Hail to all who add to the evidence base
The races are over.
The two that played out prominently for me this week were quite different. One was the presidential election, a political fisticuffs that concluded with one clear winner. The other was the American Heart Association’s (AHA) scientific sessions, a collegial gathering to showcase clinical victors and those that proved less than victorious.
President Barack Obama’s re-election ensures that the Patient Protection and Affordable Care Act will proceed, but probably not without a fight. As I watched the nation under ice at Rockefeller Plaza be transformed from a blank map to blocks of the red and blue states, it became graphically clear that politically we remain a divided country.
Will the next Congress and current administration find ways to work together on strategies to tamp down healthcare costs and bump up quality? It may be a challenge, given the schism of red and blue states.
There likely are dueling scientific camps at any medical conference, too. But the AHA sessions exemplified progress—even if progress sometimes means recognizing that what looked like a promising pathway to better patient outcomes is a dead end.
The MADIT-RIT trial might be a game changer for patients who need implantable cardioverter-defibrillator (ICD) therapy and the physicians who care for them. Study results from this large, randomized trial showed that changing the devices’ programming can reduce the probability of inappropriate shocks in patients and increase survival.
An editorial accompanying the study, which was simultaneously published online in the New England Journal of Medicine, pointed out that neither the ICDs used in the study nor the changed parameters were new. Instead, it is now a matter of integrating this evidence into practice.
As sometimes happens in phase 3 trials, the dal OUTCOMES study showed that dalcetrapib, a cholesteryl ester transfer protein inhibitor, failed to reduce the risk of recurrent cardiovascular events in patients with an acute coronary syndrome (ACS). This lack of benefit occurred despite that fact that the drug increased the levels of high-density lipoprotein (HDL) cholesterol in these patients.
Unlike politics, in science there are winners even when results fail to support the hypothesis. Within negative findings there is knowledge to be gained that leads to insights and advancements.
Please be sure to check out our AHA coverage on Cardiovascularbusiness.com to learn about the many other trials presented in the scientific sessions.
Candace Stuart
Cardiovascular Business, editor