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