Cardiology Trials - A New Project for 2024
Along with two other cardiologists, I am co-authoring a special type of cardiology project. It's textbook; but not a normal one.
My friend Dr. Andrew Foy had this idea: during rounds in the hospital with learners, Foy noticed that many things get done (drugs prescribed, tests ordered) as a matter of culture or history. As in…we do this because that is what we do. It’s what everyone does.
Well, that can be a problem. Established patterns of practice don’t just come from thin air. Many stem from clinical trials done years ago.
Sometimes things we do are well grounded in evidence. But. But. Sometimes, the so-called seminal trials studied different types of patients, in different settings, during a different era. The results ought not apply to the patients we see now.
Here’s another discovery: cardiology training is technical. Learners have to spend oodles of time learning how to do stuff. Things like reading ECGs, echocardiograms, as well as learning to do procedures. There isn’t a lot of time to go back and read the underlying evidence for established practice.
A classic recent example is left atrial appendage occlusion. I’ve spoken to young people learning to do this procedure. They can speak in great detail how to seat the device in the appendage but have no idea that the main regulatory trial did not meet its first co-primary endpoint.
The Project and Our Change of Plan
Our plan is to write a textbook of cardiology trials. A place where a learner (or curious person) can go to read the actual details of the major clinical trials.
We use beta-blockers after MI, for instance. Well, do you know the actual trials underpinning this evidence? Our book will explore each of these trials. We will do this for coronary artery disease, arrhythmia, heart failure, etc.
And it won’t just be a recital of the trial data. Foy, myself and Dr Mohammed Ruzieh will add our commentary on the results and take-home points of each trial. Ruzieh trained with Foy and gosh is he smart.
We’ve already written many of these reviews. They sit in a Google document. It would take another year to finish.
Our change of heart happened recently. We’ve decided to write this book on Substack. One review at a time. They will come out as separate posts. It will be a working document. We will also add podcasts where we discuss a trial.
In the end, we hope to put this altogether in one collection where a learner can have short collections of the important clinical trials. Like a real textbook. We believe the seminal trials are an evergreen topic.
Here is the link. The posts start tomorrow. Sign up. JMM
This is what makes a great physician: being curious, individualizing treatment and looking closely at the details of studies which inform practice. In other words getting to the heart of the matter (yes, pun) instead of “this is what we always do.” So grateful for professionals like you!
I love this idea! I am a Registered Nurse working pediatric emergency since 2011, so Cardiology is not even a field I’m very familiar with, but I love learning what you post about here, as well as everyone at Sensible Medicine. The pandemic really opened my eyes to the faults of modern medicine and public health. Something changed after the pandemic. We are seeing so many more sick people being hospitalized now than I’ve ever seen before. I’m now having to also care for adults because we don’t have rooms for everyone. Adult medicine frustrates me and I constantly question why we do the things we’re doing. For example, why are we prescribing Paxlovid to patients who are vaccinated?! (Well, I know why 🙄) Why are we doing a cardiac work-up in the emergency department on a senior patient even though they came in for a mechanical fall and don’t have any cardiac complaints?! I could go on and on. Then there are the things we do that seem to make sense to me, but does that mean there’s good evidence for it? Not necessarily. And that’s why what you are doing is so important! I love it! I only wish it would be done for every practice. True evidence based medicine. Thank you!