A Five-year Retrospective on Futures in Cardiology - Part One

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In the 2006 summer edition of The American Heart Hospital Journal (AHHJ), titled ‘Futures in Cardiology’, 19 of America's leading cardiologists and cardiovascular surgeons predicted what changes might occur in both the practice and science of their specialty five years hence. Five years have now passed. This edition of The AHHJ, the first of two 2011 editions, includes six retrospective views on what changes those five years have wrought.

Within these pages, Drs Cohn and Hubbard deal extensively with the improvements in valve and coronary artery disease. He alludes to the continuing tension in indications for implantation of interventional devices versus definitive cardiac surgery. He provides a comprehensive review of the evolution of cardiac surgery over the last five years. Dr Fogarty considers some of the bureaucratic impediments to patient access to new and sophisticated devices and medications in the US. Drs Schatz and Israel note progress beyond the days when angioplasty and bypass surgery were the only options and in their words: “medical therapy was pedestrian for acute, chronic angina, myocardial infarction, and heart failure”. Their optimism was tempered somewhat by financial and regulatory issues. Drs Blanco and Wann, in an incisive analysis of the status of imaging, suggest that both doctors and hospitals will face accountability in terms of regulation, certification, accreditation, and mandatory contribution to public databases, which will measure cost, quality, and value. On a somewhat somber, but I believe to be a realistic note, they say that “physician autonomy will be challenged and their professional judgment closely scrutinized”.

Dr Taylor has written on cell therapy for cardiovascular disease in the 21st century both retrospectively on the fate of predictions made five years ago, but also about what may be anticipated in the future. She noted that in 2006, there were huge numbers of unmet clinical needs and unanswered questions regarding cell therapy. Among these were: what cell for what patient? What route for administration? How to determine effectiveness? Are cells unsafe? and mechanisms of cell action, etc. In 2006, Dr Taylor predicted that we would see surgical and percutanous Phase I studies with bone marrow, blood and adipose derived-cells completed. She goes on with an enlightening review of the current status and prospects for cellular therapy in cardiovascular disease in the 21st century.

Drs Stewart and Roberts, in their contribution “A Genomic Revolution for Cardiovascular Disease—A Progress Report at Five Years”, provide fascinating insight into recent developments and note that the most important finding to emerge from the genome-wide associations studies for CAD is the observation that of 31 risk variants, only six mediate their risk through known risk factors. Therefore, there remain mechanisms contributing to atherosclerosis that remain unknown.
Elsewhere, in review, Drs Younus and Rodgers examine the epidemic of obesity in the US and the significance of an obese patient’s level of leptin and adiponectin as indicators of increased risk for cardiometabolic disease.

The December 2011 issue of The AHHJ will contain many more five-year retrospectives of the observations by the authors of ‘Futures in Cardiology’, 2006 edition of The AHHJ.