ACC 2019: A Media Roundup

Massachusetts General Hospital cardiologists at the 2019 ACC Annual Meeting discussed research findings on predicting and preventing adverse cardiovascular events and optimizing patient care. Highlights included research on the relationship between air pollution and adverse cardiovascular events and how naps could reduce blood pressure in patients with hypertension. Cardiologists also emphasized the importance of improving patient care. They gave their perspectives on how to make electronic consultations meaningful and how to gain wisdom through cardiovascular crises.

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Their discussions were covered in various trade articles and videos, which are highlighted below.

The Connection Between Air Pollution and Arterial Inflammation Linked to Major Adverse Cardiovascular Events

Air pollution is a critical risk factor for cardiovascular disease. In MD Magazine, Ahmed Tawakol, MD, co-director of the Cardiac MR PET CT Program, describes a study in which researchers investigated how air pollution, normally associated with lung disease and cancer, could lead to major adverse cardiovascular events (MACE). In the study, Dr. Tawakol found that air pollution and arterial inflammation are independently related and could predict MACE, such as stroke or myocardial infarction. In the study, 477 patients were screened for cardiovascular diseases for five years. The team found that 39 individuals had adverse events and they had increases in arterial inflammation. The possibilities for combating cardiovascular disease caused by air pollution could involve policy change or addressing air pollution like any other risk factor for cardiovascular disease.

Low Cardiac Rehab Referrals and Gaps in Care for Patients

Low referrals to cardiac rehabilitation means low attendance for patients with type 2 myocardial infarction (MI). In Healio/Cardiology Today, Jason Wasfy, MD, director of Quality and Analytics at the Mass General Heart Center, explains how little is known about the best way to treat patients with type 2 MI. However, the recent advent of a separate billing code for type 2 MI has made it easier to identify patients and understand their outcomes. In a study, Dr. Wasfy and his colleagues used the new ICD-10 billing code to identify patients who have type 2 MI from October 2017 to May 2018. They collected information on cardiac rehab referral, scheduling and attendance. They found that 359 patients had type 2 MI. Of the 321 patients alive at discharge, only 21 were referred to cardiac rehab. These low referral and attendance rates create gaps in care for patients with coronary disease.

Wisdom Through Cardiovascular Crises

Learning from cardiovascular crises can prepare cardiologists for the next time they face a challenge. In MD Magazine, Douglas Drachman, MD, director of the Cardiovascular Fellowship Program and the Interventional Cardiology Fellowship Program, emphasizes the importance of learning from the most critical points of providing care. Open communication and following an emergency protocol can help cardiologists working in trauma care. Dr. Drachman stresses the importance of recognizing a crisis, engaging the appropriate protocol and communicating to the rest of the team to prevent adverse outcome for patients and provide wisdom should another one occur.

Naps Could Lower BP in Patients with Hypertension

Taking naps could be a new addition to the list of therapies, which include exercise and weight-loss, that are outside of drug therapy for high blood pressure (BP). In Healio/Cardiology, Randall M. Zuzman, MD, director of the Division of Hypertension, discusses a study that has generated a hypothesis on how napping can lower BP. The results of the study are not definitive because it was not a randomized trial. To improve the study, Dr. Zuzman suggests conducting a randomized trial where some people are encouraged to nap and others are prevented from napping.

Early Discharge, Home Treatment with Rivaroxaban Promising in Patients with Low-Risk PE

Physicians worry that discharging patients with PE too early could result in adverse outcomes such as recurrent PE or death. Due to insufficient data to guide decision-making, physicians will often vary in how they manage PE. In Healio/Cardiology, Kenneth Rosenfield, MD, MHCDS, explains that patients with relatively low-risk PE can be discharged within 48 hours on rivaroxaban. This was discovered after the HoT-PE trial, which identified a cohort of PE patients who are safe enough to send home early. Even though these patients have a relatively low-risk for PE, physicians should continue to follow-up with them because they may still be at risk for PE in the future. This study is important in establishing a threshold for measuring when it is safe to discharge a patient on a direct oral anticoagulant and leading to better decision-making for physicians.

Sacubitril/Valsartan Helps Patients with Acute HF

An eight-week study shows that when patients with acute HF are switched from enalapril to sacubitril/valsartan, there is an acute and significant reduction in NP pro-BNP. In Healio/Cardiology, James J. Januzzi, MD, director of the Dennis and Marilyn Barry Fellowship in Cardiology Research, suggests that starting sacubitril/valsartan in the hospital or soon after being hospitalized will likely lead the patient to experience reduced risk for recurrent decompensation and rehospitalization. Dr. Januzzi believes that a large trial is needed to observe a more definitive effect on how NT-proBNP reduction can decrease adverse events in patients treated with sacubitril/valsartan.

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