AHA 2021 Puts Scientific Dialogue, Health Equity Center Stage

Patrice Wendling

November 08, 2021

Virtual platforms democratized scientific meetings during the COVID-19 pandemic but, as any meeting-goer will tell you, it's the questions from the floor and the back-and-forth of an expert panel that often reveal the importance of and/or problems with a presentation. It's the scrutiny that makes the science resonate, especially in this postfactual era.

The all-virtual American Heart Association (AHA) Scientific Sessions 2021 — set for this Saturday through Monday — is looking to recreate the engagement of an in-person meeting by offering more live interactive events. They range from seven late-breaking science (LBS) sessions to Saturday's fireside chat on the Pfizer and Moderna COVID-19 vaccines and Monday's dive into the controversial new AHA/American College of Cardiology Chest Pain guidelines.

To help digest the latest science, attendees will be able to have their questions answered in real-time via Slido, meet with the trialists, and hear live commentary from key opinion leaders after the live events. A networking function will also allow attendees and exhibitors to chat or meet virtually.

"In this day and age, many people pretty quickly can get access to the science but it's what I call the IC sort of phenomenon — the presentation of the information, the context of the information, putting it into how I'm going to use it in my practice, and then the critical appraisal — that's what most people want at the Scientific Sessions," program committee chair Manesh R. Patel, MD, of Duke University School of Medicine, told theheart.org | Medscape Cardiology. "We're all craving for ways in which we can interact with one another to put things in context."

Plans for a hybrid in-person meeting in Boston were scuttled in September because of the Delta variant surge, but the theme of the meeting remained: "One World. Together for Science." Attendees will be able to access more than 500 live and on-demand sessions including 117 oral abstracts, 286 poster sessions, 59 moderated digital posters, and over a dozen sessions focused on strategies to promote health equity.

"Last year there was a Presidential Session and a statement on structural racism, so we wanted to take the next step and say, what are the ways in which people are starting to interact and do things to make a difference," explained Patel. "So, this year, you'll see different versions of that from the Main Event session, which has some case vignettes and a panel discussion, to other health equity sessions that describe not just COVID care, but blood pressure care, maternal–fetal medicine, and congenital kids. Wherever we can, we've tried to infuse it throughout the sessions and will continue to."

Late-Breaking Science

The LBS sessions kick off 9:30 AM ET Saturday with AVATAR, a randomized trial of aortic valve replacement vs watchful waiting in severe aortic stenosis proved asymptomatic through exercise testing.

"The findings of that trial, depending on what they are, could certainly impact clinical practice because it's a very common scenario in which we have elderly patients with aortic valve stenosis that might be severe but they may not be symptomatic," he said.

It's followed by a randomized trial from the Cardiothoracic Surgical Trials Network, examining whether tricuspid repair at the time of mitral valve surgery leads to beneficial outcomes. "I think it's a pretty important study," Patel said "because it'll again affect how we think about our clinical practice."

Rounding out the LBS.01 session is RAPID CABG, comparing early vs delayed coronary bypass graft surgery (CABG) in patients with acute coronary syndromes on ticagrelor, and the pivotal US VEST trial of an external support device already approved in Europe for saphenous vein grafts during CABG.

Saturday's LBS.02 at 3 PM ET is devoted to hypertension and looks how the COVID-19 pandemic affected blood pressure control. There's also a study of remotely delivered hypertension and lipid management in 10,000 patients across the Partners Healthcare System and a cluster randomized trial of a village doctor-led blood pressure intervention in rural China.

Sunday's LBS.03 at 8 AM ET is focused on atrial arrhythmias, starting with the CRAVE trial examining the effect of caffeine consumption on cardiac ectopy burden in 108 patients using an N-of-1 design and two-day blocks on and off caffeine. "There's an ability to identify a dose response that you get arrhythmias when you increase the amount of coffee you drink vs not in an individual, so I think that will be likely discussed a lot and worth paying attention to," Patel said.

The session also includes GIRAF, a comparison of cognitive outcomes with dabigatran (Pradaxa) vs warfarin (Coumadin) in nonvalvular atrial fibrillation (AF); PALACS, a randomized trial examining whether left-sided pericardiotomy prevents AF after cardiac surgery; and AMAZE, which study sponsor AtriCure revealed missed its primary efficacy endpoint of freedom from AF with the LARIAT suture delivery device for left atrial appendage closure plus pulmonary vein isolation.

LBS.04 at 3:30 PM ET Sunday takes on digital health, with results from the nonrandomized Fitbit Heart Study on AF notifications from 450,000 participants wearing a Fitbit smartwatch or wrist-worn tracker. "A lot of technologies claim that they can detect things and we should ask that people go through the rigorous evaluation to see if they in fact do. So, in that respect, I think it's an important step," observed Patel.

Also on tap is I-STOP-AFib, another N-of-1 study using mobile apps and the AliveCor device to identify individual AF triggers; and REVeAL-HF, a 4000-patient study examining whether electronic alerts that provide clinicians with prognostic information on their heart failure (HF) patients will reduce mortality and 30-day HF hospitalizations.

LBS.05 at 5:00 PM ET provides new information from EMPEROR-Preserved in HF with preserved ejection fraction and main results from EMPULSE, also using the sodium glucose cotransporter 2 (SGLT2) inhibitor empagliflozin (Jardiance) in 530 patients hospitalized for acute HF.

The session also features CHIEF-HF, a randomized trial leveraging mobile technologies to test whether 12 weeks of another SGLT2 inhibitor, canagliflozin (Invokana), is superior to placebo for improving HF symptoms; and DREAM-HF, a comparison of transendocardial delivery of allogeneic mesenchymal precursor cells vs a sham comparator in chronic HF as a result of left ventricular systolic dysfunction.

Monday's LBS.06 at 8 AM ET details the safety and cholesterol-lowering efficacy of MK-0616, an investigational oral PCSK9 inhibitor. "It's just a phase 2 [trial], but there's interest in an oral PCSK9 inhibitor, given that the current ones are subcutaneous," Patel said.

Results will also be presented from PREPARE-IT 2, which tested icosapent ethyl vs placebo in outpatients with COVID-19. In the recently reported PREPARE-IT 1, a loading dose of icosapent ethyl failed to reduce the risk of hospitalization with SARS-CoV-2 infection among at-risk individuals.

LBS.07 at 11:00 AM Monday completes the late-breakers with new results from ASCEND, this time examining the effect of aspirin on dementia and cognitive impairment in patients with diabetes.

Next up is a look at the effectiveness of P2Y12 inhibitors in hospitalized patients with COVID-19 in the adaptive ACTIV-4a trial, followed by results of the pivotal phase 3 REVERSE-IT trial of bentracimab, a recombinant human monoclonal antibody antigen fragment designed to reverse the antiplatelet activity of ticagrelor in the event of major bleeding or when urgent surgery is needed.

Closing out the session is AXIOMATIC-TKR, a double-blind comparison of the safety and efficacy of the investigational oral factor XI anticoagulant JNJ-70033093 vs subcutaneous enoxaparin (Lovenox) in elective total knee replacement.

For those searching for more AHA-related science online, the Resuscitation Science Symposium (ReSS) will run from this Friday through Sunday and the Quality of Care and Outcomes Research (QCOR) Scientific Sessions will take the stage next Monday, November 15.

Follow Patrice Wendling on Twitter: @pwendl. For more from theheart.org | Medscape Cardiology, join us on Twitter and Facebook.

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