A brief report was recently published in JAMA Cardiology about the estimated benefits of a drug called Finerenone (nonsteroidal mineralocorticoid receptor antagonist) in heart failure (HF). I read the cardiology literature because as a field, they understand a lot more than cardiology.
Cardiologists emphasize the BAD outcomes of cardiac conditions (e.g., reduced life expectancy and death): “Patients with heart failure with mildly reduced ejection fraction or HF with preserved ejection fraction have median life expectancies that are up to 15 years shorter than persons of comparable age in community settings.” They emphasize the lack of innovation in treatment options: “Despite this survival gap, few truly disease-modifying therapies have been available in their care. Indeed, until recently, the management of [heart failure] was largely empirical and centered around short-term control of symptoms…” They design trials with very sick people whose outcomes are likely to be bad (e.g. death) and then look at avoiding [bad] endpoints over realistic timeframes (e.g., event free survival) which can be extrapolated to estimate long term benefits. They don’t pretend that everyone “heals,” and they often evaluate cost-effectiveness of their treatments (although they didn’t in this particular article). They talk openly about where gaps exist in treatments for conditions. That’s at least part of the reason that new treatments keep being developed for cardiac problems. Yes, it’s true that they have the HUGE advantage of a myriad of drugs and thus pharmaceutical support for research. They have money for research, and that’s a big advantage, it’s true.
However, no cardiologist’s salary is linked to inflated outcome data, and no cardiology program pretends that every patient gets well. I would say that there is a lot we can learn from cardiologists besides cardiology.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.
