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Perspective on Late-Breaking Research, Patient Voice, with Martha Gulati, MD

A deep dive into exciting late-breaking trial data at AHA 2022, differences in chest pain guidelines, and bringing patient voice into clinical research.

The American Heart Association (AHA) Scientific Sessions 2022 in Chicago served as not only the site of significant late-breaking data from important trials, but a meeting place to debate the current state of cardiology and map out where the field needs to head next.

On the floor at AHA 2022, Martha Gulati, MD, Director of Cardiovascular Disease Prevention, Cedars-Sinai Medical Center, joined HCPLive to share perspective on trial data, the differences in global guidelines on chest pain, and how to better center the patient voice in the care process.

Gulati highlighted a few of the trial findings that either surprised or excited her, the first of which being the TRANSFORM-HF on the comparative effectiveness of torsemide versus furosemide in heart failure. The trial data reported no difference in the treatments, which Gulati called "reassuring" because of their common prescription in clinical practice. However, she noted the shocking mortality rate (30%) over the time period after discharge.

"It just tells us that again, heart failure is a serious disease that needs to be treated aggressively," she said. "Getting them on the guideline-directed therapies, particularly therapies that have more potential to save lives is most important for our heart failure patients."

Gulati additionally discussed the DCP trial comparing chlorthalidone to hydrochlorothiazide which additionally had negative findings. She expressed surprise at the results, expecting blood pressure control and better outcomes for patients treated with chlorthalidone.

"I've always considered them different drugs in terms of their intensity and how I use them in patients in terms of getting better blood pressure control," Gulati said. "Chlorthalidone has a longer half life than hydrochlorothiazide, so I expected better results and I was surprised that that's not what we saw. This is why we need trials."

The final late-breaking trial Gulati highlighted was the CTS-AMI trial on the use of Chinese herbal medicine, tongxinluo, in patients with acute myocardial infarction. She noted the growing interest in nontraditional, alternative medicines, perhaps due to skepticism or lack of accessibility to traditional pharmacological agents.

Gulati emphasized that the trial was well-done and provided good information about the commonly used drug in China. Individuals who took tongxinluo saw better major adverse cardiovascular outcomes, driven by a reduction in all-cause mortality, but not necessarily cardiac events.

While the mechanisms are unknown, Gulati noted the data may lead to interest in figuring out how the drug works with the additional reassurance that it is not harmful for patients.

"It's great because it provides us with data so we can talk with our patients based on the choices that they want to make," Gulati said. "And when they tell you they don't want to take traditional medications, can we have something else to offer them?"

Gulati additionally provided insight into the 2021 US ACC/AHA chest pain guidelines on the use of multimodality imaging and the similarities and differences with the 2019 ESC guidelines on chronic angina. She presented an educational session at the conference on the same topic.

In the final part of the interview, Gulati spoke to the patient's voice being key in everything in medicine, noting the need for patient-focused research. She discussed a recent challenge in getting patient facing research published in a medical journal, with the research ultimately being published after multiple rejections.

"We need to, first of all, bring the patient's voice to these meetings, bring their voice in everything that we do, including our research, asking them with their disease states, what's the most important thing to them, and that's where we should be doing focusing some of our research," Gulati said. "Certainly we know what questions we want to ask, but there's probably questions that our patients would bring to our attention that perhaps we haven't thought about."