A study in NEJM found that heart attack patients who took a “polypill” —a three-part cocktail of aspirin, ramipril, and atorvastatin—had fewer major cardiovascular events. But findings from the trial also left some docs scratching their heads.

In the study, researchers randomized 2.5k patients who had experienced a heart attack within the last six months into a “polypill” group or “usual-care” group. The polypill group received aspirin, statin, and ACE inhibitor in the form of one combo tablet, while those receiving usual care took each medication separately.

Over a three-year follow-up period, patients who took the polypill were 24% less likely to experience cardiovascular death, myocardial infarction, stroke, or urgent revascularization.

The polypill advantage likely came down to adherence. Patients who received the polypill were more likely to still be taking the pill consistently at two years compared to those who had to take three pills separately (74.1% vs. 63.2%).

The Twist: While the polypill seemed to protect against cardiovascular events, it did not produce meaningful changes in blood pressure or lipid levels.

The polypill and usual-care groups had nearly identical systolic (135.2 vs. 135.5 mmHg) and diastolic (74.8 vs. 74.9 mmHg) blood pressure scores at two years. LDL-cholesterol levels were also similar (67.7 vs. 67.2 mg/dL).

The Takeaway

The study underscores that convenience is often the key to compliance. Treatments won’t work unless they are consistently utilized, and the polypill was the patient-friendly solution some needed to stick to their prescribed regimen.

The fall of Roe v. Wade garnered reactions from cardiologists across the country, many emphasizing the burden pregnancy places on the heart– literally– and how the Supreme Court’s decision may endanger patients.

Cardiovascular disease is the leading cause of pregnancy-related death in the US, making cardiologists a key part of at-risk pregnant patients’ care teams. Cardiologists may discuss these patients’ CV health risks, the risks to the fetus, and the relative safety of continuing the pregnancy versus undergoing pregnancy termination.

Now, state lawmakers have the power to restrict the scope of these discussions. While most state abortion bans provide exceptions for pregnancies threatening the mother’s life, experts say the definition of “lifesaving” is murky.

Georgetown University law professor, Lawrence Gostin, explained how the vague language leaves cardiologists and other physicians’ criminal liability up in the air. “At best, it will make physicians hesitate to save the life of a woman; at worst, outright refuse to.”

The Consequences for cardiologists and other clinicians who breach abortion bans also vary widely by state, ranging from losing a medical license to life in prison.

Cardiology societies widely criticized the SCOTUS ruling, citing concerns about the integrity of patient-physician relationships, including this statement by The American College of Cardiology:

“The College is deeply concerned about the potential implications of the Supreme Court decision regarding Roe v. Wade on the ability of patients and clinicians to engage in important shared discussions about maternal health, or to remove previously available health care options, especially given the alarming maternal health crisis in the U.S.”

The Takeaway

Cardiology leaders made it clear that the decision to overturn the landmark ruling will have downstream consequences for cardiologists. These consequences will vary by state, and are still shrouded in ambiguity.

Physiological pacing has witnessed tremendous growth in the last ten years, and new funding may provide the evidence physicians need to make it the heart failure standard of care.

PCORI awarded $31M to Baylor University researchers to compare the standard Biventricular pacing (BiV) with the emerging conduction system pacing (CSP) – two cardiac resynchronization therapies that restore healthy heartbeat patterns in both HF and reduced ejection fraction patients.

BiV improves heart failure in 60-70% of patients by pacing simultaneously from two discrete sites: the right ventricular apex and the left lateral wall. In contrast, CSP relies on one lead implanted at either the His bundle or left bundle branch to directly stimulate the heart’s native conduction network. It is considered more physiologic, and it closely reproduces what happens naturally.

Observational and small-scale RCTs have shown that CSP produces equal or even better QRS duration and LV function improvements and possibly greater hemodynamic benefits. But CSP still needs to pass a large-scale RCT test before widespread adoption can happen.

Enter: PCORI-funded Baylor researchers. Here is what we know about how they plan to investigate the long-term mortality benefits and safety of CSP compared to BiV:

— Fifty-five centers will randomly assign more than 2k eligible patients to receive either CSP or BiV pacing.

— Follow-up will be five years.

— The endpoints will be death and heart failure hospitalization.

The Takeaway

Baylor's comprehensive study, backed by PCORI's significant funding, aims to shed light on the potential of CSP as a heart failure treatment standard. With CSP showing promise in preliminary studies, this large-scale trial could redefine cardiac pacing therapies and shape the future of heart failure care.

Medtronic is entering a strategic partnership with coronary artery disease startup CathWorks, deepening their relationship and securing an option to potentially acquire the company for up to $585M.

The CathWorks FFRangio System is at the heart of the new alliance. In contrast to traditional fractional flow reserve (FFR) techniques, the AI-powered FFRangio solution delivers multi-vessel FFR results from routine angiograms, eliminating the need for invasive pressure wires or drug stimulations. Data published in JACC in 2020 showed strong performance for FFRangio, which achieved a diagnostic accuracy of 93%.

Medtronic has kept a close eye on CathWorks since 2018, when it made a minority investment in the Israeli startup. Since then, CathWorks has secured FDA clearance for the FFRangio System, locked in two funding rounds totaling $60M, and expanded commercial availability to Japan.

Medtronic, recognizing the momentum, is now taking the alliance to new heights:

-Medtronic will invest an additional $75M in CathWorks.

-Together, they will co-promote the FFRangio System in the US, Europe, and Japan.

-If CathWorks achieves certain milestones, Medtronic will have the option to acquire the company for up to $585M.

Per the agreement, CathWorks has the right to compel Medtronic to acquire the company if Medtronic chooses not to exercise its option.

The Takeaway

Medtronic is tightening its ties to CathWorks through a $75M investment while laying the groundwork for a future acquisition. The partnership appears to benefit both parties: Medtronic gains a new AI solution to improve the diagnosis of CAD patients, and CathWorks scores a partner with a strong commercial team and a large existing customer base.