My Takeaways From AHA 2015
I understand why the major cardiovascular societies like the American Heart Association (AHA) choose Orlando for their meetings, logistically speaking, but as far as I’m concerned, heart disease and the theme-park capital of the world make for strange bedfellows. For one, it’s no mean task finding a meal there with the portion size and sodium content that would pass muster with the AHA’s own nutrition committee. Then there are the frigid halls of the Orange County Convention Center, which tend to induce a hypothermic lethargy ill-suited to energetic interaction and clear thinking.
Outside, the heat and humidity combined with a dearth of sidewalks are a powerful deterrent to vigorous outdoor exercise. My first morning in Orlando, I made the mistake of going for a long, blistering run with 2 faster, fitter colleagues and had to drop back to carry on alone, many miles from my hotel, digging into resolve I didn’t know I had.
Looking back at the big trials and topics of this year’s AHA meeting made me think of that run and how the biggest, seemingly insurmountable hurdles are always diminished with time, although hindsight always takes hard work.
In the late 2000s, some of the most sensational news in cardiology centered on high-profile cases of inappropriate stent implantation, leading to a lot of finger-pointing and handwringing (not to mention lawsuits and federal investigations). In response, appropriate use criteria for PCI were created and NCDR CathPCI Registry data were tracked. Six years later, in what was one of the biggest news stories of this year’s AHA meeting, Desai and colleagues showed that “inappropriate” PCI procedures, typically in non-acute settings, have been cut by half, while the proportion of procedures performed for ACS have remained more or less the same, at approximately 75%.
An even more pressing issue for interventionalists dating back to the middle of that decade was how long patients should be placed on dual antiplatelet therapy to mitigate the risk of stent thrombosis. The massive DAPT trial, designed to answer this question, was presented at last year’s AHA meeting but seemed to prompt as many questions as it answered. This year, however, DAPT investigators presented the DAPT Score, an easy-to-use, numeric tool derived from the study that practicing interventionalists can use to weigh decisions about the risks/benefits of recommending protracted therapy with 2 antiplatelet drugs in any given patient.
At least one other prickly problem of the past few years also appears on the brink of resolution. The Achilles heel for the novel oral anticoagulants has been their irreversibility. Now, according to several smaller studies presented during the meeting, it seems likely that all of the approved agents can be reversed, if needed, with safe, effective “antidotes.”
Present Solutions: Now What?
On the flip side, of course, are all the problems we think we’ve got answers for, only to find that those solutions aren’t easily put into practice. The blockbuster trial at AHA 2015 was undoubtedly SPRINT, showing that treating systolic blood pressure to a target below 120 mm Hg vs the standard target of less than 140 mm Hg reduces the rate of adverse clinical outcomes in nondiabetic patients who are at high risk for cardiovascular events. Even as those results were making headlines, however, commentators were pointing out that getting “real-word” patients to the lower blood pressure goals achieved in this trial will take more medication, more monitoring, and more patient visits—things notoriously hard to achieve in practice.
In the same theme, MI-GENES, a much smaller trial also presented as a late-breaker at AHA 2015, showed that when patients were told about their genetic risk for MI, they seemed more motivated to get their cholesterol levels down and were more likely to be prescribed a statin. But tellingly, knowledge of genetic risk did not appear to lead to changes in dietary fat intake or physical activity levels.
I’ll put one other study in this same category, where identification of a problem doesn’t necessarily mean an easy solution is just around the corner. This is the research—accepted as a poster at AHA but simultaneously published in the Journal of the American College of Cardiology—showing that median annual salaries for female cardiologists are more than $100,000 lower than for men, even after adjustment for all relevant variables. As many observers pointed out, the fact that a wage gap exists is not surprising. Instead, it’s the extent of the difference that is both disappointing and disturbing. This particular news story on TCTMD got more of a reaction on social media than anything else we wrote at AHA this year. As one tweet pointed out, cardiologists respond to data: here, finally, are some stone-cold numbers documenting the problem. Now it’s time to act.
Some Breaking News of Our Own
This was my first meeting leading the news team at TCTMD. Todd Neale and Yael Maxwell joined me in Florida, while Caitlin Cox and L.A. McKeown kept watch over other news from New York. I’m proud of our coverage of the big studies and hidden gems in this year’s program. And I’m delighted to be working alongside a team of smart, fast reporters who know a good story when they see one.
In fact, we have some breaking news of our own. One of the 2 fast runners who dragged me around the hot streets of Orlando last week is my friend and former colleague from theheart.org, Michael O’Riordan. Next month, Michael is joining the news team at TCTMD.
So what’s around the next bend in the road? You’ll have to wait, watch, and see.