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Posts Tagged ‘jama cardiology’

Today , September 29th is the World heart federation, backed official World Heart day.

Reclaiming the Soul of World Heart Day

Have you ever wondered why cardiologists, physicians, and big hospitals celebrate World Heart Day in a most sacred way as if it is festival of Diwali, Dussehra, or Onam? The scale of these celebrations and the accompanying mainstream media blitz have become truly overwhelming.

Originally, this day was meant to create genuine awareness about the rising global epidemic of heart disease. It was designed to propagate healthy lifestyle choices among the public and protect vulnerable hearts.

But it does not stop there. There is a concealed interest public rarely sees. Although we often emphasize that prevention is preferable to a cure , the explosive growth of high-tech diagnostics and aggressive therapeutic modalities has ironically become the enemy of true preventive care. World Heart Day has increasingly been hijacked as a marketing to drive hospital footfalls rather than to create true wellness.

The much glamourised , gadget based diagnostics , advanced screening packages, & biochemistry based “preventive heart checkups” have not yielded the desired results. In fact, by creating unnecessary anxiety and over diagnosing minor anomalies, they can have the exact opposite effect. As custodians of health, we must shift the focus away from lucrative diagnostic packages and return to the simple, low-cost fundamentals of diet, exercise and lifestyle modification.

I think, on this world heart day , We should make the public realise, it is absolutely possible they can prevent a heart attack in their life time, without fearing about their calcium scores, exotic lipid sub fractions or CT angiograms. Let us reclaim World Heart Day as a forum for genuine public health, not a corporate festival.

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Caution: Harsh language & Unscientific truths

It is a pattern out there, rolled out periodically in cardiac- pharma literature . It happened for Digoxin. They have been trying to do this to beta blockers for quite some time. They successfully ditched beta blockers in systemic hypertension with synthesized evidence. Mind you, BBs are the only drug that received a Nobel Prize for its invention, and its role in post-MI protection is well established.

The script is well written. Trying to ring a death knell for cheap and established medical therapeutic norms, citing lack of evidence. It is done based on some non-sensical study designs called Non-Inferiority Trials. (Tannock I, Buyse M, De Backer M et al.The tyranny of non-inferiority trials The Lancet Oncology, 25, e520-e525 Now, powerful cartels want to get rid of BBs in  post-MI ecosystem. REBOOT, REDUCE-AMI, ABYSS all were done with fixed ideas. Of course, ABYSS didn’t follow their agenda. Now, a  the latest trial has come out with a magical name SMART – DECISION.

Read this paper https://www.nejm.org/doi/full/10.1056/NEJMoa2601005

One famous statistician said, non-inferiority study concept is foundationally flawed. Hence, it is generally not worth reviewing them, as most conclusions are deemed to be wrong and not scientifically consumable. Still, looking beyond the trial design, three important flaws are obvious in SMART-DECISION’ trial , which argues for beta-blocker discontinuation after MI.

The study population is highly selected (median 4.7 years 98% revascularized; median LVEF 59%). The study advocated discontinuation among long-term accrued beneficiaries of BBs rather than typical 6–36-month post-ACS patients. Physician-driven HF hospitalization amplifies open-label bias. A wide non-inferiority margin (HR upper CI <1.4) plus low events (132 total) leave it underpowered, unable to exclude modest 15–25% harm (7.2% vs 9.0%).

Final message

In science, we need to be right first … being polite is optional.

When big science tries to corrupt our minds, what should we do? Let us continue with our conscience and follow the instinct and work for the welfare of our patients. We know the healing power of BBs. Let us be cautious and alert. Never allow wayward science to intrude upon our minds to take STUPID DECISIONS and defame the OMT in CAD.

Postamble

A newchallenge to take on

Fact : There is no published RCT that proves diuretics improve mortality and survival in heart failure.

Action requested : Let all evidence-based cardiologists withhold injections of Furosemide or Torsemide when they encounter their next patient with acute heart failure and pulmonary edema.

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