Circulation: Speed of info flow changed DES clinical practice patterns

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Email, search engines, smartphones and other new technologies that can disseminate new medical information quickly led to an almost immediate change in clinical practice for drug-eluting stents (DES), according to a large study published online July 28 in Circulation: Cardiovascular Quality and Outcomes.

With the rapid-fire release of data, studies presented at medical conferences in the age of instant information can have an almost immediate impact on patient treatment, according lead author Matthew T. Roe, MD, associate professor of medicine at Duke University Medical Center and Duke Clinical Research Institute in Durham, N.C.

"We were interested in whether practice patterns changed after the presentation of these studies," he said. "That's indeed what we showed."

Researchers examined data from two large patient registries that showed from January to September 2006 (before the data were released) about 90 percent of patients with non-ST-elevation MI (NSTEMI) underwent coronary DES implantation.

In September 2006, several studies were presented at the European Society of Cardiology (ESC) scientific sessions that found DES were associated with a higher risk of late stent thrombosis, compared with bare metal stents. By the end of March 2007, the use of DES fell to 67 percent and usage continued to drop to 58 percent by the beginning of 2008, Roe noted.

"There was a rapid change of practice patterns after these presentations in September 2006," he said. "To our knowledge, this was the most rapid change in practice patterns in cardiology. We presume it was because of a rapid uptake of information."

The swiftness in which practice patterns changed signaled that speedy distribution of information through media and scientific outlets may become the "predominant stimulus for changes in practice in the future," the authors wrote.

Researchers examined records of 54,662 patients with NSTEMI, which included 27,329 DES patients. The information was gathered from two large registries: CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) during 2006, which transitioned into the ACTION Registry-GWTG (Get With the Guidelines) beginning in January 2007.

The researchers said that hospital or patient characteristics didn't change during the study. These results show the need for experts to put results in context, according to Roe.

"This study demonstrates the dynamic shifts that are occurring in the distribution of medical information," said Clyde W. Yancy, MD, president of the American Heart Association (AHA) and medical director at Baylor Heart and Vascular Institute in Dallas. "The opportunity to widely share important findings that promptly impact practice is becoming a powerful tool to drive change. The requirements for prompt but thorough peer review and nimble responsiveness to new data are evident. Managing this new health IT space will require focus, assessment and realignment."