6 SCIENTIFIC SESSIONS DAILY NEWS | Day 3 Monday, Nov. 18, 2024 Harnessing AI for better heart health Saturday’s Late-Breaking Science session “Smart Cardiology: Harnessing AI and Innovation for Better Heart Health” found that: • Pharmacy management can improve guideline-directed medical therapy for heart failure. • Wearable sensor matches implanted sensor for pulmonary capillary wedge pressure in heart failure. • Artificial intelligence can boost echocardiogram performance with less sonographer fatigue. • PanEcho can automate echocardiographic interpretation Initial results from a randomized trial found that empowering pharmacists to titrate guidelinedirected medical therapy (GDMT) for heart failure can significantly increase pharmacist engagement in heart failure care. Pharmacists embedded in primary care practices received an audit and feedback intervention in addition to heart failure education compared with usual care pharmacists that received heart failure education alone. Pharmacists in the audit and feedback arm completed more monthly heart failure encounters and more encounters with heart failure medication adjustment compared with usual care pharmacists. Heart failure patients managed by pharmacists that received audit and feedback were more likely to receive new mineralocorticoid receptor antagonist prescriptions, 11.6% versus 9.2% for usual care (p<0.01), which have historically been the most under-prescribed components of heart failure GDMT. Sandhu “We are fortunate to have a variety of incredibly effective medication therapies that dramatically reduce morbidity and mortality of heart failure,” said Alexander Sandhu, MD, assistant professor of cardiovascular medicine at Stanford University School of Medicine. “Unfortunately, these therapies remain under-utilized. There is an urgent need to find and implement care strategies that improve our utilization of guideline-directed medical therapy for this incredibly high-risk group. “Audit and feedback” is an effective approach to increasing guideline-directed heart failure medication management by pharmacists.” The PHARM-HF A&F Study randomized 120 primary care pharmacists in Veterans Administration facilities across Northern and Central California, Nevada and the Pacific Islands to usual care, audit and feedback, or A&F+. VA pharmacists have independent prescribing authority, Sandhu said, and are actively involved in GDMT management of hypertension, diabetes and other chronic conditions. However, pharmacists often lack the experience or comfort with managing heart failure medications. All pharmacists in the study had access to heart failure-specific education, including a monthly webinar, to learn more about heart failure management. Pharmacists in the audit and feedback arm received emailed audit and feedback information on their heart failure medication activities compared to peers in their local VA facility and region. Pharmacists in the A&F+ arm also received lists of patients eligible for heart failure medication titration. The primary outcome was the difference in rates of heart failure medication adjustment encounters between usual care and the combined A&F/A&F+ arms. Pharmacists’ heart failure management activities were followed for six months. An additional six months of follow-up will be reported at a later date. “We hope that increased audit and feedback and heart failure education will empower pharmacists to confidently improve heart failure medication therapy. We hope we will see the effect of this intervention grow over time as pharmacist experience increases,” Sandhu said. “We would like to improve and adapt these practices and then scale them to other VA regions to further improve heart failure care.” External sensor results match implanted sensor for intracardiac hemodynamics in heart failure A novel wearable sensor that sits on the chest of patients with heart failure shows similar pulmonary capillary wedge pressure (PCWP) and other data as implanted sensors. The noninvasive CardioTag uses accelerometers to measure chest movement with each heartbeat and a novel algorithm to translate chest movement into intracardiac pressures. The SEISMIC-HF I trial showed a mean error for PCWP of 1.04 mmHg compared to gold standard right heart catheterization (RHC) measurements. Klein “A sensor on the chest is able to capture the heart’s movement in tridimensional space,” said Liviu Klein, MD, MS, professor of cardiology and director of the Advanced Heart Failure Comprehensive Care Center at the University of California, San Francisco. “These movements are related to heart contractions, which are related to pressures in the heart. We can get results that are very similar to an implantable device such as a CardioMEMS or Cordella PAP sensor using a wearable sensor.” Hemodynamic-guided management of heart failure using an implantable sensor to measure pulmonary artery pressures can improve the quality of life and decrease the risk of heart failure hospitalization, Klein said. But clinical adoption has been limited due to the invasive procedure and reimbursement challenges. The prospective observational SEISMIC-HF I study followed 943 heart failure patients at 15 U.S. centers scheduled for routine RHC. The mean age was 63, 58% were male, 55% White and 27% African American. Most, 88% had a heart failure diagnosis, 39% with LVEF ≤ 40%, and 90% had NYHA class II-IV symptoms. In addition to the RHC, participants used a CardioTag to collect electrocardiography, seismocardiography and photoplethysmography data. The CardioTag device and algorithm received a Food and Drug Administration Breakthrough Device Designation in 2022. The mean RHC measured pulmonary artery pressures were 42.6 mmHg systolic and 18.4 mmHg diastolic, while the mean RHC measured PCWP was 15.9 mmHg. Klein reported the validation set results showed a mean error of just over 1 mmHg for PCWP compared to gold standard RHC. “In heart failure, we know that people feel poorly and end up in the
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