CardioExchange Archive

Fellowship Training co-moderator John Ryan discusses the studies he’s most looking forward to checking out at the AHA Scientific Sessions 2011 meeting. See what he has to say and share your own suggestions and comments.

• ADOPT: The past twelve months have seen the now famous introduction of novel anticoagulants for AFib. The potential for these agents to change the face of treatment options for other conditions that require anticoagulation is enormous. In the ADOPT (Apixaban Dosing to Optimize Protection from Thrombosis) study, Goldhaber et al compare the effect of enoxaparin with that of apixaban for preventing deep vein thrombosis and pulmonary embolus in patients admitted with acute medical illness. This study, which enrolled over 6500 patients, has the potential to change our traditional management of DVT/PE prevention, unless it suffers from the bleeding complications that plagued APPRAISE-2.

• Post-MI FREEE: I am also excited to learn about the results of the Post-MI FREEE (Post-MI Free Rx Event and Economic Evaluation Trial) study, in which patients were randomized to have their pharmacy benefits changed so that they have no out-of-pocket costs for any ACEi, ARB, β-blocker, or statin. In the interventional arm, all co-pays are waived, as is any amount that the cost of the drugs contributes to a patient’s deductible. This study interests me for two reasons: (1) it addresses the long-held question of whether patients would be more compliant if they get their medicine for free, and (2) more importantly, it represents a deviation from the usual pharmaceutical-sponsored research. This study was performed in collaboration with the insurance company Aetna, a practice that may become increasingly common.

• POWER: The obesity epidemic continues to cripple U.S. healthcare, and there are few recognized long-term successful treatments available aside from bariatic surgery. I think the POWER (Evaluating Weight Loss Programs for Obese People at Risk for Heart Disease) study will be useful, as it compares the effects of self-directed weight loss, cell-center directed programs, and in-person weight loss counseling. As well as weight loss at 2 years follow up, the investigators have also studied BP control, lipid levels, insulin sensitivity, and Framingham Risk factors. There does not appear to be cost-analysis in this part of the study, but demonstration of efficacy will at least be the first step to address this epidemic.