2022 in Review Through a Cardiology Lens
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2022 in Review Through a Cardiology Lens

Live Meetings, COVID, Wearables and AI, RCTs in China

; C. Michael Gibson, MD

Disclosures

December 19, 2022

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This transcript has been edited for clarity.

Robert A. Harrington, MD: Hi. This is Bob Harrington from Stanford University, here on theheart.org | Medscape Cardiology. Over the past several years, I've had the pleasure of doing a yearly wrap-up in December with my good friend and colleague, Dr Mike Gibson, from Boston.

In these segments, what we'd like to do is cover the landscape of cardiology. What are some of the trends? What are some of the things that Mike and I are talking about with our broader circle of colleagues that really caught our attention in the past year?

This year, I thought we'd cover topics that will run the gamut from what I'll call high-level policy issues to some specific clinical trial observations. Mike and I will, in our usual way, go back and forth.

With that, let me introduce my good friend and colleague. Dr Mike Gibson is an interventional cardiologist at Beth Israel Deaconess in Boston. He's also a professor of medicine at the Harvard Medical School, and he is the CEO of the Baim Institute, a not-for-profit academic research organization. Mike, thanks for joining us here on theheart.org.

C. Michael Gibson, MD: It must be December. You and I are back and it.

In-Person Meetings

Harrington: The Bob and Mike show goes again. Mike, let's start with big, broad topics and then maybe filter down. The first one I want to talk about in 2022 is live meetings — they're back. We went to ACC, we went to ESC, we went to AHA, and there were smaller meetings in between. You cover many of the meetings from a news perspective. Give me your observations.

Gibson: We're back and it's great. I think the societies have done a great job of this whole virtual thing. I mean, it was amazing. People around the world could get on, watch what was going on, and participate in some way where they could get the information. They got the data, but meetings are about more than data. They're about relationships. We practice evidence-based medicine, but we also practice relationship-based medicine.

No matter what business you're in, you're in the people business, where 70%-90% of communication isn't the words but the body language. When you do things virtually, you lose the ability to connect and have that trust that develops from those more intimate face-to-face connections. Many of the meetings happen outside the rooms, and that's why it's so important to go to the meetings. It's the hallway conversation that's almost as important as what's said at the podium. There's what's said at the podium, but then everyone's walking around and saying, "What did you think?" They're looking for the digestion of that content.

I think it's been great. The meetings are smaller, but I'm running into all the people I really want to see. I do think they could maybe downsize the venues a little bit so the density is better. Sometimes when you have a great big convention center, there's just not that bumping into each other. It doesn't feel as hot or as exciting. The best thing is being able to see my friends — going up to you, Bob, and giving you a big hug. Can't do that online.

Harrington: I agree with you. The networking. How many times do I say, "Hey, Mike, there's this person I want you to meet," and I introduce you to somebody who ends up working with you, or you introduce me to somebody who ends up being a fellow here in the next couple of years. I do think that those sorts of interactions are critically important.

Then, as you and I always talk about, there's the, "Hey, I got this idea" conversation, where in the morning over a cup of coffee, or in the evening over a beer, you can sketch out a grant we want to put in together or a proposal we want to pitch to somebody. Those things only take place in that sort of intimacy.

At the same time, wow — to be able to share the education with people who, for whatever reason, either don't want to or can't go to a live meeting; they can still get the education. I agree that the societies and the other organizations have done a great job.

One thing, Mike, that I want to comment on. You just finished a very large clinical trial that enrolled many patients during the COVID-19 pandemic. One of the things that amazed me at the three big meetings in cardiology was that the late-breaking clinical trials didn't stop. Work was still getting done. You want to comment a little bit?

Gibson: Yes, it's dumbfounding. We got through COVID-19, we got through some unrest and war. Amazingly, the people in Ukraine are better able to follow their patients up than some of the US investigators. It is a testament to, I think, the dedication of people around the world to continue to get the job done.

On the other hand, Bob, I have to say that we are going to have the walking wounded after all this. I think many sites closed down. They made it through some of these trials, but then they closed down. We're going to have to go through a rebuilding phase. It's really a testament to everyone we work with that they got the job done.

Harrington: Well said. I do think many sites did suffer, and research nurses moved off to the clinical domain because there was a need at their institution or they just were exhausted trying to do everything they were doing. I do agree with you. I think there's going to be a rebooting of research — not only in the United States but also around the globe — to see if we can continue to do this better. I do agree with you that the cardiovascular research community is amazing with their dedication to really wanting to answer questions.

COVID 19 Trials

Gibson: We moved over to doing COVID-19 trials, too.

Harrington: That brings you to my next topic, which is COVID-19. We're certainly not done with the pandemic. The vaccines have made a big difference. The antivirals and the monoclonal antibodies have made a big difference. We lost many people in the United States and we're not done yet. There are still people dying every day. Our own hospital still has a number of patients with COVID-19 this morning. I suspect that yours is the same.

Let's talk about two things, Mike, including lessons learned in the research realm and then a little bit about cardiovascular issues post–COVID-19.

Gibson: I think we learned many things about ourselves. One of the strengths of the United States is that we are fiercely independent. One of the weaknesses of the United States is that we are fiercely independent. What happened was that we had many well-intentioned people trying to answer the same question in 20 different ways. The UK got it right. They got together and they had a series of well-organized studies that showed a path forward with a few therapies like steroids.

We did get our act together in April 2020. Different agencies, including the NIH, the FDA, and the CDC, all came together and said, "Look, we have to get organized, we have to identify what we think some of the best shots on goal are, we have to create some master trial protocols so everyone's doing things the same way, and we have to develop some networks." That was successful.

The lessons weren't all positive trials, and that's okay. That's important. We learned that some things didn't work. We learned that therapeutic doses of heparin were no better than prophylactic doses. We learned that adding antiplatelets didn't help at all. We learned that things like ivermectin didn't work, and we learned that many of these new antibodies or combinations of monoclonal antibodies really didn't improve care either.

It's a little bit like what you're saying in Silicon Valley: Fail fast. It's important in trials to fail fast, too, and to discard therapies that aren't going to work so that we can go assess some that are going to work. One of the most important enduring lessons is getting organized and getting these master protocols together so that we can do this again in the future when the next pandemic happens.

Harrington: There were networks that have existed that were not designed for infectious disease pandemics, like the Cardiothoracic Surgical Trials Network, which turned their attention to doing COVID-19 studies. Guess what? They did it really well because they were an organized group of investigators with supported infrastructure that then did really well.

I love your comment on master protocols. I also like your comment, Mike, on failing fast. All of these studies that came out of NIH had built into them very aggressive, early interim analyses to discard the ones that weren't likely to be working. You're absolutely right that sometimes knowing what doesn't work is as important as knowing what works.

The final thing I'll say from a US perspective is that I do think we are uniquely positioned because of the type of investigators that work with NIH. We haven't even seen yet all the mechanistic work that's going to emerge and all the biologic insights that are going to be made. I think there is more to come about trying to understand this disease and our biologic response to it.

Gibson: We have many battles to fight. We have many patients with long COVID out there.

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