Recap of 2017 in Cardiology

Hi all.

TheHeart.org | Medscape Cardiology published my picks for the top stories of 2017. Here is the link: Mandrola’s Top 10 Cardiology Stories of 2017

I called it the year of the medical reversal. Medical reversals occur when a superior study contradicts current practice.

I love medical reversals. First, they make you think about history. History teaches us a lot. Second, reversals reduce hubris–always a good thing. Finally, writers must have controversy. Controversy is our canvas. Reversals and doctors’ delay in accepting the new practice is fun to watch and write about.

Some highlights from 2017:

Doctors were shocked to the core that stenting a major blockage did not relieve chest pain any better than a sham procedure. That’s shocking because we already knew stents used in patients with stable disease don’t reduce the odds of a heart attack or death. Now, if they don’t even relieve chest pain. OMG. Billions are spent looking for and fixing blockages.

Another reversal of recent years was the failure of a special kind of stent, called the BVS. The name is not important. The idea was that the cage would disappear over time. Vanishing stents promised to make the artery healthier in the long run. BVS failed. Miserably. But we knew this in 2016. The story in 2017 was that experts denied to accept the failure. When key leaders don’t admit error and they keep promoting a treatment that harms people, that breaks our trust. The medical profession needs trust.

One of the biggest reversals of our lifetime may be the revelations on fat intake. I discussed the issues in point 3 of the piece.

Sucking clots out of blood vessels seems like a good idea. Nope. Studies showed it doesn’t work any better than standard care. Yet here is the thing: doctors keep doing it because “they know” it works.

Since I began cardiology, we have tried to prevent kidney injury from contrast agents given to show blood vessels. This year, two studies found that three common practices to protect the kidneys did not work. Yet, you guessed it. Doctors still do it. Even crazier: one of the practices shown not to work is considered a marker of healthcare quality.

(Imagine that: a practice used to grade doctors and hospitals on quality was proven useless and actually slightly more harmful than doing nothing. My friends, here is a pro-tip: most quality measures, star ratings and the like are a total farce. I have never been more convinced that many quality measures reduce quality.)

Speaking of farces, that we say patients with pacemakers and defibrillators must have special devices (called MR-conditional) to undergo MRI scans is also utter nonsense. This year, a major study, and an expert consensus statement from Heart Rhythm Society (I was an author on it), showed that old thinking needs revision. Another truth: almost any cardiac device is safe in an MRI if the scan is done with a protocol and supervision.

Opioids made the top-ten. Tragic is the best word to describe what’s happening to youngsters afflicted with infections in the heart from IV heroin.

Inflammation made the list. So did a possible (emphasis on possible) new way of ablating heart tissue without invading the body.

Finally, there was no big news in atrial fibrillation in 2017. We still don’t understand the condition. We still ablate in the same inelegant way. I still see tons of overuse and misuse of AF treatments.

JMM