Top Policy and Practice News of 2024

Top headlines in the realm of policy and practice in cardiology throughout 2024 revolved around innovation, particularly the use of artificial intelligence (AI), as well as reimbursement news—with some wins—and changes to how care is delivered.

A clearer picture is beginning to emerge as to how AI will affect the field. In echocardiography, for example, deep learning models have shown promise both in improving sonographer efficiency as well as in performing whole heart evaluations. The large language model ChatGPT (OpenAI) was also the subject of several studies (CHATGPT; 8 Down), including one showing its potential in assisting with heart team decisions among patients scheduled for coronary revascularization.

On the policy front, the Centers for Medicare & Medicaid Services (CMS) announced the first 10 drugs to have their prices negotiated as a result of the Inflation Reduction Act (CMS; 52 Across), majority of which are used for cardiology patients. While the agency’s final rule for 2025 surprised no one by announcing further cuts to the physician fee schedule, proponents of coronary computed tomography angiography (CCTA; 11 Across) celebrated a doubling of the payment rate for that imaging modality next year.

Changes to the way cardiology practices have operated have been drastic over the last several years, but recent interest in private equity is making an impact  (PRIVATEEQUITY; 1 Across). Specifically, a new analysis showed that these firms now own roughly half of all cardiology clinics in the United States.

As glucagon-like peptide 1 (GLP-1) receptor agonists have grown in popularity, access to them has become limited, posing a conundrum for physicians whose patients who cannot get their hands on them. The shortages have affected both semaglutide (Novo Nordisk), sold under trade names Ozempic (for type 2 diabetes with or without established CVD) and Wegovy (for overweight or obesity; WEGOVY; 42 Down), as well as tirzepatide (Mounjaro/Zepbound) and dulaglutide (Trulicity; all Eli Lilly), and they’ve forced physicians to look for alternatives.

Lastly, the field of cardiology came together this year to celebrate the 100^th birthday of the American Heart Association (AHA; 27 Down). The organization was founded in 1924 to investigate the pathophysiology of cardiovascular disease and has become a world-renowned resource in prevention, diagnosis, and treatment through its annual meeting, advocacy efforts, and public health initiatives.

What the Experts Say

Speaking with TCTMD, American College of Cardiology President Cathleen Biga, MSN, RN (Cardiovascular Management of Illinois, Woodridge), said three key themes stood out to her in this space in 2024: evolution in physician employment models, implementation of AI into clinical practice, and challenges with patient access to care.

With regard to AI, Biga said what’s exciting is that the technology has become collaborative in that it leads to helpful clinical tools, including ambient clinical listening programs that can reduce administrative burdens for physicians.

Patient access, she stressed, is not only about equitable care—though that remains an issue—but also increasingly about new patients being able to be seen within a reasonable amount of time. “We used to have a rule that all new patients had to be seen within 48 hours,” Biga said. “That rule went so far out of the window this year, that no matter what I do, I cannot get enough new patient slots opened, and I'm hearing that from all of my colleagues across the country.”

David Ouyang, MD (Cedars-Sinai Medical Center, Los Angeles, CA), also commenting to TCTMD, said it became obvious in 2024 that technology is advancing such that it can be applied in a broader sense, whether that is with drugs such as GLP-1s that are showing benefits in a wide swath of the population or AI tools that are enhancing practice across the field.

Bigger AI models are being built and tested across institutions, and many are understanding the value they bring specifically with regard to clinical note taking as well as imaging, he said. The main challenge for AI going forward in this space, according to Ouyang, is the “persistent bottleneck in terms of implementation and reimbursement.”

Physicians—and society in general—are now more comfortable with the notion of AI becoming integrated into daily life, especially with how ubiquitous tools like ChatGPT have become over the last year, he added. “We are seeing inevitably AI will permeate medicine, and in many cases, we're seeing many augmentative use cases.”