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Science During A Pandemic: AHA Afterthoughts

Op-Med is a collection of original articles contributed by Doximity members.

The smooth and seamless transition of our conferences from in-person to virtual almost made it seem like they have always been like that. But, yet something felt palpably different (as it always has been with these virtual meetings all year). The human element of sitting with your friends and colleagues in the large late-breaking clinical theater (which as an aside always felt to me more like a rock concert than a scientific session at a cardiology meeting) was missing. The interactivity of discussing these scientific findings and bouncing the results off of each other was absent. The unpredictability of running into someone you haven’t seen from residency on the way to another session and having an impromptu lunch seemed like a distant memory of the past. Yet, this is the world we are living in due to the COVID-19 pandemic, and we adapted. So many fond memories from our in-person meetings were unfulfilled this year. 

But at the same time… so much online innovation took their place. The online format of the meeting made it accessible (and acceptable) to engage with the science long after the meeting is over. Because of competing clinic priorities, I actually missed the entire live meeting. With increasing numbers of COVID-19 cases and Thanksgiving coming, many patients wanting to come in, I was unable to break away from clinic and procedures to catch the sessions. So, I curled up with my laptop and my latte (with my cozy socks) and dove deep into the science the Saturday following the meeting – a luxury I could never have been afforded had if not been for the pandemic.

Once I really delved deep into the meeting, I realized there were so many aspects that I absolutely loved about the online format. Not only were the slides for each of the late breaking trials immediately available at my fingertips (which made me realize I don’t have to keep clicking photos with people’s heads in the way from the expo hall to get the slides) but each of the sessions had not just a “Faculty” moderator and also a “Social Media” moderator. This was simply brilliant! Doing this immediately changed the “face” of the moderators, adding younger and more diverse faces to the panel; it also engaged young social media leaders, who have large faithful followings, to leverage their following to increase engagement. And, as we have all shifted to social media learning, it became a forum to encourage interactivity for the trialists leading the session. Well done, AHA!

As is the case with every conference, the late-breaking clinical trial sessions always highlight some of the most exciting science from the meeting and those were, no doubt, my favorite sessions to “attend” (although I have to say the program this year was rich with many choices). 

The first late-breaking session I watched was the one that left the biggest impression on me and was entitled “Heart Failure and Atrial Fibrillation: Vitamins, Nutrients and More.” The session started with Dr. Marc Pfeffer from Brigham and Women’s Hospital in Boston, Massachusetts talking about the “pillars” of heart failure care. This really resonated with me not only because I love the Brigham (it was my home during medical school and residency and its iconic entrance with its six pillars that I passed through countless times) but because this analogy highlighted a fundamental scientific methodology of how we should be managing treatment paradigms in all disciplines in medicine. We should be using fundamental pathophysiologic derangements in disease and systematically addressing those with therapies to improve outcomes. Dr. Pfeffer discussed these six pillars in detail: Ace Inhibitors/ARNI, beta-blockers, mineralocorticoid receptor antagonists, ICD/CRT device therapy, SGLT2 inhibitors, and research (as the sixth pillar). The last pillar resonated with me the most because it is a pillar that is needed regardless of the disease or condition being treated. It’s a pillar that paves the way for future pillars. Just like in acute coronary syndrome or afib or coronary artery disease, the numbers of pillars grow each year with more meetings and more science. I realized the pillars had grown from one to three to six over the history of heart failure. 

But isn’t this what we always do in medicine? We keep adding more and more medications, sometimes only reaping a marginal benefit of each additional medication. So, at what point do we stop adding more medications because they may be compromising the patient’s quality of life? At what point do those dozen pills treat the doctor more than the patient? That’s where the second late-breaking session, which addresses this problem, really caught my eye. It questioned the way we practice medicine with more and more prescriptions with a simple yet brilliant solution. It was entitled “Bending the Curve for CV Disease – Precision or Polypill?” Something so conceptually simple as a polypill… in a large international trial led by Dr. Salim Yusuf was able to lead to a 21-31% reduction in the primary endpoint, even after accounting for compliance. 

One late-breaking clinical trial session was about use of novel drugs, vitamins, and minerals to improve heart failure outcomes. The other was more about health care delivery and compliance. And yet the two went together like lock and key. It was the realization of these distinct yet perfectly harmonious sessions that made me appreciate that a scientific meeting is really very much like a symphony of each of the individual sessions. And, appreciating them alone and in aggregate really allows true appreciation of the scientific findings and how they can be applied to disease management.

My biggest “pet peeve” about the online format (like with all other meetings, educational sessions and with our lives nowadays) – too many great choices! It’s like sitting down to watch a movie on Netflix and wasting 45 minutes just to pick something because you are unable to decide what to choose. When the AHA designs their programs, I urge them to simplify, simplify, simplify. Despite all the great science out there that needs to be covered, having fewer choices may actually increase attendance and engagement at those sessions and with the virtual format, it can focus and harness the audience.

But, beware of the double-edged sword. As great as the online format was, I worry in general about the litany of online meetings occurring week after week and weekend after weekend blurring the line between work-life balance. It used to be we attend the meetings we could and the ones we couldn't because of clinical or family priorities, we couldn't. Now, whenever I find myself with a few minutes of free time, there is always a little voice in the back of my head urging me to login into whatever meeting may happening that weekend and if I ignore that voice, I am flooded with guilt.

This year, despite the pandemic, I have to say the AHA really delivered and definitely met and exceeded expectations. The question on everyone’s mind remains though… is this online format here to stay?

Payal Kohli, MD is a Cardiologist and was a 2018–2019 Doximity Author.

Image: Tasha Art / shutterstock

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