Do you remember the anticipation around renal denervation? And then the ACC.14 presentation of the SYMPLICITY HTN-3 results, where the excitement about a new way to treat resistant hypertension seemed to crash (N Engl J Med 2014;370:1393-401)?
What about bioresorbable scaffolds? Recall the cardiovascular community’s eagerness for the next big stent innovation—one that might dissolve away the adverse events associated with stents’ long-term residence in arteries. And then came the series of lackluster ABSORB trial findings, the FDA warning letter to providers and, finally, Abbott’s decision to pull the devices from the commercial market.
Why revisit these disappointing moments in recent cardiovascular history? Because two articles in this issue return the memories to relevance. These articles suggest that renal denervation and bioresorbable stents, or at least their underlying goals, haven’t died and may in fact recover enough to impact patient care, though perhaps less dramatically than initially hoped.
This is what I love about cardiology. The field’s appetite for problem-solving; its tireless pursuit of solutions; its persistence in the face of what appear to be, at least on the surface, failures. There’s always an exciting new advance percolating, getting cardiologists fired up about a new possible game-changer that might solve a vexing problem and help patients. And when, on occasion, the innovation doesn’t change the game—or perhaps it flat-out tanks—cardiovascular researchers keep studying the data, puzzling out what could be learned from the details and, maybe, just maybe, salvaging the innovation.
In this issue’s cover story, we look at how creative thinking in the “smart” arena (artificial intelligence, machine learning, intelligence augmentation … call it what you want) is birthing intriguing new products aimed at solving frustrating challenges. The curious thing has been, at least to my ear, cardiology’s rather quiet reaction to AI and its kin. Are these ideas too vague, too “out there,” too reminiscent of Star Trek? Are cardiologists withholding judgment because much of the innovation is coming from outside its usual incubators, from the likes of big data and high tech rather than traditional medical companies? Or are cardiologists watching and waiting to see if these new inventions will be subjected to the same rigor they’ve required for stents, valves, pacemakers and clips?
These may be viable reasons to temper enthusiasm for today’s so-called smart advances, but I’d suggest now is exactly when cardiologists should rev up for action. Now, in these early stages, is when new innovations and innovators may most need clinicians to speak up, ask questions, poke holes and explain what they really need and want from the smart tools that might eventually earn a place in their workflows.