The genuinely unsettled questions in clinical cardiology, ranked by debate-worthiness. Scanned continuously from the major journals, FDA actions, new guidelines, and the conversation among cardiologists on X.
6 live debatesLast scanned Jun 11, 2026, 11:59 PM UTC
Heat — how live this debate is
A 0–10 estimate of how live and consequential this disagreement is in cardiology right now. It drives the ranking.
This debate’s factors
How much practice changes8.0 · 30%
Weighted (40 / 30 / 20 / 10) into the 8.3 heat score.
1.A continuous scan (Grok, with live web access) reads the cardiology literature, FDA actions, new guidelines, and the clinician conversation on X to find genuinely contested questions and gather the evidence behind them.
2.Two AI reviewers from different model families — Claude and GPT-5 — then independently rate four factors, led by how genuinely the field disagrees, plus how much practice changes, how much genuinely new evidence there is, and how much real clinician (not lay) attention it draws. Neither sees the other’s ratings.
3.Key factors are grounded in real signals we collected — named experts quoted on opposing sides, and actual new trials, guidelines, or FDA actions — so heat isn’t just the models’ opinion.
4.Fixed editorial weights combine the factors — models never set the weights.
5.Scores are smoothed across scans, so one viral moment can’t whipsaw the board.
Heat is an AI estimate, not a vote — no cardiologist has voted on it yet. As cardiologists vote on Synapse, measured expert disagreement replaces this AI estimate as the headline number.
Sources — the evidence behind it
How many distinct sources we linked for this debate (2 sources here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
01★ Top debateField-wide debate
Positioning of Baxdrostat (First Aldosterone Synthase Inhibitor) in Uncontrolled Hypertension
For a patient with resistant hypertension on maximally tolerated ACEi/CCB/thiazide (eGFR 55, K+ 4.6), do you now reach for baxdrostat as the fourth agent — or does PATHWAY-2-proven, pennies-a-day spironolactone remain first-line, with baxdrostat reserved for those who fail or can't tolerate an MRA, given baxdrostat has only Phase 3 BP-lowering data (BaxHTN) and no CV outcomes, no head-to-head vs spironolactone, and unproven hyperkalemia advantage at this eGFR?
Heat — how live this debate is
A 0–10 estimate of how live and consequential this disagreement is in cardiology right now. It drives the ranking.
This debate’s factors
How much practice changes8.0 · 30%
Weighted (40 / 30 / 20 / 10) into the 7.7 heat score.
1.
Heat — how live this debate is
A 0–10 estimate of how live and consequential this disagreement is in cardiology right now. It drives the ranking.
This debate’s factors
How much practice changes8.0 · 30%
Weighted (40 / 30 / 20 / 10) into the 7.5 heat score.
1.
Heat — how live this debate is
A 0–10 estimate of how live and consequential this disagreement is in cardiology right now. It drives the ranking.
This debate’s factors
How much practice changes8.0 · 30%
Weighted (40 / 30 / 20 / 10) into the 7.3 heat score.
1.
Heat — how live this debate is
A 0–10 estimate of how live and consequential this disagreement is in cardiology right now. It drives the ranking.
This debate’s factors
How much practice changes8.0 · 30%
Weighted (40 / 30 / 20 / 10) into the 7.3 heat score.
1.
Heat — how live this debate is
A 0–10 estimate of how live and consequential this disagreement is in cardiology right now. It drives the ranking.
This debate’s factors
How much practice changes5.0 · 30%
Weighted (40 / 30 / 20 / 10) into the 6.9 heat score.
1.A continuous scan (Grok, with live web access) reads the cardiology literature, FDA actions, new guidelines, and the clinician conversation on X to find genuinely contested questions and gather the evidence behind them.
Debates are surfaced by a continuous scan of the cardiology literature and the conversation among clinicians. The heat score (0-10) reflects how live and consequential the disagreement is right now and drives the ranking; it becomes the measured expert split as cardiologists weigh in. Quotes and engagement counts are scan-reported and link to their primary source.
Who: Adults with uncontrolled or resistant hypertension on background therapy·2 sources
On the board:since Jun 11, 2026 (1 mo)— time live on Synapse
›The evidence
FDA approved May 18, 2026 based on BaxHTN Phase 3 (ESC 2025/NEJM); significant SBP reduction as add-on, but long-term CV outcomes, hyperkalemia risk vs MRAs, and cost-effectiveness unknown.
Quotes and engagement counts are scan-reported and link to their primary source — not yet independently verified.
A continuous scan (Grok, with live web access) reads the cardiology literature, FDA actions, new guidelines, and the clinician conversation on X to find genuinely contested questions and gather the evidence behind them.
2.Two AI reviewers from different model families — Claude and GPT-5 — then independently rate four factors, led by how genuinely the field disagrees, plus how much practice changes, how much genuinely new evidence there is, and how much real clinician (not lay) attention it draws. Neither sees the other’s ratings.
3.Key factors are grounded in real signals we collected — named experts quoted on opposing sides, and actual new trials, guidelines, or FDA actions — so heat isn’t just the models’ opinion.
4.Fixed editorial weights combine the factors — models never set the weights.
5.Scores are smoothed across scans, so one viral moment can’t whipsaw the board.
Heat is an AI estimate, not a vote — no cardiologist has voted on it yet. As cardiologists vote on Synapse, measured expert disagreement replaces this AI estimate as the headline number.
Sources — the evidence behind it
How many distinct sources we linked for this debate (1 source here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
02Field-wide debate
New AHA/ACC Acute PE Clinical Categories and Management Implications
Whether new categories change anticoagulation duration or interventional thresholds in intermediate-risk PE.
Who: Adults with acute pulmonary embolism·1 source
On the board:since Jun 11, 2026 (1 mo)— time live on Synapse
›The evidence
February 2026 guideline introduces refined severity categories for prognosis and therapy selection; real-world validation and DOAC vs advanced therapies balance evolving.
Quotes and engagement counts are scan-reported and link to their primary source — not yet independently verified.
A continuous scan (Grok, with live web access) reads the cardiology literature, FDA actions, new guidelines, and the clinician conversation on X to find genuinely contested questions and gather the evidence behind them.
2.Two AI reviewers from different model families — Claude and GPT-5 — then independently rate four factors, led by how genuinely the field disagrees, plus how much practice changes, how much genuinely new evidence there is, and how much real clinician (not lay) attention it draws. Neither sees the other’s ratings.
3.Key factors are grounded in real signals we collected — named experts quoted on opposing sides, and actual new trials, guidelines, or FDA actions — so heat isn’t just the models’ opinion.
4.Fixed editorial weights combine the factors — models never set the weights.
5.Scores are smoothed across scans, so one viral moment can’t whipsaw the board.
Heat is an AI estimate, not a vote — no cardiologist has voted on it yet. As cardiologists vote on Synapse, measured expert disagreement replaces this AI estimate as the headline number.
Sources — the evidence behind it
How many distinct sources we linked for this debate (1 source here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
03Field-wide debate
Implementation of 2026 CKM Syndrome Guideline: Role of New Risk Enhancers and PREVENT Equations
For a 55-year-old primary prevention patient who is statin-eligible under the pooled cohort equations (10-year risk 9%) but reclassified to borderline risk (5%) by PREVENT — with no outcomes trial showing it's safe to withhold therapy in the reclassified-down group — do you defer the statin based on the new equations, or treat to the old threshold and use PREVENT only to escalate, never to de-escalate?
Who: Adults 30-79 years without CVD for primary prevention·1 source
On the board:since Jun 11, 2026 (1 mo)— time live on Synapse
›The evidence
Guideline released June 9, 2026 emphasizes CKM syndrome staging, lifestyle/weight management, and risk enhancers for intensification decisions; PREVENT equations recommended but real-world validation and adoption barriers unknown.
Quotes and engagement counts are scan-reported and link to their primary source — not yet independently verified.
A continuous scan (Grok, with live web access) reads the cardiology literature, FDA actions, new guidelines, and the clinician conversation on X to find genuinely contested questions and gather the evidence behind them.
2.Two AI reviewers from different model families — Claude and GPT-5 — then independently rate four factors, led by how genuinely the field disagrees, plus how much practice changes, how much genuinely new evidence there is, and how much real clinician (not lay) attention it draws. Neither sees the other’s ratings.
3.Key factors are grounded in real signals we collected — named experts quoted on opposing sides, and actual new trials, guidelines, or FDA actions — so heat isn’t just the models’ opinion.
4.Fixed editorial weights combine the factors — models never set the weights.
5.Scores are smoothed across scans, so one viral moment can’t whipsaw the board.
Heat is an AI estimate, not a vote — no cardiologist has voted on it yet. As cardiologists vote on Synapse, measured expert disagreement replaces this AI estimate as the headline number.
Sources — the evidence behind it
How many distinct sources we linked for this debate (1 source here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
04Field-wide debate
Lp(a) Measurement and Novel Risk Score in 2026 Dyslipidemia Guideline
With the 2026 guideline recommending once-in-a-lifetime Lp(a) measurement for all primary and secondary prevention patients — but no approved Lp(a)-lowering therapy and outcome trials (e.g., Lp(a) HORIZON) still unread — should health systems implement universal Lp(a) screening now, or restrict testing to targeted populations (family history of premature ASCVD, FH, recurrent events despite LDL control) until a therapy proves measuring it changes hard outcomes rather than just intensifying statin/PCSK9 therapy we'd often give anyway?
Who: Primary and secondary prevention patients·1 source
On the board:since Jun 11, 2026 (1 mo)— time live on Synapse
›The evidence
March 2026 guideline recommends Lp(a) at least once and new risk score with lower LDL/non-HDL goals for ASCVD; implementation data and outcome impact pending.
Quotes and engagement counts are scan-reported and link to their primary source — not yet independently verified.
A continuous scan (Grok, with live web access) reads the cardiology literature, FDA actions, new guidelines, and the clinician conversation on X to find genuinely contested questions and gather the evidence behind them.
2.Two AI reviewers from different model families — Claude and GPT-5 — then independently rate four factors, led by how genuinely the field disagrees, plus how much practice changes, how much genuinely new evidence there is, and how much real clinician (not lay) attention it draws. Neither sees the other’s ratings.
3.Key factors are grounded in real signals we collected — named experts quoted on opposing sides, and actual new trials, guidelines, or FDA actions — so heat isn’t just the models’ opinion.
4.Fixed editorial weights combine the factors — models never set the weights.
5.Scores are smoothed across scans, so one viral moment can’t whipsaw the board.
Heat is an AI estimate, not a vote — no cardiologist has voted on it yet. As cardiologists vote on Synapse, measured expert disagreement replaces this AI estimate as the headline number.
Sources — the evidence behind it
How many distinct sources we linked for this debate (2 sources here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
05Field-wide debate
Safety of Impella Heart Pumps Following Multiple May 2026 FDA Early Alerts
Risk-benefit of routine Impella use in CHIP vs conservative strategies; device selection and monitoring protocols.
Who: Patients requiring temporary mechanical circulatory support during high-risk PCI or cardiogenic shock·2 sources
On the board:since Jun 11, 2026 (1 mo)— time live on Synapse
›The evidence
FDA early alerts May 21 and 27, 2026 for controller restart and purge cassette issues; prior recalls noted injuries; real-world utilization impact unclear.
Quotes and engagement counts are scan-reported and link to their primary source — not yet independently verified.
2.Two AI reviewers from different model families — Claude and GPT-5 — then independently rate four factors, led by how genuinely the field disagrees, plus how much practice changes, how much genuinely new evidence there is, and how much real clinician (not lay) attention it draws. Neither sees the other’s ratings.
3.Key factors are grounded in real signals we collected — named experts quoted on opposing sides, and actual new trials, guidelines, or FDA actions — so heat isn’t just the models’ opinion.
4.Fixed editorial weights combine the factors — models never set the weights.
5.Scores are smoothed across scans, so one viral moment can’t whipsaw the board.
Heat is an AI estimate, not a vote — no cardiologist has voted on it yet. As cardiologists vote on Synapse, measured expert disagreement replaces this AI estimate as the headline number.
Sources — the evidence behind it
How many distinct sources we linked for this debate (1 source here) — journals, guidelines, FDA actions, preprints, news, and posts on X. More bars mean deeper coverage.
Open “The evidence” below to see each one. Counts and quotes are scan-reported and link to their primary source — not yet independently verified.
06Field-wide debate
Menaquinone-7 Supplementation to Slow Coronary Artery Calcification Progression
For a 62-year-old with symptomatic CAD on maximal statin therapy and a CAC score of 280, is a single 180-patient RCT showing slowed CAC progression on a surrogate endpoint sufficient to recommend MK-7 360µg daily now — given its benign safety profile and low cost — or does the paradox that statins themselves increase CAC while reducing events mean CAC slowing is uninterpretable as a benefit signal without hard-outcome data?
Who: Patients with symptomatic CAD and mild-moderate CAC·1 source
On the board:since Jun 11, 2026 (1 mo)— time live on Synapse
›The evidence
June 10, 2026 JAMA Cardiology RCT (n=180) showed MK-7 360µg daily attenuated CAC score increase over 2 years (P=0.02) with no safety signals, but surrogate endpoint only.