What has been the biggest transformative change in cardiology since 2007, and why?

This has been such an exciting time in cardiology—although the lens we use is often cloudy. Why? Because the pace of change is truly unparalleled. From massive changes in the physician fee schedule resulting in a rapid migration to employment to a total transformation in cardiovascular care delivery models, our practices are not what they were a decade ago. Cardiovascular service lines, dyad leadership and payment for quality and patient outcomes were unheard of in 2007. Yet I find our world invigorating and inspiring. We have successfully reduced mortality related to cardiac events!

Cathie Biga, RN, MSN

Chief Executive Officer, Cardiovascular Management of Illinois, Woodridge

The explosive growth of catheter-based therapies for congenital and structural heart disease takes center stage for transformative, paradigm-shifting advances for patients with heart disease. Less invasive, nonsurgical therapies are now available for many disorders that previously required major open cardiac surgery. Consider mitral balloon valvuloplasty, percutaneous atrial septal defect closure and, of course, percutaneous valve replacement. Randomized, controlled clinical trials support transcatheter aortic valve replacement as an acceptable alternative to surgery in all except the very lowest-risk patient subsets. The FDA has approved a treatment for mitral regurgitation and therapies for stroke prevention in patients with cryptogenic stroke and high-risk nonvalvular atrial fibrillation. In the near future, we will see percutaneous technologies for mitral valve replacement and for repair of chronic tricuspid regurgitation. Due to advances in percutaneous therapies, there are now more adults with congenital heart disease than children. As we move forward, this trend will continue as there is a greater and greater push toward less invasive procedural therapies for our patients with heart disease.

Clifford J. Kavinsky, MD, PhD

Professor of Medicine and Pediatrics; Section Chief, Structural and Interventional Cardiology; Director, Cardiovascular Fellowship Training Program; Director, Center for Adult Structural Heart Disease, Division of Cardiovascular Medicine, Rush University Medical Center, Chicago

First, cardiac catheterization and coronary interventions have been revolutionized by the comfort and safety offered by the radial artery approach. Over the last decade, recognition and adoption of the technique from our European and Asian colleagues have accelerated use of radial catheterization in the U.S. The radial approach provides benefits not only to patients but also to nurses caring for these patients and to overall lab functioning. Same-day discharge for stenting is now commonplace after radial access. Reduced femoral bleeding and the associated complications coupled with excellent patient comfort has made radial access the default approach for cardiac catheterization in 2017.

Second, for patients at high and intermediate risk of surgical complications for aortic valve replacement for aortic stenosis (AS), transaortic valve implant or replacement (TAVI or TAVR) has demonstrated noninferiority to surgical valve replacement with lower morbidity in most patients. TAVI has provided additional years of functional life to the elderly with AS and is becoming a standard for intermediate-risk AS patients who need a valve replacement. The results of TAVI appear to be durable and preferable for most patients.

Finally, bleeding complications for patients taking warfarin for atrial fibrillation or other conditions requiring oral anticoagulants have been reduced by the introduction of novel oral anticoagulants (NOACs). NOACs favorably impact quality of life, eliminate visits to the lab for INR checks and improve the time patients are in the anticoagulated range unaffected by diet and other confounding factors. This class of agents is useful in thousands of patients and will likely increase in the coming decade.

Morton J. Kern, MD

Chief of Medicine, Veterans Administration Long Beach Health Care System; Professor of Medicine, University of California, Irvine

The biggest transformative change in cardiology, and in medicine in general, since 2007 has been the dissemination of medical information through social media. When I started as a medical student, we were still using card-catalogs and photocopy machines, and we had to physically go to a library to read up-to-date information. Textbooks were useful, but always five years out of date. The internet changed everything with online searching and instantly accessible articles. Social media has ramped up the pace at which cardiologic information (research, publications and especially interventional techniques) can be shared. Doctors don’t have to wait until major meetings to discuss new ideas. There’s a vibrant online community of doctors who are willing to share their knowledge and give advice. You used to rely on your local colleagues (if available) to bounce ideas off of. Now you have the entire world.

Jeffrey M. Schussler, MD

Medical Director, CVICU, Baylor University Medical Center; Jack and Jane Hamilton Heart and Vascular Hospital, Baylor Scott & White Health Care System, Dallas