From interactive (ACC) to inactive (SGR)

We are nearing the end of March. That means one big event is behind us and another looms.

The American College of Cardiology (ACC) wrapped up its annual scientific session on March 16 in San Diego. For those of us who experience real winter (Washington, D.C., doesn’t count), the venue was a welcome change. Ajay Kirtane, MD, MS, of Columbia University Medical Center in New York City, listed the joy of a morning jog before that day’s conference among his highlights.

The meeting itself held the vibe of San Diego. The conference center was easy to navigate, sunny and well-staffed. Outside of the occasional PowerPoint fumble during a presentation, I witnessed no technology glitches or Internet paralysis, and the electronic access to abstracts, schedules and other materials worked seamlessly.

That’s the backdrop. When things run smoothly, attendees and presenters can concentrate on the content. The late-breaking clinical trials consistently drew substantial audiences. It was a mix of the positive (PARTNER I and CoreValve) and negative (REG-1 and EMBRACE STEMI), and in all cases the trials provided insights beyond the top-level results.

Cardiologists looking at the details of PROMISE (PROspective Multicenter Imaging Study for Evaluation of chest pain) identified a trove of valuable information beyond is key finding: There was little difference in outcomes for symptomatic patients being evaluated for suspected coronary artery disease, either by coronary CT angiography or functional testing. About 3 percent in both groups experienced the composite primary outcome of death from any cause, MI and other events.  

For Jeffrey Cavendish, MD, of Kaiser Permanente in San Diego, PROMISE gave a clear signal on the overuse of imaging in this patient population. “For me, it begs the question: What are we doing with all this testing? Do we really need to do a CT scan or a stress test at all?” he said in an interview. As a result of PROMISE, he planned to encourage his organization to cut back on testing.

“This study validates that these patients might not need anything done,” Cavendish said. “We could do a better job at fine-tuning stress tests and CT ordering in the patients who we see.”

The next day, Ami Bhatt, MD, co-director of the adult congenital heart disease program at Massachusetts General Hospital in Boston, offered another view on PROMISE. She found the low event rates to be reassuring.

Independent of each other, Cavendish and Bhatt said this year’s conference was more interactive and educational. Bhatt described a session where cardiologists discussed a problem, listened to experts and then reconvened.

“It makes a difference,” she said. “It makes learning fun again and interactive. A lot of people talk about patient engagement but there should be equal focus on physician engagement, not only in care and adopting electronic medical records but in being part of a society. This was a year where physician engagement was prioritized.”

And the looming event? The patch on the sustainable growth rate (SGR) formula is once again ready to come loose. We’ll see if Congress can pitch the patch and agree on a permanent repeal. They have until the end of the month. Based on past history, don’t expect any resolution until the final minute.

Candace Stuart

Editor, Cardiovascular Business