I think the next movement in CV is going to be remodeling agents for stage IV NYHA (and then going backwards from there). This is a niche area that is amenable to smaller trials with less of a requirement for a pristine side effect profile (median survival for Stage IV is ~ 6 months, not unlike many cancers).
I agree that the current SOC, which is started much earlier on, is not going to be meaningfully changed by any NCE. This area is going to be a fight between SOC drug treatment versus intervention for the next little while.