Top in endocrinology: Incretin-based therapies; updated diabetes guidance Healio
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Top in endocrinology: Incretin-based therapies; updated diabetes guidance - Healio
Monthly Archives: December 2023
Normal BMI Associated With Improved IVF Outcomes – Endocrinology Advisor
Same-Day Prostate Cancer Surgery Associated With Satisfaction, Lower Costs – Endocrinology Advisor
Coffee and Tea Consumption Linked to Lower Metabolic Syndrome Mortality – Endocrinology Advisor
Hypothyroidism vs Hyperthyroidism Associated With Intracranial Aneurysm Risk – Endocrinology Advisor
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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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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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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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
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