From the Apple Watch to Heart Failure at Annual Cardiologists' Meeting

Mary Caffrey

In recent years, the big news on the first day of the American College of Cardiology (ACC) Scientific Session and Exposition has involved a therapy—usually an expensive cholesterol drug with a name almost no one could pronounce: proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors.
But when ACC.19 kicks off tomorrow morning at the Ernest N. Morial Convention Center in New Orleans, Louisiana, the study everyone is waiting for involves one of the world’s most universal brands: Apple. Dubbed the Apple Heart study, it asks whether the Apple Watch and a related app can accurately detect atrial fibrillation and, if it can, what patients do with that information. Technology, not a drug, will occupy one of the juicier time slots in medical science.

Richard Kovacs, MD, FACC, vice president of ACC, said it’s not just the technology but also the method of the trial—more than 400,000 patients were tracked virtually—that captured the interest of the scientists and clinicians attending the meeting. “The virtual visit, the enrollment—being able to push this out so rapidly to so many people—that’s exciting regardless of the result,” he said.

Virtual trials have been touted as a way to save money and include patients—including key subgroups—who might otherwise be hard to enroll in trials. When asked if ACC would see more virtual trials, Kovas said, “I am sure we will.”

Other expected noteworthy news includes:

Practice guidelines. To be sure, most of the conference covers more traditional topics: updates on the effectiveness of new therapies and medical devices and updates on clinical guidelines. In the past year, there’s been a significant level of collaboration between ACC and the American Diabetes Association (ADA) to cross endorse guidelines involving novel therapies for patients with diabetes and atherosclerotic disease, following the release of a series of cardiovascular outcomes trials. A high point will come Sunday when the session, “Changing the Paradigm in Cardiovascular Risk Reduction in Diabetes,” will feature a presentation by Mikhail Kosiborod, MD, on the ACC Expert Consensus Decision Pathway, which was published last fall. ACC will also be releasing guidelines for primary prevention on Sunday, which will also consolidate several existing guidelines on cholesterol and hypertension.

SGLT2s and heart failure. Consistent data showing that the class of type 2 diabetes (T2D) therapies, sodium glucose co-transporter 2 (SGLT2) inhibitor, may prevent heart failure will be explored in the Saturday session, “The Intersection of Heart Failure and Diabetes.” There is also anticipation for additional results from the DECLARE-TIMI trial for dapagliflozin, which will be presented Monday morning. The first results for DECLARE, presented at the American Heart Association in November, pointed the SGLT2 inhibitor having the ability to prevent heart failure.

Clinical trials. Beyond DECLARE-TIMI, the meeting is loaded front to back with important clinical trial results and other research. All 3 days have potential newsmakers: After the Apple Heart Study on Saturday (not a randomized clinical trial) and DECLARE-TIMI on Monday, there’s Sunday’s AUGUSTUS results on apixaban in patients with atrial fibrillation and acute coronary syndrome. Monday brings INFINITY, which examines how blood pressure affects functional decline in older adults; CREOLE compares combination therapies to treat blood pressure in African Americans; and there will be more results from the REDUCE-IT trial studying Amarin’s prescription fish oil, icosapent ethyl.
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