Reflecting on HRS 2016: Lessons Learned

The last several days in San Francisco have been quite busy. Nearly 15,000 international and national heart rhythm specialists had gathered to share important innovations and treatments for patients suffering from heart disease.

While many interesting abstracts and clinical trials had been presented, I leave the meetings with a few important observations:

· The HRS members and healthcare professionals that gathered this week are highly committed to improving outcomes for their patients.

· Collaboration is king. This year, more than ever, attendees have been engaged (both in person and in the digital space) and many are eager to forge new professional relationships that may significantly advance the science of heart rhythm disorders.

What’s New and Impactful?

As far as the research and findings from the meetings, I think it is best to divide these observations into categories based on the disease process:

1. Atrial Fibrillation (AF) - My impression was that the largest group of meaningful abstracts and presentations were related to AF. Monitoring and surveillance for AF is BIG. Anticoagulation strategies — and safety concerns – also had garnered a lot of attention.

Jared Bunch, MD, of Intermountain Health Care presented a study that suggests long term anticoagulation with Coumadin for AF (as compared to mechanical valves or prior thromboembolism) were significantly more likely to develop dementia. In fact, those with AF and poor anticoagulation control were at highest risk — bringing into question the ways in which we balance risk and benefit in AF management and prevention of stroke.

In another study, researchers from Massachusetts General Hospital analyzed the impact of AF ablation on healthcare costs. The study evaluated insurance claims of nearly 10,000 patients undergoing AF ablation and found that more than 50% of the patients did not require repeat procedures or have complications.

This resulted in a 40% decrease in cost.

However, those that did have repeat ablations had significantly higher costs to the healthcare system in the following year. It is clear that successful AF ablations can produce a significant cost savings. The investigators argue appropriately that we must do MORE to improve AF peri-ablation procedural care in order to realize even more cost savings.

2. Device Management — More data supporting the choice many physicians make to defer defibrillation threshold testing (DFT) was presented.

Avoiding not DFT testing in low risk primary prevention patients was again shown to be an acceptable clinical choice. More work is necessary to identify patients who are more likely to benefit from DFT testing. Researchers at Mt. Sinai Hospital, New York provided evidence supporting the safety of discharging new implantable devices.

In the study, low risk primary prevention patients were randomized to either a traditional overnight stay or a same day discharge and this approach was found to be non-inferior when a 30-day outcome of procedural complications was utilized. It is likely that professional societies such as HRS will need to come to a consensus and offer published same day discharge guidelines in the near future.

What is the Future of the Care of Heart Rhythm Disorders?

I left HRS thinking about what may lie ahead.

Based on the activity and the research presented, I think that we will see more attention turned to improving ablation techniques for AF — making the procedures safer, faster, and more effective.

In addition, I think more global, cost effective approaches to patient care will be emphasized in the future. Risk factor modification and lifestyle and behavioral changes will become more involved in the care of the arrhythmia patient.

Researchers such as Prash Sanders, PhD, Royal Adelaide Hospital in Australia, continue to produce powerful data that reminds us to “keep it simple” when we can.