The words of 19th Century novelist and playwright Wilkie Collins could define the paths through which clinicians attempt to preserve human life. Unfortunately, targeting the appropriate treatment for a specific patient is an objective that tends to be much less attainable. However, the trend within cardiovascular medicine is moving toward that type of specificity.
This week in the Annals of Internal Medicine, researchers revealed that a strategy of tailoring statin therapy based on patients' overall risk of cardiac events compared with a strategy of targeting cholesterol levels resulted in fewer events while treating fewer persons with high-dose statin therapy. To properly evaluate a high-risk patient, the authors said that knowing the overall heart attack risk is more important than knowing the cholesterol level.
At the Boston Atrial Fibrillation Symposium last week, electrophysiologists attempted to clarify treatment strategies for various states of this ever-burgeoning disease. Specifically, in his presentation, Dr. John Camm suggested that asymptomatic atrial fibrillation patients are understudied and potentially underserved, despite their prevalence. He suggested it is because they are "undiscovered."
Over the past year, partly due to a multitude of positive clinical studies, ablation for AF has become a more common treatment choice. Yet, cardiac surgeon Dr. Ralph Damiano, Jr., questioned whether surgical ablation has a place. He argued that minimally invasive atrial fibrillation surgery techniques need to be patient-specific rather than a single operation.
However, personalizing treatment doesn’t mean that care can’t be standardized. In fact, the American Heart Association issued a policy statement, encouraging the use of regional systems of cardiac resuscitation care to improve out-of-hospital cardiac arrest survival rates. Also, a prospective, observational study in January’s Catheterization and Cardiovascular Interventions reinforced that pre-hospital ECG assessments significantly reduced door-to-balloon time.
Much like understanding the nature of humanity, the proper treatment for various cardiovascular disease states tends to be elusive. As Collins suggested: “It is the nature of truth to struggle to the light.”
On these topics, or any others, please feel free to contact me.