A New Approach to Evidence in Cardiology
I am in Berlin at the European Heart Rhythm Society meeting. Sadly, this meeting conflicts with the American College of Cardiology meeting in Atlanta.
ACC has produced a bunch of trials worthy of consideration. Since I have duties here at EHRA, I will defer this Monday’s Study of the Week to my friend Vinay Prasad who has an incredible video appraising the REDUCE-AMI study.
I see REDUCE-AMI as one of the most important trials of the modern era—because it tests not using an established therapy. In this case, beta-blockers in patients with recent MI.
I have just sent in a formal appraisal of this trial for editorial review at TheHeart.org | Medscape Cardiology. Until that comes out, please do listen to Vinay.
As you listen, think about a piece of advice I give to trainees.
I often say that the challenge of future cardiologists will not be having a therapy to use, but whether they ought to use it.
Future trials, I think, will increasingly need to study not doing things that we used to do.
Here is Vinay
The titration off BB is very interesting aspect. How did it pass IRB? Or was there really equipoise? It's a pretty bold move to titrate off of BB if that is standard of care.
It's the kind of gimmick that arguable is often to used to promote a new drug by making control group less than SoC. Although here if there is bias toward less is more minimalism we may wink so long as it turns out ok, which is problematic.
VP notes the conundrum but it raises important ethical questions of how to ethically show less is more after the horse is out of the barn.
His comments on quality metrics needs to be shouted from the rooftops... especially since they are antithetical to true shared decision making