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The Emergency Cardiology Group

The ACRE project was featured on the ABC radio AM news and current affairs programme this morning.

You can listen to the story featuring interviews with Will Parsonage and Terry George from Nambour Hospital here.

Nambour was where the ACRE project pilot was rolled out and the results of the pilot project have been published here.

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Things don’t always get the attention they deserve…

Duchamp's FountainOne of the triumphs of the recent ACC 2013 meeting was the the host city of San Francisco and the meeting venue, the Moscone Centre, which is central to downtown San Francisco and it’s associated attractions. One of the notable attractions is the San Francisco Museum of Modern Art (MoMA) right next door to Moscone. In a spare couple of hours during the meeting it was great to be able to call in there for some diversion.

There I was delighted to find one of the replicas of Duchamp’s 1917 work ‘Fountain’ pictured above. If it looks like a urinal that’s because that is what it was. This is no ordinary urinal but one that in 2004 was voted one of the most influential modern art works of all time (and therefore possibly one of the most important works in the MoMA). Duchamp’s 1917 original was lost but celebrated by a series of replicas – this one, in the MoMA quietly celebrating the 50th anniversary of its creation in 1963. Unceremoniously placed on a non-descript, plain white plinth garners a level of inattention that I am sure the artist would perhaps have appreciated. I took the short movie below to illustrate this (you can see ‘Fountain’ centre frame on the white box).

It was in no way my intention, but a matter of fact, that I didn’t attend any of the late breaking clinical trial sessions at the recent ACC meeting. In fact, I admit to taking at least 24 hours to figure out what an LBCT actually was (a new mode of cardiac imaging that had passed me by?).

I enjoyed blogging some of the less travelled sessions of the meeting (Day 1, Day 2, Day 3). So I feel I did my bit for some of the things that don’t get the attention they deserve but for those in need of a good summary of the headline trials, that did garner most of the attention, here are a few suggestions.

Here is perhaps the definitive video summary of the key trials from the heart.org’s Cardiology Show

...and here a more personal view from Melissa Walton-Shirleys “Heartfelt’ blog, also on the heart.org

…and in a slightly different format a slideshow of the key findings of the major trials that were presented at the meeting.

Plenty to be getting on with there…

An interesting view of events around the last minute ‘pull’ of the PREVAIL study from the ACC program last weekend.

Old CardioBrief

SPIN
The biggest story at the American College of Cardiology meeting last week was the missing story. As reported here and just about everywhere else, the PREVAIL trial, probably the most-anticipated late-breaker of the meeting, was pulled from the program at the last minute by the ACC leadership after Boston Scientific broke the embargo by issuing a press release several hours before the scheduled presentation.

To understand this event we first need to know what happened in the week before the ACC. And there’s a major gap in the story that has not come out before that I think holds the key to a full understanding of the story.

More than a week before the scheduled presentation I received an email invitation from a PR firm representing Boston Scientific:

“If you have any interest in speaking about the trial under embargo with Dr. Ken Stein, chief medical officer, Cardiac Rhythm Management, Boston…

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This is a post from CardioBrief – Important with respect to maternal heart disease. See this post 

Old CardioBrief

Hospitals are treating increasing numbers of adults with congenital heart disease, thanks to tremendous progress in treatment for this condition in recent decades. A clear picture of this dramatic change emerges in a new study, presented at the ACC in San Francisco and published simultaneously in JAMA.

Jared O’Leary and colleagues analyzed data from the Nationwide Inpatient Sample and compared congenital heart disease hospital admissions from 1998 through June 30, 2004, with those from July 1, 2004, through 2010. From the first period to the second, adult admissions grew much more rapidly than pediatric admissions.

  • Adult admissions increased by 87.8%, from 331,162 in the first half to 622,084 in the second half.
  • Pediatric admissions increased by 32.8%, from 815,471 to 1,082,540.

Adults constituted a growing percentage — from 28.9% to 36.5% — of congenital heart disease admissions.

The authors wrote that the “observed trend is likely due to a number…

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The striking thing about Day 4 of #ACC13 was that there was no Day 4!!!

I’ve not been to the ACC meeting for a few years but I am pretty sure that it had previously stretched over 4 days, and other comparable meetings, e.g. ESC in Amsterdam this year, certainly will be.

I think that the ACC may have made a positive move here. Perhaps in response to the global challenges of dwindling delegate numbers, innovative but disruptive information technology or maybe just to do something different – or perhaps a combination of such factors. Whatever the reasoning the decision to run the meeting over 3 days seems to have been a good one. The sessions certainly came thick and fast – maybe there were more parallel sessions to make up for the shorter program – but I never felt that the program was too crowded or difficult to negotiate. Notwithstanding the more concentrated program the College were also able make other significant moves, such as the lengthy period of time without opposition for the morning posters. There is no doubt that this was a good thing with the poster sessions literally packed on each day, and with the presence of many of the high profile opinion leaders who often would be elsewhere, or otherwise engaged were it not for the unopposed nature of the posters. For those of us pondering the future direction of these large medical meetings and how to maintain enthusiasm in some of the traditional areas of discussion, like the poster sessions, this is food for thought.

Day 3 began with the excellent Session 696: Battles in the Emergency Room over Management of Possible ACS. Pollack, Mueller, Hollander, Than et al covered most of the big questions in this area with all the strengths and weaknesses of clinical assessment, risk stratification, biomarkers and non-invasive testing, especially CT coronary angiography (CTCA) of course. Whilst there are many answers it’s also clear that many questions remain.

Christian Mueller, as you’d expect, provided a great overview of the benefits of the increasingly sensitive troponin assays in this context. What many people don’t realise is that none of the high sensitivity troponin assays available elsewhere have yet been approved for clinical use in the US. But it is very likely that they will be over the next 18 months and so there is quite intense interest in this now. Martin Than had sent the scene for all of this with much of our own data including the ASPECT and ADAPT studies along with what I think was the first look at the results of Louise Cullen’s highly sensitive troponin I data (which is now in press in the Journal of the American College of Cardiology).

The debate over CTCA has, I think, some time to run. Judd Hollander makes a compelling case for this as the ‘best test’ for ruling out coronary disease in patients with chest pain but then he works in a hospital where the test is available until 10pm each night and for four hours on Saturdays and Sundays!!!

And from there it was on to have our poster moderated…