I’d like to get some final comments. I want to start with professor Chupp. Geoff, where’s the wisdom?

 Well, I’m going to have to dig deep to find wisdom, Rey. But I will say that I think this has been a fantastic discussion. I really enjoyed everyone’s insight and your moderation of the discussion. The 1 thing I will say is that I think we will have an opportunity to see a modification of the disease in our lifetime. I believe that there’s a chance we’re going to be able to change progression of the disease. As we know, some of these may be early-life trials, and even if you catch the patient soon enough after this injury or whatever the sentinel moment is for people to develop asthma—whether it’s early in life or as an adult—if we can reverse that, we have a chance of curing the disease. The drugs we have now and our understanding of endotypes is really making me hopeful that we’re going to achieve this at some point in the next few decades.

That would be fantastic. That’s what we’re in the business of doing. We would love to see a cure, or at least decreased susceptibility for your reversible airflow obstruction. Nic, parting comments?

It’s really hard to add more comments. I’m hoping—I may not be as optimistic—that we will see it in our lifetime. I hope I live long enough to do so. But I think we’ve taken good strides in asthma. We’re now thinking outside the box. We’ve really changed our approach from a “one-size-fits-all” disease. We know how to do phenotyping. We know that asthma affects multiple groups of patients. This generalistic approach is changing slowly, but it is changing. We’re seeing this on the other hand with the patients’ outcomes. We’re seeing better control. I can tell you that in the ICU [intensive care unit] of our hospital, Baylor College of Medicine in Houston, Texas, we’re seeing less admissions in the last 5 to 10 years compared to what we have seen when I first started 25 years ago. There is definitely an outcome improvement in whatever we’re doing in asthma—the guidelines, the treatments, the approach, and the thinking of the disease. I am hoping we’ll see 1-time interventions that can change that natural history that I was talking about earlier.

Well, if you remember—at least I remember—when I started out in the space of asthma, asthma mortality was an epidemic. There was a red flag and there were flashing lights saying we were losing in asthma. There was an increased death rate and that death rate was in a diverse population, unfortunately. But we’re seeing marked improvements. Death rate is almost unheard of from asthma now. What a wonderful outcome. Sid, you have the last words.

 Well, you almost took the last words out of my mouth. Nic was reflecting on the last 5 to 10 years. I was going to reflect on the last 30 years. In 1991, the first guideline came out, the NAEPP [National Asthma Education and Prevention Program] guideline. You’re absolutely right. Prior to that time, despite the fact that we were doing things we thought were safer with asthma: we weren’t giving intravenous aminophylline, we weren’t giving ephedrine across the blood-brain barrier, and we were giving more beta-2 specific agents. In the ICU, we were focusing on hypercapnia and not marrow trauma, and all the wonderful things we were doing. Mortality kept going up, up, and up. I think the final word is that we’ve spoken about maybe 5% to 10% of what we call “the severe asthmatic” today. But what about all those other individuals out there with asthma who we’ve helped so much and have had asthma relief? As you just mentioned, asthma mortality now is quite rare. I think that we need to look at the positive side: those extra 90% or so patients that we didn’t really concentrate on today, have done quite well.

 Well, on behalf of Sid, Geoff, Nic, and I, thank you, you’ve hung in there. Thank you for watching this 

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Videos

The panel provides their final thoughts on the treatment of asthma and what they see and hope for in the future.  

Looking Forward in Asthma Treatment 

We know that giving the right products can sometimes be a challenge. Keri, would you talk about some of the non-pharmacologic approaches and management, trigger avoidance, and how you coach those patients and families lifestyle-wise?

My recommendations are simple. The skin is dry and irritated, so we have to treat both of those components. I recommend that patients moisturize throughout the day, whenever their skin starts to feel dry or itchy—it’s especially helpful after a shower—and that method is called soap and seal. This combats the dry skin and helps to reduce the flares. This is a technique where I have patients shower for 10 minutes, use a gentle cleanser, wash but don’t scrub, their skin then they’ll pat their skin dry and leave it slightly damp and put the topical moisturizer on over that, all over the body. You don’t have to spend a lot of money to get a great product, and these are products that mostly have water and ceramides, no fragrances or dyes. They usually come in a tub, but not always. If spending more money will encourage my patient to use them, then that’s half the battle. 

I have a list of my favorite things that I give to my patients. I write everything down, because this world can be confusing to them, especially when they go to the store and see piles of products. I like common products, things like CeraVe, Eucerin, and Vanicream. Another technique I do often is wet wraps. When patients are itchy, I’ll tell them to put on their moisturizer and do a wet wrap therapy, which is putting a wet towel over that area for 10 minutes. It rehydrates and calms the skin and can boost the effect of topical medications when you use it in combination with that. We also want to decrease the irritants—things like water softeners, air purifiers, and laundry techniques. We need more studies to support those techniques. They’re interesting thoughts, but those aren’t the things that I run to first. I run to my moisturizers. I run to my avoidance of irritants. If patients don’t like topical creams because it’s too cold, I‘ll tell them to float that tub of cream in a bath of warm water. If it burns, I tell them to put it in the fridge to cool it down.

Another problem that we see is that if we don’t give patients the guidance on those over-the-counter products, they’re going to get things that they think are good—maybe homeopathic, or what they call natural products—which sometimes have a lot of seed extracts, oils, fragrances, and other things. We’re all familiar with that. Susan, I know you’re on the West Coast, Douglas is on the East Coast, and Keri and I are in between. What guidance do you give to your patients for accessing the over-the-counter types of things that can be an adjunctive therapy to the prescriptive medicinal products that you’re going to recommend?

 I do a lot of the same things that Keri mentioned. But the other thing I want to interject is that I encourage my atopic patients—or any patient that comes in that has sensitive skin or dry skin—to look for products that have the National Eczema Association seal of acceptance. They’re not endorsing products, but they have a panel of people that have reviewed ingredients for any company that wants to promote their product and have it used for patients with eczema. Aveeno products have it, and Cetaphil, CeraVe, and all those common ones, like Vanicream, also have it. The seal of acceptance from the National Eczema Association means there’s no fragrance, no irritating ingredients, and it should be safe for most sensitive skin and eczema patients. I strongly recommend that. I also like products that come in big jars because people run out of them quickly. I will say, you must find a product that your skin likes and that you can stick with. It has to be a lifetime thing. They’re never going to not be able to get in and out of water and not put something on their skin.

 What about petroleum jelly or coconut oil?

For sure, yes. Coconut oil is a big thing right now. Sometimes I’ll say oils aren’t going to be enough, but if you combine them with something else, sure.

 Susan and Keri, are you guys recommending that they use bleach in their baths, and how much and how often, if you do? I’m curious.

If patients have multiple staph reinfections, the literature doesn’t support that, but it doesn’t say that it’s going to be colonized staph on their skin. But I have used it, yes—maybe, for people who continually get staph infections, regular chlorine bleach in a bath once or twice a week.

 We do a quarter cup of bleach to a full tub of water and have some anecdotal reports of it also helping to reduce itch. 

Let me chime in here, talking about bleach baths, because this is a game changer for me and my patients. After they soak in the water for 15 minutes and apply moisturizers afterward, they then use freshly laundered towels, sheets, and pajamas. That's been a real change for my patients that needed that boost with the help of colonization of staph.

 When we had a day care center for psoriasis and eczema or atopic dermatitis patients at Baylor [University Medical Center] in Dallas, we did the soak and seal techniques for sure. We would have them get their pajamas wet or damp and put that on after they bathed, then put their topical medications and emollients on. Then we would put wet cotton pajamas, particularly on the children, and wrap them in some sort of plastic wrap to try to get that penetration, and we can turn them around within about 3 days of doing that. There are some data in the dermatology nursing literature about how to do it and why it helps. It’s probably 25 years old. The same things that you’re recommending can be helpful and low cost but labor intensive for the family.

 I’ll tell you guys a quick story. I had a patient that came in to see me recently, and he had spent hundreds of dollars on prescription medications and never got better. So, he came to me, I looked at his skin and his skin was incredibly dry. I asked if he had used a moisturizer and he said he had never been recommended that. Now, I simply said, “Let’s go with the techniques that we mentioned. Let’s use something in a tub.” I saw him 6 weeks later, and just by giving him the instruction, he started using a moisturizer, and his skin was 50% better. Patients may forget, when it’s such a critical and important part of therapy.

Handouts and other literature can be very helpful.

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Non-pharmacological strategies that can help patients with atopic dermatitis cope with symptoms and advice to help healthcare professionals counsel patients on proper use of these products and techniques. 

Non-Pharmacological Treatments for Atopic Dermatitis 

 We’ve seen a lot of development and a lot of new drugs coming to market in this space. But I think as we move forward, we have to think of the trifecta for drugs that will be approved. We have very effective therapies that improve the efficacy, exacerbation rates, and patient-reported outcomes. I think as we move forward—and of course, we’re all on corticosteroids—they are a burden. But as we move forward, new drugs have to hit at least 3, if not all 4 of those aspects for them to really surface as a viable benefit to patients with severe asthma. Do you see drugs coming out that are acquiring 2 of those 4 metrics? Or are you in unison with my thought process that you need all 4 metrics to move forward? What’s your sense, Sid?

My sense is the same as yours but I would like to add the fifth. As we’ve already discussed earlier today, many patients, especially patients who were either poorly controlled having exacerbations or perhaps didn’t get their therapy early enough, have an excess of the client of lung function. We call this airway remodeling and understand that it involves a lot of cell types, such as smooth muscle and so forth. Do we have anything that’s effective in blocking this decline and improving? Let’s say we have the decline to improve it. So I would say that I’d like to add a fifth criteria for drugs in the future. I think, so far, we don’t have any of that.

Those are great points. You’re right, that’s going to compel phRMA [Pharmaceutical Research and Manufacturers of America] to do 15- and 20-year-long studies.

I think the bar is very high for clinical trials. As you said, we have good, novel therapies that have been shown, at least in selected population, if we select them right, to improve outcomes. So to come and put in another new agent and to compare it with an existing agent, you have a very high ceiling effect of the ones already available. Clinical trials may be very hard to do because it may be unethical to give a placebo to a patient with severe asthma for a long period of time because we have existing drugs that work. That’s another issue. Another issue I’m going to bring up, and it may be controversial—at least in the era of COPD [chronic obstructive pulmonary disease] now—, is that we may be shifting from phenotyping to tapping into what we call treatable traits. We always like to sort of— and I am from that school—have a cut of this asthma; this is an affiliate of an allergic disease. Maybe we may be too strict in doing this in the COPD arena, for example, we’re shifting to what we call treatable traits: treating traits that the patient presents with. Some of them have cough and shortness of breath. Others have exercised limitation. A third group have more emotional distress, anxiety, and the psychiatric aspect. These are things that have been talked about in the asthma world now. Should we shift to treatable traits and look at interventions based on how the patient presents and what his or her symptoms are? I think it’s all up in the air right now. But I think, from the biologic point of view, it’s very hard to beat drugs that we already have. For the non-T2 [type 2] asthma, we still need a lot. It gets a bit more complicated than it was in that era.

Yeah. I agree with you. We stand on case definitions for everything, but we recognize that case definitions must be dynamic. They must be refined: what we call asthma, and congestive heart failure are really syndromes. Within that syndrome, we must have better approaches that give us insight.

A discussion on the future of emerging therapies and whether they will have an impact on improving lung function in patients with severe asthma.  

Emerging Therapies for Severe Asthma 

At what point do you think patients begin to seek care? We know care can be delivered at the pediatrician, at the allergist, at an urgent care center, in dermatology, and there’s a tremendous number of patients who go to the emergency room when they just can’t take it anymore. What has been your experience, Douglas?

 I see all of the above. The most recent study done 2 years ago shows that only 19% of pediatricians refer patients in the first year, who have severe atopic dermatitis [AD]. They don’t get referred soon enough, in our opinion. But I get a lot of referrals from urgent care, and some are from parents who go online and do their own research and say, “I’m tired of using topical steroid creams or being told that my child has persistent impetigo and is always given antibiotics.” I practice in the area with good pediatrics and people that appreciate our care. I see a lot of 3- to 6-monthers that are getting diagnosed early on. But on the flip side, we see Medicaid patients, and we’re the only Medicaid practice in all of northwest Georgia. We see a lot of patients who come in very late that don’t have that level of care at home. I saw a 15-year-old yesterday with severe atopic dermatitis who had never seen a physician for it before and finally was able to get on Medicaid. I saw her for the first time ever, so she was completely naïve to treatment.

The word needs to get out to our primary care on what atopic dermatitis is and that we have new, exciting treatments that can change lives, beyond topical creams. Get [the patients] into our offices early. We must educate our primary care [physicians] so they know what they’re dealing with. It’s not just impetigo and an allergy to soaps, even though those things can play a role. This is a more complex, multifactorial disease that we get to be the point on. We partner with rheumatologists because it can affect the joints in psoriasis. But here, they’re partnering with allergists and us. I don’t know if you have things to add to that. 

 I agree with Douglas. Patients come in when they’re desperate for answers and for relief. They’re usually in a flare, when their skin is insanely itchy, and they’ve exhausted the options and are wanting more answers. They’re tired and worn out. I’ve seen most of my cases are moderate. They have been suffering for too long. I’d like to think that our AD patients are being seen by dermatology providers, but the majority of them—let’s be real—it’s likely that primary care and pediatricians are diagnosing [more cases] and treating more of our atopic dermatitis patients.

 Susan, you’ve spent decades advocating for eczema and you’ve been president of the National Eczema Association. I’m sure you’ve heard a lot of stories. If you could speak about trying to help patients navigate their way: When they finally are looking for the provider that’s going to give them some expertise in this disease, how do you help them as an organization?

I agree with Douglas and Keri; patients are seen in urgent care clinics and emergency departments because they’re so desperate to get the help they need. Unfortunately, my biggest pet peeve is when patients go to an urgent care clinic and are given a 15-g tube of a topical steroid to treat whole-body eczema. There’s nothing that aggravates me more because those poor patients are left hanging. They become so desperate that they fight their way to get to a specialist. Unfortunately, we are bound by managed care rules and all kinds of preauthorizations and things where patients can’t get in. Patients become desperate enough to push their way in and offer to pay, self-pay, or whatever it might take. These patients are mismanaged or misdiagnosed in those urgent care [clinics] and emergency rooms, and often will be given a course of Prednisone, just to get them in and out quickly, or an injection of Kenalog, which is not good long-term management.

I do feel it is our job as dermatology providers to help educate primary care [physicians] and pediatricians because those patients can be managed in those specialty areas, but they need to have the toolbox to be able to know how to treat them appropriately.

 Yes, and there are school nursing associations that are other opportunities for care.

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Recommendations on educating primary care physicians about atopic dermatitis and the importance of early referral to dermatologists.  

Atopic Dermatitis: Early Referral to Dermatology Clinics 

Ever since the COVID-19 vaccines were approved for the public population, conversations have persisted regarding their efficacy, especially regarding people who had immediate allergic reactions with the first dose.

Despite this, a multicenter, retrospective study confirmed that most patients with immediate and potentially 

 to the COVID-19 vaccines tolerated the 2nd dose.

In an interview with HCPLive, 2 of the leading authors of the study, Kimberly Blumenthal, MD, MSc, Quality and Safety Officer for Allergy, Massachusetts General Hospital, Co-Director, Clinical Epidemiology Program, Division of Rheumatology Allergy and Immunology and Matthew Krantz, MD, Clinical Fellow, Allergy/Immunology, Vanderbilt University Medical Center spoke of the genesis of the study as well as the data gathered on reactions from participants.

Prior to the study, the team targeted healthcare workers who had received some of the first doses of the Pfizer-BioNTech and Moderna vaccines.

“One of the unexpected observations early on after emergency use authorization in December of 2020 where we primarily targeted vaccinating healthcare workers was we did observe a higher rate of immediate potentially allergic reactions and anaphylaxis than with traditional vaccines,” Krantz said.

Krantz, Blumenthal and colleagues set out to find if participants in the study were truly allergic to the COVID-19 vaccines.

“If you're allergic to something, you have an IgE antibody, [so] you have to avoid it,” Blumenthal said. “That’s really important for mRNA vaccines: were people forming true, classic allergy to these vaccines?”

From January 1, 2021-March 31, 2021, the investigators enrolled 189 patients from participating centers, all of whom recorded an immediate reaction to their first Pfizer-BioNTech or Moderna vaccine.

Patient population demographics showed that the mean age of all patients was 43 years, and that most of the total population (86%) were women. Of the vaccine first-dose reactions, 130 (69%) were Moderna and 59 (31%) were Pfizer-BioNTech.

Allergic reactions were defined as symptom onset within 4 hours of dose 1, at least 1 allergic symptom, and referral for an allergy/immunology consultation with in-clinic or tele-heath assessment.

Anaphylaxis was scored using the Brighton and the National Institute of Allergy and Infectious Diseases/Food Allergy and Anaphylaxis Network Criteria.

Blumenthal, Krantz and colleagues defined second dose tolerance as 1 of the following:

1. No immediate symptoms after second dose administration

2. Symptoms that were mild, self-limited and/or resolved with antihistamines

Phone calls regarding clinical details were made for individuals who did not have their second dose observed by allergy/immunology departments.

The investigators noted that the most frequently reported first-dose reactions in patients were flushing or erythema (28%), dizziness or lightheadedness (26%), tingling (24%), throat tightness (22%), and hives (21%), and 32 participants (21%) met the anaphylaxis criteria.

Encouragingly, 159 patients as well as 19 individuals who experienced first-dose anaphylaxis tolerated the second dose of the COVID-19 vaccine. Only 20% of participants reported immediate and potentially allergic symptoms associated with the second dose, which were either self-limited, mild, or resolved with antihistamines alone.

Additionally, most of the participants in the study (89%) received the second dose, and 47 patients (30%) were given an antihistamine premedication before the second dose.

“It's important to note that in terms of classic IgE allergy, we do not expect premedications to abort a reaction,” Krantz said. “But, in the case of a non-IgE mediated reaction, antihistamines can also blunt or make these reactions (milder).”

The effectiveness of the drugs on some patients supported the hypothesis that the participants did not have to avoid the COVID-19 vaccines, as they did not have what’s considered a “classic allergy” response.

Blumenthal also noted the effectiveness of the premedication and clarified that the study was not intended to recommend a specific medication, as each patient was treated with individual methods depending on what their allergist felt was appropriate.

“Everybody had a different [recommendation],” Blumenthal said. “This study wasn't designed to test how best to get from a dose 1 immediate reaction to safe dose 2 completion. But it gives us a hint that it's largely possible.”

Blumenthal noted that further research might explore the possibilities of a specific premedication or treatment methods for patients who had a reaction to the COVID-19 vaccines, especially considering the possibilities of COVID-19 vaccine boosters in the coming fall season.

“What we really need is a prospective study when it comes to the booster doses,” Blumenthal said. “So, prospective, meaning that we enroll people who had reactions before (and) who didn't have reactions, and we have them diary their medication so that we can piece out what premedication regimen might work.”

Blumenthal and Krantz both noted the potential for improvement in identifying allergic reactions in patients regarding the COVID-19 vaccines and general vaccines. 

“Safety Evaluation of the Second Dose of Messenger RNA COVID-19 Vaccines in Patients With Immediate Reactions to the First Dose,”

 was published online in JAMA Internal Medicine.

Research showed that the second dose of the COVID-19 vaccine was well tolerated by patients who experienced allergic reactions from their first dose.

Study Shows Improved Tolerance with Second COVID-19 Vaccine

EP. 1: Schuyler Jones, MD: CAD/PAD: Identifying Risk & Summary of Recent Clinical Trials

EP. 2: Tracy Wang, MD: Extended Thromboprophylaxis: What Do We Know About Scoring, Risk and Contemporary Trials?

EP. 3: Christopher Granger, MD: Atrial Fibrillation: What Have We Learned About NOACs in Special Populations?

EP. 4: Manesh Patel, MD: Putting This All Together: Treatment Pyramid

On June 23, Manesh Patel, MD, Chief of Cardiology and Clinical Pharmacology, Duke University School of Medicine, led the HCPLive® State of the Science Event "Institutional Perspectives in Cardiology: Cardiovascular Risk Management."

Patel was joined by his colleagues at the Duke University School of Medicine, including Schuyler Jones, MD, Tracy Wang, MD, and Christopher Granger, MD, to discuss recent trials, identify risk, and treatment options in the cardiovascular risk management space.  

The conversation surrounded the following topics:

CAD/PAD: Identifying Risk & Summary of Recent Clinical Trials

Extended Thromboprophylaxis: What Do We Know About Scoring, Risk and Contemporary Trials?

Atrial Fibrillation: What Have We Learned About NOACs in Special Populations?

Putting This All Together: Treatment Pyramid

In this series of HCPLive® State of the Science, 4 experts discuss knowledge and treatment in the cardiovascular risk management space. 

Institutional Perspectives: Cardiovascular Risk Management, Chaired By Manesh Patel, MD 

Even with the slightest glance of the presentations and discussions being held at the American Society For Preventive Cardiology (ASPC) 2021 Virtual Summit, it is abundantly clear that much is happening in the cardiovascular disease prevention space.

One of the most progressive of presentations, “Technologies and Wearables”, comes from Seth Martin, MD, who leads The Mobile Technologies to Achieve Equity in Cardiovascular Health at Johns Hopkins Medicine.

Martin spoke of the ongoing COVID-19 pandemic and its impact on cardiology research, as well as the future of cardiovascular technologies, in an interview with HCPLive.

“In a way it I mean, (COVID-19) shined a light that there is disparate access,” Martin said. “But, in a way, it's accelerating the future of access, because we got a taste of what it's like to really need technology to deliver care. I think it's overall accelerated our pathway to that, to that future of care where we have much greater access.”

Acceleration, as Martin alluded to in earlier coverage, is as prominent a concern as accessibility. He has urged fellow researchers in the cardiology field to press on with new strategies and technologies that can be easily accessible to their patients.

A project Martin has worked closely on in the past 5 years at Johns Hopkins Medicine is the Corrie Health app. Working alongside Dr. Francoise Marvel and lead engineer Matthias Lee, as well as members from the Apple Health Team, he has had a hand in creating smartphone technology with a strong focus on preventive cardiology.

Martin and colleagues have recently published encouraging results on the circulation quality and outcomes of 200 patients who experienced a heart attack and participated in a health intervention via the Corrie Health app.

A point of pride for Martin was that much of what was built into the application was driven by patient input, which was coupled with the latest cardiology guidelines. 

Martin spoke of the important of quality care for patients with cardiovascular diseases, and the importance of improving patient confidence as well.

“That confidence will then play into their care,” Martin said. “Ultimately, having that (confidence) that you have something a program guiding you and you know what you need to do, that's going to make or break patient outcomes. That's going to make or break whether they take their antiplatelet therapy or their cholesterol lowering therapy.”

Dr. Martin explains the connection between inclusive cardiology technology and patient care and confidence.

Seth Martin, MD: Patient Confidence and Emerging Smartphone Technology

, Ty Gluckman, MD, discussed his own perspective on both the potential and challenges of the rollout of new digital tools for 

, noting his own involvement in an ASCVD risk estimator app. 

Gluckman moderated "Practical Strategies in Practice" as part of the American Society for Preventive Cardiology’s 2021 Virtual Summit on CVD Prevention.

"We're challenged by parts of the country demographics of patients based often on where they live, that may not have access to broadband, or the ability to be able to even collect and transmit the information," Gluckman said. 

However, he noted the usefulness of devices, such as smartphones, in collecting data and sharing information to be able to keep patients engaged in their care.

"I think just as important as that technology is advancing and us understanding how to utilize it," Gluckman said. "There has to be a regulation or regulatory component of this to make sure that the devices that are being used are accurate."

Gluckman also spoke on the role of telehealth, regarding both its challenges and positives as a clinician treating patients during the COVID-19 pandemic, noting that clinicians are nascent into the process. 

He observed part of the challenge was the need to pivot for experts who had never done a telehealth visit before, but he found that there was also a level of insight into patients that had never existed before. 

"Figuring out how we on the healthcare delivery side connect between primary care and specialists to be able to provide information, without the necessity to have patients seen by a specialist provides a lot of value," Gluckman said. "Remote patient monitoring and telehealth visits, all of these things are going to increasingly gain greater importance."

In part 2 of an interview with HCPLive, Ty Gluckman, MD discusses both the advantages and disadvantages of technology replacing traditional care.  

Ty Gluckman, MD: Disparities in Care Despite Increased Technology Use 

As part of the 2021 American Society for Preventive Cardiology Virtual Summit on CVD Prevention, Marc Bonaca, MD, MPH, CPC Clinical Research, presented a talk entitled "Peripheral Artery Disease: Evaluation, Treatment, and Management." 

, Bonaca highlighted two important research trends in 

In the first, he noted that while the focus of medical therapy has traditionally been preventing major adverse cardiovascular events, there is minimal research on how to prevent major adverse limb events, including amputation and acute limb ischemia. 

"I think one of the trends right now that we're seeing is that there's a recognition that the dominant morbidity in peripheral artery disease is limb morbidity, functional issues, amputation, acute limb ischemia, critical limb ischemia," Bonaca said. "And we need better therapies there, and that we shouldn't do trials of therapies without understanding what the effects are in the limb."

Further, the second trend he observed was the recognition of what he noted was the "heterogeneity of risk" within patients with PAD and that all patients are not the same. 

"There's some patient populations like those with polyvascular disease that are at a very high risk of heart attack and stroke and those who've had prior revascularization, who are in a very high risk of limb events and better understanding who the highest risk populations are as important as we think about personalizing therapy," Bonaca said. 

Bonaca also mentioned emerging therapies including lipid modifying agents, such as Lp(a), PCSK9i combined with statins, and anti-thrombotic drugs, including rivaroxaban in combination with aspirin. 

In addition, Bonaca spoke on the barriers in treating patients with PAD, in terms of research and under-recognition of the risk profiles of the patient population. 

"We have many many randomized trials looking at the best medical therapies for patients with coronary disease, whether it be the acute coronary syndrome or stable secondary prevention, but there are a tiny number of PAD trials, because there hasn't been the same level of interest in investment and I think that is hopefully changing," Bonaca said. 

Marc Bonaca, MD discusses the personalization of treatment in PAD patients, lack of proper research into the condition, and optimizing delivery of care. 

Marc Bonaca, MD: Personalizing Therapy in Peripheral Artery Disease Patients 

research, some of the most promising forms of cardiovascular care involve new technologies and wearables that are being introduced to patients and doctors around the world.

Dr. Seth Martin, MD, leader of The Mobile Technologies to Achieve Equity in Cardiovascular Health at Johns Hopkins Medicine, spoke with HCPLive about some of the advancements being made in the world of cardiovascular technology, a subject he will be speaking intensively on at this year’s American Society For Preventive Cardiology (ASPC) Virtual Summit.

In an interview with HCPLive, Martin spoke of the importance of ambition in the cardiovascular field, and how health care professionals should be ambitious and efficient in caring for patients with cardiovascular diseases.

“I think we have to think big,” Martin said. “We need to be thinking bigger about accelerating q version of the healthcare system in the future where patients truly are at the center and empowered and can achieve better outcomes. I think our pace of adoption of new evidence and guidelines is just too slow, and we really need to leverage technology to do that.”

Martin spoke of human centered design methodology, a practice used often in the technology industry, to create technology that is centered around the health and concerns of the patients, both mentally and physically.

For Martin, the process of creating effective technology for patients with cardiovascular diseases is dependent on patient satisfaction as well as the acknowledgment a myriad of health care professionals, all of whom make up an important collection of stakeholders.

“We need to make sure we're engaging the input of our nursing colleagues of our pharmacy, colleagues of our social work colleagues from a cardiac rehab standpoint, our exercise physiology colleagues, the list goes on,” Martin said. “We need to really be bringing in this diverse stakeholder input earlier in the process, and I think that will increase the probability of success.”

According to Martin, several advancements have been made from a diagnostic perspective.

His colleagues who work within the neurology space have developed diagnostic tools that can diagnose a stroke in patients based on their eye movements, and he feels as though there’s been momentum in arrythmia detection technology in the world of cardiology.

Martin also referenced studies that are being conducted based on patients’ blood pressure, resulting in Bluetooth connected blood pressure technology that is currently in development.

However, the development of these new technologies was not Martin’s sole concern. Accessibility of these new technologies and coaching for patients who are not accustomed to them was also vitally important.

Martin believed low-cost internet and technology coaching services could provide a path forward in terms of progressive cardiology research.

“In the future, I envision a robust kind of network (and) that we find ways to get patients access to technologies, if they can't otherwise afford it, just like we have programs to get patients access to medications, if they can't otherwise afford it,” Martin said.

Advancements in technology and the availability of resources for patients and doctors alike could mean a bright future for cardiology research.