Manesh R. Patel, MD, FACC, FAHA, chair of American Heart Association (AHA) Scientific Sessions program, chief of the Division of Cardiology, chief of the Division of Clinical Pharmacology, and professor of medicine at Duke University School of Medicine, explains what he saw as the top takeaways from AHA 2022.
"There was a lot of excitement from people to be back in person to share and make connections," Patel said. "We had about 735 programs and over 4,000 abstracts. So [that's] a fairly large amount of amount of scientific information, and nine late-breaking clinical trial sessions and nine featured science sessions, which included about 50 randomized trials. This was exciting for us because a lot of it was not around COVID. Cardiology knows the seriousness of COVID, but it was nice to see science in other places."
Key late-breaking trials:
• TRANSFORM-HF: Comparative Effectiveness of Torsemide versus Furosemide in Heart Failure: Primary Results of the TRANSFORM-HF Trial — results showed similar effectiveness.
• Chlorthalidone Compared to Hydrochlorothiazide for the Prevention of Cardiovascular Events in Patients With Hypertension — no difference between the drugs.
• PROMINENT: A Randomized Trial of Pemafibrate for Triglyceride Reduction in the Prevention of Cardiovascular Disease — this is the third trial to show vibrates do not reduce cardiovascular outcomes.
• PRECISE Trial: Comparison of a Precision Care Strategy with CT and FFR-CT vs. Usual Testing to Guide Management of Stable Patients With Suspected Coronary Artery Disease — data showed CT combined with FFR-CT had better outcomes than the current standard of care.
• ECMO-CS: Extracorporeal Membrane Oxygenation in the Therapy of Cardiogenic Shock: Primary Results From the Multicenter, Randomized ECMO-CS Trial — no difference seen with use of ECMO.
• STRESS Trial: Steroids to Reduce Systemic Inflammation After Infant Heart Surgery - no difference was seen, but there may be subgroups of patients that do respond.
• BEST-CLI: Best Endovascular versus Best Surgical Therapy for Patients With Chronic Limb Threatening Ischemia (BEST-CLI) Trial: Clinical Results — it showed a pretty pretty dramatic reduction in amputation in patients who received a vein bypass surgery.
• OCEAN(a)-DOSE: Reduction of Lipoprotein(a) With Small Interfering RNA — use of an mRNA drug reduced lipoprotein(a) by between 60% to 95%
• EMPA-KIDNEY: Empagliflozin and Cardiovascular Outcomes in Patients With Chronic Kidney Disease.
He also noted hypertension was a big topic of discussion at AHA, with two late-breaking trials sessions. One session explored new drugs and renal denervation to combat drug-resistant hypertension. The other session looked at disruptive ways to tackle hypertension using apps to encourage patients to pay more attention to they blood pressure, use of a quadruple polypill, and the use of village doctors in rural China to help combat hypertension on a very local level.
• CRHCP: Effectiveness of a Village Doctor-Led Multifaceted Implementation Strategy on Cardiovascular Disease Among Patients With Hypertension: A Cluster Randomized Trial.
• Mindfulness: The Effect of Adapted Mindfulness Training in Participants With Elevated Office Blood Pressure: The Mindfulness-Based Blood Pressure Reduction (MB-BP) Randomized Clinical Trial.
• SPYRAL HTN-ON MED: Effect of Radiofrequency Renal Denervation on Blood Pressure in the Presence of Antihypertensive Drugs: 6-Month Primary Results From the SPYRAL HTN-ON Med Expansion Randomized Trial.
• QUARTET USA: Efficacy and Safety of a Quadruple Ultra-Low-Dose Treatment for Hypertension.
Health equity was a big focus at AHA 2022
Another area of focus at this year's AHA was on health equity and how to address health disparities, rather than just framing the problems. This was certainly a focus of AHA President Michelle Albert, MD, who spoke on the topic. It was also addressed in several sessions. The opening session also concentrated on health disparities between not only minority communities, but also a winding gap between rural and urban U.S. populations.
Patel mentioned FDA Commission Robert Califf, MD, a cardiologist, who spoke in the opening session and explained the need to address health inequities, in addition to doing a better job of treating patients and preventing disease, as the U.S. falls behind outcomes seen in other developed countries, despite larger amounts of healthcare spending.
"The opening session, which discussed taking science to public health, I hope was a moment of reckoning, as Dr. Califf said. It is a moment to take in and understand what we should be doing and doing it better, but it is also setting up systems so we can keep learning to do it better," Patel explained.
The future of cardiovascular medicine
Patel said some sessions topics and overall trends seen at AHA this year hint to what we will see in the future of cardiology.
"As we go into the future of cardiovascular medicine, which I suspect will be more and more complex things in the hospitals and going further from the hospitals to find the people where they are to help them and prevent cardiovascular events," Patel said. "This includes digital therapeutics, digital access, virtual ways of caring, being culturally aware of what people will respond to. And in the hospitals, with the ICU, cardiogenic shock patients, critical limb ischemia, myocardial infarction, you are going to need a team, because one strength is not going to be the best."
He said the heart team approach that grew out of the transcatheter aortic valve replacement (TAVR) trials a decade ago moved the needle of improving care and outcomes. Today, cardiac surgeons and interventional cardiologists, often joined by echocardiographers, radiologists and nursing staff, make team decisions not only on TAVR, but an array of other decisions on what is best for cardiac patients. The heart team approach has spread across many cardiology departments and is now seeing adoption by electrophysiology and now vascular medicine, as seen in the collaboration in the BEST CLI trial.
"Where are cardiovascular medicine and therapies going? More toward personalized infusions, closer and closer to patients' homes, and bigger and bigger teams to manage complex problems in the hospitals," Patel said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com