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Medical Advancements Help to Detect and Treat Heart Disease

Smart stethoscopes and new uses for diabetes drugs are transforming heart health care

Charles Griggs golfing
Josh Letchworth

The news is full of ‘promising’ developments that may ‘one day’ lead to a brighter, healthier future. But for our annual survey of the latest medical breakthroughs, we decided to focus on game changers that are improving lives today. Each of these astounding new technologies and treatments is available, or will be in the near future, to make your life, and the lives of millions of other Americans, better.

Charles Griggs eats healthily most of the time (“I did have some fried fish today,” he admits with a laugh) and plays golf and basketball whenever he can. Yet he’s long had a nagging worry about his heart health. “As an athlete growing up, I always seemed to get tired first,” he says. “I wondered if I had a slight heart murmur."

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Last summer Griggs, 61, a public relations professional from Jacksonville, Florida, participated in a health screening, and one of the tools the doctor had on hand was a “smart” stethoscope, which can detect the slightest of heart murmurs. When the doctor placed the stethoscope on his chest, Griggs admits, “I was a little nervous.”

His heart was fine, but several other people screened that day showed signs of heart disease. “Invariably, we find 5 to 10 percent of the people we screen have some form of valvular heart disease or atrial fibrillation [which raises their risk for heart failure and stroke],” says Antoine Keller, M.D., a cardiothoracic surgeon at the Ochsner Lafayette General Medical Center in Lafayette, Louisiana, and cofounder of HeartSense, a nonprofit project aimed at detecting heart disease and other health risks in underserved and underrepresented populations. “This stethoscope allows doctors to identify heart murmurs before they can be heard. It changes the paradigm for early diagnosis.”

Heart-valve disease affects 8.5 to 13.2 percent of adults over age 65, according to the Alliance for Aging Research, boosting their risk for heart failure, stroke, blood clots and sudden death as valve flaps thicken and stiffen with age, weakening the heart’s pumping capacity. By prompting preventive treatment such as heart-valve replacement, early diagnosis can improve a patient’s prognosis. Problem is, many people don’t discover they have a damaged valve until they’re hospitalized with it. One reason: Conventional stethoscopes often miss it — so people have no warning, Keller says. In a 2017 British study of 251 older adults with no cardiovascular symptoms, regular stethoscopes detected just 32 percent of early valve problems and only 43 percent of more serious cases. Smart stethoscopes, Keller says, could help change that. “Sometimes it’s very difficult to hear subtle heart tones that could potentially be worrisome. This gives doctors more confidence about referring people to specialists with advanced training and technology.”​

One smart stethoscope, called the Eko Duo, is a stethoscope plus electrocardiogram (ECG). Developed by Eko, an Oakland, California, medical-device company, and cleared by the Food and Drug Administration (FDA), it amplifies heart, lung and other body sounds up to 32 times, performs a single-lead ECG, and analyzes the data on a smartphone app for subtle signs of heart disease, including heart murmurs and atrial fibrillation (A-fib). The analysis uses machine-learning algorithms developed with one of the world’s largest repositories of clinically validated heart sounds, says cofounder and CEO Connor Landgraf.

rendering of a mans chest with a stethoscope that ends in a device which hears the slightest of heart murmurs.
The Eko Duo is a stethoscope plus ECG that can hear the slightest of murmurs.
IBRAHIM RAYINTAKATH

In studies, the Eko Duo detected murmurs 88 percent of the time and A-fib 99 percent of the time. ​​Smart stethoscopes like the Eko Duo could help close gaps in the diagnosis and treatment of patients from low-income, underserved and rural communities, Keller says. African Americans, for example, are 54 percent less likely than white individuals to be referred to a specialist for heart-valve problems and 14 percent less likely to have severely damaged heart valves replaced. Still, Keller points out, using smart stethoscopes to find these diseases is just one part of the larger solution. “If you don’t take care of your wellness, you’ll have to take care of your illness.”​

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More new innovations in heart disease care

3D view of coronary arteries ​​

HeartFlow FFRct Analysis
The HeartFlow device can provide a 3D look at the arteries of the heart.
Courtesy HeartFlow

For people with chest pain, shortness of breath or signs of heart blockage, an FDA-cleared test called HeartFlow FFRct Analysis can provide a three-dimensional look at the arteries of the heart without an invasive imaging procedure. Studies show the test can help identify who does — and doesn’t — need more invasive tests and treatments. A growing number of U.S. medical centers offer the procedure.

​​Diabetes drugs for heart protection​​

The American Diabetes Association recommends diabetes drugs called SGLT2 inhibitors for standard diabetes care, in part because they help control blood sugar but also because they can protect the heart and kidneys from diabetes-related damage. Now doctors are talking about using these drugs for people without diabetes. In late 2021, a large New England Journal of Medicine study found that people with heart failure who took empagliflozin (sold as Jardiance and under other brand names) were 27 percent less likely to be hospitalized from heart failure — whether or not they had diabetes. ​​

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‘Interchangeable’ biosimilar insulin​​

In July 2021, the U.S. Food and Drug Administration approved the first biosimilar insulin, Semglee (insulin glargine-yfgn), that’s “interchangeable,” meaning a pharmacist can substitute it for Lantus, the most widely prescribed insulin in the U.S., without first getting a prescriber’s approval. The list price difference? About $50 per vial. There are other biosimilar insulins on the market, though they cannot be substituted for brand-name options by a pharmacist.​