AHA20 – The Early Career Voice

The Adaptation of Virtual Learning Platforms for Scientific Sessions: A Change Worth Keeping!

December 31, 2020December 28, 2020 Sheila Sahni, MD, FSCAI

It was Sunday, February 23^rd when I boarded my first and last flights of 2020. It was one of those very rare trips where you’re roundtrip would be within 12 hours. Destination: Cardiovascular Research Technologies 2020 meeting in National Harbor, Maryland. Why only a one-day trip? It was all I could swing with my clinical schedule, professional and personal commitments. To be honest, I felt grateful that the requested speaking engagement was on a Sunday relief that saying “yes!” to a meeting wouldn’t disrupt my patient care schedule. Within the span of 7 hours that Sunday, I reviewed my presentation in the Speaker Ready Room, connected with the moderators and other interventional cardiologists on the panel, presented a lecture, reunited unexpectedly with colleagues and mentors, and sat for an interview about my participation. My last encounter was an impromptu meeting with a mentee which began in person and completed by phone as I rushed to catch my flight home to New Jersey just in time for the workweek to begin. The types of jaunts surely sound familiar to many of you. This was the way of many professional cardiologists committed to advancing science, spreading awareness of evidence-based therapies, creating forums for advocacy and networking across of the spectrum of cardiovascular societies and national meetings. This was a commitment we all embraced regardless of the sacrifices. And then, weeks later, the world fundamentally changed.

As coronavirus began to spread worldwide in March 2020, our nation changed dramatically with fear of an invisible enemy – the SARS-CoV-2 virus. The COVID-19 pandemic changed all of our lives as physicians, personally and professionally. Impressively, national societies adapted to an unprecedented time rapidly – the commitment to bridge practice-changing, ground-breaking science to physician offices globally remained its primary mission. Therein birthed the onset of virtual meetings with physicians worldwide participating and engaging in science virtually. As I reflect on my personal experience attending the virtual American Heart Association’s 2020 Scientific Sessions highlights was such a stark contrast to the moment I described earlier in February.

Going into this year’s scientific session, it was clear that this year would look and feel completely different. What was less obvious, however, was the positive impact a virtual meeting had on my learning, engagement, and participation. Despite many technological advancements to facilitate virtual learning, transitioning to this model to create a well-rounded experience necessitated thoughtful consideration of the right ways to optimize learning. While the experience of listening to lectures and symposiums may be easily replicated virtually, the essence of conferences is the moments to engage with colleagues and peers on late breaking research as well as discuss professional challenges. I was particularly impressed with how AHA facilitated fireside chats on Zoom alongside sessions both live and on-demand. The discussion was dynamics – covering a wide array of topics regarding social injustice in healthcare, imposter syndrome, early career advice, and debates in dual-antiplatelet therapy It enabled active participation, optimized learning, and allowed me to consume more content than ever before. A hybrid model can achieve clear cost savings, minimize travel while also maintaining an ideal learning environment to advance evidence-based medicine. By striking this balance, I am optimistic about a future that leverages a hybrid virtual and physical format.

“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.”

COVID-19 Changing Clinical Trials

December 30, 2020December 28, 2020 Kylia Williams

This year was the first time I’ve attended the AHA’s Scientific Sessions, and although I didn’t get the full experience in a busy conference hall, the virtual experience did have some advantages. I was able to attend every session that interested me, either live or later on demand. In-person discussions were substituted with Zoom rooms, and Twitter threads allowed me to interact with people I may not otherwise have seen. I also liked that I could see all the sessions and posters that are available at a glance. When looking at the schedule, I noticed how much focus Scientific Sessions places on clinical trials and was surprised by the number of variety of ongoing trials.

Before Scientific Sessions, my knowledge of clinical trials was limited to the information in the AHA’s “A Guide to Understanding Clinical Trials”. I learned a lot by watching the various talks, late-breaking science presentations, and “Meet the Trialist” Q&A sessions. I also appreciated that these presentations focused not only on positive results of interventional trials but also on the results of null trials as well as implementation trials focused on care delivery. Several other early career bloggers have written blog posts about the individual trials covered at Scientific Sessions. What interested me the most was the intersection of clinical trials and the COVID-19 pandemic.

Dr. Clyde Yancy stated that “we cannot partition the social experience from the scientific reality, because they are intertwined.” COVID-19 has made this fact especially clear, as science is at the forefront of the public conversation and the social disparities in science and medicine are stark. During the Opening Session, two giants of cardiovascular medicine, Dr. Eugene Braunwald and Dr. Nanette Wenger, along with Dr. Yancy and Dr. Robert Harrington discussed some of these issues in the context of clinical trials and the changes that have been brought about or accelerated by COVID-19.

One important change has been the increase in public-private partnerships and the sharing of data between groups. Dr. Wenger noted that in some fields, there has already been the development of consortiums, large networks of study sites, that are consistently maintained so that large trials can be started efficiently. The prevalence of these is only growing as the benefits of data sharing are becoming more obvious.

They also discussed the increase in clinical trial enrollment during the pandemic. Dr. Braunwald noted that there has been an increase in scientific literacy among the general public, and people know more about clinical trials. They also acknowledged the expansion of telehealth, including video visits, virtual consent, remote monitoring, and the inclusion of patient-entered data, which makes it easier for participants. There has also been a streamlining of protocols, leading to COVID-19 vaccine trials to be conducted with unprecedented speed and allowed the continuation of other current trials.

These changes have led not only to an increased number of study participants but also greater diversity. There tend to be gender and racial disparities among participants of clinical trials, but virtual platforms reduce the cost associated with study participation. However, Dr. Wenger made it clear that minority populations remain underrepresented; trial populations for COVID-19 still do not reflect those most affected by the disease. During the Closing Session, Dr. Norrina Allen discussed some of the population science research presented at Scientific Sessions, showing that racial disparities in health can be attributed to social and environmental drivers. She emphasizes that one way to narrow these gaps and increase diversity in trial enrollment is to increase the diversity of research teams and clinical trial leaders. This has been a thread throughout all of the Scientific Sessions – that diversity and inclusive environments in science and medicine leads to greater equity and better health for all.

Tips from TIPS-3: an International Polycap Study

December 29, 2020December 28, 2020 Noora Alhajri, MD, MPH

The burden of cardiovascular disease (CVD) is increasing globally despite some favorable changes in epidemiology during the last three decades. Changes in the mortality rate of CVD are to some extent explained by changes in the main CVD risk factors. The burden of CVD across low- and middle-income countries (LMIC), now accounts for 75% of all CVD cases. Although the risk for CVD in LMIC is lower when compared to high-income countries, however, the morbidity and mortality from CVD is higher in LMIC. Access to more affordable and effective primary prevention strategies is needed to reduce the global burden of CVD. Strategies that are cost-effective, affordable by local economies, highly impactful, easy to adopt, and easy to implement across a wide range of healthcare settings are warranted.

Findings from the Late-Breaking Scientific session titled: “Bending the Curve for CVD: Precision or Polypill” or as known as the Polypill got me intrigued. In a statement by Dr. Prabhkaran he pointed out that there are immense opportunities to lower the risk of CVD by controlling blood pressure, lipids, and other modifiable risk factors that could reduce the global burden of CVD, yet we need to increase their use. Could Polypill be that innovation?

Fixed-dose combination polypill reduces CVD events by 21% in the intermediate score population.

Study Design

Patients were randomized in a 1:1 fashion to either a once-daily polypill (n=2,861) or a matching placebo (n=2,852), a total of 5,713 participants were enrolled that were followed up for up to 4.6 years. The mean age of participants was ~ 64 years and females constituted 53% of all study participants. The 2x2x2 trial compared a fixed-dose combination hypertension lowering agents + lipid-lowering components: atenolol 100 mg + ramipril 10 mg + hydrochlorothiazide (HCTZ) 25 mg + simvastatin 40 mg.

Principle Findings*

Overview

Results from TIPS-3 trial showed that a once-daily polypill (fixed-dose combination of simvastatin, atenolol, ramipril, HCTZ), reduced the risk of cardiovascular events by 21% at ~5 years among intermediate CV risk patients when compared to placebo. The study also highlighted that Polypill plus Aspirin beats polypill alone for primary prevention in individuals at intermediate risk for CVD.

Polypill vs. placebo: The primary outcome of CV death, myocardial infarction (MI), stroke, heart failure (HF), cardiac arrest, revascularization, was 4.4% vs. 5.5% (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.63-1.0).

CV death: 2.9% vs. 3.5%

MI: 0.6% vs. 0.9%

Stroke: 0.9% vs. 1.3%

Arterial revascularization: 0.4% vs. 0.9% (p < 0.05)

Secondary outcomes for polypill vs. placebo:

Mean difference in systolic BP: 5.8 mm Hg (5.1-6.4 mm Hg)

Mean difference in LDL-C: 19 mg/dl (17.3-20.8 mg/dl)

CVD/MI/stroke: 3.9% vs. 4.9% (p > 0.05)

All-cause mortality: 5.2% vs. 5.7%

Dizziness or hypotension: 2.7% vs. 1.1%

Secondary outcomes for aspirin vs. placebo:

All-cause mortality: 5.1% vs. 5.9%

International Society on Thrombosis and Haemostasis (ISTH) major bleeding: 0.7% vs. 0.7%

Gastrointestinal bleed: 0.4% vs. 0.4%

Combination of polypill + aspirin vs. double placebo: The primary outcome was 4.1% vs. 5.8% (HR 0.69, 95% CI 0.50-0.97).

CV death/MI/stroke: 3.6% vs. 5.3% (p < 0.05)

All-cause mortality: 5.2% vs. 6.5% (p > 0.05)

Stroke: 0.7% vs. 1.6% (p < 0.05

Given these results, Dr.Salim stated that “even if half the people who were eligible took this polypill we can prevent about 3 to 5 million people from getting a heart attack or stroke or dying from heart disease or stroke every year and the polypill we used cost about $0.50 per dose and is clearly cost-effective, maybe even cost-saving”.

The findings of the polypill trial are attractive because it seeks to provide major cardiovascular drug agents all in one simple pill minimizing drug non-compliance and thus improving cardiovascular outcomes, specifically among socioeconomically vulnerable communities with the largest health disparities and where use of these therapies is reduced. However, some might argue that this approach is contradicting the concept of precision medicine and might amount in overmedication a large group of people since many people in the target population may never experience a cardiovascular event. At the very end, it is important to emphasize that population-based and risk reduction-based strategies are not mutually exclusive

* Results adapted from JAAC: https://www.acc.org/Latest-in-Cardiology/Clinical-Trials/2020/11/11/21/14/TIPS-3

References

Yusuf S, Joseph P, Dans A, et al., on behalf of the International Polycap Study 3 Investigators. Polypill With or Without Aspirin in Persons Without Cardiovascular Disease. N Engl J Med 2020;Nov 13:[Epub ahead of print].

Presented by Dr. Salim Yusuf at the American Heart Association Virtual Scientific Sessions, November 13, 2020.

Presented by Dr. Prem Pais at the American Heart Association Virtual Scientific Sessions, November 13, 2020.

Muñoz D, Wang TJ. The Polypill Revisited: Why We Still Need Population-Based Approaches in the Precision Medicine Era. Circulation. 2019;140(22):1776-1778. doi:10.1161/CIRCULATIONAHA.119.043491

AHA2020 – The Next Steps in Treating Heart Failure

December 29, 2020December 28, 2020 Baljash Cheema, MD, MSCI

AHA 2020 came and went, and now is the time to put into context the scientific advances presented. While all areas of cardiology saw therapeutic innovations, the ever-evolving landscape for heart failure (HF) therapies stood out in particular.

These were among the key discoveries shared at AHA20 in the HF space:

GALACTIC-HF: In patients with chronic heart failure with a reduced ejection fraction (HFrEF), the cardiac-specific myosin activator omecamtiv mecarbil reduced the primary composite endpoint of time to HF event or cardiovascular death, driven by a reduction in hospitalizations and ED visits. Importantly, the therapy appeared to be hemodynamically neutral, and subgroup analysis showed those with lowest ejection fraction (EF) may benefit in particular.

AFFIRM-AHF: In patients with HFrEF and iron deficiency stabilized from an acute HF event, IV iron repletion reduced the risk of subsequent hospitalization for HF but not death.

SOLOIST-WHF: In patients with worsening HF, the SGLT1/2 inhibitor sotagliflozin significantly reduced the risk of death and hospitalization for HF subgroup analysis showed the results persisted regardless of EF.

SCORED: In patients with diabetes and chronic kidney disease, sotagliflozin reduced the risk of cardiovascular death and subsequent hospitalization and/or urgent visits for HF. Similarly, the effect was seen regardless of EF.

These results not only add to the proven therapies for HFrEF including the cornerstones of ARNI, MRA, BB, and SGLT2 inhibitors, they add therapies for worsening heart failure and strongly suggest therapy for heart failure with a preserved ejection fraction. They may even hint at therapy for those with very low EF. With the VICTORIA trial showing benefit for vericiguat at ACC 2020, and additional therapies already indicated for subsets of patients including ivabradine and fixed-dose isosorbide dinitrate and hydralazine, we now find ourselves with a number of medications our patients should be receiving.

The path forward will be deciphering how best to implement these therapies at doses with proven benefit. Dealing with the issue of cost will be key. Sequencing trials, collating datasets with prescription fill data, machine learning tools to support clinical decision making, and personalized medicine through “omics” technologies may all play a role, as recently discussed by the HF Collaboratory (1).

While there is much to be seen, it’s certainly a very exciting time for heart failure!

Reference

Bhatt AS, Abraham WT, Lindenfeld J et al. Treatment of HF in an Era of Multiple Therapies: Statement From the HF Collaboratory. JACC: Heart Failure 2020.

Building Your Brand: Research Career Planning and Scientific Writing

December 28, 2020December 17, 2020 Zain Ul Abideen Asad, MD, MBBS

AHA 20 had a fantastic session titled “Building Your Brand” and it provided excellent insights on how to be a successful researcher in academic medicine. Panel participants Dr. Erin Michos, Dr. Louise McCullough, Dr. Andrew Landstrom, and Dr. Pradeep Natarajan shared their stories on how they got involved in research and the lessons they learned along the way. While the session focused on fellows in training, I will present my viewpoint on how these general principles are applicable to early-career physicians (ECP). Based on this session, I have developed a step by step approach.

When is the right time to get involved in research?

No doubt, it is good to start as early as possible, but it is never too late. Residency is the ideal time to get involved in the research. This head start allows you to explore different areas of research, find what interests you, and at the same time allows ample time to acquire skills needed to conduct research. For ECP, this means if you already started research during your training you are on the right track. If you were not exposed to much research during training, you can always start now.

Step#1: Start now.

How to get started?

The significance of finding the right mentor cannot be over-emphasized. It is important to meet different potential mentors and get to know them. This allows you to assess overlapping areas of interest, learn how research shaped their careers and most importantly get inspiration from their journey. For an ECP, it is important to work with different mentors that can develop you in different areas of research. These mentors can be across different institutions in the country.

Step#2: Find your mentoring team.

What skills are needed and how to acquire them?

“Writing” and “Statistics” are the two most important skills needed for any type of research. There are multiple ways to acquire these skills depending on how much time you want to invest. Most of these skills can be acquired by taking online classes or a degree program. Most academic programs offer classes in scientific writing, epidemiology, biostatistics, clinical trial design, and grant writing. For an ECP, if you think you will be doing research throughout your career, consider getting additional training through a master’s degree in clinical and translational sciences or in some cases a PhD.

Step#3: Acquire scientific writing and statistical skills.

What are the effective strategies for manuscript writing?

Writing the first draft is challenging but it is important to write it quickly and not worry about perfection. Start by writing the methods, followed by results, and leave an introduction and discussion to the end. Feedback from your mentor and collaborators will improve the paper.

Step#4: Write the first draft quickly, following this order: methods, results, introduction, discussion.

Quality or Quantity?

While it is ideal to always conduct high-quality and novel research projects, in-reality all such projects need research funding. Therefore, early in your research career, it is important to be productive and complete some less extensive projects starting from case reports, review articles, and retrospective studies. This allows you to practice the skills you acquired and get some confidence that you carried an idea from start to finish. It will build your research profile and make you a competitive candidate for grant funding in the future.

Step#5: Publish something even if it is a case report or a retrospective study.

How to build a brand?

Once you have found your mentoring team, acquired writing and statistical skills, and published at least one manuscript, it is time to develop a focus. You cannot build a brand without a focus. The first step is to find an area of research that you truly find fascinating and it typically includes ideas that you cannot stop thinking about and questions that give you an epiphany. Often, the most important research questions arise from your clinical work. Second, see if these ideas are vital from a clinical, research, and public health standpoint (significance). Third, see if you have the right environment (research team, institutional support, skills) needed to turn this idea into reality (feasibility). Often, we have to spend many years exploring different research interests and acquiring more skills (grantsmanship) before we arrive at an idea that we see ourselves developing into a brand (niche). For ECP, if you are busy clinicians with an interest in research, try your best to align your clinical interests with your research interests. Once you have established your niche, it is extremely important to stay focused so that all your time and energy is spent on developing your brand.

Step#6: Develop your niche, advance your skills, align clinical work with research, stay focused, avoid distractions.

What personality traits are needed?

A key trait is showing persistence despite multiple failures as it is not uncommon to have your first manuscript rejected by a journal or multiple journals. Having the persistence to learn from this experience, improve your manuscript and resubmit, is necessary. For mentees, it is important to develop a “can-do attitude”, be authentic, honest and follow through on commitments.

Step#7: Develop persistence, learn from failure, be a good mentee.

I hope you found these steps useful for building your brand in research. “The game has its ups and downs, but you can never lose focus of your individual goals and you can’t let yourself be beat because of lack of effort.” (Michael Jordan)

This session will be available on-demand until January 4^th, 2020, and AHA Partners have FREE access to Scientific Sessions 2020 OnDemand Extended Access through 2021.

Lose the COVID, Keep the Virtual Platform

December 23, 2020December 16, 2020 Shreya Rao, MD, MPH

As we close the chapter on a successful—if different—AHA conference in this pandemic year, and usher in the much-anticipated vaccination phase of the global pandemic, it is worth taking a moment to consider what future science and scientific conferences may gain from the insights of 2020 in the years to come and beyond. As my colleague Mo Al-Khalaf writes in his recent blog, 2020 has been a year of rapid adaptation and innovative solutions, particularly in the development and sharing of medical knowledge and expertise. Consider, for example, that four short weeks ago as we convened virtually for Scientific Sessions, the prospect of the rollout of two highly efficacious vaccines against COVID19 within weeks would’ve seemed so optimistic as to be foolhardy. Indeed, as quickly as COVID changed the reality of daily life, the scientific community changed its practices—for developing and testing therapies, sharing lessons learned from hard-hit regions, and revising journal and conference experiences so as to expand access to information and knowledge. It has been an imperfect process that has at times revealed weaknesses in existing systems, demonstrating for example the value of thorough peer-review in curating research and the bureaucratic roadblocks to rapid maneuvering of healthcare systems to respond to and prepare for surges, and highlighting the individuals and communities routinely excluded from scientific gains.

Nonetheless, the benefits of an at least partly virtual conference experience should not be lost as we tentatively allow ourselves to imagine a post-pandemic world. For starters, virtual conferences in the cardiology world have resulted in higher turnout than seen in prior years, likely due to the reduced costs of participation, ease of access to content, and time flexibility for participation. In fact, the European Society of Cardiology saw attendance increase by nearly four-fold this summer from a previous recent record of about 33,000 professionals representing 150 countries in 2019 to more than 125,000 professionals from 211 countries in 2020.¹ Much of this growth likely represents groups previously disadvantaged when it came to conference participation, including students and trainees whose time and financial restrictions are often more stringent than more advanced stage practitioners, as well as providers with family and caregiving responsibilities for whom travel to distant cities for several days may be an impractical proposition. An online platform offers a degree of anonymity and equalizing of audience members, moreover, encouraging participation in discussion by attendees. One need look only as far as the chat boxes of live events at this year’s Sessions for evidence of strangers—ranging from students to experts—coming together to discuss research methodology and implications. The inclusion of such groups is to the advantage of all in the end, as the value of scientific conferences undoubtedly rests on their ability to reflect the diversity of the field and draw upon the most experiences and broadest audience.

At the same time, virtual formats have resulted in a smaller carbon footprint within the scientific community. Since the pre-pandemic world of 2015, climate change researchers have urged scientific groups to seek innovative ways to convene and share information, recognizing that academic researchers represent a high-emitter group due to frequent air travel for conferences, meetings and fieldwork, and noting the benefits of example setting to strengthen public investment in behavioral change for climate protection.² As conferences in other fields of science experimented with virtual components, the pandemic ultimately forced all of us to embrace a more dramatic adjustment to entirely virtual experiences. Though not perfect—as others have noted, virtual conferences have suffered from a loss of some networking opportunities—this year’s initial experience demonstrates that virtual conferencing is both possible and practical. This will be an invaluable lesson as the existential crisis of climate change increasingly occupies the shared consciousness of society.

Sooner or later, our lives will begin the transition back to something resembling the world before COVID19. This will be for the better, as we again benefit from the experience of human contact and connection but need not come with an erasure of the lessons learned during this challenging year. Future conferencing may indeed benefit from a component in-person participation, but the demonstrated demand for a virtual experience suggests that on-demand lectures and virtual live chats are here to stay, and we will all be the better for it.

References

Figures from ESC Congress.
Quere CL, Capstick S, Corner A, Cutting D, Johnson M, Walker-Springett K, Whitmarsh L and Wood R. Towards a culture of low-carbon research for the 21st century. 2015.

#AHA20: Reflections from 2020 AHA Scientific Sessions

December 22, 2020December 17, 2020 Catherina Chang Martinez, PhD

As an American Heart Association Early Career Professional, attending the #2020 AHA Scientific Sessions will be an unforgettable experience. The virtual modality of the conference provided an alternative to the social distancing challenges presented by COVID-19. There was creativity in the programming to allow opportunity to engage through the various forums and live chats for those interested in live participation; and this added to the unique experience of online networking and learning. Participants also had the opportunity to join the on-demand sessions, learning at their own pace, within the comfort of their home or work setting.

From the early morning health and wellness sessions to late-breaking science, technology application to support better patient outcomes in the treatment of cardiovascular disease, and COVID-19 topics, the conference programming was comprehensive, diverse, and appealing to the interest of the participants. It was also in tune with the current state of global health and social issues, addressing ongoing debates in cardiovascular disease management.

The wide range of topics presented at the sessions truly reminds us of the AHA’s mission to be a relentless force for a world of longer, healthier lives.

Highlights of the #AHA 2020 Scientific Sessions included the following:

Focus on Fitness and Health. Participants had the opportunity to join the morning fitness and dance breaks, as well as and on-demand exercise sessions. Attendees who could not join the early scheduled meetings had the opportunity to join the on-demand model.
Discussion on racism in Medicine. The opening session featured a fireside chat with two legends in the education and treatment of cardiovascular disease, Dr. Eugene Braunwald and Dr. Nanette Wenger. This was followed by a robust discussion of racism as a public health crisis at various sessions delivered over the course of the five days. They also presented a call to support and embrace diversity, equity, and inclusion in the delivery of care to our growing racial and ethnically diverse population.
Late-Breaking Science. Recent findings from clinical trials were presented during the sessions on precision or polypill with TIPS and TIPS+ASA, the STRENGTH and OMEMI trials, the GALACTIC-HF and VITAL Rhythm trial.
Women Professional Development. Session topics ranged from discussions on leadership, self-care during COVID-19, and management of cardiovascular disease risk among women across the lifespan.
Latest Insight on COVID-19 and Cardiovascular Disease. The session addressed a wide range of topics from diagnostics and treatment, to the management of complications as a result of COVID-19. Discussion on complications such as thrombosis and myocardial involvement was presented and provided a fresh view of the latest treatment guidelines and the need for monitoring for cardiovascular complications.

These sessions will be available on-demand until January 4^th, 2020, and AHA Partners have FREE access to Scientific Sessions 2020 OnDemand Extended Access through 2021. Please check these out to learn about the latest evidence.

Be In the Room Where It Happens

December 21, 2020December 16, 2020 Huan Wang, PhD

“It was the best of times, it was the worst of times” ––Charles Dickens

COVID pandemics has changed courses in many people’s lives, as well as approaches in professional development. Amidst many obstacles and disadvantages in 2020, the American Heart Association (AHA) made a remarkable attempt to host a successful virtual scientific conference and brought the scientific community even closer. It exemplifies the AHA mission perfectly: “To be a relentless force for a world of longer, healthier lives”.

Can you image a scientific conference started out with a dance tutorial at the beginning of the day? Can you image a virtual matchmaker helping you arrange a meeting schedule based on your own interest? Can you image getting fresh insights on how to cook and eat healthy food in a scientific conference which traditionally centered mostly on basic and clinical sciences? None of these are classic meeting experiences. The technological development and the focus on mental health as well as physical health in the past few decades made these experiences possible. AHA implemented a well-thought-out plan to capitalize technology and carry out its goal elegantly. The “previews” and “daily recap” videos in the Scientific Session 2020 are both entertaining and informative. Each day, a few short videos encompassed the highlights and the anticipations of the next day featuring four prominent scientists including Drs. Donald Lloyd-Jones and Manesh Patel (Fig. 1). This sophisticated approach helped attendees navigate the meeting effortlessly.

Fig 1: Screen shot of the daily recap from AHA website. (http://sessions.hub.heart.org)

Just like the president of AHA, Mitchell S.V. Elkind, MD, MS, FAHA, FAAN, mentioned at his Conner lecture in Scientific Session 2020, there are many problems we are facing right now such as COVID pandemics, economic depression, structural racism and climate change. These seemingly distinct crisis underlies the fundamental threat to humanity and public health disparities. He sees the “bridges” connecting these issues and which will shed light to “the brighter and more hopeful future beyond”.

The AHA new 2024 impact goal announced by AHA CEO Nancy Brown provides a clear vision of the AHA future endeavor:

“Every person deserves the opportunity for a full, healthy life. As champions for health equity, by 2024, the AHA will advance cardiovascular health for all, including identifying and removing barriers to health care access and quality.”

Brown emphasized the everlasting long-term commitment of AHA to the well-being of all people everywhere. She listed many significant contributions AHA made in 2020 to address these issues. These efforts span a wide range of addressing issues including supporting social entrepreneurs working in under-resourced communities, supporting Voices for Healthy Kids project, Lifeline projects in many regions, COVID related supports, research and technology-focused projects to help heart and brain research, women’s health, establishing a center of hemorrhagic stroke research and training opportunities, investing research on e-cigarettes and nicotine consumptions among youth, etc. These extraordinary efforts AHA made in the year of COVID pandemic bring us hope that humanity can still thrive even in the events of great disadvantages.

The “OnDemand” function is the crown jewel of virtual experience in Scientific Session 2020. A well-organized scientific conference usually is very compact. Running around and trying to navigate in a big convention center is not a fun memory, especially if the meeting schedule was back-to-back. Another frustration involves in having to choose between two concurrent sessions and inevitably missed the other. The “OnDemand” function makes the old problems obsolete. To maximize the meeting experience, it provides freedom to visit the session when and where it’s convenient to you and rewind as you please. It ultimately puts you “in the room where it happens”. Thanks to this “intimate” approach, the meeting experience is even more welcoming in Scientific Session 2020. It’s undeniable that face-to-face conversations cannot be completely replaced by virtual experience, this year’s unique opportunity provides a strong potential for a “hybrid” meeting format, which could maximize future experiences in scientific learning and interactions profoundly.

COVID-19 and Historical Distrust

December 18, 2020December 16, 2020 Aubrey J. Grant, MD

As a member of the AHA FIT programming subcommittee, I could not have been more excited about the upcoming scientific sessions meeting. The planning for this meeting began many months in advance with lots of zoom sessions, emails, and organizing to help lay the groundwork for a successful event. As a new member of the committee, I was excited to facilitate the preventative cardiology fireside chat and the racism in medicine discussion.

However, two days prior to the session, I woke up with a terrible headache and I generally felt unwell. Considering the ongoing pandemic, I was concerned that I may be infected with COVID-19. Over the next twenty-four hours, my symptoms worsened and the following morning I tested positive for the virus.

As my illness progressed, I experienced all of the common reported symptoms: myalgias, headaches, cough, shortness of breath, and fevers. The fatigue persisted despite adequate rest. The barking cough was painful, and the constant fevers were so agonizing. The onslaught of symptoms persisted throughout my time in quarantine, and the experience was extremely debilitating. Moreover, Instead of conversing with amazing and thoughtful leaders in the field of cardiology as previously planned, the virus forced me to focus on my own physical well-being.

One of the more insidious, yet profound effects, of the COVID-19 infection, is the effect it has on your mental wellbeing. As a physician who manages COVID patients, I am uniquely sensitive to the dramatic and acute trajectory the disease may take. Being isolated in quarantine for 10-14 days, while intimately perceiving every symptom in fear, was a distinctly stressful symptom of COVID that I could have never predicted. I was confronted with my most crippling fear of progressing to critical condition and needing to be hospitalized. Regardless of the fact that I am a physician, I stared in the face of the reality that as a black man, I have a greater chance of worse outcomes.

The pandemic has further highlighted the disparity in care that exists in this country among different racial and ethnic groups. A recent publication reviewed the American Heart Association (AHA) COVID-19 registry of race and ethnicity data, which included 7,868 hospitalized patients across 88 registry sites from Jan 1 to July 22, 2020, revealed an over-representation of Non-Hispanic Black and Hispanic patients, which accounted for >50% of hospitalizations [1]. Further, these minority patients were significantly younger than patients of other ethnicities at the time of hospitalization [1]. The disproportionate rates of COVID-19 illness, hospitalizations, and death in Black and Hispanic communities are linked to several structural risk factors including living in crowded housing conditions, working in essential fields, Inconsistent access to health care, chronic health conditions, and chronic stress.

This specific health disparity is just one example of the striking effects of structural racism, years of distrust in healthcare, and lack of physical representation in the medical field on healthcare outcomes in this country. What is more alarming, is that even with the availability of a safe and effective vaccine, the historical pretext of racism in healthcare will delay and prohibit mass vaccination among many vulnerable minority populations. In a recent Kaiser Family Foundation poll, half of Non-Hispanic Black adults are not planning to take a coronavirus vaccine once one becomes available, even if scientists declare it safe and if it is available free of cost [2]. Among Non-Hispanic Black adults who say they are not planning to get a vaccine, nearly 40% cite safety concerns, including that it will be too new and assume insufficient testing [2]. Another 35% attributed their concerns to a general lack of trust or have doubts about the government or the health care system [2].

If we ever hope to get back to some sense of normalcy, herd immunity secondary to general vaccination needs to be the utmost priority among healthcare professionals. Overcoming the understandable barriers of distrust that exist in the minority community will not happen overnight. However, consistent efforts to understand, relate, and effectively communicate with patients of color can slowly help to assuage fears about vaccinations and create positive relationships between the healthcare system and the most vulnerable communities that are often ignored.

So I ask the question, what can you do as a healthcare provider to better understand and address these hurdles and to help encourage acceptance of the COVID-19 vaccination?

References

Rodriguez F, Solomon N, de Lemos JA, Das SR, Morrow DA, Bradley Smet al. Racial and Ethnic Differences in Presentation and Outcomes for Patients Hospitalized with COVID-19: Findings from the American Heart Association’s COVID-19 Cardiovascular Disease Registry. Circulation. 2020 Nov 17. Doi: 10.1161/CIRCULATIONAHA.120.052278. Epub ahead of print.
Hamel, L., Muñana, C., Artiga, S. and Brodie, M., 2020. KFF/The Undefeated Survey On Race And Health. [online] Kaiser Family Foundation. Available at: <https://www.kff.org/racial-equity-and-health-policy/report/kff-the-undefeated-survey-on-race-and-health/> [Accessed 16 December 2020].

Virtual Meeting Preparation and Reflection of Scientific Sessions 2020

December 17, 2020December 17, 2020 Patrick Tomko

As I complete my first virtual meeting of 2020 as a graduate student in science, there was two things I decided to take away from Scientific Sessions 2020. First, there is a specific agenda you could create to help yourself at professional conference meetings. I have some tips on getting involved with the content at the meetings. Second, I want to provide a reminder about the few advantages of virtual meetings.

An Agenda for Professional Conference Meetings:

First you need determine your priorities for attendance. This could be looking at the science specific to your interest that compliments your current work, or engaging in a way where you will communicate with someone outside your current network. Professional meetings have loads of information and dynamics that could create an overwhelming feeling, especially if it is your first meeting as a student. This is the “adulting” component of being a graduate student.

To help with attendance cost, a student should apply for everything. That means any student travel grants, waivers for registration fees, of even finding other agencies that offer to fund “professional development” in students. As frustrating as it can be, plan to be a “penny-pinching patty.” This is part of the goal in prioritizing what you hope to get out of a conference; you need to have the stamina to handle all the sessions you hope to see. This means making sure you eat throughout your entire experience, even if it is virtual.

Second you need to develop general outline for the time frames of the sessions you plan to attend. This is almost like brainstorming what you hope to experience in the scientific sessions you attend at a conference. For me, this year I used the app associated with the American Heart Association meetings. The “AHA” conferences app helped provide reminders and take notes, it’s a virtual planner for your brainstorm session. I found myself on three different occasions changing the sessions I planned to attend virtually. These changes were more related to sessions I was asking others to attend for me, where then I attended a session they could not see in return.

So that brings me to my third point for creating an agenda. Third, a buddy system, which seem obnoxious for scientific conferences. However, if there is an overload of content you want to see and engage with, like I did for this year’s Scientific Sessions, then creating a system to get coverage for all sessions is ideal. Furthermore, this buddy system can lead to an expansion of networks due to attendance of sessions you may not always find yourself becoming involved with.

A Research Tool Box and Advantages of Virtual Meetings:

The main point of research conferences is the presentation of new research in a format that catches attendee interest. Presentations at conferences are typically followed by questions and discussion between presenters and their audience. All of which is was still the framework for virtual scientific conference.

One advantage is no travel and lodging expenses. Most students have to pay out of pocket for travel and lodging at conferences (1). Although, there is nothing that can replace human interaction, there is some light from reduce burden of costs for students in virtual meetings. The stress of affording the expected costs of scientific meetings becomes slightly more manageable. I highlight this because depression and anxiety continue to grow with graduate students. Almost 40% students showed anxiety and depression scores in the moderate to severe range (2). Virtual conferences still allow you connect with others in a different manner. This point is especially important considering the how the pandemic is eroding graduate student mental health. From a current survey of about 4000 U.S. STEM doctoral students , 40% reported symptoms aligning with generalized anxiety disorder and 37% with depression (3).

In addition to the reduced conference expenses, two are three helpful tools for your research conference tool box.

Take breaks and or watch conferences sessions in different environments. Do not be afraid to go outside with the laptop and listen to a session while being in the sun. This can help create a comfortable environment for you to fully immerse yourself in the session.
Get involved on social media for these virtual conferences, it allows for continuing conversation and to expand networks. You can take notes from posts on social media reported by others that you may have missed.

2020 carefully reminds us about the value of human interaction for our lives. We will continue to learn and grow as students, adding to our toolbox. Have a safe, socially distanced, and peaceful holiday.

Malloy J. Stop making graduate students pay up front for conferences. Nature. 2020;13:2020.
Evans TM, Bira L, Gastelum JB, Weiss LT, Vanderford NL. Evidence for a mental health crisis in graduate education. Nature biotechnology. 2018 Mar 6;36(3):282.
Chirikov I, Soria KM, Horgos B, Jones-White D. Undergraduate and Graduate Students’ Mental Health During the COVID-19 Pandemic.