Your ACC 2019 Highlights

We had a great showing at the ACC Scientific Sessions in New Orleans! Thanks to those of you who took some time this week to drop us a note with photos and summaries about what you enjoyed the most. Great job, everyone!  We likely didn’t get it all but will keep sharing all of the ACC presentations and science.

AUGUSTUS

Renato Lopes, MD, PhD presented the results in the late breaking clinical trials session on Sunday. AUGUSTUS was a 2 x 2 factorial design randomized clinical trial of apixaban vs. warfarin and aspirin vs. placebo in patients with atrial fibrillation and either acute coronary syndrome or undergoing PCI. The main findings were that apixaban caused 31 percent less bleeding and reduced hospitalization compared with warfarin and that aspirin caused 89 percent more bleeding than placebo. There was no difference in ischemic events with apixaban vs. warfarin or aspirin vs. placebo. The investigators concluded that, “In patients with atrial fibrillation and a recent acute coronary syndrome or PCI treated with a P2Y₁₂ inhibitor, an antithrombotic regimen that included apixaban, without aspirin, resulted in less bleeding and fewer hospitalizations without significant differences in ischemic events than regimens that included a vitamin K antagonist, aspirin, or both.” The study was simultaneously published in the NEJM. AUGUSTUS provides critical data on how best to treat our patients who need both oral anticoagulation for atrial fibrillation and antiplatelet therapy for an acute coronary syndrome or PCI. Amit Vora, Chris Granger, and John Alexander were other Duke cardiology fellows/faculty involved with AUGUSTUS. Great job to all!

Race and Sex-Based Disparities Persist in the Treatment of Patients With Severe, Symptomatic Aortic Valve Stenosis – Poster presentation

Using a large nationwide claims-based database, Angela Lowenstern and team found that only approximately one third of patients with severe symptomatic aortic stenosis undergo treatment with AVR. While disparities in the treatment of non-hispanic black patients have improved over time, female patients still undergo treatment with AVR less often than male patients. Unsurprisingly, untreated patients in each group had poor outcomes. However, survival among female patients who underwent treatment was also worse than treated male patients, driven by higher mortality in the SAVR group.

Patient Perceptions and Management of Cholesterol Among Individuals With or Without Diabetes in Community Practice: Results From the PALM Registry – Moderated Poster presentation

Using the PALM registry, Angela Lowenstern and team examined statin prescriptions and patient perceptions among patients with and without diabetes. We found that a large proportion of high-risk patients remain untreated or under treated based on the 2013 ACC/AHA guideline recommendations for management with statin medications. Diabetic patients were more likely to perceive themselves to be at higher risk for future cardiovascular events and more likely to worry about these potential events. There remain significant gaps in guideline-recommended statin therapy use in patients with diabetes, despite objective and patient-reported assessment of higher risk and patient willingness to consider treatment with a statin medication.

Jimmy Tcheng was active in the innovation space at ACC.19. According to Jimmy, he had the most fun serving as a judge at the Artificial Intelligence “Shark Tank” competition Sunday morning in the Future Hub space. He also was a panelist on the Heart to Heart stage discussing artificial intelligence approaches in cardiovascular imaging, clinical risk prediction, and in reducing clinician burden.

Picture – left to right: Issam Moussa (Urbana-Champaign, IL), Jimmy Tcheng, Dipti Itchhaporia (Newport Beach, CA), Tom Maddox (St. Louis, MO)

Manesh Patel was interviewed by Dr. Gibson & the CTR team. His interview can be found here:  www.clinicaltrialresults.org or at the following link: http://tv.clinicaltrialresults.org/play.php?submission_id=2296.

Manesh enjoyed catching up with Bill Smith and Chris Cabell

Rob Mentz was awarded the W. Harvey Young Teachers Award. Well deserved!

John Serfas presented a poster entitled “Adults and Adolescents with Congenital Heart Disease: Who are we Losing to Follow Up?” We took a look at a database of North Carolina congenital heart disease patients seen at one of four centers in NC (Duke, UNC, Wake Forest, and ECU), and looked at rates of follow up at 1 and 2 years from an index encounter. We discovered that more than 40 percent of patients do not follow up within two years, and that Black race, Hispanic ethnicity, and less severe congenital heart disease are associated with lower rates of follow up.

Haider Warraich designed and led a session on the intersection of palliative care and cardiovascular disease, giving a presentation that provided an overview of end of life care for patients with heart disease.

Many Twitter posts with great photos – many comments from the team on how great it is to catch up with old friends at ACC!

Michael Nanna presented his work from the PALM registry as a moderated poster on Sunday, March 17 highlighting practice variation in lipid treatment and achieved lipid goals across U.S. community practices. Additionally, he presented his abstract demonstrating the lack of association between LDL-C and cardiovascular events in older adults free of cardiovascular disease from the pooled cohorts as a moderated poster on Saturday, March 16. Nanna presented this work again on Sunday as an invited oral presentation at the 2019 Geriatric Cardiology Section Poster Session, which was selected as the winning abstract in the Clinical/Translational category.