some are pushing pause on some digital interactions, they may yet be turning to other online tools, including artificial intelligence (AI) and large language models. ChatGPT (19 Across) became one of the most talked-about technologies of the year and left journal editors scrambling to create rules around how to acknowledge AI authorship on submitted articles.

On the regulatory front, major US Food and Drug Administration decisions on drugs and devices made headlines. These include the approval of the first pulsed-field ablation catheter, two renal denervation (RDN; 54 Down) systems for treating high blood pressure, the first extravascular ICD (EVICD; 16 Across), the LimFlow (20 Down) device, and colchicine (2 Down), an old drug made new in CAD prevention, among others.

Lastly, two evolving approaches may help with the chronic shortage of hearts for transplantation. Leading the way is research supporting the safety and efficacy of hearts donated after circulatory death (DCD; 52 Down), while much more preliminary steps continue in the realm of genetically modified porcine hearts (PIG; 37 Down).

What Did We Miss?

Our Cardiology Crossword Challenge inevitably missed plenty of important developments this year.

Biga pointed out that the US Centers for Medicare & Medicaid Services physician fee schedule issued in late 2023, set to go into effect January 1, 2024, has elements that will impact the delivery of CV care: community health integration services, social determinants of health risk assessment, caregiver training, and principal illness navigation services. The latter two help overcome some limitations of existing chronic care codes, which have been hard for practices to implement, she explained. If we can really teach the family members to prevent readmissions and hospitalizations and ED visits, such caregivers would be a valuable focal point.

The endorsement for social determinants of health, noted Biga, will make it easier for clinicians to do their part in addressing equity.

Also pivotal, from a financial perspective, is the American Medical Associations ongoing Physician Practice Information Survey. Responses to the survey will help policymakers understand the costs involved in running a medical practice, Biga stressed: if these numbers arent accurate, Medicare physician payments could suffer.

The other thing that I think is critical that weve got to watch next year [is] how we do shared services, said Biga. The goal is to help maximize the skill sets of everyone on the teamphysicians, advanced practice nurses, registered nurses, pharmacists, etcto get that patient where they need to go . . . and still get paid for that whole embracing of the team.

And finally, US cardiologists should expect Medicare to continue the trajectory toward quality as a metric that factors into reimbursement, Biga highlighted. Within the agencys Quality Payment Program (QPP), theres now not only the Merit-Based Incentive Payment System (MIPS) but also, as of 2023, the MIPS Value Pathways (MPVs) reporting option. In 2024, she predicted the concept of value will become even more important.

As to the stewing controversies over scope of practice and shifting roles in cardiology, she herself has faced pushback over being the first nonphysician to lead the ACC. In her view, this expertise brings a unique perspective.

The reality is we have a physician workforce shortage [and] a nurse workforce shortage, so its necessary to find solutions, Biga commented. There are changes afoot, such as HR 2583, a bill specifying physicians arent the only ones able to prescribe cardiac rehabilitation, which will bring changes in this regard.

Team-based care, to be done right, requires balance, she stressed. It involves making sure everyone is working at the top of their license and not over their license, making sure people are working in their lane, said Biga. What we need within CV care delivery is a mechanism that weaves. . . . Medicine is an art as well as a science. This weaving together of everybodys skill sets comes out into a beautiful brocade, but only if its woven with the strengths of each individual aligned in the right way.

As cardiology becomes ever more specializedand subspecializedevery team member offers their own expertise, she added.

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Top Policy and Practice News for Cardiologists in 2023 - TCTMD

Cardiology

Colchicine Not the Answer for Recurring Arrhythmias After Ablation – Medpage Today

For patients undergoing catheter ablation for atrial fibrillation (Afib), there was no signal that a brief course of colchicine reduced atrial arrhythmia recurrence or improved clinical outcomes when taken for 10 days starting right before the procedure, a small pilot trial found.

By 14-day Holter monitoring, colchicine did not prevent atrial arrhythmia recurrence immediately after ablation (31% vs 32% with placebo; HR 0.98, 95% CI 0.59-1.61), nor at 3 months (14% vs 15%; HR 0.95, 95% CI 0.45-2.02), reported Alexander Benz, MD, MSc, of the Population Health Research Institute at McMaster University in Hamilton, Ontario, and colleagues.

The anti-inflammatory drug also did not reduce the composite of emergency department visits, cardiovascular hospitalizations, cardioversions, or repeat ablations during a median follow-up of 1.3 years (29 vs 25 per 100 patient-years; HR 1.18, 95% CI 0.69-1.99).

Yet IMPROVE-PVI was "not sufficiently powered to definitively exclude a clinically significant benefit with colchicine," Benz and team cautioned in their report published in Circulation: Arrhythmia and Electrophysiology.

They highlighted the finding that the incidence of post-ablation chest pain suggestive of pericarditis was reduced with colchicine (4% vs 15%; HR 0.26, 95% CI 0.09-0.77).

"This reduction was observed within days following catheter ablation, suggesting anti-inflammatory effects of short-term treatment with colchicine. This finding is in line with evidence on the efficacy of colchicine in the prevention and treatment of pericarditis and postpericardiotomy syndrome following cardiac surgery," Benz and colleagues wrote.

"Although our definition of pericarditis differed from more stringent definitions, the observed beneficial effect of colchicine on post-ablation chest pain in this placebo-controlled, double-blind trial was clinically meaningful," they argued.

Colchicine is a widely prescribed anti-inflammatory agent that is known to have cardiovascular prevention benefits.

Given that the success of catheter ablation via pulmonary vein isolation is often marred by recurrent atrial arrhythmias, and such arrhythmias are predicted by inflammatory biomarkers, the trialists had hypothesized that colchicine would be of help.

As expected, colchicine therapy resulted in diarrhea as a side effect in IMPROVE-PVI. Yet the incidence of diarrhea was particularly high in this trial (26% vs 7% with placebo; HR 4.74, 95% CI 1.95-11.53) compared with prior observations.

"Possible reasons for the discrepancy in diarrhea incidence between our and other studies include differences in outcome definitions and patient characteristics, as well as potential interaction of colchicine with concomitant medications," the authors suggested.

The present trial had been conducted at a single center and enrolled patients scheduled for catheter ablation. Those with contraindications to colchicine, namely those taking certain medications or those with serious gastrointestinal disease, overt hepatic disease, or severe renal disease were excluded.

Participants were randomized to colchicine 0.6 mg twice daily or placebo for 10 days, starting within 4 hours before ablation.

Recurring atrial arrhythmia was defined as Afib, atrial flutter, or atrial tachycardia >30 seconds on two 14-day Holters performed immediately and at 3 months following ablation.

The study cohort consisted of 199 patients (median age 61 years, 22% women, 70% undergoing their first ablation procedure) who had either received radiofrequency ablation using the Carto 3 system from Biosense Webster (79%) or cryoballoon ablation with Medtronic's Arctic Front system (21%).

Antiarrhythmic drugs were prescribed at discharge for 75% of patients. At 6-month follow-up, the proportion of patients off antiarrhythmic therapy was 62.2% and 57.0% of the colchicine and placebo groups, respectively.

One person died of sepsis in the colchicine group, whereas there were no deaths in the placebo group.

Benz and colleagues acknowledged that on top of the small sample, they did not look for recurrent arrhythmias using implantable loop recorders, likely resulting in an undercounting in both treatment groups.

Since IMPROVE-PVI was conducted, another technology for catheter ablation, pulse field ablation (PFA), was FDA approved. Medtronic's PulseSelect PFA system was approved last week, while rival PFA system Farapulse from Boston Scientific has yet to be given the green light.

Unlike conventional catheter ablation for Afib, PFA avoids thermal damage to the esophagus or phrenic nerve.

Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow

Disclosures

The trial was supported by the Hamilton Health Sciences' New Investigator Fund and the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario.

Benz reported a personal research grant from the German Heart Foundation and lecture fees from Bristol Myers Squibb.

Primary Source

Circulation: Arrhythmia and Electrophysiology

Source Reference: Benz AP, et al "Colchicine to prevent atrial fibrillation recurrence after catheter ablation: a randomized, placebo-controlled trial" Circ Arrhythm Electrophysiol 2023; DOI: 10.1161/CIRCEP.123.012387.

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Colchicine Not the Answer for Recurring Arrhythmias After Ablation - Medpage Today

Cardiology

Chamber Cardio Launches Innovative Value-Based Cardiology Care Platform with Early Success – PR Newswire

WASHINGTON, Dec. 19, 2023 /PRNewswire/ --Chamber Cardio, a pioneering technology-enabled delivery platform, is proud to announce its official launch. Positioned as a partner for cardiology practices navigating the transition to value-based care, Chamber Cardio addresses the pressing clinical and financial challenges faced by the cardiology industry today.

In the current landscape, only a fraction - less than 15% - of cardiology practices have embraced value-based contracts, while the financial burden of cardiovascular disease remains substantial for the healthcare system. Chamber Cardio, leveraging technology-enabled support, emerges as a transformative solution, providing evidence-based insights as well as operational support crucial for success in value-based care.

Designed with cardiologists in mind, Chamber Cardio offers a suite of tools aimed to help them in their transition to value-based care. The customizable platform enables cardiologists to regain control by offering real-time data, evidence-based guidelines, and contracting support. Additionally, Chamber Cardio provides a dedicated care team that acts as an extension of practices, facilitating the implementation of value-based contracts.

Co-Founded by George Aloth, a former BCBS health plan President & CEO and kidney care VBC executive, Dr. Sameer Sheth, a cardiologist at Massachusetts General Hospital, andDr. Jeffrey De Flavio, a Co-Founder of Pearl Health and founding CEO of Group Recover Together,Chamber Cardio is positioned as the go-to solution for cardiologists committed to improving outcomes and growing their practice.

"As a practicing cardiologist, I've both experienced and witnessed the challenges faced within practices," notes Co-Founder and President, Dr. Sameer Sheth. "Chamber Cardio is our response to these challenges. It's a platform built by cardiologists, for cardiologists, empowering us to deliver the best care possible while fostering collaboration and innovation in our field."

"Chamber Cardio is not just a platform; it's our vision to transform cardiology care," explains George Aloth, Co-Founder & CEO. "Our goal is to provide unparalleled support to cardiologists in their transition to value-based care, putting them in control of their practice while offering patients the best experience, ultimately improving health outcomes for heart disease."

The platform addresses inefficiencies in existing care models that often lead to increased acute events for patients and challenges for cardiologists. "Practicing outcome driven cardiology reduces health disparities and improves care for everyone," said Co-Founder Dr. Jeffrey De Flavio. "We are going to change the way our nation's cardiologists practice, freeing them from short-sighted incentives and aligning them with patients."

Chamber Cardio distinguishes itself by offering its technology platform, contracting services and care team support in the transition to value-based care free to practices. This commitment to partnership with network practices ensures a win-win scenario for all. Additionally, Chamber Cardio facilitates local physician networking for patient referrals, creating a robust and interconnected cardiology community.

Chamber Cardio is poised to make a dramatic impact on both cardiology practices and health plans. By making the transition to value-based care more accessible, Chamber Cardio empowers cardiologists to provide top-quality care, increasing revenue potential for practices and substantially lowering health plan costs.

About Chamber Cardio:Chamber Cardio is a groundbreaking healthcare company designed to support cardiologists in their shift to providing value-based care. Co-Founded by George Aloth, Dr. Sameer Sheth, and Dr. Jeffrey De Flavio, Chamber Cardio empowers cardiology teams with the tools, resources, and support needed to excel in the evolving healthcare landscape. Chamber Cardio is committed to improving patient care and enhancing the capabilities of cardiology practices.

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Chamber Cardio Launches Innovative Value-Based Cardiology Care Platform with Early Success - PR Newswire

Cardiology

Drinking in moderation can help avoid ‘holiday heart syndrome’ – UT Southwestern

(Photo credit: Getty Images)

DALLAS Dec. 20, 2023 The holiday season is a time for celebration, but too much celebrating can be bad for your health.

December brings a notable bump in the number of patients who show up at hospital emergency rooms with whats known unofficially as holiday heart syndrome heart rhythm problems caused by excessive alcohol consumption, said Sharon Reimold, M.D., Professor and Vice Chair for Clinical Operations and Faculty Development in the Department of Internal Medicine at UT Southwestern Medical Center.

Sharon Reimold, M.D., Professor and Vice Chair for Clinical Operations and Faculty Development in the Department of Internal Medicine at UTSouthwestern, holds the Gail Griffiths Hill Chair in Cardiology.

Its common for people to go to multiple parties during this time of year. You go to one party and have a drink or two, go to the next party and have a couple more. Its the cumulative effect of alcohol that can put you at risk, sending your heart into atrial fibrillation, noted Dr. Reimold, who is a cardiologist.

Atrial fibrillation, or AFib, is an irregular and rapid contraction of the upper chambers of the heart. The most common symptoms include shortness of breath, lightheadedness, chest pain, heart palpitations, and a feeling that the heart is beating much faster than normal. AFib is associated with an increased risk of stroke and heart failure.

Symptoms may be sporadic and usually clear up within 24 hours, but you should never ignore them. Always seek medical assistance whenever you experience heart problems, including holiday heart syndrome.

The condition doesnt manifest only during the holidays. It can occur any time excess alcohol is involved. Too much food, particularly salty foods, can also be a contributing factor.

Federal health guidelines define moderate alcohol consumption as no more than two drinks a day for men and no more than one a day for women. A drink is defined as 8 ounces of beer, 5 ounces of wine, or 1.5 ounces of spirits. Those guidelines also recommend no more than 2,300 milligrams of sodium a day. The American Heart Association advocates limiting sodium to 1,500 milligrams a day.

Studies have found a significant proportion of new AFib cases are linked with drinking too much alcohol. And once an episode has been confirmed, patients have a greater chance of AFib recurring in the future.

Dr. Reimold advises people in the holiday spirit to pay attention to how much theyre drinking and eating this season. Moderation is key, she said. Another option includes the growing market of nonalcoholic beers, alcohol-free wines, mocktails, and no-alcohol spirits, from tequila to whiskey to gin.

Dr. Reimold holds the Gail Griffiths Hill Chair in Cardiology.

About UT Southwestern Medical Center

UT Southwestern, one of the nations premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institutions faculty members have received six Nobel Prizes and include 26 members of the National Academy of Sciences, 21 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,100 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year.

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Drinking in moderation can help avoid 'holiday heart syndrome' - UT Southwestern

Cardiology

Top Cardiology Trials and Studies of 2023: Insights and Breakthroughs – Medriva

The world of cardiology continually progresses with new trials and studies, yielding vital breakthroughs and insights. In 2023, several significant cardiology trials were presented at major conferences such as the American College of Cardiologys Annual Scientific Session (#ACC23) and the American Heart Associations Scientific Sessions (#AHA23). Esteemed cardiologists @HeartBobH and @CMichaelGibson revisited these trials, providing a comprehensive review of the latest developments and research.

The American College of Cardiology highlighted several clinical topics in 2023. These included acute coronary syndromes, anticoagulation management, arrhythmias and clinical EP, atherosclerotic disease, and cardiac surgery. The ACC.org also provided related content such as guidelines, JACC journals, education and meetings, membership details, and tools and practice support. These resources offered invaluable insights into the latest findings and strategies in cardiology.

The American Journal of Managed Care provided coverage of five major topics from 2023s cardiology conferences. These included the elevated in-hospital mortality among female patients who had Acute Myocardial Infarction (AMI) and Myocardial Contusion (MC), the effective management of Heart Failure (HF) self-care post-discharge using an app, and the reduction of recurrence risk by 25% in the most common type of breast cancer by combining Ribociclib with hormonal therapy. Additionally, the importance of examining and preventing atrial fibrillation was emphasized, along with updates on efforts toward eradicating Chronic Lymphocytic Leukemia (CLL).

Various studies and clinical trials related to cardiology were featured on the JAMA Network in 2023. These encompassed a broad range of topics, from the impact of dietary interventions on blood pressure to AI explanations for biased AI models in cardiology. There was also a focus on food industry behavior, late-breaking science, and clinical highlights from the American Heart Associations Scientific Sessions meeting. Other studies compared health outcomes using different cardiac risk stratification pathways, and examined topics such as hypothermia, neprilysin inhibition, statins, medication nonadherence, and cardiovascular complications among survivors of childhood cancer.

The major cardiology trials of 2023 presented at #ACC23 and #AHA23 have shed light on numerous aspects of cardiovascular health. The valuable insights and breakthroughs gained from these trials are shaping the future of cardiology, leading to improved strategies for prevention, diagnosis, and treatment of cardiovascular diseases. As we move forward, it is crucial to continue revisiting these trials and studies to keep abreast of the latest developments in the field, ultimately enhancing patient care and outcomes in cardiology.

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Top Cardiology Trials and Studies of 2023: Insights and Breakthroughs - Medriva

Cardiology

Overview of Major Cardiology Trials in 2023 – Medriva

Overview of Major Cardiology Trials in 2023

With each passing year, advancements in the field of cardiology are made at an astonishing rate. The year 2023 was no different, with crucial cardiology trials and research being conducted, pushing the boundaries of our knowledge and understanding of cardiovascular health. Renowned cardiologists, Robert A. Harrington and C. Michael Gibson, reviewed these trials, shedding light on the latest developments and their potential impact on the field.

The ACC 23 held in New Orleans was a significant event that brought together cardiology experts from around the globe. One of the highlights was the CLEAR Outcomes trial. This trial showed that the addition of bempedoic acid to other therapies significantly reduced clinical events for patients who are intolerant to statins. The studys findings emphasize the importance of having alternatives and choices for lowering LDL-C levels.

Another noteworthy trial discussed by Harrington and Gibson was a phase 2 trial with an oral PCSK9 inhibitor. This study underlines the importance of exploring different methods of treating cardiovascular diseases. The PCSK9 inhibitor trial is a prime example of how alternative therapies can provide viable options for lowering LDL-C levels, thus broadening the spectrum of potential treatments.

A comprehensive review of the top cardiology trials of 2023 further underscores the importance of these trials for the future of cardiology. This includes major clinical topics highlighted by the American College of Cardiology, the top five conference coverage, and key studies and clinical trials featured on the JAMA Network. Revisiting these trials is essential as it not only provides a better understanding of the studies but also paves the way for future research and developments.

2023 saw some remarkable breakthroughs in heart disease treatment and research. These included new drug therapies, innovative medical devices, and novel treatment approaches. These advancements have the potential to revolutionize the way cardiovascular diseases are treated, offering new hope to patients worldwide. The top cardiology trials of 2023 have demonstrated that the field of cardiovascular research is continuously evolving, with each breakthrough bringing us one step closer to finding more effective treatments for heart diseases.

The top cardiology trials of 2023 have provided valuable insights into the latest advancements in the field. The trials not only showcased the potential of new and alternative therapies but also emphasized the importance of continuous research. As we move forward, these trials will undoubtedly play a crucial role in shaping the future of cardiology, providing a strong foundation for upcoming research and the development of more effective and efficient treatments for cardiovascular diseases.

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Overview of Major Cardiology Trials in 2023 - Medriva

Cardiology

New drugs, updated treatment strategies: 5 important trends in cardiology from an eventful 2023 – Cardiovascular Business

With the end of the year rapidly approaching, the American Heart Association (AHA) editorial staff has published a list of some of 2023s biggest breakthroughs in cardiovascular disease (CVD) research.

In 2023, investigators made important strides toward improving and extending the lives of people affected by these conditions, along with potentially lowering the burden of disease with therapies and strategies that hold promise for prevention, the AHA editors wrote. Particularly noteworthy were advances in technology to restore blood flow to blocked and narrowed arteries, potentially preventing death and disability for a wide range of patients, including those with severe illness.

The AHAs choices included:

A new investigational drug, zilebesiran, can decrease the production of angiotensinogen, a protein believed to contribute to a patient's risk of high blood pressure. Early data suggests taking zilebesiran for eight weeks is associated with reductions in key blood pressure measurements compared to a placebo; higher doses are linked to higher reductions.

Not only does the suppression of angiotensinogen hold promise for more effectively reducing hypertension for extended periods of time after injection, there is growing excitement over the possibility it also might be therapeutic for kidney and heart disease, AHAs editors wrote. The results are also highly significant because only a single dose was needed, which could improve access to care and adherence to long-term drug regimens.

The full analysis was published in The New England Journal of Medicine.[1]

The concept of using intravascular imaging to guide percutaneous coronary intervention (PCI) procedures gained significant momentum in 2023. (Cardiovascular Business wrote about this topic several times, including here, here and here.)

AHAs editors highlighted multiple studies that examined the potential impact of intravascular imaging. The ILUMIEN IV study, for example, found that PCI guided by optical coherence tomography (OCT) resulted in a larger minimum stent area than angiography-guided PCI. That analysis was published in full in The New England Journal of Medicine.[2]

The OCTIVUS trial, published in Circulation, showed that OCT-guided PCI and intravascular ultrasound were both safe and effective treatment options for patients with significant coronary artery lesions.[3]

Treating atrial fibrillation (AFib) patients with direct-acting oral anticoagulants (DOACs) after a stroke can reduce their risk of experiencing another strokebut the exact timing of prescribing those DOACs remains unclear.

Doing so too early could increase the risk of brain bleeds, while doing so later could raise the risk of having a second stroke, AHAs editors wrote.

Physicians typically recommend stroke patients wait a few days before they start taking DOACs, but new research published in The New England Journal of Medicine provided evidence that those patients could start treatment even sooner.[4]

Overall, the study found that starting DOAC treatment within 48 hours of a stroke was associated with outcomes comparable to starting treatment on day three or four after a strokeone key difference was that the risk of recurrent stroke appeared to decrease with early treatment.

The trial was not designed to test whether earlier treatment was better than later treatment, but to help health care providers estimate possible outcomes, the editors wrote.

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New drugs, updated treatment strategies: 5 important trends in cardiology from an eventful 2023 - Cardiovascular Business

Cardiology

Cardiologists’ Holiday Wish: Medicare Pay Cuts Roasting on an Open Fire – TCTMD

As in Decembers past, the cardiology community is once again calling on Congress to stave off cuts to the Medicare Physician Fee Schedules that go into effect in 2024.

Annually, the US Centers for Medicare & Medicaid Services (CMS) announces its Physician Fee Schedule (PFS), and for the past several years, cardiologists have protested cuts for the care or services they provide. Some have called for an overhaul of the whole system, which often results in advocacy groups scrambling for last-minute legislation to push off proposed cuts to reimbursement. This year is no different, with an impending 3.37% cut to the Medicare PFS next year.

We have once again arrived at American clinicians annual holiday tradition: urging Congress to not allow cuts to Medicare services that exacerbate financial uncertainty for practices, further threaten patient access to care, and disproportionately impact Americas rural and senior populations, said B. Hadley Wilson, MD (Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC), president of the American College of Cardiology (ACC), in a press release. For decades we have spent December looking for a quick fix to a problem that requires significant reforms. We must seek and establish sustainable payment practices that allow clinicians to continue providing access to high-quality care. While addressing this upcoming cut is critical, it is a short-term adjustment that will not create a long-term solution. It is necessary to protect patients now while we work together on lasting reform.

The ACC, as well as other medical groups like the American Medical Association (AMA), are urging members of Congress to pass the Preserving Seniors Access to Physicians Act of 2023 (HR 6683), proposed by Congressman Greg Murphy, MD, of North Carolina. This would eliminate the planned 3.37% Medicare cuts scheduled for January 1, 2024.

Last month, a total of 54 medical societies, including the ACC, the Society for Cardiovascular Angiography & Interventions (SCAI), and the Society of Thoracic Surgeons (STS), sent a joint letter to Congress demanding the full cut be dropped.

Because physicians, unlike other providers, dont receive an automatic inflationary update within Medicare, a cut of this magnitude would be detrimental for most, especially given the current rate of inflation growth. Medicare physician payments have dropped by 26% in the last 20 years, while practice expenses have risen by 47% over the same period, according to the ACC.

Continuing down this road is unsustainable, said AMA President Jesse M. Ehrenfeld, MD, MPH (Vanderbilt University Medical Center, Nashville, TN), in an AMA press release. These cuts will be felt first and hardest in rural and underserved areas that continue to face significant healthcare access challenges.

That said, Ehrenfeld continued, as Kate McCallister famously said in Home Alone, This is Christmasthe season of perpetual hope. . . . We urge lawmakers to act quickly, preserve Medicare access, and pass this vital legislation.

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Cardiologists' Holiday Wish: Medicare Pay Cuts Roasting on an Open Fire - TCTMD