As we prepare for the 2018 Lown Conference on April 9-10, we want to help you get ready as well. So we’re putting out interviews with some of our keynote speakers and panelists so you learn more about what to expect at the conference, and start getting excited!
Last year, the ORBITA trial raised serious doubts about the effectiveness of stents in stable patients, shaking the world of cardiology. Since then, there has been a lot of discussion about the study, but there hasn’t been an opportunity for us to deeply engage with the broader implications of this landmark trial in person — until now.
The Lown Institute is featuring a panel on ORBITA at our Annual Conference, April 9-10 in Washington, DC. The panel will be discussing what ORBITA means for clinical cardiology practice, medical device approval, and hospitals.
Panelists include Dr. Rita F. Redberg, Professor of Medicine at the University of California, San Francisco, and Chief Editor of JAMA Internal Medicine; Dr. David L. Brown, cardiologist and Professor of Medicine at Washington University School of Medicine; Susan Heilman, Senior Vice President at Corazon service line experts; and Dr. Vikas Saini, president of the Lown Institute.
We talked with the panelists for a sneak preview of what they plan to discuss at the conference. A key point all the panelists mentioned was that ORBITA has implications beyond just how cardiologists use (or don’t use stents). Redberg brought up the necessity of more trials like ORBITA to assess common practice that don’t yet have a strong evidence base, like shoulder and knee arthroscopy.
For Brown, ORBITA should be paradigm-shifting for cardiologists, but that the change we need is as simple as putting patients in the drivers’ seat. “The decision about whether to put in a stent for stable angina is not a life-or-death issue, it’s a quality of life issue, so patients should be making the decision after they are informed of all the benefits and risks,” said Brown.
Heilman touched on the economic implications of ORBITA for hospitals – if hospitals can no longer justify giving patients stents for stable angina, will they perform more other procedures to make up the difference? “Nature abhors a vacuum,” said Heilman.
In many ways, hospitals have already been shifting gears to adjust to lessening margins from PCI over the years. “We used to say ‘cardiovascular turns on the lights in the hospital’ but margins are much much smaller now,” said Heilman, “Programs have already begun to migrate from pure coronary focus [stents in arteries near the heart] to peripheral vascular procedures [procedures in leg arteries & carotid arteries].” However, as Redberg pointed out, the evidence supporting effectiveness of peripheral vascular procedures is also very weak.