Seven cardiologists and leaders of cardiology service lines discuss the key clinical developments that are improving heart care.
Editor's note: Responses have been edited for clarity and length and are presented alphabetically.
Question: What is the most promising clinical innovation in cardiology today?
Kimberly Bell, vice president of Altamonte Springs, Fla.-based AdventHealth Cardiovascular Institute
From the AdventHealth Cardiovascular Institute perspective, the most promising clinical innovations in cardiology today include:
● Wireless iFR (wireless evaluation of stenotic CAD)
● TAVR for aortic stenosis and aortic insufficiency
● Robotic LIMA to LAD (left internal mammary artery to left anterior descending artery)
● Leadless AICD (implantable defibrillator)
● Renal artery denervation for hypertension
● Shock wave therapy for treatment for peripheral arterial disease and coronary artery disease
Gopi Dandamudi, MD, medical director of Tacoma, Wash.-based CHI Franciscan's cardiovascular service line
The ability to provide on-demand clinical appointments to patients virtually on a large scale and the ability to monitor patients in real time on a continuous basis using wearable technologies are two of the most promising clinical innovations in cardiology today. With the emergence of COVID-19 and the need for social distancing, these two innovations have enabled us to continue to deliver care to our most vulnerable patients by keeping them in familiar surroundings while continuing to provide access to timely care.
Wearable technologies have enabled us to extend vital signs monitoring on a continuous basis rather than through episodic encounters. As we learn to analyze this data and use it to its fullest benefits, it is highly likely that we will improve our care delivery and move toward continuous care. These emerging wearable technologies will hopefully reduce the cost of care and translate into better clinical outcomes, as they can be implemented among populations rather than individuals. Coupled with continuous monitoring, virtual care brings tremendous value to the patient, because the appropriate healthcare decisions can be made as the need arises.
Sanjeev Gulati, MD, chief of adult cardiology and medical director of heart failure and transplant services at Atrium Health's Sanger Heart & Vascular Institute in Charlotte, N.C.
There have been many incredible innovations in the field of cardiology over the last couple of years. One particular advancement that warrants highlighting is a newer class of drugs called sodium-glucose transport protein 2 inhibitors (SGLT-2 inhibitors) for Type 2 diabetes.
In patients with HFrEF (EF less than 40 percent) with or without diabetes, dapagliflozin reduced cardiovascular deaths and heart failure hospitalizations when compared to a placebo. For this reason, the recommendation is to add dapagliflozin for patients with HFrEF and NYHA class II-IV symptoms on optimal pharmacologic and device therapy. In addition, SGLT-2 inhibitors have been shown to reduce risks of heart failure events in patients with Type 2 diabetes mellitus at high risk for or with cardiovascular disease.
This class of drugs is truly a breakthrough in how we take care of cardiovascular patients due to the fact that these are 'diabetic' medications which are being used in cardiovascular patients without diabetes for their cardiovascular benefits. This class of medications is now an integral part of the cardiologists' tool box to improve cardiovascular outcomes.
David Kanzari, MD, chief of Atlanta-based Piedmont Heart Institute and the cardiovascular service line
The most promising clinical innovation in today's clinical practice remains transcatheter aortic valve replacement therapies. Since early development of the technology, several 100,000 individuals worldwide have been treated with this lifesaving procedure as an alternative to more invasive surgery, or in some instances, for patients for whom surgery was not an option. Initially proposed for surgical high-risk and no-option patients, TAVR has now advanced as a standard of care for the treatment of aortic stenosis across a much broader range of patients. Equally important, the less invasive method of TAVR forged a path of innovation and exploration for catheter-based therapies to treat other heart valve conditions, such as mitral and tricuspid valve disease. All together, TAVR has offered a less-invasive, lifesaving therapy and introduced a new standard of care for patients with valvular heart disease.
The most promising forthcoming technology in cardiovascular medicine is catheter-based renal denervation therapy. Hypertension is the leading global cause of death and disability. Despite increasing awareness of the impact of more intensive blood pressure lowering, rates of treatment and achievement of guideline-recommended blood pressure goals have plateaued, if not steadily declined. Moreover, it is estimated that at least one-third of patients treated for hypertension do not adhere to their prescribed medical regimen. These findings underscore the opportunity for alternative therapeutic approaches to hypertension. Renal denervation therapy has been consistently shown to safely reduce blood pressure among individuals with persistently elevated blood pressure, both in the presence and absence of pharmaceutical therapies. As such, the therapy is poised to have substantial global impact on public health.
Scott Lim, MD, medical director of the Advanced Cardiac Valve Center at UVA Health's Heart and Vascular Center in Charlottesville
For patients with heart failure related to a weakness of their heart's ability to pump blood forward, the Accucinch device is being studied as a device to improve their heart's strength. It is a band placed on the inside of the heart to reshape the heart into a shape that is stronger. It is being studied in a randomized clinical trial, and early data from the feasibility trial was encouraging.
Lisa Marteney-Mock, RN, interim executive director of cardiovascular services at Beebe Healthcare in Lewes, Del.
There are so many technological advancements in cardiology today, but one that has really made an impact at Beebe Healthcare is the access to minimally invasive technology like the transcatheter aortic valve replacement procedure. We are a 210-bed hospital in Lewes, Del., that serves a rural population that sees an influx of visitors in the summer. Now our community has the option for this innovative procedure as an alternative to open heart surgery that is close to home and allows them to return home the next day. That creates overall better healthcare for a community when their neighborhood health system can offer this these innovations.
Hal Skopicki, MD, chief of cardiology and co-director of the Stony Brook (N.Y.) University Heart Institute
Comprehensive analysis strategies are transforming our approach [around] simultaneous initiation of multiple medications for heart failure with reduced ejection fraction (HFrEF). Since medications for HFrEF have been incrementally tested over optimal medical management, clinicians have been constrained and sometimes confused by the need to add therapies 'one at a time.'
Recent analyses of contemporary clinical studies have shown the dramatic potential of comprehensive initiation of medical therapy for HFrEF (β-blockers, angiotensin receptor–neprilysin inhibitors, mineralocorticoid-receptor antagonists and sodium–glucose cotransporter 2 inhibitors) to reduce the risk of a combined end point of cardiovascular death or hospitalization for heart failure over 70 percent when compared to historically approved heart failure therapy.
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