The American Heart Association’s (AHA) annual conference concluded on Monday, and naturally, #CardioTwitter was pulsing with the scientific sessions’ biggest findings — many of which have potential to be practice-changing.
Here’s some of the research that’s generated the most chat online and beyond.
This federally funded, international study compared the efficacy of invasive procedures, namely stents or bypass surgeries, to lifestyle changes and medication for patients with severe but stable heart disease. It found no evidence that invasive procedures are more effective at reducing the risk of five common complications: cardiovascular death, heart attack, hospitalization for unstable angina, hospitalization for heart failure, or resuscitation after cardiac arrest.
Many experts are calling the research a repudiation of the medical care that tens of thousands of individuals have received, and are claiming these findings could save the healthcare system hundreds of millions of dollars. Others say the study’s actual data doesn’t support the authors’ assertions.
Prompted by e-cigarette research that’s made the news every week for that past several months, the #QuitLying campaign launched by AHA calls out the vaping industry for mischaracterizing information about the safety of e-cigs. According to the AHA, the number of teens who vape has doubled in the past two years. As of Nov. 14, 42 people have died and 2,172 people have gotten sick from vaping-related illness, also known as EVALI.
Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis?
Another study that generated a lot of excitement (and more consensus among cardiology specialists than other research) looked at asymptomatic aortic stenosis. It found that early surgery was more effective than conservative care at preventing operative mortality and death from cardiovascular causes in such patients.
Dapaglifozon for Heart Failure Patients
This AstraZeneca-sponsored trial found that dapagliflozin was superior to placebo at preventing cardiovascular deaths and heart failure events. As one editor of Circulation explained it, “Dapaglifozon should be standard of care in HF [patients] irrespective of [diabetes mellitus] status.” There are even benefits in patients with a normal HbA1c, he added.
Colchicine for Myocardial Infarction
Colchicine is an orally administered anti-inflammatory traditionally used for the treatment of gout and pericarditis. Given the experimental and clinical evidence supporting the role of inflammation in atherosclerosis and its complications, researchers gave participants, who had experienced a myocardial infarction within the past 30 days, either a low dose of colchicine or placebo.
“Among patients with a recent myocardial infarction, colchicine at a dose of 0.5 mg daily led to a significantly lower risk of ischemic cardiovascular events than placebo,” the authors noted.
Is Impella safe?
Researchers compared the safety of Impella, a temporary ventricular support device in people with depressed heart function, to intra-aortic balloon pumps. They found that Impella was not only more expensive but also was associated with greater mortality.
Roughly 34 percent of patients treated with the intra-aortic balloon pump died, versus 45 percent of those with Impella, MedPage Today reports. In addition, major bleeding rates with the Impella were almost double those of the balloon — 31.3 percent versus 16 percent. Whether the devices were implanted before/during percutaneous cardiac interventions or after the intervention did not effect the results.
Reps from Impella’s manufacturer Abiomed have since questioned the results of the study. “This observational, non-FDA audited analysis is fundamentally flawed because it is based on poor quality, retrospective, payer coding data that lumps all indications together and is impossible to properly propensity match,” Seth Bilazarian, MD, medical director of Abiomed, told MD Magazine. “In this data set, a patient walking in for an elective procedure looks the same as a patient in cardiac arrest with cardiogenic shock.”
Researchers have also said that their results do not prove causation.
Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products, Centers for Disease Control and Prevention.
Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis, New England Journal of Medicine.
Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction, New England Journal of Medicine.
Impella More Expensive, More Dangerous?, MedPage Today.
Last Updated 11/19/2019.