Atrial fibrillation Doctoring Knowledge

On doing clinical research without a foundation

I learned a lot from putting together an abstract for a national heart meeting.

  • More than just learning how to e-submit, e-upload and e-print a large poster;
  • More than what t-tests and chi-squares measure;
  • More than learning that females respond differently to AF ablation;
  • And surely more than which coffee shop offers the best work place.

Putting this thing together showed me stuff: the process of discovery, it’s role in helping us be better doctors and the difficulties inherent in doing this kind of valuable research in our current system.

So of course…bloggers blog.

First: Many have asked why we bothered doing research? What’s the motivation? Money? Fame? A greater purpose?

It was none of these. I had no plan for an institute or a new career, or anything that far-meaning. The idea that looking at our experience over the past few years might be interesting just popped in my noggin. Poof. We have been ablating AF nearly non-stop for 4-5 years. Surely, I thought to myself, there were at least a couple valuable lessons to be unroofed.

I ran this whim by my seasoned colleague, a former academic heart-rhythm specialist, to see if I was crazy. He confirmed that looking at our results could be interesting. He was curious. (Sidebar: that’s a good quality in a doctor.)

What got us interested in gender differences in AF was a comment on a blog post of mine. I was questioning whether AF in females differed from AF in males? The commenter suggested that until we looked at our data, we wouldn’t really know?

And was he ever correct.

Our data showed marked gender differences in the treatment of AF.  We found that women fared less well with AF ablation. Despite undergoing more ablation and more repeat procedures they still had significantly lower success rates.

This is relevant data that can be used in real-world patient encounters. In fact, I have already used it in the office when discussing AF ablation in females.

But we also showed something else: We are doing good work. Our complication rate was low. The numbers of re-do ablations were in line with published rates. And our success rates were in the range of those reported by centers that publish believable results.

So all this sounds cheery. The process of discovery as well as its results proved both rewarding and actionable. Our patients can be better informed.

Nifty, heh?

The downside is the reality, the sobering facts.

(Not complaints mind you, just facts.)

It was really hard to get this done without a paid research team. It required volunteerism to the highest degree. The other authors killed it (cycling term): Vicky Swift, a busy cardiac nurse spent many hours culling charts and data; Kathryn Grace Thorne, a medical student trying to study for exams also put in summer hours and worked in between exams; Sean Kettring, a college student worked weekends and between classes to get the stats right. He even kept me honest on what I could (and could not) say about the p-values. My colleague, Dr Mann, suffered through numerous sessions where I was the dumb fellow and he the wise professor. (These sessions, at least for me, felt nostalgic.)

We worked hard and long. And all for free. No sponsorship. No disclosures. There is little doubt that if you added all the hours worked as payable, there would be enough for a small car or carbon-fibre bike. Really…it took that much manpower for a just humble poster.

Though we learned a lot and contributed a very small amount to the understanding of AF ablation and gender, it would be impossible to make this a regular habit. That’s sad, because if clinicians had the means or the incentive to do even nominal research, we would surely know a lot more about how well (or not) our treatments work. For instance, what if we were able to look at the last thousand patients to whom we prescribed AF drugs? We might find some interesting facts. Real world data might look different than that which comes from carefully controlled clinical trials. (Think warfarin.)

The problem though is that people might occasionally work for free on a whim, but they aren’t going to do it on a regular basis. This means most data will continue to come from centers that are empowered by either foundation money or industry money. (Not a complaint, just fact.) Questions of how to generalize data from specialized centers and clinical trials to the real world will continue.

Maybe I am just a frustrated professor, or a dreamer that sees academics as a greener pasture?

But perhaps, a day may come when regular doctors—those who intersect with the real world—can contribute to the scientific understanding of this great field—the practice of Medicine.

Imagine the scientific growth if clinicians were bonus-ed on the number of abstracts accepted rather than procedures done?

Sorry, folks that was just a dream. I’m awake now.



2 replies on “On doing clinical research without a foundation”

I applause your enthusiasm for clinical research. I have it as well. It is like watching your child grow up, anxious to see how your work turns out. Whether it is all good or peppered with negatives, it all adds to growth of knowledge. As a CABG Patch Trial investigotor, one learned that not all good quality research is positive. All that matters is that we learn what is best for our patients. And that’s all anyone can ask. I would have felt like a robot just doing procedures without the joys of clinical research. Carry on. Fee for service is fading slowly, and outcomes count. Interesting times ahead.

Beautiful description of the poster generation process. Was fun and nostalgic for me as well. Glad the “real world” (maybe just a different world from academic medicine, but a big world nevertheless) could contribute something significant to the AFB literature.

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