In the U.S., about 647,000 people — or one in four — die from cardiovascular disease each year, making the condition a leading cause of death, according to the Centers for Disease Control and Prevention. Annual treatment costs exceed $555 billion, per the American Heart Association.
The good news? Groundbreaking cardiology studies from the past year show major potential for improving both patient outcomes and reducing costs of care.
As Leslie L Davis, PhD, RN, ANP-BC, FAANP, FACC, FAHA, FPCNA, an associate professor of nursing at the University of North Carolina, Chapel Hill, explains, “Each one is a paradigm shift.” Jane Nelson Worel, RN, MS, ANP-BC, FAHA, clinical education director at the Preventative Cardiovascular Nurses Association, goes as far as to call the research “game changing.”
The Most Important Cardiology Research from 2019
With February, also known as Heart Month, well underway, here’s a roundup of studies, all published in the New England Journal of Medicine, that the AHA’s selection committee considers “momentous.”
Patients with high triglycerides are at increased risk for heart attacks and strokes. Research from the landmark, Amarin-funded trial of more than 8,000 patients with high triglycerides and on statins found that icosapent ethyl (Amarin’s Vascepa), an omega-3 fatty acid EPA from fish oil, cut the risk of ischemic events, including cardiovascular death, by a whopping 25 percent compared to placebo.
In December, the Food and Drug Administration approved the use of the prescription drug to reduce adverse cardiovascular outcomes.
While the mechanism is still unclear, Dr. Davis notes that the trial, which followed patients for about five years, has apparently hit upon the right formulation and dose— a highly purified 2 grams twice a day.
“Irrespective of how much [the drug is] lowering triglycerides, it’s able to reduce bad outcomes,” she says.
Adds Worel, “Certainly, this is a game changer in many ways.” The key, though, depends upon education, she continues. Clinicians need to be aware that Vascepa’s benefits include not only lowering triglycerides, at times modestly, but also reducing risk.
“This is the first omega-3 out there, that has demonstrated … pretty dramatic risk reduction,” Worel says.
A STEMI heart attack is a serious event in which a coronary artery is completely blocked, reducing blood flow to the heart muscle. Treatment typically involves inserting a balloon angioplasty to open up the so-called culprit lesion, or clogged artery. The 4,000-patient trial, funded by the Canadian Institutes of Health Research and others, found that when physicians cleared other narrowing arteries, as well as the culprit lesion, patients saw 32 percent less risk of another heart attack compared to patients treated only for the culprit lesion.
Complete revascularization, however, could be controversial, says Worel. “Other studies show medicines could have the same effect in the long run as angioplasty and stents,” she explains, adding that more research is necessary before changing the standard of care.
Dr. Davis, however, sees more urgency. Many people don’t display symptoms until they reach a 70-percent blockage, but a blockage of 50 percent or more could trigger a heart attack. That’s why she’s in favor of complete revascularization — to treat the blockages that aren’t yet noticeable.
“We’re all trying to prevent that second heart attack,” Davis says. “This changes practice overnight. … It’s OK to go after those other lesions.”
“We’re all trying to prevent that second heart attack,” she says. “It’s OK to go after those other lesions.”
Prescribers rely on Dapagliflozin (AstraZeneca’s Farxiga) to lower blood sugar in patients with type 2 diabetes — but it may have other applications. A study that followed for more than 4,700 patients for 18 months found the drug kept heart failure from worsening and reduced risk of cardiovascular death. The results held up even among the 58 percent of participants who didn’t have diabetes. (AstraZeneca funded the study.)
Cardiology providers should now look to this class of drugs for their heart benefits, Worel says. Dr. Davis seconded that the drug offers a strong option for patients who suffer from heart failure. “It’s costly,” she says. “But this is exciting because it’s a new pathway.”
Atrial fibrillation (AFib) is a serious condition where an irregular heartbeat can lead to blood clots, stroke, heart failure and other cardiovascular complications. Left untreated, AFib doubles the risk of heart-related deaths, according to the AHA.
Enter wearable health tech, which just might save your AFib patient’s life.
In an Apple-funded study of 419,000 Apple Watch users, the device’s optical sensor detected irregular pulses in about 2,000 participants — 0.52 percent of the total group — over four months. Among the 450 who returned the follow-up electrocardiography patch for analysis, the device accurately detected AFib in more than one-third.
According to Worel, smart devices can make a real difference in detection. “While these devices that alert people might result in added phone calls and clinic visits, in the end, they may help save somebody from having a debilitating or life-threatening stroke.”
Dr. Davis cautioned, however, that the device could increase anxiety and those using smart watches to detect AFib need education on how to respond to alerts.
“It doesn’t mean you always have AFib,” she emphasized.
Aortic stenosis is a serious heart valve disease that commonly occurs as people age. The condition is usually treated with surgery, but recently, a newer, minimally invasive approach — transcatheter aortic valve implantation or replacement (TAVI or TAVR) — has been favored for people at intermediate or high risk for death from surgery. In TAVR, a replacement valve is inserted through a thin tube and placed atop the old one.
The 1,000-patient study, funded by Edward Lifesciences, provided strong evidence that TAVR also benefits low-risk surgery patients, validating the trend. Study participants had severe aortic stenosis, an average age of 73 and a low risk of death from surgery. Results showed that the rate of death, stroke or rehospitilization from any cause at the one-year mark was significantly lower with TAVR — about a 44 percent decrease — versus traditional surgery.
“This is a very patient-centered, less invasive surgery, and it has better outcomes,” Dr. Davis says. “It’s doubly great.”
When someone suffers an ischemic stroke, typically a result of a blocked vessel supplying blood, speedy treatment is of the essence. The clot-busting drug alteplase (brand name Activase) can reduce neurological damage. But standard practice has held that the medication must be administered within four and a half hours of the start of stroke symptoms to see benefits.
The study of 225 patients found alteplase can help up to nine hours after onset of symptoms. It was funded by the Australian National Health and Medical Research Council and others.
“The window of opportunity opens up for treatment, for life-saving and potentially quality-of-life saving,” Dr. Davis says. “All of a sudden, many more patients are eligible for this treatment than in the past.”
Heart Disease Facts, Centers for Disease Control and Prevention.
Cardiovascular Disease: A Costly Burden for America Projections through 2035, American Heart Association.
Top heart disease and stroke research advances in 2019, American Heart Association.
Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia, New England Journal of Medicine.
Complete Revascularization with Multivessel PCI for Myocardial Infarction, New England Journal of Medicine.
Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction, New England Journal of Medicine.
Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation, New England Journal of Medicine.
Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients, New England Journal of Medicine.
Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke, New England Journal of Medicine.