AHA20 – Page 5 – The Early Career Voice

The Story of SGLT-2 Inhibitors

November 15, 2020November 15, 2020 Yehia Saleh, MD

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:

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.
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.
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.
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.”

Greatness in Grant Writing

November 15, 2020November 15, 2020 Jennifer Kong, PhD

As a first time AHA Scientific Session attendee, I was thrilled with the diversity of topics covered in today’s program. As I learned about topics ranging from structural racism in science and healthcare to the difficulty associated with diagnosing hypertrophic cardiomyopathy, I had the opportunity to see some of the major challenges that prevail in cardiovascular health and was in awe of the advances being made to address them.

As a researcher constantly striving to write better grants and fellowships, I would highly recommend checking out the recording of “My first grant writing breakthrough — tips and tricks for early career researchers” by Lifestyle Council’s Early Career Committee. In this Zoom hosted chat, Dr. Alain Bertoni (Wake Forest School of Medicine), Dr. Norrina Allen (Northwestern University), and Dr. Kara Whitaker (University of Iowa) shared their secrets for grant writing success. Below are a few points that I took away with me.

Give yourself time to write
I was surprised to learn that some of the panelists had spent years working on a research idea and crafting it into a successful R01 grant. While most of us don’t have the luxury of years to write a grant, the panelists made it clear that writing a solid specific aims page (the backbone of any NIH grant) is a long process that requires many drafts and critical feedback from close colleagues. Thus, a theme repeated throughout the panel was time. Give yourself a lot of time to write and start your grant writing process as early as possible.

Surround yourself with people that are smarter than you are

Don’t be shy, reach out to others for help. A constant theme of this session was the sense that our peers are our strongest asset. As the grant will be read by experts in the field, the panelists emphasized that it is likewise important to get feedback from knowledgeable peers to ensure that the science is exciting, the approach is solid, and that the ideas you are presenting are fundable.

Read other grants and try to gain the first-hand experience with the NIH peer review process

In a final tips takeaway, the panelists noted that one of the best ways new faculty members can learn how to write excellent grants is to expose themselves to excellent grants. This can be achieved through reading successful grants written by peers. Alternatively, the NIH has an Early Career Reviewer Program that allows early-career scientists to participate in the NIH peer review process to help them understand how grants are evaluated.

What Do We Know About the Future? The Digital Health Era

November 15, 2020November 17, 2020 Huan Wang, PhD

What do we know about the future? Although millions of possibilities come into mind, one thing is certain. One way or another, our lives are more and more dependent on computers and social media networks. How many of you check on your smartwatch or social media feeds more than once a day? I, for instance, am occasionally obsessed with my heart rate measurements and sleep patterns and constantly try to get a better understanding on how to optimize my own health. It’s very easy to get lost in trying to find the right kind of research from scientific journals. Most of the time people turn to social media to get ideas to make a healthcare decision. Study shows that 80% of internet users are looking specifically for health information¹.

In today’s American Heart Association Scientific Sessions, a group of pioneers shares their insights in novel technologies for arrhythmia detection² using big data to manage patient care systems. Dr. Leslie Saxon, of the University of Southern California Center for Body Computing, discussed the advancements of digital health, such as increased diversity of computer monitoring devices, increased data accessibility via the cloud, and novel digital biomarker identification. Particularly, using remote device follow-up improved 30-40% survival rate of patients after cardiac defibrillator implantation, according to a published clinical study (the ALTITUTE survival study)³. Another highlight from Dr. Leslie’s research, CORA, is a patient-facing, manufacturer-agnostic mobile application. CORA can help improve communications between patients and caregivers, visualize complex data in a simple way, and educate patients and caregivers about their health conditions.

Other advances in finding software solutions driven by big data collection are also critical in this digital era. An ongoing clinical study to determine if the Apple Watch and a heart health program can improve heart health outcomes, HEARTLINE, are recently launched in Feb 2020 with a collaboration between Johnson& Johnson and Apple (Clinical Trial NCT04276441).

Dr. Marco V. Perez from Stanford University talked out the recent developments of patient-acquired wearable technology, such as devices to monitor blood oxygen levels, glucose levels, and sleep rhythm. One of the challenges is potential data overload. Dr. Perez’s team implemented a machine learning algorism using a convolutional neural network to investigate 1.5 million ECG graphs from 500,000 patients collected from wearable devices. This artificial intelligence approach opens a new window with many possibilities in the health care systems and address novel research problems. Dr. Khaldoun G. Tarakji from Cleveland Clinic discussed how to use wearable devices to detect atrial fibrillation from a clinical practice perspective. He presented several case studies on using Apple watch to help diagnose and manage atrial fibrillation. In the field of telemedicine, Dr. Tarakji mentioned the advantages of using wearable devices to conduct virtual visits to improve patient care outcomes.

Figure 1: New technologies for the detection of atrial fibrillation ²

Despite apparent advantages of the application of wearable devices in the health care system, Dr. Paul D. Varosy from the University of Colorado discussed the challenges of using wearable devices regarding clinical, legal, cybersecurity, and ethical implications. The main questions are: How to fit data management into busy clinical practice? How to maintain financial sustainability? How to improve cybersecurity vulnerability? How to handle potential oversight? And who owns the data? These questions require continuing efforts from policy workers, researchers, doctors, and patients to work together to find solutions.

The new kid on the block: social media in the health care system. Dr. Janet K. Han from UCLA talked about the possibility of using social media to transform arrhythmia health care. Social media can make health information more accessible, engage patients better, provide valuable social and emotional supports⁴. Combining social media with big data with artificial intelligence and machine learning provides faster diagnosis and management⁵.

Wearable devices in combination with big data analyses in healthcare practices have a promising future. They are more accessible, engaging, and high payoff. Despite potential challenges, the era of digital health presents many possibilities and advantages in patients’ healthcare outcomes.

Reference

Fox S. Profiles of Health Information Seekers. Pew Internet & American Life Project. 2011.
Zungsontiporn N, Link MS. Newer technologies for detection of atrial fibrillation. BMJ (Online). 2018.
Saxon LA, Hayes DL, Gilliam FR, Heidenreich PA, Day J, Seth M, Meyer TE, Jones PW, Boehmer JP. Long-term outcome after ICD and CRT implantation and influence of remote device follow-up: The ALTITUDE survival study. Circulation. 2010.
Hawkins CM, DeLaO AJ, Hung C. Social Media and the Patient Experience. Journal of the American College of Radiology. 2016.
Simonsen L, Gog JR, Olson D, Viboud C. Infectious disease surveillance in the big data era: Towards faster and locally relevant systems. Journal of Infectious Diseases. 2016.

Can Fish Oil Supplements Help Your Heart? Consumer Discretion is Advised

November 15, 2020November 17, 2020 Huan Wang, PhD

The health benefits of fish oil, particularly omega-3 long-chain polyunsaturated fatty acids (n-3 LC-PUFAs) have been studied for decades. The key discoveries regarding the beneficial effects of n-3 LC-PUFAs include anti-inflammation, lowering blood lipid levels, anti-thrombotic effects, and possibly anti-arrhythmia (Mason, Libby, and Bhatt 2020). The market size of fish oil supplements expands rapidly in recent years and is estimated to reach USD 4.5 billion by 2027 (REPORTS AND DATA 2020). In many European nations, omega-3-acid ethyl esters have been prescribed to patients to reduce blood lipid levels for at least a decade and they also obtained US FDA approval in 2004 (Bays et al. 2008). However, not all news is encouraging. The findings of anti-arrhythmia effects of fish oil are mixed, with some trials demonstrating beneficial outcomes (Fig 1) and others finding no significant effects (Mozaffarian and Wu 2011; Reiffel and McDonald 2006).

Fig1. Physiological effects of n-3 PUFA that might influence cardiovascular risk.

The results of REDUCE-IT clinical trial published in 2019 promised a bright future for cardiovascular risk reduction using omega-3 fatty acids (Bhatt et al. 2019). In AHA 2020 late-breaking science session: “Fish Oil, Fancy Drugs, and Frustrations in Lipid Management”, Drs. A Michael Lincoff, Are Annesoenn Kalstad and Alberico Catapano presented compelling evidence on surprising neutral effects with omega-3 carboxylic acids supplement in two clinical trials. These controversial results provide an interesting argument on whether or not to take fish oil supplements for cardiovascular health protection.

Dr. Lincoff presented recent results about the effects of high-dose omega-3 fatty acids from the STRENGTH clinical trial (Nicholls et al. 2020). Despite moderate improvements in the blood lipid levels, patients with omega-3 supplementation have significantly increased risks of atrial fibrillation. The net outcome of omega-3 fatty acid supplementation is not beneficial. One of the possible explanations for this controversial result is using corn oil as a control condition instead of mineral oil–the control treatment in REDUCE-IT trial. Mineral oil treatment caused adverse effects, and corn oil had neutral effects on patients. Dr. Kalstad shared results from another clinical trial which showed similar findings (the OMEMI clinical trial) (Kalstad et al., n.d.). The overall effects of omega-3 fatty acids were neutral with an increased risk of atrial fibrillation. To bring together what we have learned, a summary was presented by Dr. Catapano to further evaluated the STRENGTH and OMEMI clinical trials. He thoughtfully discussed the discrepancies in REDUCE-IT, STRENGTH, and OMEMI trials, and provided several explanations such as the biochemical nature of DHA and EPA, different control conditions, and treatment dosage discrepancies.

Regardless of the discrepancies between STRENGTH and OMEMI trials, one thing is common, the increased risk of atrial fibrillation. So, if you are elderly with high cardiovascular risk, please think twice and monitor your response closely when taking fish oil as a dietary supplement. The frustrating results from STRENGTH and OMEMI trials don’t necessarily negate the beneficial effects in other aspects of the physiological benefits of fish oil (Fig 1) (Mozaffarian and Wu 2011). More research studies are needed in the future to better understand the effects and mechanisms of fish oil supplementation.

Reference

REPORTS AND DATA. 2020. Omega-3 Market To Reach USD 4.50 Billion By 2027 | CAGR: 7.2% | Reports And Data. Aug 10. https://www.prnewswire.com/news-releases/omega-3-market-to-reach-usd-4-50-billion-by-2027–cagr-7-2–reports-and-data-301109147.html.

Bays, Harold E., Ann P. Tighe, Richard Sadovsky, and Michael H. Davidson. 2008. “Prescription Omega-3 Fatty Acids and Their Lipid Effects: Physiologic Mechanisms of Action and Clinical Implications.” Expert Review of Cardiovascular Therapy. https://doi.org/10.1586/14779072.6.3.391.

Bhatt, Deepak L., P. Gabriel Steg, Michael Miller, Eliot A. Brinton, Terry A. Jacobson, Steven B. Ketchum, Ralph T. Doyle, et al. 2019. “Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia.” New England Journal of Medicine. https://doi.org/10.1056/nejmoa1812792.

Kalstad, Are Annesønn, Peder Langeland Myhre, Kristian Laake, Sjur Hansen Tveit, Erik Berg Schmidt, Pal Smith, Dennis Winston Trygve Nilsen, et al. n.d. “Effects of N-3 Fatty Acid Supplements in Elderly Patients after Myocardial Infarction: A Randomized Controlled Trial.” Circulation 0 (0). https://doi.org/10.1161/CIRCULATIONAHA.120.052209.

Mason, R. Preston, Peter Libby, and Deepak L. Bhatt. 2020. “Emerging Mechanisms of Cardiovascular Protection for the Omega-3 Fatty Acid Eicosapentaenoic Acid.” Arteriosclerosis, Thrombosis, and Vascular Biology. https://doi.org/10.1161/ATVBAHA.119.313286.

Mozaffarian, Dariush, and Jason H.Y. Wu. 2011. “Omega-3 Fatty Acids and Cardiovascular Disease: Effects on Risk Factors, Molecular Pathways, and Clinical Events.” Journal of the American College of Cardiology. https://doi.org/10.1016/j.jacc.2011.06.063.

Nicholls, Stephen J, A Michael Lincoff, Michelle Garcia, Dianna Bash, Christie M Ballantyne, Philip J Barter, Michael H Davidson, et al. 2020. “Effect of High-Dose Omega-3 Fatty Acids vs Corn Oil on Major Adverse Cardiovascular Events in Patients at High Cardiovascular Risk: The STRENGTH Randomized Clinical Trial.” JAMA, November. https://doi.org/10.1001/jama.2020.22258.

Reiffel, James A., and Arline McDonald. 2006. “Antiarrhythmic Effects of Omega-3 Fatty Acids.” American Journal of Cardiology. https://doi.org/10.1016/j.amjcard.2005.12.027.

Structural Racism: A Call to Action

November 15, 2020November 17, 2020 Anika Hines, PhD, MPH

If there is any silver lining to the horror that the COVID-19 pandemic has invoked, it is that this time has positioned us to take a critical look at systemic failures (or successes). Undoubtedly, the COVID-19 pandemic has magnified the institutionalized inequities that scholars have pointed to for decades as the root causes of health disparities. It is easy to point out the ways that we perceive the system has failed. It is much more sobering to consider that the system, in fact, has done exactly what it was designed to do. Rooted in structures as old as slavery and maintained by subsequent post-slavery policies aimed at maintaining white privilege well into the 20^th century, structural racism represents a stronghold in American society hundreds of years in the making. As aptly drawn out by the AHA’s recent Presidential Advisory, these historical structures are tied to modern-day health outcomes. In a volley between ideals and policies, at face value, the effects of structural racism are easily disguised as individual behaviors, but we must be keen.

Structural racism (as defined by Lawrence and Keleher and employed by the advisory) is “the normalization and legitimization of an array of dynamics—historical, cultural, institutional, and interpersonal—that routinely advantage White people while producing cumulative and chronic adverse outcomes for people of color”. For example, Dr. David Williams pointed out during Saturday morning’s Structural Racism keynote that African American people earn $0.59 to every $1 earned by White people—a disparity that has existed since 1978. Moreover, regarding wealth—an even stronger predictor of health—African Americans have $0.10 to every $1 of wealth for White people. At every education level, race matters. Inequities reverberate through every social sector, including housing, the physical built environment, education systems, access to capital, and manifest in health outcomes. Indeed, “racism has produced a truly rigged system” by which the marginalized life and, ultimately, die.

The AHA highlights its strategies to address structural racism, including advocacy, quality improvement, leadership, human resources/business operations, and, of course, science (see Figure 3, below). CEO Nancy Brown summarized the AHA’s role as one of “catalyst, convener, and collaborator”.

Assuming that “the long arc of the moral universe leans towards justice”, speakers during Tuesday’s press release and Saturday’s panel discussion emphasized that undoing structural racism should not fall solely on the shoulders of the communities that already bear the burden. Instead, the issue of achieving equity should be of interest to all. Further, Dr. Regina Benjamin emphasized that “allyship is more important than collaboration and that the privileged should work hand-in-hand” with the affected to dismantle these social ills. Solutions entail reforming the science and healthcare workforce, according to Dr. Lisa A. Cooper, to include more diversity, which leads to improved academic and workplace environments, organization academic excellence, improved access to care, and reductions in healthcare disparities. Others emphasized that we should evaluate our “investments as a moral template” and that real change may require “remapping entire curriculum and rethinking mentoring”.

In summary, as an early career scientist, I’m encouraged by the direction of this discussion. Though the length of my career in health disparities research pales in comparison to the giants on whose shoulders I stand, the attention to structural racism as a fundamental driver of health disparities feels like a long-awaited arrival. The path ahead will be even longer, but admission is the first step towards recovery. Moreover, I believe that all involved in the AHA’s thrust to acknowledge structural racism would agree with the African proverb,

“If you want to go fast, go alone. If you want to go far, go together.”

Quotes from AHA 2020: Structural Racism in Healthcare

November 15, 2020November 15, 2020 Dapo Iluyomade, MD

In a year wrought with challenges spanning social, political, and healthcare spheres, one issue has risen to the forefront of our collective consciousness. Structural racism.

What is structural racism? A recently published presidential advisory from the American Heart Association states that “structural racism refers to the normalization and legitimization of an array of dynamics–historical, cultural, institutional and interpersonal–that routinely advantage white people while producing cumulative and chronic adverse outcomes for people of color.”

The planning committee for this year’s AHA Scientific Sessions took it upon themselves to address the presence of structural racism in Cardiology with a comprehensive series of lectures and discussions on the topic. The sessions kicked off on Friday, November 13^th with an awe-inspiring fireside chat featuring legends in the education and treatment of cardiovascular disease, Drs. Eugene Braunwald and Nanette Wenger. The discussion was moderated by legends in their own right, Drs. Clyde Yancy and Robert Harrington.

“When I arrived in Atlanta in the early 1960s, racism was prevalent…and sadly, it continues more than half a century later” – Dr. Nanette Wenger

The morning continued with the main event session, “How to Use Behavioral Interventions to Advance Equity in Cardiovascular Health.” Drs. Keith Norris, Eberechukwu Onukwugha, and LaPrincess Brewer eloquently proposed solutions for tackling disparities in hypertension management and post-discharge care, as well as shared a bold new vision for cardiovascular health interventions to address disparities across the board.

“I am issuing a call for us, as an American Heart Association, community to integrate community-based interventions to promote cardiovascular health […] First, we must recognize the historical improprieties and wrongs in research, from events such as the Tuskegee syphilis study and the Henrietta Lacks cell line, which have led to a lingering mistrust of scientists and clinicians among racial and ethnic minority groups.” – Dr. LaPrincess Brewer

Arguably the main highlight of the morning was the AHA Fellows-in-Training session, titled “Racism in Medicine: What Medical Centers & Training Programs Can Do to be Antiracist.” This program sought to implore early career cardiologists to engage in the fight against structural racism, as well as provide trainees with a forum to learn more about racism in Medicine. The esteemed panelists, Drs. Clyde Yancy, Ileana Pina, and Michelle Albert led an incredible discussion with plenty of teaching points and actionable items to strengthen and support diversity, equity, and inclusion in medical training.

“It’s not about the number of people in the room or what they look like […] it’s about the diversity of thoughts in the room” – Dr. Clyde Yancy

This year’s AHA Scientific Sessions is off to a great start! Judging by the quality of programming on Day 1, there will be plenty more to write home about after this weekend.

Making the Most of Virtual AHA 2020: Keeping Focus

November 14, 2020November 17, 2020 Sanjum Sethi, MD, MPH

COVID-19 has dramatically impacted every aspect of our lives. We have been forced to redesign both our work and professional lives to accommodate social distancing efforts to reduce virus transmission. Therefore, the 2020 American Heart Association (AHA) Scientific Sessions is a virtual program this year (1). While we will miss the in-person aspects of a big scientific meeting, the virtual format has created new and exciting opportunities for data science communication.

As a virtual program, the information can be streamed directly to the participant’s office and workspaces, thereby broadening the range of potential attendees. Attendance levels, marked by the number of participants registered, have the potential to exceed those able to attend in an in-person format. For instance, earlier this year, the European Society of Cardiology had 116,000 attendees this year (2) versus roughly 35,000 per year in recent years (3). The cost associated with travel can be significant, particularly for early career participants. The time away from home and work may also be a factor for many, particularly those with young families.

However, the same benefit of saving time through diminished travel may also factor in the ability to concentrate while virtually attending the meeting. If a participant maintains the same work and family schedule as normal, these competing commitments may actually diminish the experience as partial immersion may not allow for the same depth and breadth of attention. Another unique quirk may be the competing commitment of another scientific meeting. This was the dilemma that I faced today. Having been invited to speak on COVID-19 and venous thromboembolism for the VEINS meeting (4), I created a two laptop and phone setup this morning to help me navigate both meetings (Figure 1). This “command center” allowed me to simultaneously attend both and participate in those sessions in which I was most interested. While this was a great way to participate, there are limitations in time and attention span. A recent analysis of the American College of Cardiology meeting suggested that a virtual meeting format actually reduced social media engagement compared to the previous year (5).

Given the potential for wider dissemination of data, the virtual format has promised to reach a broader audience across the globe. However, competing commitments and responsibilities may minimize this reach. What can you do to maximize yield from this format and get the most out of AHA Scientific Sessions 2020?

Make time for your education
- It will be impossible to concentrate on the conference if you continue to work a normal work schedule including clinical, research, or administrative responsibilities. Just as you would for the meeting, block time out for the virtual meeting so that you can dedicate your attention and focus appropriately
Plan out your sessions
- The AHA Scientific Sessions has a fantastic web platform that allows for customization with the creation of a personalized schedule (https://eventpilotadmin.com/web/planner.php?id=AHA20). Using this tool in advance can allow a participant to plan out the sessions in which they are most interested and make sure the time is best utilized.
Get Engaged
- The AHA Scientific Sessions has planned networking sessions and satellite sessions every evening between 5-8 pm CST. Take advantage of these opportunities to connect with mentors, answer questions, meet people in your council, and network with other participants
- Follow the relevant posts on social media platforms such as Twitter (@AHAMeetings). There are social media ambassadors and virtual Co-Pilots assigned to each day (Saturday and Sunday for me). Following these accounts can allow you to key into important sessions of interest
Making the Most of Virtual AHA 2020: Keeping Focus
- One of the advantages of a virtual format is that many of the sessions are pre-recorded. This allows for playback at a later time, if necessary. Furthermore, there is tremendous On-Demand Sessions content including many of the top oral abstracts being presented.

Above all, enjoy the convening of minds over the next few days. The energy, innovation, and intelligence are amazing to experience. The AHA program chairs have really created a platform to simulate the best parts of the in-person meeting in this virtual format.

Reference

https://professional.heart.org/es/meetings/scientific-sessions
Enrique Gallego-Colon E, Bonaventura A, Vecchié A, Cannatà A, Martin Fitzpatrick C. Cardiology on the cutting edge: updates from the European Society of Cardiology (ESC) Congress 2020 BMC Cardiovasc Disord. 2020 Oct 19;20(1):448.
https://www.escardio.org/Congresses-&-Events/ESC-Congress/About-the-congress/Figures-from-ESC-Congress
https://vivaphysicians.org/veins-programming
Mackenzie G, Gulati M. 20: Impact of social media at the virtual scientific sessions during the COVID-19 pandemic. Clin Cardiol. 2020 Sep;43(9):944-948

Improving Your Experience at a Virtual Conference

November 14, 2020November 17, 2020 Barinder Hansra, MD

2019-2020 AHA FIT & Early Career Bloggers at AHA Scientific Sessions 2019

In 2019, I was fortunate to be an Early Career Blogger for the AHA and attending the scientific sessions in Philadelphia (pictured below). It seems hard to believe that one year later, the same conference is being held exclusively via an online platform. COVID has caused a lot of changes, including the way we strive to provide education and conferences that still have the same impact.

Attending a conference such as AHA can be intimating due to its venue size, the numerous presentations, and navigating your way through the thousands of attendees. I was fortunate to discuss how best to be successful at such a conference and with the transition to an online platform, I want to equip others with a few tools I think will help make the experience enjoyable.

Before

Organize your schedule. With the increased flexibility of attending from the comfort of our own homes, it’s critical to plan ahead to optimize what sessions we want to see. Look ahead and block off your schedule so you can be free of distractions during the sessions.
Prioritize your time. multitasking isn’t very productive and we may have the urge to answer work emails, phone calls, or text with friends. Focus on making the best use of your time during the presentations.

During

Be an active participant. Try to participate beyond listening. I encourage fellows to take notes, ask questions, and get active on social media by using conference hashtags, live chats, and other tools to connect. Several sessions are dedicated to meeting trialists, researchers, and leaders in the community in order to provide the same opportunities as the live conferences did. I believe, it’s critical for us to engage in these sessions.
Build your virtual community. At in-person conferences, the audience normally listen to the speakers and may make small talk in the coffee line. With virtual conferences, we all have the chance to engage in more meaningful ways. By being more actively engaged, you can expand your network and start to potentially collaborate with others in the field.
Take Breaks: It’s important to recognize we can all fatigue from attending back-to-back-to-back sessions. I always make sure I have a snack, water, and time to stretch. Getting up to walk for a few minutes in-between sessions will help keep you fresh and more engaged.

After

Replay. You can easily catch any recorded sessions you may have missed. By being able to watch the sessions later, you can continue to keep the conversation going and continue to expand your network.

There are multiple ways to continue to have an amazing experience at the AHA but participants have to have a few tools to be successful. I believe the above tips are a great pathway to make the most of any virtual conference.

#AHA20: Be in the ‘Zoom’ Where It Happens

November 14, 2020November 17, 2020 Aaysha Cader, MD, MRCP

Last year, I blogged about my experience of attending AHA Scientific Sessions for the first time as an international attendee. As I reminisce about the wonderful experiences and front row seats to the Hamilton musical performance (The Room Where It Happens) at the opening session of #AHA19, I am equally amazed at the fabulous scientific content and networking opportunities available with this year’s #AHA20 virtual format.

Late-breaking science (LBS)

Late-breaking science sessions are always one of the highlights of scientific sessions that I really look forward to. #AHA20 has nine late-breaking sessions spanning across various sub-specialties of cardiology on all 5 days of scientific sessions. With questions being posed to presenters by the social media moderators in real-time, every effort has been made to replicate the exciting component of late-breakers as much as possible, giving us the experience of “being in the room (or in this case zoom)” where it happens. The additional “Meet the trialists” segment offers further opportunities for interactive conversations with select researchers who will provide answers and insights to questions that very often occur in the immediate aftermath of late-breaking science.

The Heart Hub: Something for everyone

Scientific sessions have always had something for everyone, with the Heart Hub being the hub of activity. This year promises no less, with an easy-to-navigate platform taking you to the various dedicated “lounges”. #AHA20 also offers some incredible informal networking sessions, panel discussions, and programming targeted to specific communities (women in cardiology, early careers, and fellows-in-training #AHAFIT). #AHA20 is extra special for me, as I had the opportunity to be a part of an incredibly inspirational session on the Imposter Syndrome, with powerhouse women in cardiology sharing refreshingly honest takes on their experiences and advice on how they overcame it. Fellow #AHAEarlyCareerBlogger Kylia Williams shares some highlights here.

Social Media & Virtual Networking

Despite the “virtualness” of scientific meetings, almost a year into the pandemic, we have all rapidly adjusted to this new normal. As fellow #AHAEarlycareerBlogger Mo Al-Khalaf blogged, social media has been leveraged to increase virtual conference interactions and networking between peers. This has also, inadvertently perhaps, showcased the increasing need to build one’s professional social media brand. Here’s an on-demand session we put together on how to best build and protect one’s brand. Please do also join us for a live Q&A panel discussion today (Saturday, November 14^th, 6-7 pm CT) at the Go Red Women in Science and Medicine lounge Zoom Room B.

With four more science-packed days to go, I’m excited about everything else #AHA20 has to offer. I’ll be live-tweeting late-breakers and content on interventional cardiology throughout sessions. Make sure you follow the #AHA20 social media ambassadors for each day on Twitter, as well as the virtual co-pilots to help navigate your conference experience and be in zoom where it happens.

Clinical trials in interventional cardiology to watch out for at the virtual AHA20!!

November 14, 2020November 14, 2020 Lina Ya'qoub, MD

Our virtual AHA20 has started with all of the science, engagement and excitement!!! Since many of us are working and still want to squeeze in some time to check out what is going on at AHA20, I have decided to summarize clinical trials to look out for at AHA20 with their brief description.

Friday 11/13/2020

Trial Name

Arrest Trial

Trial title

Advanced Reperfusion Strategies For Refractory Ventricular Fibrillation Out-of-hospital Cardiac Arrest

Description

In this trial, patients (18-75 years old) with refractory ventricular fibrillation/pulseless ventricular tachycardia out-of hospital cardiac arrest, who are transferred by emergency medical services (EMS) with ongoing mechanical cardiopulmonary resuscitation (CPR) or who are resuscitated, were randomized to receive either early Extracorporeal Membrane Oxygenation (ECMO) or standard Advanced Cardiac Life Support (ACLS) Resuscitation [1]

Saturday 11/14/2020:

ALPHEUS, ATLANTIS, and RIVER Trials

Trial Name

Alpheus Trial

Trial title

Assessment of Loading With the P2Y12 Inhibitor Ticagrelor or Clopidogrel to Halt Ischemic Events in Patients Undergoing Elective Coronary Stenting.

Description

This is a multicenter study in stable patients undergoing elective PCI with a randomization between clopidogrel and ticagrelor. The primary ischemic endpoint is peri-procedural MI and myocardial injury and safety endpoint is bleeding by BARC definition [2].

Trial Name

Atlantis Trial

Trial title

Anti-Thrombotic Strategy After Trans-Aortic Valve Implantation (TAVI) for Aortic Stenosis

Description

This trial looks at the strategy of anticoagulation with novel anticoagulant, apixaban, compared to the current standard of care in patients who had a successful TAVI. The randomization is performed according to the presence or absence of a mandatory indication for anticoagulation, including atrial fibrillation or venous thromboembolic disease [3].

Trial Name

RIVER Trial

Trial title

RIvaroxaban for Valvular Heart diseasE and atRial Fibrillation Trial

Description

This trial compares Rivaroxaban Versus Warfarin In Patients With Bioprosthetic Mitral Valves And Atrial Fibrillation [4].

Sunday 11/15/2020:

One-Month DAPT

Trial Name

One-Month DAPT

Description

One month dual antiplatelet Therapy Followed By Aspirin Monotherapy After Drug Eluting Stent Implantation.

References:

ARREST trial: https://www.clinicaltrials.gov/ct2/show/NCT03880565
ALPHEUS trial: https://clinicaltrials.gov/ct2/show/NCT02617290
ATLANTIS trial: https://clinicaltrials.gov/ct2/show/NCT02664649
RIVER trial: https://clinicaltrials.gov/ct2/show/NCT02303795

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