Just a few weeks before the 2013 American Heart Association Sessions, Shelley Wood, the managing news editor of theheart.org emailed to ask if I was up for going to the meeting. With trips to San Francisco, Denver, Athens and Amsterdam already in the books this year, I had counted 2013 as a win. I was ready to ease into Thanksgiving and conclude the bike season with a couple of cold-weather CX races. But when opportunity presents itself, ie…when the big strong guy in front of you attacks, it makes sense to follow.
Yes. Yes. I am in. I was excited to see my THO friends again. I was excited to write and learn.
My role at meetings is to be a physician adviser for the THO journalism team and to write a daily opinion column on a topic of interest. THO is very careful to separate its news and editorial content. We meet each night before dinner to discuss the next day’s events. In many cases, as media, you get a heads-up of what’s coming before a study is released. This allows for varying degrees of pre-writing. (I used to think journalists were speed-writers because lengthy essays on a topic were posted immediately after an announcement. Journalists do write far faster than I do, but having the study results and discussions beforehand helps.)
The daily routine for me is to get up very early (0400) and start writing. I don’t know about you, but my writing brain works much better in the morning. In the best case, when writing about a big study (with pre-embargo details), I can get much of the essay done before breakfast. Then, at the Sessions (which is called Congress in Europe), I go to the morning press conference and/or presentation. That gets me back to the press room by late morning. I aim to finish writing by early afternoon. There isn’t exactly a deadline, but you want to get the piece to the editors as early as possible. Plus, in my case, I also like to allow time for exercise before dinner.
That’s the best case scenario. Often, though, the big studies are less interesting. Everyone is writing about them; everyone has the pre-embargoed material, and really, as an opinion writer, you could opine on big studies from home. This is why I like to find smaller studies that you have to be at the meeting to cover. Maybe the study has small numbers, or it’s an animal study, or it’s looking at a novel technology. These sorts of presentations are frequently given as posters, which are cool because you can walk by and talk to the researchers.
The logistics on small-story days is different. Rather than pre-writing in the morning, I’ll be scouring the session book for interesting studies. At the same time, I’ll be researching the topic on the Internet. That morning, I’ll head to sessions and take notes. (I use Evernote.) If it’s an oral presentation, I record it using the voice memo app and take notes with the laptop. If it’s a poster, I tap notes on the iPhone and take pictures. Either way, the stuff goes into Evernote, which syncs across all devices. Smaller-study days are harder because the writing doesn’t begin until midday. This is serious butt-to-chair time.
Enough with the race report. Let’s get to the actual content of my AHA2013 coverage.
Improved survival in cardiac arrest:
Day 1 at AHA is reserved for a resuscitation conference. Heart disease remains the number one killer. Cardiac arrest is the most common means of dying from heart disease. The chance of meaningful recovery after an out-of-hospital cardiac arrest is low–in most cities, below 10%. These facts have stimulated a great deal of research in the treatment of sudden death. My Day 1 post touched on two studies that added to the knowledge base of basic CPR, which is critical because if you suffer cardiac arrest, you depend on fellow mankind for help. One study measured the effects of showing mall shoppers a 1-minute video on basic CPR. The other study analyzed the threshold duration of CPR in the field. In short, a 1-minute video made a huge impact in the quality of bystander CPR, and, to my surprise, CPR should be continued for as long as 38-minutes. The title of the post is AHA 2013 Day 1: Improving Survival in Cardiac Arrest—A worthy goal!
The other news from the resuscitation symposium is that the notion of therapeutic hypothermia (extreme cooling) for cardiac arrest victims went the way of many good ideas in medicine: it did not stand up to scientific rigor. As my colleague Steve Stiles said in his title…cooling disappointed and tantalized.
The Snapchat of Echocardiography:
Day 2 at AHA was a slow day for heart rhythm news. It was mid-morning and I was getting nervous about finding a topic. Then, while cutting through a poster section, my eye noticed a poster on portable ultrasound. The stethoscope of the future? The young fellow asked, “do you have any questions?” Yes, indeed I do. We talked for many minutes and soon the senior researcher came over. They were from Scripps in Southern California, and I later learned that this group of researchers are leaders in using the handheld ultrasound. I believe the portable ultrasound device has great potential to improve doctoring. It won’t be long before your doctor’s stethoscope isn’t just audio but visual as well. The other thing about portable ultrasound that appeals to me is that it demands simplicity. If you make it complex–like a formal echocardiogram–it fails. It isn’t a procedure; it’s an extension of the physical exam. The title of the post is Portable Ultrasound as the Stethoscope of the Future: Is It the Snapchat of Formal Echocardiography?
AF ablation, the fall of dabigatran, and ICD/CRT news:
Day 3 at AHA hummed with electrophysiology news. One post on one topic wouldn’t have worked. In AF news, there was an interesting study on 10-year outcomes of AF ablation; there was one on citation bias for positive ablation results, and yet more news on the important role of lifestyle. The first novel anticoagulant drug, dabigatran, made headlines–and I stuck my head out and made a definitive call about this drug’s future. An intriguing study on CRT programming and two on ICD use caught my eye. And perhaps the most important study of the day was one in which the authors cheekily suggested ICDs prevented hip fractures. The idea here was to emphasize the need for doctors (and patients and journalists) to pay attention to the ‘methods’ sections of papers. The title of the post is Day 3 at AHA 2013: Top Seven EP Stories: AF Ablation, ICDs, CRT, Dabigatran, and Clinical Effectiveness Research
The controversy surrounding statin drugs pales in comparison to the turmoil of chelation. Here the word disruptive really does fit perfectly. The medical establishment is at a loss to explain the incredibly positive results for chelation therapy. Dr. Gervasio Lamas is the principal investigator of the TACT trial–a 31-million dollar NIH funded study of chelation v placebo in the treatment of atherosclerosis in high risk patients. Earlier this year, the controversial results were published in JAMA. At AHA, Dr Lamas presented a substudy of more than 600 patients with diabetes. The results were astounding. I had the pleasure of sitting down for coffee with Dr. Lamas. The title of my post is Chelation Therapy: Promising for Diabetic Patients but Disruptive to the Medical Establishment. If chelation really does work–now that would be something.
On the final day of AHA, a number of useful studies were released on the matter of treating atrial flutter. It’s a vexing problem because atrial flutter and atrial fib are related. My approach to the commonly encountered situation when both AF and AFL are present has changed. The AHA studies reinforced my new approach. What is also interesting about this story is that less may not be more–at least initially. In other words, striving to treat atrial flutter with minimal disruption may actually require a bigger upfront procedure. The title of the post is Say It Isn’t So. . . . In the Treatment of Typical Atrial Flutter, Less May Not Be More
That’s it for now.
The statin story and new guidelines are compelling. I will weigh in soon enough on that one. Stay tuned.