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The Impact of COVID on Medical Education

Since the beginning of the COVID-19 pandemic, our lives have been significantly affected on every level. Different countries reacted in various ways and almost everybody was under lockdown at a certain point. With time, everyone has adapted to the new “normal”. Masks are on all the time, no handshakes or hugs, and if anyone gets slightly closer physically, we tend to get extremely uncomfortable. On the professional side, all health care workers were impacted too. At the very beginning, all elective procedures were delayed, there were long working hours, more stress, and a lack of personal protective equipment. Patients who were legitimately sick did not seek medical advice and hospitals were at full capacity. Additionally, didactics were canceled, medical students were asked to stay at home, in-person national and international conferences were canceled, and many more. As a result, training and education were disrupted but the medical community stepped up to the challenge and explored different avenues to ensure steady and proper education for all healthcare workers.

In the past several months, all professional societies (AHA, ACC, ESC, TCT, ASE, and many more) did a phenomenal job in reducing the impact of the pandemic on medical education. All conferences were switched to a virtual platform, different ideas were applied to keep everyone engaged, registration fees were reduced significantly or completely waived. I must point out that now it is possible to attend all national and international conferences from the comfort of your living room, listen and interact with experts in the field, and attend the sessions that you have missed at your convenience. Additionally, for grand rounds and didactics, remote education facilitated learning from experts from all over the world. Although all these efforts helped mitigate the effect of the pandemic on education, however, everyone is still hoping for in-person conferences. Unfortunately, the ESC has decided to deliver its full portfolio of congresses and events virtually up to the ESC Congress in September 2021. Moreover, the ACC annual meeting was pushed back to May 2021 and it is expected to be in-person and virtual. Although recently, promising news about the vaccine has been published however it is unclear for how long will the pandemic last. In my opinion, the COVID pandemic expedited the development of remote education and eventually, it will become a cornerstone in medical education. In the time being, we have to work on overcoming this pandemic without impacting our education and most importantly staying safe.

 

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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The Story of SGLT-2 Inhibitors

There were a lot of interesting presentations at the American Heart Association 2020 Scientific Sessions today. However, I found the most interesting was “But Wait, There are More Targets: SGLT-2 inhibitor…” by Dr. Marc Pfeffer. In his presentation, he discussed how did we end up using an antihyperglycemic drug (SGLT-2 inhibitors) in treating and preventing heart failure.

In 2008, the Food and drug administration (FDA) mandated that in order to approve glucose-lowering medications, cardiovascular safety should be established. Which was defined at the time as cardiovascular death, myocardial infarction, and stroke (heart failure was not included). Subsequently, all antihyperglycemic drugs were passing the bar when it comes to cardiovascular events. Until 2015, unexpectedly the EMPA-REG OUTCOME study showed that in patients with type 2 diabetes, empagliflozin had a lower rate of cardiovascular deaths, heart failure hospitalizations, and death from any cause.(1) Following this study, the endocrinologic and metabolic drugs advisory committee vote was split in regards to the impact of SGLT-2 inhibitors on cardiovascular outcomes. The final vote was 12 “Yes” vs 11 “No”, and as a result, the FDA concluded that SGLT-2 inhibitors reduced cardiovascular death.

Afterward, EMPA-REG OUTCOME results were reproduced in several studies (CANVAS, DECLARE-TIMI). Most importantly, this effect was independent of HbA1c level. However, the population in the aforementioned studies were not predominantly heart failure patients. At this point, the cardiovascular community adopted the drug, and from 2017 to 2018 four large outcomes trials were launched (DAPA-HF, EMPEROR-Preserved, EMPEROR-Reduced and DELIVER) In 2019, DAPA showed that among patients with heart failure and a reduced ejection fraction, the risk of worsening heart failure or death from cardiovascular causes was lower among those who received dapagliflozin than among those who received placebo, regardless of the presence or absence of diabetes.(2) In 2020, EMPEROR-Reduced showed that among patients receiving recommended therapy for heart failure, those in the empagliflozin group had a lower risk of cardiovascular death or hospitalization for heart failure than those in the placebo group, regardless of the presence or absence of diabetes.(3) The previous findings were confirmed in a metanalysis that included both studies.(4) Although it is not very clear how SGLT2 inhibitors decrease cardiovascular events and heart failure, currently we have robust evidence proving its efficacy.

While many discoveries in medicine are incidental. I find the story of SGLT2 inhibitors as fascinating as other landmark accidental discoveries in medicine such as penicillin and warfarin. The moral of the story is always be observant and trust the data.

References:

  1. Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med. 2015;373(22):2117-28.
  2. McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019;381(21):1995-2008.
  3. Packer M, Anker SD, Butler J, et al. Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure. N Engl J Med. 2020;383(15):1413-24.
  4. Zannad F, Ferreira JP, Pocock SJ, et al. SGLT2 inhibitors in patients with heart failure with reduced ejection fraction: a meta-analysis of the EMPEROR-Reduced and DAPA-HF trials. The Lancet. 2020;396(10254):819-29.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”