The Rhythm | Issue 27
Issue 27 | Week of 5 October 2026
The European Association for the Study of Diabetes (EASD) Annual Meeting took place in Milan from 28 September to 2 October, and several of the week's cardiometabolic trials were published while it was under way.
Cardiology Intelligence Briefing: care is leaving the hospital, and the evidence has to follow it
This week's evidence pointed in one direction: cardiovascular care is moving away from the hospital and towards the patient. In the ambulance, a paramedic-applied risk score left 34.6% of patients with chest pain at home, compared with 24.5% under usual care, and met its non-inferiority test for serious adverse events at 3 days.2 After discharge from the emergency department, peer-supported internet-based cognitive behavioural therapy (CBT) gave patients with low-risk chest pain and persistent anxiety a modest improvement in anxiety scores.5 In diabetes, a once-daily oral glucagon-like peptide-1 (GLP-1) receptor agonist was non-inferior to injectable insulin glargine for major adverse cardiovascular events (MACE), with a hazard ratio (HR) of 0.84.1
Each makes care easier to give or receive, but none lowers the standard of proof. Non-inferiority to insulin is evidence of cardiovascular safety, not benefit.1 A modest effect on anxiety is worth offering, but it does not justify a new pathway.5 A triage model tested in Dutch ambulances still has to show that it works elsewhere.2
Obesity therapy sharpened the same point. A weekly triple-hormone agonist produced a mean weight change of -25.0% at its highest dose.4 That is a striking change, but it is a change in a risk factor, not in outcomes. Whether it prevents myocardial infarction (MI), stroke or cardiovascular death has not yet been tested.4
The clearest lesson came from cardiac surgery. A vein-harvesting technique designed to protect graft biology did not reduce death, MI or repeat revascularisation at 7 years (HR 0.98), and the same trial had already reported more leg-wound complications.3 A plausible mechanism is not a clinical benefit.
Moving care out of hospital is welcome, provided each change meets the standard of the care it replaces. None of this week's five papers established a mortality benefit. Convenience can change the pathway of care, but it cannot replace the evidence.
