AHA 2013: What's Going to Be Hot? (Long-Awaited Guidelines!)

Shelley Wood

November 14, 2013

DALLAS, TX — The hottest thing at the American Heart Association (AHA) 2013 Scientific Sessions may be something most cardiologists had come to think of as stone-cold and pulseless: namely, the long-awaited CVD prevention guidelines developed in conjunction with the National Heart, Lung, and Blood Institute (NHLBI).

According to a video posted on the Scientific Sessions website, a special session has been added to the final day of the meeting, Wednesday, November 20, at 9 am, that "will address the major recommendations of these joint clinical-practice guidelines for prevention."

This session, the website notes, is "pending publication" of the guidelines, and of note, just four of the five long-awaited NHLBI-sponsored documents are listed to be covered in this special session:

  • Lifestyle management to reduce CV risk.

  • Treatment of blood cholesterol in adults.

  • Assessment of cardiovascular risk.

  • Management of overweight and obesity in adults.

Slated to moderate the special session are AHA president Dr Mariell Jessup and ACC president Dr John G Harold, with panelists representing the NHLBI and writing-group leaders.

Conspicuously absent is any mention of JNC 8, the long-awaited hypertension guidelines, although the Scientific Sessions website does list a presentation as part of this special session tackling the management of high blood pressure entitled "A Statement from the American Heart Association, the American College of Cardiology, and the Centers for Disease Control and Prevention."

The National Institutes of Health (NIH) website, however, which has long been tracking progress of these systematic-evidence reviews, lists all of the documents as being at the same stage of development—namely, "Partnerships Formed." Indeed, heartwire reported on this surprising partnership step back in June 2013.

The last NIH-sponsored adult cholesterol guidelines (ATP 3) came out in 2001, with an update in 2004. The last, and only, overweight and obesity guidelines in obesity date back to 1998, while the seventh version of Managing Blood Pressure in Adults: Report from the Joint National Committee (JNC 7) was released in 2003. Both the prevention and CV risk assessment guideline documents are new.

Late-Breaking Clinical Trials

Of course, the AHA 2013 meeting also has a hefty lineup of late-breaking clinical trials, five sessions in total, featuring 20 trials. Monday will be an action-packed day for attendees, since three of these five LBCT sessions will be held that day.

Speaking with heartwire , program chair Dr Robert Harrington (Stanford University, CA) said that this year's meeting had received a record number of late-breaking clinical-trial submissions, ultimately choosing the 20 featured in these sessions, plus an additional 19 to be showcased in the separate Clinical Science and Special Report sessions.

On Sunday, in LBCT 1, Harrington singled out two trials that, while important for cardiology, are also eagerly awaited results within the overlapping Resuscitation Science 2013 Symposium. These are both testing the use of hypothermia for improving survival and neurological outcomes in cardiac-arrest patients.

Monday's smorgasbord includes sessions on prevention; medical and surgical strategies in heart failure; and coronary and peripheral vascular disease.

In the prevention session, LBCT 2, Harrington pointed to a large, randomized Chinese study addressing sodium reduction to reduce blood pressure. Other trials in this session tackle weight loss and lifestyle education of preschoolers. Monday's second session, LBCT 3, includes a much-anticipated NHLBI-funded study comparing mitral-valve repair with replacement in patients with severe ischemic mitral regurgitation.

"This is one of those clinical conundrums that we don't know the answer to," Harrington observed.

Also in this second Monday session is another NHLBI-sponsored trial, TOPCAT , looking at spironolactone vs placebo in patients with heart failure and preserved systolic function.

A highlight of the third Monday session, LBCT 4, is CORAL , once again sponsored by the NHLBI, looking at the use of renal-artery stenting vs medical therapy as a treatment for hypertension.

The fifth and final LBCT session, on Tuesday, is devoted to atrial fibrillation. Here Harrington highlighted two studies, EU-PACT and COAG , testing the use of genotyping to guide warfarin usage in AF patients, and a third, ENGAGE-AF TIMI-48 . This 21 000-patient trial is testing two doses of the oral direct factor Xa inhibitor edoxaban (Lixiana, Daiichi-Sankyo), trying to find the optimal dose for preventing stroke and systemic embolic events in AF patients.

In all, AHA 2013 will feature over 440 original research sessions with a ratio of poster:oral sessions of almost 3:1.

Walking the Talk

The theme of this year's "global congress" track is physical activity and cardiovascular health. To that end, everything within this particular track will explore different aspects of this issue, including funding for physical-activity research, basic science in exercise research, obesity and diabetes trends, physician roles in promoting physical activity, the athlete's heart, exercise for both prevention and CVD rehab, and more.

To drive the point home, meeting organizers have also invested heavily in making sure physicians walk the talk.

"Throughout the convention center there will be a lot of reminders about physical activity, including signage telling physicians how far they've walked," Harrington told heartwire . Meeting attendees can also join in the Wireless Walking Challenge, either alone or as part of teams, using devices and apps to count their steps during the meeting, with results being publicly displayed at the convention center and in the app itself.

Taking it one step further, meeting organizers have declared day 3 of the meeting a day for speed and comfort: all attendees are encouraged to wear their "workout shoes" that day, said Harrington, "and show that physical activity is part of the science, but also a part of the meeting."

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