Category Archives: Cardiology

Cardiology

7 New Year’s Resolutions for Heart Health From Cardiologists – Livestrong

If you're over 40, make an appointment this year to get your heart checked.

Image Credit: andreswd/E+/GettyImages

February is American Heart Month, but you don't have to wait until then to show your heart some love.

Heart disease is still the leading cause of death in the U.S., per the Centers for Disease Control and Prevention (CDC), so it's important to stay on top of your heart health in any way you can.

We asked cardiologists what resolutions they'd like patients to make in regards to their hearts year. Here's what they said:

As with most New Year's resolutions, we start out super motivated in January with diet and exercise goals, then lose momentum as the days go by.

This year, try to be more realistic about your resolutions. This can set you up for consistent, long-term changes in your health, which will ultimately protect your heart in the long term, too.

Case in point: "Diets [and exercise] that begin in colder months fail more than those that begin in the spring," says Allan Stewart, MD, a cardiac surgeon in Miami, Florida. "A great New Year's resolution is to set modest, realistic goals from January to March, and then as you succeed, ramp up those goals in the spring."

For example, maybe a 10,000-step-per-day goal is unrealistic in the wintertime, so start with 5,000 per day and increase as the weather gets warmer.

Only 1 in 10 Americans eat the recommended amount of produce per day, according to the CDC.

But eating enough fruits and veggies reduces your risk of having (and dying from) heart disease and a stroke by up to 27 percent, per an October 2020 meta-analysis in the Journal of the American Heart Association.

One doable way to eat more produce? "Add a piece of fresh fruit to your breakfast and a side of veggies to lunch and dinner," says Karishma Patwa, MD, a cardiologist with Manhattan Cardiology in NYC and contributor to LabFindDieter.

Another bonus: Eating more produce aligns with the Mediterranean diet, which has been shown to be beneficial for your heart, per the Mayo Clinic.

"The five major risk factors for heart disease high cholesterol, high blood pressure, high blood sugar, overweight and poor diet are often food-related," says Elizabeth Klodas, MD, FACC, a preventive cardiologist in Edina, Minnesota, and creator of Step One Foods.

"Changing your diet is especially powerful, but I'm not asking anyone to turn their life upside down," Dr. Klodas says.

Instead, plan to add one nutritious food and remove one not-so-nutritious food from your diet each day.

This could look like eating an apple a day and removing a can of soda each day (or whatever is applicable to your diet). While one day of change won't do much, sticking with this habit over the course of a year is very beneficial.

Dr. Klodas also mentions this two-per-day approach has helped people significantly reduce their "bad" LDL cholesterol within 30 days. This method was also supported by February 2020 research in The Journal of Nutrition.

The Physical Activity Guidelines for Americans recommend getting 150 minutes of moderate-intensity exercise every week for optimal health, per the CDC, which equals about 30 minutes of activity five days per week.

"If this amount feels daunting, you can try to break it into shorter bursts of exercise," Dr. Patwa says.

She recommends taking small, two- to three-minute walks every hour. If you spend eight hours of the day sitting at a desk, for example, that's about 24 minutes of walking a day almost at the goal. Plus, you'll be giving your body a much-needed break from sitting still.

Alcohol in any amount is associated with a higher risk of heart disease, according to a March 2022 study in JAMA Network Open.

If you've tried to commit to a "dry" January (where you don't drink alcohol for the month) and have missed the mark, know that this is the ideal year to do it, Dr. Stewart says. That's because "New Year's Day is a Monday," he says.

Many people see Monday as the day to start fresh and kick off healthier habits. In contrast, Dr. Stewart says when the day falls on a Friday or Saturday, it's more difficult to start dry January, especially because the New Year parties can keep going through the weekend.

If you feel you've overindulged in alcohol over the holidays (as many of us do), dry January can give you a break. Plus, it gives you a chance to reevaluate your relationship with alcohol.

Keep in mind: This means you may have to change up how you socialize with friends, so planning is key, Dr. Stewart says. And try to avoid counting down the days until February 1, he adds.

"It's important not to count down the days until January 31, as it somewhat defeats the purpose of the potential joy you could feel in the process, or the potential to stay sober [beyond January 31]," he says.

If the hectic holiday season left you even more sleep-deprived than you already were, let January be the time you get into a good sleep schedule.

When we're low on sleep, we tend to reach for "quick pick-me-ups like caffeine and sugar," Dr. Klodas says, which can lead to heart palpitations and other issues.

The American Heart Association suggests getting seven to nine hours of sleep per night, as well as getting treated for sleep disorders, such as insomnia, restless leg syndrome or sleep apnea.

To that end: "Non-restorative sleep, especially when due to sleep apnea, can be a major contributor to high blood pressure," Dr. Klodas says, which is a risk factor for heart disease, heart attack and other serious health conditions.

If you, your bed partner or someone in your household suspects you have a sleep disorder (because you snore, talk in your sleep or stop breathing during sleep), this may be the year to finally get a sleep study done and treat the problem.

Are you over 40? If so, Dr. Patwa recommends going to the cardiologist for a preventive screening.

This can help ensure your heart's working properly.

If your doctor has any concerns about your heart, they may run tests such as an electrocardiogram, echocardiogram or stress test, which are the best ways to pick up on heart disease, Dr. Patwa says.

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7 New Year's Resolutions for Heart Health From Cardiologists - Livestrong

Cardiology

Smidt Heart Institute at Cedars-Sinai opens Aortic Surveillance Clinic for patients with enlarged aortas – News-Medical.Net

The Smidt Heart Institute at Cedars-Sinai has opened an Aortic Surveillance Clinic for the evaluation and long-term monitoring of patients with enlarged aortas, or aortic aneurysms, for whom surgery may not be necessary.

The clinic is the newest offering from the heart institute's dedicated Aortic Program, an interdisciplinary team of highly specialized cardiologists, cardiac and vascular surgeons, radiologists, genetic counselors, and nurses treating the full spectrum of aortic disorders.

"When patients hear that they have an aortic aneurysm, they often think they are ticking time bombs, but that is not always the case," said Robbin Cohen, MD, professor of Cardiac Surgery and director of the Cardiac Surgery Program at Huntington Health, a Cedars-Sinai affiliate. "Most of the patients that we see-;many with genetic conditions affecting the heart-;have aortas that are not large enough or serious enough to need surgery, but they do require ongoing monitoring.

"Through the Aortic Surveillance Clinic, we offer reassurance that they are being carefully and closely monitored and that proper therapy, including surgery, will be offered if needed."

Smidt Heart Institute patients benefit from access to a multidisciplinary team including cardiac and vascular surgeons skilled in treating a range of aortic conditions.

We take pride in our collaborative approach, which benefits patients with various complex aortic diseases. Our team is versed in innovative, minimally invasive procedures, in which cardiac surgeons and vascular surgeons are thorough and thoughtful in how best to manage each individual patient's needs."

Ali Azizzadeh, MD, vascular surgeon, professor and director of Vascular Surgery, associate director of the Smidt Heart Institute at Cedars-Sinai and an aortic aneurysm expert

Cohen has more than 25 years of experience monitoring and treating patients with aortic aneurysm.

"Aortic surgeons know that over time, they will accumulate hundreds of patients with aneurysms that they are following and not operating on," Cohen said. "This requires expertise in aortic imaging, the natural history of aortic disease, and the guidelines and criteria for surgery-;areas in which the Smidt Heart Institute team is highly skilled."

The aorta is the largest and most important artery. It carries blood away from the heart into the rest of the body. Careful monitoring of a significantly enlarged aorta, or aortic aneurysm, can help prevent the possibility of a life-threatening condition, such as aortic dissection-;a tear that develops along the inner layer of the aorta.

The Aortic Surveillance Clinic also provides expert care for patients with certain genetic syndromes, such as connective tissue disorders like Marfan syndrome and Loeys-Dietz syndrome, as well as other genetic disorders affecting the aorta and aortic valve, such as Turner syndrome. These patients are at high risk of developing an enlarged aorta and subsequently, a tear or dissection in the aorta due to abnormalities in the heart and blood vessels. Because these disorders also can affect other areas of the body, the Aortic Surveillance Clinic goes a step further and addresses these issues by connecting patients with genetic counselors, ophthalmologists, orthopedists, psychologists, reproductive endocrinologists and other specialists, as needed.

"We are pleased to have the ability to focus on a subset of patients when they don't need surgery-;and educate them on how to prevent acute aortic events, which can be fatal," said Joanna Chikwe, MD, chair of the Department of Cardiac Surgery and the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery in the Smidt Heart Institute at Cedars-Sinai. "And if these patients do need surgery-;which can be complex and challenging-;the Smidt Heart Institute has the expertise of a comprehensive, multidisciplinary team to take care of them, with superb results."

The Aortic Surveillance Clinic is located at 127 San Vicente Blvd., in Los Angeles and is open for patient evaluation the second Friday of each month. Patients can call 310-423-3851 for more information.

Cedars-Sinai once again has been recognized by U.S. News & World Report, this year as the #2 program in the nation for Cardiology, Heart & Vascular Surgery. The Smidt Heart Institute is also #1 for Cardiology, Heart & Vascular Surgery in California and Los Angeles (highest U.S. News ranking in the region).

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Smidt Heart Institute at Cedars-Sinai opens Aortic Surveillance Clinic for patients with enlarged aortas - News-Medical.Net

Cardiology

Creatinine and Cystatin C-based GFR Estimation in HF Mortality – Physician’s Weekly

The following is a summary of Prognostic Value of Creatinine versus Cystatin C-Based Estimation of Glomerular Filtration Rate for Mortality in Heart Failure, published in the November 2023 issue of Cardiology by Roehm et al.

Researchers conducted a retrospective study to examine heart failure with reduced ejection fraction (HFrEF) data, comparing the prognostic power of creatinine and cystatin C-based estimated glomerular filtration rate (eGFR), alone and combined, to pinpoint the most accurate predictor of mortality.

They examined data from 310 participants in the Registry Evaluation of Vital Information for Ventricular Assist Devices in Ambulatory Life with baseline serum creatinine and cystatin C. The primary outcome was all-cause mortality. Cox models were adjusted for age, gender, race, diabetes mellitus, and NYHA class.

The results showed median eGFR by cr, cys, and cr-cys were 60, 58, and 60 ml/min/1.73m2, respectively. In the 2-year follow-up, 45 participants died, with eGFRcr and eGFRcys differing by -49 to 50 ml/min/1.73m2 within each patient. Worse survival was observed for estimates with baseline eGFR <60 ml/min/1.73m2. Lower baseline eGFRcr [HR 0.97, 95% CI (0.96-0.99), P =0.008, C 0.67], eGFRcys [HR 0.98 (0.97-0.99), P= 0.006, C= 0.68], and eGFRcr-cys [HR 0.98 (0.96-0.99), P= 0.004, C= 0.68] correlated with higher mortality. C-statistic comparisons revealed no significant difference in predictive ability: eGFRcr vs. eGFRcys, P=0.7; eGFRcr vs. eGFRcr-cys, P=0.9; eGFRcys vs. eGFRcr-cys, P=0.3).

They concluded that eGFR was linked to HFrEF death, but creatinine and cystatin C flunked as accurate predictors.

Source: ahajournals.org/doi/10.1161/circ.148.suppl_1.17090

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Creatinine and Cystatin C-based GFR Estimation in HF Mortality - Physician's Weekly

Cardiology

Pulse Biosciences Announces First-in-Human Procedures with its Novel CellFX Nanosecond Pulsed Field Ablation … – Diagnostic and Interventional…

December 26, 2023 Pulse Biosciences, Inc., a company primarily focused on leveraging its novel and proprietary CellFX Nanosecond Pulsed Field Ablation (nsPFA) technology for the treatment of atrial fibrillation, announced the completion of the first five procedures in its first-in-human feasibility study with its novel CellFX nsPFA cardiac catheter. All patients were successfully discharged by treating physicians. Patients will continue to be monitored and evaluated over the coming months to assess safety and effectiveness with the primary safety endpoint at 30 days.

Dr. Vivek Reddy, Director of Cardiac Arrhythmia Services at Mount Sinai Hospital, NY, and Dr. Petr Neuzil, Chief of Cardiology at Na Homolce Hospital, Prague, and colleagues used the Companys CellFX nsPFA 360 cardiac catheter integrated with 3D mapping and navigation technologies (iMap System, CardioNXT) to successfully treat five patients with atrial fibrillation (AF) at Na Homolce Hospital, a renowned research institution hospital in Prague, Czech Republic.

We have been collaborating with Pulse Biosciences to bring their novel nsPFA technology to the clinical realm, and are excited to report that our experience with these first five patients has validated our belief that this may represent the next generation of PFA technology for the treatment of AF, said Dr. Reddy. The results were consistent with our preclinical experience. Importantly, the speed and ease with which we were able to isolate the pulmonary veins with the nsPFA 360 catheter was impressive and all patients tolerated the procedure well. Now we look forward to completing enrollment in this study to fully assess the safety and durability of nsPFA treatment.

Pulse Biosciences CellFX nsPFA 360 cardiac catheter, which is still in the investigational stage, is uniquely designed to produce a nonthermal ablation, initially targeted for pulmonary vein isolation, using the Companys proprietary CellFX nsPFA energy in the treatment of atrial fibrillation. The catheter is designed to deliver a fast, transmural and fully circumferential ablation in a single energy delivery. The CellFX nsPFA cardiac catheter is integrated with 3D mapping and navigation to deliver a comprehensive visualization and precise ablation delivery solution.

Were honored to work with Dr. Reddy and his team and Prof. Petr Neuzil and his team at Na Homolce to bring our next generation nsPFA technology to the clinic. The unique value of nsPFA to deliver fast, precise, transmural and contiguous ablations in thick cardiac tissue is extremely exciting for the treatment of AF and we could not have found better partners, said Dr. Gan Dunnington, Chief Medical Officer, Cardiac Surgery of Pulse Biosciences. This initial clinical experience delivered as expected. We look forward to continuing our catheter clinical program and to starting our cardiac surgery clinical program with our surgical nsPFA clamp in 2024.

Kevin Danahy, President and CEO of Pulse Biosciences, having attended all patient cases, remarked on the recent milestone, As we embark on this new era of advancement in medical device technology, our mission is clear: to revolutionize healthcare with CellFX nsPFA, with the intention of significantly improving clinical outcomes for both patients and physicians. Through relentless innovation, unwavering dedication, and commitment to pushing the boundaries of what is possible in bioelectric energy, we are reshaping the future of the treatment for atrial fibrillation with our cardiac catheter in electrophysiology and with our cardiac clamp in cardiothoracic surgery. CellFX nsPFA will empower doctors, inspire patients to seek life-altering treatment, and create a world where CellFX nsPFA technology can become a catalyst for healing and hope.

The Company expects to enroll up to a total of 30 patients in the current feasibility study. Treated patients will be evaluated at regular intervals to further assess the safety and effectiveness of the treatments. The Company expects to provide additional updates on the first-in-human procedures with the CellFX system in the upcoming months. Pulse Biosciences will inform stakeholders promptly if results differ materially from the stated expectations addressing safety and efficacy. The observations to date have been positive but the broad set of risks associated with cardiac surgery remain. The Company anticipates initiating the regulatory process with the U.S. FDA and appropriate regulatory authorities worldwide including Europe in the coming quarters and expects additional studies will be required.

For more information: http://www.pulsebiosciences.com

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Pulse Biosciences Announces First-in-Human Procedures with its Novel CellFX Nanosecond Pulsed Field Ablation ... - Diagnostic and Interventional...

Cardiology

Holidays linked to surge in heart attacks, warns cardiology chief ahead of Christmas – WTOV Steubenville

OHIO COUNTY, W.Va. Heart health is not something most think of during the holidays but it should be.

Studies show the holidays are among the deadliest times of the year for heart attacks.

"There is a rise in heart attacks around the holidays, in particular this year because Christmas falls on a Monday. So, we will have more heart attacks and possibly even bigger heart attacks," said Mike Campsey, chief of cardiology, WVU Medicine Wheeling Hospital.

Studies show heart attacks most commonly occur on Mondays, as people push off their symptoms and wait until the weekend is over to address any issues.

And since its the holiday, they will just push them of further.

Campsey says there is a 15 percent increase of heart episodes during the holidays and a 35 percent increase on Christmas Eve alone.

"You know, I think it is important for patients to remember what the symptoms of a heart attack are," he said.

Chest discomfort, cold, clammy sweats, shortness of breath, arm pain, neck pain, shoulder pain, and jaw pain are the big ones.

"If its something that is new that has just come out of the patient of the person, I would just come in and get it checked out, come into the emergency room, Campsey said. I don't think putting it off until Monday or Tuesday is the way to do it."

In addition to calling 911, Campsey says make sure you are taking your medicine, and check your blood pressure and you can use aspirin if you are getting chest discomfort.

And for the holiday, he says not to steer away from your normal routine. Don't do more activities or eat more than usual. Stay consistent,

"You only get one heart, so you want to take care of it, Campsey said. So that would be the biggest reason to take care of your heart is you only get one."

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Holidays linked to surge in heart attacks, warns cardiology chief ahead of Christmas - WTOV Steubenville

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