📚️ Stories You Missed in Medicine This Week

👋 Happy Friday. So a vascular surgeon that chopped off his own legs has been jailed for insurance fraud… I would write an article on it, but I fear I can’t make it any more entertaining than it already is 🤣 . Don’t worry though. We’ve got more top medical stories for you!

Here’s what we got:

If you want to read any previous editions of The Handover, you can on our website.

Cardiologists.
They walk among us.
In our hospitals, our coffee shops and our dating apps(at an oddly high frequency on Raya).

Once a year, this curious species of heart enthusiasts pilgrimage to a secret location to nerd out over all things cardiovascular. 

This year, it was Madrid for ESC Congress 2025: Comicon for Cardiology.

So much glorious research to sink our teeth into…but the premier study was this:
The REBOOT Trial, published in the New England Journal of Medicine.

Here’s what we know:
It's good to give beta-blockers as a treatment for those with heart failure.
But ONLY IF they have reduced ejection fraction (<40%).
It’s been well established by trusted sources (the Passmed High-yield textbook) that it has no effect on those with preserved ejection fraction(HFpEF = >50%).

But there is a flaw.
This fact had been established back in the 1970's. The Seventies…? 

Aside from the fact that this research was likely conducted by scientists high on a potent cocktail of edibles and quaaludes, the science itself predates basically everything we now consider standard: No statins. No stents. No PCIs, which didn’t become routine until the 2000s.

So these researchers decided this management plan was due a REBOOT(see what i did there ;)  

This open-label RCT set out to determine if beta-blocker actually did reduce mortality in HFpEF in the modern era.

8,438 patients across Spain and Italy were included in this trial (Avg Age: 61.3yrs, 19.3% women, 88.2% received PCI after MI). They were randomised 1:1 to a beta-blocker and non beta-blocker group.
The beta-blocker of choice was bisoprolol – 85.9% of participants were on it. 

And they found… no significant difference 

Kinda underwhelming :/ 

Luckily, no idea is original. There were 3 other studies with similar aims: BETAMI, DANBLOCK and CAPITAL-RCT. So what happens when you put all these results together?
That's right… a meta-analysis. 

The results of this analysis greatly contrasted the REBOOT trial alone:

So whilst the REBOOT trial disagrees, the meta-analysis shows the patients with HF with preserved ejection fraction can share in the beta-blocker love long-term.

Just leave out the asthmatics, that always ends ugly.

Good bye diaphragms, Good bye bells. Stethoscopes have moved on…
You’ve officially been replaced by a USB dongle.

Alongside all the research that dropped at the European Cardiology Society Congress 2025, this piece of tech was also unveiled: An all new AI stethoscope, Eko Duo, developed with Imperial College London and EKO Health.

I know it’s a funny looking device, but try not to judge a book by its cover. It looks to be pretty useful.

So the big problem with diagnosing heart conditions is that they are detected just too damn late. 70–80% of new HF diagnoses occur only after an emergency hospital admission. This is despite ample opportunities to triage in primary care. 

That's where this device comes in:

It takes a 15-second ECG and PCG reading, runs it through an AI model trained to detect signs of atrial fibrillation, valve disease, and heart failure, and spits out a diagnosis that, in theory, could catch these things before a person ends up horizontal in the back of an ambulance.

There is a study going called the TRICORDER trial. 200 GP Surgeries across North London and North Wales are enrolled. Practices were randomised 1:1 to either use the stethoscope(at the discretion of the practitioner) or continue as normal(control arm). The total patient population is 12,000 patients– 6000 per study arm.

The aim is to see if these AI stethoscopes could actually detect heart failure, atrial fibrillation and heart murmurs any faster than the bog standard stethoscope.

Results aren’t in yet; the trial is still on going. It’s set to finish this December, so it’ll be interesting to see if it actually has any clinical benefit. 

But the pressing question I have is this:
If the AI is doing all the analysis, why does this thing still have an earpiece?
Is it just for style? Legacy cosplay? Does it play elevator music while awaiting results?

I don’t know. But I hope it does work, I still haven’t quite nailed the difference between S1 and S2.

Handover Over 🫡

If you liked it, tell your mates**.
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Please vote in the pole below(even if you’ve voted before!)

**Week 2 of The Handover FIGs Scrub giveaway

The top referrer for the Handover at the end of September will get a free pair of FIGs scrubs.

Currently Ella Job is at the top of the list with 14 referrals. Fair Play Ella 👏

There’s still 3 weeks of challenge left. That’s 5 a week to win it.
Reckon you can do it?
Use your personal referral link below.

Each week I’ll announce who’s top of the list, and how many referral they made.

N.B. Referral gotta be nhs.net, doctors.net or university email address. Referral requires double opt in verification, so tell your mates to check their email after they sign up!

Good luck

Hello! If you haven’t already, would you mind letting me know your role. Just one tap is all it takes. You’re so helpful.