As we continue to evolve from the restrictions of COVID-19, this was the first in-person AHA meeting since the onset of the Pandemic. While it was a hybrid, the in-person experience was quite enjoyable and one that everyone I met counted as one the meeting highlights. Perhaps the in-person connection was not as remarkable as I experienced at earlier meetings this year because the opportunity to connect with colleagues has already occurred at earlier meetings, but that did not lessen the enjoyment. I continue to wonder if the lack of colleague interaction at cardiology meetings over the past two years has caused us to scientifically “skip a beat”? Regardless, there seemed to be a lot of innovative studies presented.
One interesting sidelight for me was catching up with AHA Educational and Quality Programs. There are relatively new hospital certifications, jointly branded with The Joint Commission. The requirements are dependent on hospital size, providing potential certification for all hospitals provided they perform at a quality level for their size. Much of the data analysis is built around the Get with The Guidelines registry, which they say is less intense than the NCDR, likely requiring less staff entry time. In addition these programs are being introduced internationally with the prospect of improving care around the world. In addition to hospital recognition programs promoting quality care, there is a small hint that provider certifications are coming as well. Currently, there is a 7-hour telehealth education program which will is affirming the goal of using telehealth as a mechanism to reduce disparities in the delivery of healthcare. While this program certifies hospitals, it also certifies providers. This program is not cardiology specific but provides certification to to other disciplines. Discussing with staff, suggests that other, similar education programs leading to provider certification are on the way. It will be interesting to see how these programs roll out given the hospital complaints of the cost of such programs. Quality is important but it certainly made me wonder if we may be headed to a certification frenzy.
However, the AHA is about new science and the translation of the science into patient care. For this, the meeting met its goal. Furthermore, seeing the large number of young trainees and early career investigators and clinicians presenting their data was very reassuring. We are seeing the continued evolution of our search for knowledge and best practices. Lastly, the commitment to diversity was evident throughout, perhaps most developed in the focus on the unique and important differences in disease presentations and best treatments for women.
And now a couple of examples of the science:
ISCHEMIA-EXTEND: This was an interim analysis of follow up beyond the earlier reported study. It is important to note that the population randomized were patients without Left Main disease, with normal or only modestly reduced left ventricular function. At 5.7 years the mortality for the conservative medical treatment group was not different to the invasive treatment group. What’s unexplained is the while mortality rates were similar, the invasive group had less cardiac deaths compared to the conservative medical group but more non cardiac deaths. It is also to note that the cause of death in the long term follow up was not centrally adjudicated. But this is interim data and so we wait and watch.
The precision care strategy for the evaluation of stable chest pain compared usual care to the use of Coronary CT (CCTA) as well as selective use of CCTA with FFR (precision protocol) to evaluate for ischemic risk. Overall, the use of coronary angiography was less, but revascularization was slightly higher. The composite MACE endpoint showed a lower rate for the precision pathway. While there were gaps in the data including unknown cost issues to apply CCTA to usual care and a short follow up period. However, this study suggests a noninvasive CCTA strategy in stable chest pain patient’s mare improve outcomes by focusing on CCTA positive patients.
These studies represent a small sample of the science translating into care, potentially improving the evaluation and treatment of stable coronary artery disease.
The AHA is back!
Dr. Vetrovec is a consultant for Abiomed.
Illustration by April Brust