CardioExchange at the AHA: A New Voice Emerges Reply

Some of you may be aware that my “day job” for the last year has been with the Massachusetts Medical Society, publishers of NEJM. I’ve been working with the great people at MMS helping develop and publish CardioExchange, a social media website for cardiovascular healthcare professionals. Now that may sound silly to many of you (and it did to me at first) because most cardiologists are the last people on earth you’d expect to see “friending” each other on Facebook.

But those guys in Massachusetts are smart. They recognized that the traditional model of medical communications– embodied most notably, of course, by the august and magnificent NEJM itself– might not have the same impact as it has in the past, and certainly its role would be tested by all sorts of newer, alternative communication models.

So over a year ago they created CardioExchange as an experiment. Harlan Krumholz, who lives in Connecticut but is also really smart, is the editor-in-chief. The editorial team is taking it slow, working through difficult problems and figuring out complex solutions. The concept has evolved over time (and will continue to evolve). Last summer a new version of the site was launched and the MMS began its first few modest efforts to publicize the site. Reaction to the publicity was fantastic, and the number of registered members has grown from a few hundred to nearly 2500.

Far more important than numbers, user involvement with the site has really taken off in recent weeks. It turns out that even if cardiologists don’t want to friend each other on Facebook they may well want to share with their colleagues their thoughts about news and other areas of common concern.

At the AHA this year CardioExchange seems to have entered a whole new phase. The quantity and quality of content– the vast majority of which is coming from our members– has been extraordinary. Rather than write about it in detail, I thought I’d share with you some of my favorite items from just the last few days.

As a prime example, here’s a sharp and incisive comment from Rick Lange and David Hillis, who write the interventional cardiology blog for the site, about GRAVITAS, presented earlier today:

The GRAVITAS study shows that high-dose clopidogrel doesn’t improve outcomes in patients with high residual platelet activity. An alternative interpretation is that assessment of platelet reactivity doesn’t effectively identify individuals at high risk for a cardiovascular event following PCI.

Of all patients considered for enrollment, more than 40% had high “on-treatment platelet reactivity” (i.e., level of platelet reactivity during clopidogrel therapy), according to the VerifyNow P2Y12 Test ─ yet only 2.3% of them had a cardiovascular event in the 6 months following PCI. In essence, the positive predictive value of the test is low.  Although the investigators call for testing “alternative treatment strategies” in patients with high platelet reactivity, it may be more worthwhile first to develop tests that are better at identifying individuals at high risk of having a cardiovascular event after PCI despite routine therapy. The notion that alteration of therapy based on platelet function measurements improves outcomes is still unproven.

And here’s an observation from John Ryan, a cardiology fellow at the University of Chicago, about presenting a paper at the AHA for the first time:

This was the first  formal scientific conference at which I have presented data. Over the last few days I have been struck by the solemn, serious tone of the presentations. Unlike CCU conferences that we present at during fellowship, these were taciturn discussions of science with no room for jokes or inaccuracies. To say that I was nervous would be an understatement. I am not normally anxious about talks, but this was so different from what I was used to.

And here’s Ryan on a nagging problem about real-life meetings in the information age that I’m sure has occurred to others in the past:

But does it not seem odd at times that the results of the late-breaking clinical trials have been released to the press several hours before the discussants present it to their peers? When Dr. Keith Aaronson was describing his group’s excellent study of the HeartWare HVAD, I already knew the results from an email I received earlier in the day. It is like knowing when you watched The Sixth Sense for the first time (spoiler alert) that Bruce Willis was already dead.

Finally, here’s a complete blog post from Susan Cheng, one of the Associate Editors of CardioExchange, about an Exceptional Late-Breaking Session:

To start, I should confess that I normally avoid late-breaking sessions like the plague. I’m not a huge fan of massive impersonal venues, the good presentations are often on data that were already published the same day, and I usually don’t find the discussions to be so enlightening. But this Sunday afternoon’s late-breaking session (which featured the RAFTADVANCEEMPHASIS-HF, and ASCEND-HF trials) was actually a fantastic learning opportunity — and not just because of the science.

I decided to go to this session for two main reasons. First, it was focused on heart failure, a rapidly expanding problem in cardiology that everybody knows is in dire need of new, innovative therapies. Second, I knew the research was going to be compelling (given what I’d seen of the same-day publications), and I wanted to see if my own lingering questions about the data might be addressed in the panel discussion.

As expected, several hot topics in heart failure were covered. And, as it turns out, the moderated discussions were really informative. But what made the session extra-special were the little things that happened outside the main content being presented…

To start, two discussants suffered from IT problems that caused their slides to be either missing or incorrect. This caused quite a bit of on-stage awkwardness, although both discussants were eventually able to do their part without the need for slides. So I learned that the mishap of malfunctioning slides isn’t something that only happens to fellows — and that even plenary speakers can be caught off guard when this happens.

Then, in addition, I also began to take notice of whether or not the speaker was presenting from memory or reading off notes. I guess the reason I was paying such close attention to this was because I recently helped a friend prepare last-minute for her AHA oral presentation. She was absolutely convinced that she needed to have everything memorized and, although I used to make a habit of doing the same, I wasn’t sure it was really necessary. Now, having observed what the plenary speakers do, I would definitely say it’s not necessary — and perhaps not even preferred. If somebody is really pressed for time before their big talk, I think I’d prefer that they spend their prep time honing the content of their talk rather than memorizing less-polished material. And then, if their slides were to malfunction, they’d still be able to read off their notes.

Finally, I thought it was interesting that, at this particular session, most attendees stayed until the very end. In late-breakers that I’ve been to before, there is usually something of a mini-exodus after every other speaker, depending on what’s popular. For instance, the moment after the ARBITER presentation ended at last year’s AHA, it felt like more than 200 people just got up and started walking out of the auditorium (a common side effect of the large impersonal venue) — which made me feel a bit sorry for the subsequent speakers lined up for that session. But at this session, even though the last presentation was not the most interesting of the whole line-up, relatively few people left before it was over. Then I realized it was probably because Eugene Braunwald was the discussant. Pretty darn smart of the moderators to order the presentations that way.

So, I guess I learned 3 things from this session, beyond the science presented: Always be prepared to do a talk in case the slides malfunction. It’s okay to read from notes. And, if you want people to stay to the end, get Braunwald to be the last speaker.

This is just a small sample of what’s on CardioExchange.

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