As the fall medical conference season begins to take stride, the cardiovascular community will be flooded with a plethora of clinical data, and the question remains about how quickly these trial results will become a part of clinical practice—will the data convert any physicians? Classical Greek philosopher Plato may provide some insight into adopting new practices, by suggesting that if the data ring true to one’s experience, it will further reinforce movement in that direction—rarely do data run contrary to real-life clinical practice, especially in well-designed trials.
This past week in Boston, the Heart Failure Society of America (HFSA) held its 13 th annual meeting, furthering reinforcing the need for more focus on the burgeoning heart failure patient population. In the late breaking clinical trials, the FAST trial revealed the potential need to incorporate fluid status monitoring, in addition to daily weight assessments, when monitoring at-home heart failure patients. Daily weight evaluations are traditionally unreliable.
Dr. Lynne Stevenson, who presented commentary on the trial, praised it for being well designed and asking the right questions, but also recognized that fluid status monitoring isn’t foolproof either. However, she noted that because one out of every three Medicare dollars is going to care for heart failure patients, more needs to be done to produce better patient management.
In another HFSA commentary on the MADIT-CRT trial, presented two weeks ago at the ESC conference, Dr. John G. F. Cleland questioned why the mortality results of the trial were high, and why did they contradict previous large, randomized trials of a similar patient population. As a result of these questions, he recommended a strategy implanting CRT first, and only if the patient deteriorates, to increase to CRT-D therapy.
Several other studies at HFSA examined the management of in-hospital heart failure patients; one of which found that high-volume providers have better outcomes and another that examined the “worst” patient symptoms for in-hospital patients.
Looking ahead to next week, Dr. Gregg W. Stone was kind enough to highlight important clinical trials and sessions at next week’s TCT meeting.
As Plato’s Allegory of the Cave suggests, only those individuals who are willing to remove themselves from the shadows and face the harshness of the light (or the discomfort of change) will experience Truth—or, just possibly, provide the best quality of care.
On these topics, or any others, feel free to contact me.