CardioExchange Archive

Several Cardiology Fellows who are attending AHA.11 this week are blogging together on CardioExchange.  The Fellows include Revathi Balakrishnan, Eiman Jahangir, John Ryan (moderator), and Amit Shah. Read the previous post here. This is their final post. See their complete coverage at the bottom of this post and in this review of our AHA coverage.

Readers, were there any unique experiences or sessions at the conference that you would like to share? 

Was there anything you didn’t like and wish you could change? We welcome your comments.

Reflections on My AHA experience: Choose Your Own Adventure

Revathi Balakrishnan

Although the conference is not over at the time that I write this, my first-year duties beckon me back to the reality of fellowship back home (and I’d like my co-fellows at home to not go completely insane from coverage of our call). Reflecting on the experience, I’m amazed at the wealth of knowledge that can be gained in such a short period of time. I have gained a lot through this experience, not only from attending the sessions, but also from spending time with co-fellows and faculty from my home institution, watching presentations of their research with a sense of admiration, and having some insight into the immense effort and innumerable hours that can go into a 10-minute presentation. I was able to reconnect with old friends on similar career paths, all in different stages, gleaning some sagely advice. I’ve also gained a sense of how one can eventually use this meeting to make new connections for career building.
One thing I have learned is that one attendee can have an entirely different AHA experience than another based on how one tailors it to their interests, similar to those “choose your own adventure” books from childhood (without the 16-point font and fifth-grade reading level, of course).

Here are some highlights from my conference experience:

• Late-breaking sessions: This was the place to start — same place, same time everyday — and then branch off into more specific interests from there. I had difficulty deciding on what to go to when interesting sessions were going on at the same time as the late-breaking updates, such as the clinical science special report sessions that highlighted the stem-cell therapy trials. Since we do get emails in the morning of the late-breaking slides for the day, one could review them in the morning and decide which presentations to attend.

• Amongst the sea of catchy acronyms, several trials kept the fellows talking long after the presentations were over:

1. ATLAS ACS–TIMI 51
2. Post-MI FREEE
3. PALLAS
4. SATURN
5. AIM-HIGH

•  Thought-provoking small sessions and seminars; One that was particularly interesting to me:

Non-obstructive CAD: Not important?

A session moderated by Dr. Judith Hochman, with presentations of research from Dr. Harmony Reynolds, Dr. Noel Merz, Dr. Leslie Shaw, and Dr. Amir Lerman that calls into question how we approach management of angina and ACS in non-obstructive CAD; that it encompasses a complex spectrum of hidden macro- and microvascular disease and adrenergic response. An excerpt from the session:

ACS and Nonobstructive Disease in Women: Dr. Harmony Reynolds presented data on women with troponin positive ACS without obstructive CAD on cath. IVUS and cMRI were done to characterize lesions and presence of myocardial injury.  Plaque rupture was found in 38% of patients with non obstructive lesions, and abnormal MRI patterns (LGE, predominantly ischemic) were found in 59% of patients.  The full paper can be found here.

• What I wished I knew about beforehand: Detailed planning is key. I had a sense of what I wanted to see, but detailed planning will leave you less frustrated and overwhelmed — including planning which posters to see. Someone I know (who may or may not be a co-contributor to the fellows blog) actually had a detailed excel spreadsheet planned far in advance with dates and times of different talks they were interested in.

• The dinners: Not explicitly obvious in the programming, but seemingly valuable learning and networking experiences. One of my co-fellows went to the AHA Evening symposium on lipids and inflammation and thought it very informative and clinically relevant. A friend attended the Women in Cardiology dinner, which provided a wealth of networking opportunities with what seemed like a who’s who of female leaders in the field.

• Avoid the expo floor: Resist the temptation for freebies. There’s not much you can get for free at the booths anymore, so some have resorted to using food. My co-fellows and I were lured in by the smell of pumpkin crumble at the Pradaxa booth, and as we were waiting on line for a sample, a representative scanned our badges (which conveniently have all our information on them). It was a sneaky move, and I now fully expect to be getting Pradaxa junk mail for years to come.

• Book a later flight for the last day to maximize the experience: The big sessions usually end around 5 pm. You can bring your bags and leave for the airport from the convention center.

Overall, this was an enlightening experience and with what I have learned, I hope I can get even more out of it next year…

Impressions From a First-Time Attendee

Eiman Jahangir

I am writing my reflections of the week on Friday, three days since I left the conference, and by now the week is already a blur. As a first-time AHA attendee (but frequent ACC attendee) I found the experience quite different. First, the magnitude of people seemed to be far fewer then I would have expected. Unlike prior conferences where just walking could be difficult due to the large numbers of attendees, this time certain areas, such as the exhibition hall and posters, seemed deserted. It may be because the device and pharmaceutical companies do not provide much “swag” anymore, thereby limiting the desire for attendees to listen to their promotion.

The next thing that I learned from attending AHA is to arrange meetings pre-conference. I made the mistake of thinking that I could just walk up to old attendings and colleagues after their talks and “catch up.” This was a dire mistake. I now know that everyone is busy (including me) during the week and meetings have already been arranged. Therefore, if you want to meet with someone, even if it is for a quick chat, I recommend emailing them and arranging a lunch, coffee, or just 15 minutes.  I actually met individuals who did not attend a single scientific session, using the conference solely for socializing. It is also a good idea to have business cards on hand to pass on to those you may want to keep in touch with.

Finally, while the lectures are interesting, and you will come away with some new and exciting knowledge, most of this information can be obtained via the internet at a later time. Therefore, if you cannot see everything you would like to, don’t fret, because it will be available on line.

Now the question remains: Will I attend AHA again? I agree with John that, as we sub-specialize, we are more likely to attend our sub-specialty conferences. In my case this is TCT or SCAI. My only concern with attending the sub-specialty conferences is that I will then miss the opportunity to interact with my non-interventional colleagues.  I guess I will just have to wait and see.

 

Summary Thoughts From AHA

 John Ryan

The AHA meeting this year was an enjoyable, although at times overly busy, event. During this third year, I am doing research and clinical work in pulmonary hypertension. Therefore, inspired by Dr. Thomas Ryan’s advice, I decided to spend 60% of my time at pulmonary hypertension sessions. This actually was a feasible task as there were very few conflicting sessions. And pulmonary hypertension is so diverse (I am not joking, I have really gotten into it), that I was kept busy attending a variety of talks — there were right-ventricular sessions, pulmonary-artery updates and basic-science seminars on mitochondrial dysfunction in pulmonary artery smooth muscle cells. From this perspective, I left the sessions with a greater grasp of this field and the motivation to become a part of it.

To my regret, I found it harder than in previous years to make it to the late-breaking clinical trials. But this is a frequent observation of fellows and faculty alike: There is so much going on concurrently at the AHA that one can spend their time in almost a conference-center limbo, wandering from room to room and circling back to the exhibit hall. This year the late-breaking clinical trials were the best that I have seen since my first AHA. Part of the reason I enjoy these sessions is not only for the science but especially for the insight one obtains from the more senior investigators, either those presenting their work or serving as discussants. Seeing these senior cardiologists on the podium is an inspiring experience. Their dedication to the field and their clear interest in science serves as a reminder as to what we all hope to achieve by dedicating our lives to advancements in heart disease.

The AHA is always a place for reunions. For the first two years I met up with a lot of people from my residency. However, this being my third year, I noticed two differences: First, a lot of my friends have now decided which specialty they are going into and have opted to attend TCT or ASE as opposed to AHA. This was disappointing although understandable, and perhaps if there were an independent, stand-alone meeting in pulmonary hypertension, I would have opted for that, too. The second difference was a more positive change: Because my friends and I are getting more experienced, many more of them had presentations this year. As Dr. James de Lemos has previously pointed out, going to see your friends present is a remarkable experience. It is one thing talking to your former co-intern about their work over the phone or in the Peabody, but being in the crowd while they take the podium and watching their fear and confidence as they advance their slides is a heart-warming experience. Even if they do not see you in the crowd (and often times they are so stressed out that they do not), being there and watching them present the work that they have put so much effort into is something that never fails to satisfy.

When it comes to cardiology fellowship, while Braunwald’s may be required reading, going to see your friends present at AHA is required watching. And there is nothing that cements a friendship more than being able to say, “I was there.” Remarkably, it is also one of those feel-good bonds that reliably gets reciprocated whenever you present. And seeing familiar faces in the crowd (or at the very least knowing they are there) makes all the difference.

 

Observations From my AHA Experience           

 Amit Shah

As opposed to my first two AHA experiences, this one felt a little different. Perhaps it was the fact that I was going as a clinical fellow, which presented an entirely new set of challenges from when I attended as a research fellow last year. Perhaps it was the noticeably reduced attendance, and the refreshing lack of overcrowding? Or perhaps the nerve-racking oral presentations and last-minute preparations, chasing, and sometimes buying WiFi at every corner I turned to make the final tweaks on my talk?

Regardless, I’ve come to appreciate many things that were the same, such as the “aha!” (no pun intended) moments when learning about a study that shed some light on a clinical challenge or sparked a new research idea. Or the excitement when meeting someone with similar interests, and being on the cusp of a possibly new partnership in research. Like last year, I have also come to value my opportunity to blog with CardioExchange and engage in stimulating discussions with the other research-oriented fellows and online members across the country.

A few highlights from the sessions:

• I was surprised and refreshed to see late-breaking trials with a focus on prevention and cost-savings, such as Post-MI FREEE, as opposed to studies on new, expensive treatments that may offer only marginal benefits at great expense. With the trend of healthcare consuming larger amounts of GDP, it’s reassuring to see more work in this area. I hope it continues.

• I was only able to spend a few hours in poster-ville, but I was really happy I did so. Should have probably spent more, and in a more focused, organized way. For example, I was inspired by Chrysohoou’s poster on Mediterranean diet and systolic/diastolic function to look further into omega 3 fatty acids and diastolic CHF. This was just one of the many posters that I quickly bookmarked as I walked around.

Like Revathi, I also had some “maybe next year” moments…

• I agree about the dinners; they present a great opportunity to learn, network, and eat for free (some of them). I seemed to only learn about them too late, but regardless, had a great time with my other plans, so not all was lost.

• The expo hall indeed has all kinds of traps. Is anything in life truly free? Amongst other things, I was guilty of sneaking away a few packs of the walnuts for the road…but then again, they were preaching to the choir. I’ve been quite a walnut fan for some time!

Here are some tips I’d also like to recommend to a first-time AHA-goer…

• Bring business cards, even if you’re just a fellow – you never know who you might meet and want to keep in touch with.

• Use the excellent itinerary planner to look up not only your favorite research, but also to support those from your institution. For me, I just searched “Emory.” Even though you have plenty of time to connect back at home, it’s a little different when you’re all out of town together.

• Don’t sweat it if you miss a session; at the least, the abstracts are online, and if it’s anything like the years past, you will have free online access to recorded MP3’s of the talks you may have missed. You can otherwise get quite frustrated because of two great talks going on simultaneously.

Overall, it was a fun and hectic AHA, but also enlightening. Cheers to doing it all over again next year!

Other posts in this series:

• Evacetrapib – The New Wonder Drug? Drugs that increase HDL have failed to prove utility above statins alone. The pressure is now on evacetrapib to hit the game winning home run.

• Was AIM HIGH a Hit or a Miss? One of the best parts of AHA was the opportunity to hear experts on the panels dissect and interpret the data from a controversial trial.

• AHA Lessons on Emotions and Heart Disease: Depressing Data but Hopeful Trends: The many AHA sessions devoted to depression and heart disease gave renewed focus and drive to this researcher into the psychosocial factors of cardiovascular disease.

• POWER to the People: Two key lessons derived from this weight-loss study.

• An Event, Not a Conference: AHA requires both mental energy — science to be learned, posters to be read, and a program book the size of an encyclopedia to maneuver through — and physical energy — to hike to the various sessions spread all over this large conference center.

• MI FREE: A Free Lunch for Patients and Insurers Alike? Removing copays increased adherence, decreased events, and saved the sponsoring insurance company a tidy sum. So are the issues with insurance-sponsored studies different from those with pharmaceutical-sponsored ones?

• Go Red: Highlights from the Women and Heart Disease Session: Fascinating data on clinical and psychosocial aspects of heart disease in women.

• My First Oral Presentation: Life on the Other Side of the Podium: Not having to drag around a poster container was refreshing, but instead, this oral presenter was dragging around his dread.

• Finding Wisdom in Unfamiliar Ways in a Familiar Place: The Scientific Sessions are not the only way to learn at AHA.

• What’s Up, Interventionally? The latest in coronary intervention, including angiography for erectile dysfunction.

• Global CV Health Concerns: Macro and Micro: Now I know how to approach a potential mentor. But will it really take at least 10 years to train in research?

• Stenosis vs. Stroke: Is Treatment Worth the Risk? As a future interventional cardiologist and the grandson of someone who has suffered a debilitating stroke, a discussion of the PARTNER B trial results and TAVI really hit home for Jahangir.

• “The Center Where It All Happens”: This is the first AHA meeting for this participant who is deep in the trenches of her first year of fellowship.

• What Will Keep Me Coming Back to AHA?  AHA attendance is on the decline, however, Ryan keeps coming back because of special seminars that delve into the heart of what he’s researching.

• Epcot for Foodie Cardiologists: Epcot’s survey of food from around the world sure beats this fellow’s memories of astronaut ice cream at Disney theme parks.

• An Unexpected Preconference Overload: Anyone else surprised by the volume of ad-driven snail mail and email – most of it junk – we all got in the run up to the conference?

• Part of the System: From AHA novice to conference veteran.

• AHA.11: How Does One Choose What to Do? How I’ll make choices among the dizzying array of options for how to spend time at the AHA conference.

• AHA.11: An Orlando Eating Tour: A guide to restaurants while you’re in Orlando.