Heartfelt with Dr Melissa Walton-ShirleyView all posts »
Post-AHA 2011: So what will I do differently tomorrow?Nov 16, 2011 14:25 EST
I learn tons of stuff at every meeting, but like the average Joe, I forget more than I learn. With regard to what I do remember, it's probably a "wealth of useless information," but as I was leaving the convention center today, I made a mental list of all the things I might actually take back home with me, through the hospital entrance or exam room door. There were a few standouts:
- I'll try to get a date for bivalirudin with the entire cath lab team. I'll comb his hair and dress him up and spray on some great smelling cologne and see if I get any takers. Hey, maybe if I tell them that none of their mothers like him . . .
- I'll continue to be happy with plain old enoxaparin for thromboembolic prevention for now. So far, it's held up well against the early assault by the soon-to-be "new kid on the block," apixaban. I won't invest in vorapaxar, unless Mattel purchases the right to use its name as an alien predator for a Christmas toy. "Vorapaxar meets Godzilla?"
- I'll send out a mass email advising my CAD patients to put in applications for a second job, or they might just start now to open a new savings account, kind of like the Christmas club. They'll need it to afford the rivaroxaban I'm going to have to prescribe them as the latest add-on when they get their next ACS. Gee, wonder if the FDA will give us that indication? (Tongue in cheek.)
- I'll pound my buddy Aetna to wave the copays for beta blockers, ACE inhibitors, and statins across the board for post-MI patients. But I probably won't be able to find him because his good friends Blue Cross and Humana have probably taken him out behind the barn to give him "what for." They should thank him for participating in this trial, but based on their superior ability to recognize what's good for them and patients (like prevention coverage), I don't think Aetna will get any love anytime soon.
- I'll try to be "nicer" when heart-failure intervention trials are presented. I get kinda steamed when the basic tenants aren't part of the ground floor of any CHF trial design. No drug or slate of drugs for CHF will ever have a snowball's chance in Hades to work if the patients are drinking 3 liters of fluid per day and licking salt off the backs of their hands. The avoidance of these velociraptors of "CHF Park" is "an aim not devoid of merit." (Quote—John Hammond sans the CHF slant.)
- I might get a nice album of pictures to add to our consent forms so I can talk longer to patients before they have their procedures or maybe even let them read more so they won't have the procedure I know they really need, and maybe throw in my vacation videos and sit around a campfire and sing "Kumbaya." (Kidding—I already do a long consent and I'm all for whatever will help a patient feel more comfortable. Really, I'm kidding, so please . . . no hate mail.)
- I'm still going to be good and mad until every ACS patient in my country gets a safe and timely PCI, so I guess that means I'll be mad forever unless I move to Europe, in which case, I could have been happier 30 years ago. I sure won't give dronedarone to my patients with permanent afib, like I was going to ever do that anyway. Seriously, the drug absolutely should not be used for permanent atrial fib, hemorrhoidal pain, or acne.
- I will try to get my patients to take high-dose statins. I don't know if it's going to translate into a decreased event rate, but it just makes me feel better to slide all those LDL and HDL numbers into the normal category. I also hear it does wonders for obsessive-compulsive disorder.
- I can't wait for evacetrapib and some of its siblings to be born in America. In the meanwhile if someone walks up to you, kind of shadylike, and tells you they have some knockoff compound that starts with a "T" for sale . . . out of the trunk of their car that "works just as well"—I'd keep walkin'.
- As for niacin, the problem child of the lipid arena, I'll probably not stop it, but not sure I'll start it either. I might could use it in the spa to negate the need for blush . . . Just sayin'..
- Hmm . . . I'm thinking about using colchicine for a fib prevention post heart surgery. It seems like it just might work, but the investigators reminded us that it isn't FDA approved for the treatment of pericarditis or treatment of the pericardiotomy syndrome and well, over the course of decades hasn't really been FDA approved for much of anything. Well, I never knew that, yet I've utiizied it several times for those indications so . . . thanks for that . . . and I suppose you're going to say I’m fat too. (Sticking tongue out now.)
- Finally, thanks to the investigators who actually care enough about a drug that’s going generic to study it. It seems that boosting the maintenance dose of clopidogrel to 225 or 300 mg/day overrides genetic resistance for the unfortunate 30% of the population who will get no bang for their four bucks (after May 2012) for the standard 75-mg dose. I'd love to start boosting the doses immediately in my patients who demonstrate resistance either in the laboratory or clinically, then check my VerifyNow results as I titrate, but alas, the FDA does not currently approve of such, and there is that pesky issue of lack of proof for improved clinical outcomes, so I guess the next questions are: When can we get started poking around in the DNA of our CAD patients? Will it require we mortgage the farm or win the lottery to purchase a look at our genes? The benevolent edge of this study—looking at a drug that will actually be widely affordable in seven months in the US—will no doubt be blunted by the enterpreneurial-genomic axis of the situation.
Well, that's an irreverent look at the American Heart Association 2011 Scientific Sessions' late-breaking clinical trials thus far. It was one of the most memorable meetings I've attended in a long time, and was an honor and a privilege to attend! Not kidding this time . . . Really!!!