5 highlights from AHA Scientific Sessions 2021

One of the largest cardiovascular conferences in the world, the American Heart Association’s Scientific Sessions have just wrapped up for 2021.  The virtual meeting attracted nearly 18,000 attendees from cardiology and hundreds of presentations on latest research, clinical trials and updates. This week in the limbic we present five major highlights from the meeting.

FitBit algorithm detects AF in undiagnosed patients

A new software algorithm that lets wearable devices such as FitBit detect atrial fibrillation could lead to earlier intervention and improved outcomes in affected users, according to research presented at AHA Scientific Sessions 2021.

The algorithm, tested on 455,000 adult smartwatch or fitness tracker users from May to October 2020, accurately detected undiagnosed atrial fibrillation 98% of the time, the researchers found.

The wearables detected irregular heart rhythms in 1% of individuals and 4% of those over 65, with atrial fibrillation subsequently detected in 32% of these patients via ECG patch monitor.

ECG confirmed wearable-detected atrial fibrillation in 98% of patients overall and 97% of those over 65, the authors wrote.

“These results show that wearables have the ability to identify undiagnosed atrial fibrillation with high reliability,” study author and Massachusetts General Hospital cardiologist Associate Professor Steven Lubitz said in a statement.

“Since so many consumers use wearables, it is possible that algorithms such as the one we studied could be applied widely to help identify undiagnosed atrial fibrillation, allowing patients to obtain care before devastating complications such as a disabling stroke may occur.”

The algorithm may be most helpful during inactive periods and/or sleep, Associate Professor Lubitz said, noting that most episodes of undiagnosed atrial fibrillation occurred during sleep and were likely asymptomatic.

Though FitBit funded its development, the algorithm is said to be compatible with a “wide range of smartwatches and fitness trackers”.

It’s currently being reviewed by the FDA for clearance and widespread use.

Further studies are needed to determine whether atrial fibrillation screening leads to stroke reduction, Associate Professor Lubitz concluded.

Canagliflozin improves symptoms in HFpEF and HFrEF patients, regardless of T2D status

Canagliflozin could improve symptoms, function and quality of life in heart failure patients with preserved or reduced ejection fractions (HFpEF and HFrEF), regardless of type 2 diabetes (T2D) status, according to US research.

The placebo-controlled “Canagliflozin: Impact on Health Status, Quality of Life and Functional Status in Heart Failure (CHIEF-HF)” study, funded by Janssen, assessed cardiac and quality of life outcomes in 476 HFpEF and HFrEF patients with or without diabetes.

It found canagliflozin (100 mg daily) significantly improved heart failure symptoms such as shortness of breath, tiredness and feet and ankle swelling within two weeks of treatment and sustained the effects to the end of the three-month trial (self-report Kansas City Cardiomyopathy Questionnaire Total Symptom Score difference: 4.3, P = 0.016).

The improvements were seen across HFrEF and HFpEF patients, regardless of type 2 diabetes (LS mean difference: HFrEF: 4.0, HFpEF: 4.5, non-T2D: 3.6, T2D: 6.5).

“These findings, together with the results of other SGLT2 inhibitor trials, are transformational and should have a significant impact on care,” lead author and Daniel J Lauer Endowed Chair in Metabolism and Vascular Disease Research at the University of Missouri-Kansas City School of Medicine Professor John Spertus said in a statement.

“The impact of this class of medicines on patients’ function and quality of life is larger than many other medications used to treat heart failure, and they are very safe.”

“Since improvement in health status is such a key goal for many patients, these findings support increasing the use of SGLT2 inhibitors for people with heart failure.”

Concomitant mitral and tricuspid valve repair may be somewhat beneficial, but costly, cardiac surgeons say

Repairing a mild-to-moderately leaky tricuspid valve during mitral valve surgery could help prevent progression to more severe regurgitation, but this small benefit likely comes at a cost, cardiac surgeons say.

A study of 401 adults undergoing mitral valve surgery with or without tricuspid valve repair found only 0.6% of patients who underwent the dual procedure progressed to severe tricuspid regurgitation at two years’ follow-up versus 5.6% of those who had mitral valve surgery alone.

Overall, 3.4% of patients had moderate or severe tricuspid regurgitation after mitral plus tricuspid valve repair at follow-up versus 25% of those with mitral valve surgery.

While the dual procedure clearly showed some benefit, it did prolong patients’ time spent on the heart-lung machine by mean 34 minutes and put them at higher risk of needing a permanent pacemaker (incidence: 14.1% versus 2.5%, rate ratio: 5.75), study author Johns Hopkins Heart and Vascular Institute cardiac surgeon Professor James Gammie and his team found.

The pacemaker didn’t seem to negatively impact patients’ survival, heart function, symptoms or quality of life over the two-year study, but neither did the difference in tricuspid regurgitation, they noted.

The findings “suggest that an aggressive approach to [tricuspid repair] in high-risk patients with limited life expectancy is probably not warranted”, cardiac surgeons Professor Joanna Chikwe of Cedars–Sinai Medical Center and Professor Mario Gaudino of Weill Cornell Medical Center wrote in an accompanying editorial.

Longer-term follow-up is needed to determine the most appropriate strategy for treating milder tricuspid regurgitation, they concluded.

Patients safely undergo CABG within a few days off ticagrelor

Patients on ticagrelor may be able to undergo coronary artery bypass graft (CABG) surgery sooner after stopping medication than typically recommended, according to findings presented at AHA 21.

A study of 143 people who previously suffered heart attacks, received ticagrelor and required CABG found patients could safely have surgery two to three days after stopping medication, with no increased risk of early post-surgical bleeding versus five to seven days.

The rate of severe or massive perioperative bleeding was similar between groups, at 4.6% in early surgery patients and 5.2% in the standard group.

Some patients in the standard group had to have CABG surgery sooner than their planned date due to recurrent angina, heart attack or ventricular arrhythmias, while none in the early group had to have surgery before two days post-treatment.

Patients with shorter time to surgery also reduced their hospital stays by three days, compared with the standard of care, lead study author, University of Ottawa Heart Institute cardiologist Professor Derek So and his team noted.

“Research such as this, with people randomly allocated to early vs. delayed surgery, is integral to assure cardiologists and surgeons that early surgery is safe, especially since it conflicts with the present guidelines for people who are taking ticagrelor,” Professor So said in a statement.

“Furthermore, although our study was not large enough to evaluate whether early surgery protects people from suffering early recurrent heart attacks or angina, it opens this hypothesis and may prompt future research in the area,” he concluded.

Stem cell therapy improves cardiac outcomes in HFrEF patients

Stem cell injections to the heart could help reduce non-fatal heart attack, stroke and cardiac death risk in heart failure patients with reduced ejection fraction (HFrEF), new research suggests.

The DREAM-HF study of 537 HFrEF patients (New York Heart Association class II or III) assessed the efficacy of heart-injected mesenchymal precursor cells in reducing hospitalisations for heart failure and other adverse outcomes.

While the stem cells failed to reduce hospitalisations, they did decrease non-fatal heart attacks and stroke by 65% at mean 30 months’ follow-up.

They also decreased non-fatal heart attack and stroke by 79% in patients with high levels of inflammation (CRP levels of at least 2 mg/L), lead author, director of the Center for Clinical Research and Medical Director of the Texas Heart Institute, Dr Emerson Perin and his team found.

Finally, the treatment reduced cardiac death by 80% in patients with high levels of inflammation and less severe, class II HF.

“We were impressed to learn that stem cell treatment effects were additive to current standard heart failure treatments,” Dr Perin said in a statement.

“For the first time, the known anti-inflammatory mechanism of action of these cells may be linked to a cause-and-effect benefit in heart failure. The stem cells acted locally in the heart, and they also helped in blood vessels throughout the body.”

More research is needed to better understand how the stem cells affect heart failure progression and how these therapies may be directed to the patient groups that could see the most benefit, the authors concluded.

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