Each year since 2006, the Cleveland Clinic has surveyed its physicians to gauge the Top 10 medical innovations that will have the most influence the following year, and the list has proved to be quite prophetic. The two innovations from the current list that will impact cardiovascular medicine in 2011 are the JUPITER study and home-monitoring for heart failure patients.
The JUPITER study (No. 4 on the list) found that people with low LDL cholesterol but elevated levels of high sensitivity C-reactive protein (hsCRP) could benefit from statins. In the group receiving a statin, in this case, rosuvastatin (Crestor, AstraZeneca), the risk of cardiovascular disease and death was reduced by 44 percent compared with placebo-treated patients.
"JUPITER is important because it demonstrated that many seemingly healthy people with elevated levels of a biomarker of inflammation called high sensitivity C-reactive protein or hsCRP are actually at relatively high risk for cardiovascular disease and can benefit from statin treatment," according to information provided by the Cleveland Clinic. The JUPITER study defined a high hsCRP value as levels greater than 2.0 mg/L.
Based on the JUPITER study, first published in 2008 in the New England Jounal of Medicine, the FDA this year approved rosuvastatin for individuals who have no clinically evident heart disease but are at an increased risk of heart disease due to age, hsCRP and one additional cardiovascular risk factor.
The sixth top medical innovation on Cleveland Clinic's list is telehealth monitoring for heart failure patients. "Miniature implantable monitors to measure pulmonary artery pressure daily and at-home devices to monitor weight, heart rate and blood pressure of heart failure patients allow doctors to adjust medication quickly, improving patient outcomes and quality of life, while reducing re-hospitalizations," according to information provided by the Cleveland Clinic.
Experts at the Cleveland Clinic said that despite the quality of heart failure medications, the missing piece of the puzzle has been the inability to adjust the medication when necessary to keep the patient out of the hospital. These newer, better and more affordable wireless and remote technologies have promise to stanch the more than $20 billion associated with heart failure patients.
Among the Top 10 cardiovascular-related innovations nominated to be influencial in 2010 were continuous-flow ventricular assist devices (No. 3), non-vitamin K antagonist oral anticoagulants (No. 4), outpatient diagnosis of sleep-related breathing disorders (No. 7) and devices for occluding left atrial appendage to reduce stroke risk (No. 9).
In 2009, the Cleveland Clinic told the cardiovascular community to be watchful of percutaneous mitral valve regurgitation repair (No. 5), while health information exchanges—a comprehensive system of EHRs that connects, stores and shares clinical data from hospitals, physician offices, pharmacies, labs and other sources, got the nod for the No. 10 spot.
The innovations on the horizon for 2008 included flexible intralumenal robotics (No. 1), percutaneous aortic heart valves (No. 2), oral anticoagulant drugs for treating and preventing thrombosis (No. 5), image fusion for diagnostic and therapeutic use (No. 7) and dual-energy source CT imaging (No. 10).
Optical coherence tomography made the first list for 2007 (No. 4), as well as endografts for the aortic and peripheral vasculature (No. 7) and left ventricular assist devices (No. 9).
The Top 10 Medical Innovations had to meet four major criteria for qualification and selection:
- Significant potential for short-term clinical impact (either a major improvement in patient benefit or an improved function that enhances healthcare delivery);
- High probability of success;
- On the market or close to being introduced; and
- Sufficient data available to support its nomination.
A panel of Cleveland Clinic physicians and scientists select the devices and therapies. This year's list was unveiled during the 2010 Medical Innovation Summit held Nov. 1-3 on the clinic campus.