CardioExchange Archive

See Next Post (ACC Day 2)

Several Fellows in Cardiology who are attending this week’s ACC meeting are blogging together right here. The Fellows include Shane LaRue, Justin Bachmann, Nihar Desai, Shanti Bansal, and Hansie Mathelier. Check back often to learn about the biggest buzz at the ACC — whether it’s a poster, a presentation, or the word in the hallways.

And, if you want to learn how to make the most of a national meeting, click here.

Justin Bachmann
3/14 4:03 p.m

Busy day.  I’m glad there was another fellow at the  Healthcare Reform keynote, Shane. The room was absolutely packed.  Must have been 300-400 people.  Personally I thought it was great.  Rep.  Paul Ryan (a Republican) and Chris Jennings, a Democratic health policy  consultant, slugged it out.  They didn’t seem to reach consensus on  much.  I think it’s a good illustration of how difficult the healthcare  debate has become.

Then it was off to the Integrated Imaging talk.  Lots of good stuff. 3-D echo, speckle tracking, strain imaging. Many of these techniques seem to be technology searching for a purpose, but hopefully they will find their way into routine clinical practice.

As a member of the ACC Fellow-in-Training committee I would be remiss if I didn’t point out that there is a FIT Community Room in B216.  Don’t ever pay for coffee folks; it’s free along with other food in the  fellows’ room.  There are also fast desktop computers. The only rub is that it’s quite a hike. It’s way on the far end of the B building. The exhibitors are also giving out plenty of coffee that I used to fuel up throughout the day.  One booth is even making protein shakes.

And the day isn’t over yet. I’m off to the ACC all-chapter reception in the Omni grand ballroom, where I’ll meet up with some of the other Texas cardiologists. Talk to you all soon.

Shane LaRue
3/14 3:41 p.m.

Just watched a live CTO case.  Have to agree with Shanti re the great pictures. Also a good way to mentally refresh after listening to several talks.

Moved onto terumo radial access demonstration in the exhibit hall. Very informative talk, especially as we get little arm exposure as general fellows. The real reason to come by is that you can get access on a dummy radial artery. (in case any of you share my joy in sticking things with needles).

Hansie Mathelier
3/14 3:22

So offline, Harlan Krumholz asked for the fellowship training perspective on new presentation and data—do we read based on the presentations or is the meeting a replacement for that kind of study? For me, it is on a presentation-by-presentation basis as to whether I will do follow-up reading.

For example, I just attended a lunch conference with “management of RV failure.” There were 6 case presentations. I was surprised many times — as were other individual in the audience and panel — regarding the high dose of milrinone (0.75) used in the management of the case patients. For me, it reinforces the fact that people clearly manage pt differently. Based on my experiences in residency and fellowship this made me skeptical on the data the presenter had. Thanks to my blackberry I googled the speaker to ascertain her background. What I also took away from this lunch session was that there is also extensive center and regional variability when it comes to the decision of inotropes, RVAD /LVAD placement, and transplant listing .

By the end I was wanting more. Perhaps a more organized discussion or more controversial cases to generate a more lively discussion. Off to the “Management of ADHF: past present and foreseeable future”

FYI Fellow bloggers there was free coffee in the exhibit hall. Just in case you didn’t want to spend $15 on coffee per day.

Nihar Desai
3/14 2:57 p.m.

Wow, what a Sunday at the ACC…. Started off this morning with the late breakers, was wondering if you think anything we heard this morning will change practice. I was sitting with a couple other first year cardiology fellows and we were most surprised with the ACCORD BP results suggesting no benefit of intensive (SBP<120) blood pressure control in diabetic patients at risk for adverse CV events.

What did you think about the EVEREST II Mitraclip presentation?  I think too often we assume that newer technology is necessarily better and I think the panel discussion afterwards included a healthy skepticism.

I just wanted to echo the comments on health care reform and how central a role it is playing at this meeting. Very telling to have David Blumenthal here and I also had a chance to attend several very good sessions on using registries to drive quality improvement and how to implement a performance improvement program.

It was also nice for me to walk through the poster session, see some interesting science, catch up with friends from medical school and residency, and support colleagues!

Shanti Bansal
3/14 2:25 p.m.

I am at the Yale CTO live case. This is really impressive live feed coming from Yale.  You can see everything going on at Yale very clearly. This is like watching NBC olympics with professional commentary.  I hope they start selling a TV like this at Best Buy.

Shane LaRue
3/14 2:06 p.m.

Ok, first, thanks to the organizers for the coffee stands every 20 ft. 2nd large coffee down and the 6am flight (after the time change) is a distant memory.  Well worth the $4.75.

Healthcare reform is (mercifully) just finishing. This is obviously a provocative topic, but my foremost thought is, my med school self would be very disappointed in my fellowship self. One of the physicians vocalized my persective on the topic. We first have to decide whether everyone should be covered. If that is the case, then find the way to make it work. I am stuck at the ‘we need to find a way to make it work’ stage. I literally go cross-eyed listening to the debate. Speaking of which, the discussion at times felt a little like watching fox news, with the republican (Paul Ryan) speaking loudly, confidantly (and to his credit clearly), while the democrat mumbled, softly.  The only universal applause was when they agreed that the cuts to cards reimbursement this year were poorly researched/inappropriate.  Go figure.  Off to find another talk, hopefully will not get so lost this time.

Shanti Bansal
3/14 1:45 p.m.

I came into atlanta friday night after an annoying interaction with US airways.  I am here with my papa johns pizza watching Geoge Beller explain preoperative risk stress testing. There was a very spirited discussion of how to manage an 80-year-old female with hip fracture with trop of 0.15 and anterior twi. Any thoughts on this? My personal view point is that she should stress them rather than be more aggressive as a first step.

Hansie Mathelier
3/14/ 1:15 p.m.

The second half of the morning was interesting. Walking around the exhibit hall. Time to reflect on the morning and time to plan for lunch. Should I go to “Management  of RV failure” vs. “Clearing the Cardiac patient for noncardiac surgery.”. Being a first year fellow, I am assume I know how to “clear” a pt but what is the new data out there vs the neglected ventricle. I chose the neglected ventricle. Should be interesting to hear cardiologist and cardiac surgeons perspective. Just a side note… Thank goodness I am not a vegetarian. The selection for food options for vegetarians are limited. One of my cofellow isn’t eating lunch because his options were cheese pizza or salad.

Justin, For this afternoon I was debating about 3D echo vs mgmt of acute decompensated HF. I will email after my lunch time talk to assess imaging vs ccu

Justin Bachmann
3/14 12:15 p.m.

Anyone else get stuck on the tarmac yesterday?  My connecting flight from Charlotte came close to being cancelled, but I made it in.  I’m glad I did.  This morning I went to the Health Information Technology keynote featuring David Blumenthal, MD.  He’s at Johns Hopkins, where Hansie and I trained. There was a nice discussion between Dr. Blumenthal, Dr. Lewin and Dr. Bove about the capacity of electronic medical records to improve outcomes and efficiency. Dr. Bove mentioned that he’s effectively used HIT to enhance communication with his patients.  Apparently his heart failure patients are able to routinely send in their weights and other data through an electronic system.  This allows him to track his patients much more closely than monthly follow-up visits.

I also dropped by the Heart Songs demonstration, which was a lot of fun, as well as the exhibition hall. The hybrid OR mockup is pretty sweet. And I got a kick out of the matching lime green ties that all of the Effient folks are wearing.

Right now I’m heading towards the Health System Reform keynote with Jack Lewin and Jim Fasules, the ACC’s director of advocacy.  I’m anticipating a pretty spirited discussion.  If any of you are politically inclined, be sure to check out the ACC Political Action Committee’s hospitality suite. It’s in room #3808 at the Marriott Marquis.

I’ll probably go to the Integrated Imaging Spotlight this afternoon, Hansie.  Want to meet me there?  There will be some interesting talks on 3-D echo.  Talk to you all soon.

Hansie Mathelier
3/14 10 a.m.
Starting on my ACC experience. My first decision was to take the shuttle bus or walk 8 blocks. I chose to walk since I always try to tell my patients to exercise more. Also gave me time for me to think do I want to go for my first session. If you are interested in many topics it is hard to pick a first session. Do you go to the late breaking session or an interesting symposium or spotlight (moderators from my home institution)? I chose to go “special topics” – Joint Session of the ABC and ACC discussing race and ethnicity in different topics, ie (1) hispanics and heart failure (2) atrial fibrillation in African-Americans (3) registries being set up across the us focusing on hispanic. (4) recurring themes in cardiovascular health and race. As I leave this session wondering how do I get access to these registries? Ideas of studies that could be done with these registries. I wonder what session my fellow bloggers attended? As I look at the schedule for this afternoon, which lunch and afternoon session should I go to? What suggestions do you have, Justin, Shane, and Nihar? How about among our readers?