"...Its contents remain the same, but the medical practice changes." While we can always rely on Mark Twain for tongue-in-cheek theological perspectives, hopefully, the latter half of his statement remains accurate, and practitioners of medicine are willing to shed dogmatic, stagnant methods if newer superior evidence arises. This week, several clinical studies and analyses emerged that may serve as a platform to challenge the so-called "gold-standards" of treatment.
In this week's JACC, researchers questioned whether current practices provide the best care and reinforced the urgency for sex-specific clinical trials for heart failure, due to the difference in risk factors and treatment responses between men and women.
A German study found that calcium scoring may lend additional prognostic value to SPECT findings in patients with known, stable coronary artery disease (CAD). Currently, calcium scoring is used as a screening exam and in cases of suspected CAD--but not in cases of known CAD. Having better predictors of potential, future cardiac events in this patient population could lead to a change in a treatment plan, such as intensified medical therapy, shorter follow-up intervals and, if necessary, bypass procedures.
A new meta-analysis is suggesting that an iso-osmolar contrast agent and low-osmolar contrast media are equivalent in terms of the risk of contrast-induced acute kidney injury, despite data from previous studies that found the iso-osmolar agent safer. The investigators said that their new data provide strong support for a change to current ACC/AHA guidelines, which give a class IA recommendation for iso-osmolar contrast media in patients with chronic kidney disease undergoing coronary angiography.
One interesting note of change: A Circulation review found that data released at conferences spreads rapidly through modern high-tech means such as email, search engines and smartphones. Researchers noted an almost immediate drop in drug-eluting stents usage several years ago after negative data was presented at a major meeting. They caution that this rapid dissemination of data is part of the modern age and the process needs to be managed effectively until results are peer reviewed.
However, as our illustrious Twain points out: "A person with a new idea is a crank until the idea succeeds." So, the hesitancy of some to adopt new methodologies or rush to produce new guidelines may ultimately demonstrate prudence.
On these topics, or any others, feel free to contact me.