“…it’s difficult for me to think that FAIR-HF proves that giving iron in any form would necessarily be beneficial.”
-Stephen S. Gottlieb, MD

“... only about 10% of the patients in RALES were on a beta blocker, but those who were ... seemed to have just as good, if not a better, result from spironolactone."
~ Bertram Pitt, MD

“There’s no question that aspirin decreases non-fatal MI in randomized trials of primary prevention and their meta-analyses, probably by about 20% … Because the number of deaths is not decreased, people assume that there’s no merit in preventing nonfatal MI. I don’t agree with that.”
~ James Dalen

"...we all agree that one of our strong recommendations from this particular discussion is going to be that every institution should have a protocol for the basic framework of applying these treatments for ACS."

Christopher B. Granger, MD

“If you look at the rates, for instance, of preloading that occur in the United States, they are quite low, even though guidelines recommend preloading with antiplatelet agents (eg, P2Y12 inhibitors) prior to PCI in ACS patients.¹"

~ Ajay J. Kirtane, MD, SM

“… digoxin is even more pertinent in the context of the increasing prevalence of heart failure with preserved ejection fraction.”
~ Michael White, MD

“Alzheimer’s disease is really much more than a memory impairment, … an older adult who is having changes in their mood, their interests, their patience, their behavior, their personality; these may all herald the beginning of Alzheimer’s disease.”
~ James E. Galvin, MD

"Certainly, the procedure is performed safely in this study. There were no significant adverse events... In fact, there were fewer events, albeit ... significant in terms of the overall mortality."
~ Vivek Reddy, MD

"Hypertension continues to be a major contributor of cardiovascular events, and there is sufficient evidence to indicate that adequate blood pressure (BP) control is associated with marked reductions in the risk of not only target organ damage but also cardiovascular events such as stroke, myocardial infarction, and chronic renal failure."

Carlos M. Ferrario, MD

"I completely agree that we should avoid this kind of storm during the dialysis session. There are so many changes in the different ions that could trigger some arrhythmia. I completely agree that we should avoid important gradients, whether the ion is calcium or potassium."

Pieter Evenepoel

Adding Experience to the Evidence

"According to the ACC/AHA guidelines, routine exercise testing in the asymptomatic patient is a class III indication and therefore not recommended because the information you get is going to be more confusing and may lead to unnecessary further testing that could lead to complications."

Joseph Alpert

“All the registry data indicate that the ICD is extremely effective in not only treating fast VT or VF, but also in preventing sudden cardiac death.”
~ Mark Estes, MD

"I would like to say there are many patients who get treated with clopidogrel. This applies to the PLATO trial as well. Since 46% of patients in the PLATO trial had already received clopidogrel administered in-hospital before getting randomized,² a clinician can still safely load with ticagrelor 180 mg followed by 90 mg twice daily."

Carl J. Lavie, MD

So in other words, for coronary artery disease, a clear J-shaped curve; for stroke there was no J-shaped curve.
-Franz Messerli, MD

“Certain activities like racquet sports, skiing, and basketball seem to be associated with a greater incidence of acute cardiovascular events. Many of these victims, especially those younger than 35, often have underlying structural cardiovascular abnormalities, most notably hypertrophic cardiomyopathy.”
~ Barry Franklin

“That implies that the percutaneous-inserted prosthesis implanted inside the existing native valve without excising that valve has hemodynamics after implantation that are nearly as good as a stented bioprosthetic valve replacement. That was surprising to me…”
~ Paul Grayburn, MD

“I think the field has begun to move away from looking at percent inhibition with respect to a given drug, and toward looking at the residual platelet reactivity during treatment, and how we can associate that with outcomes in patients. Certainly, there have been ample studies demonstrating that high on-treatment platelet reactivity is associated with a greater risk of subsequent cardiovascular events.1–3"

~ David J. Schneider, MD

"The key point that we found is …that interpreting the treadmill test on the basis of the ST segment alone is obsolete and should be abandoned…I think an important point we need to make to clinicians is that the most important prognostic indicator is functional capacity."
~ Ezra A. Amsterdam, MD

“Are we ready to make clinical decisions based on the presence of a scar in a patient with dilated cardiomyopathy and no coronary disease?”
~ Javier Sanz, MD

“…this is an exciting new frontier for hypertension research and management. Masked hypertension is not just not a curiosity.”
~ Robert Phillips, MD

"I think one of the things that is important for physicians to understand is that … we’ve had a long history of using a very complicated drug, warfarin. The new drugs are a significant advance, but they’re not necessarily going to be a cakewalk."
Peter Kowey, MD

“Patients with MetS and high triglycerides are the most likely to develop diabetes in the relatively near future. All patients with MetS, especially those with high triglycerides, need to be treated aggressively with TLCs and adjunctive drug therapies of proven benefit.”
~ Charles Hennekens

“When you say the word fitness to people it often confuses them; they’ll think about flexibility, they’ll think about muscular strength, and they’ll of course think about how easily they get out of shape. Today we’re specifically talking about cardiorespiratory fitness, which is really your maximal aerobic capacity.”
~ Timothy Church

"Fibromyalgia is undoubtedly a valid condition characterized by widespread body pain as well as variable other symptoms, which can include fatigue; sleep disturbance; mood disorders; and other somatic symptoms such as headache, abdominal pain, and hypersensitivity to external stimuli. Fibromyalgia remains a clinical challenge as there is no defining test, symptoms are subjective with variable patient presentation, and ideal treatment is elusive."

Mary-Ann Fitzcharles

“So JNC 8 might say that home BPs will be helpful in determining what the pressure is over time, but presently there is no trial evidence that knowing home blood pressures will decrease events.”
~ Marvin Moser, MD

Although the two drugs lowered central pulse pressure in the brachial artery to the same degree, nebivolol lowered central pulse pressure more than atenolol.
-John Cockcroft, MD

"We are now seeing many such patients [with heart failure with preserved ejection fraction]. They’re often elderly women with many comorbid conditions, and they’re sometimes admitted with atrial fibrillation, which makes the estimation of diastolic function problematic."

Gary Francis, MD

“…many of our clinicians get caught up in the diagnosis of coronary disease... I strongly believe that this is not the purpose of the ED evaluation.”
-Michael Farkouh, MD, MSc

“So, do you think that ED is caused by HF or do you think it's just an association of two conditions with identical risk factors?”
~ Ernst R. Schwarz, MD, PhD

"We have evidence of various properties of HDL [high-density lipoprotein] that might be theoretically useful for describing its potential benefit, but we don’t have either a clinical trial or other prospective evidence indicating that any of these properties are explanatory."

John LaRosa, MD

“I believe there are some recent data that this increase [in obesity] seems to have leveled off, but at a rate that is still very unhealthy, with two thirds of the adult population being overweight and one third being obese.”
~ Jerome Fleg, MD

"Practitioners will certainly want to keep in mind that to make optimal decisions, you need systematic summaries of the best evidence."

Gordon Guyatt

"We now know that sleep and the sleep/wake cycle are intertwined with most of our bodily systems, so sleep problems can lead to pathologies in many different physiological systems, possibly causing acute and chronic effects."

David Neubauer

"Investigators and clinicians alike have realized that the pragmatic approach, using the presence or absence of constipation as a symptom of IBS, may lend itself to the subsequent evaluation and management of the disorder."

Brooks Cash

“I try to avoid the term ‘vulnerable plaque’ because it implies that we possess a crystal ball that can tell the future of a particular lesion based solely on its morphology.”
~ Peter Libby, MD

“It is very common for these patients to report New York Heart Association functional class 1 after myectomy—that is, they can do virtually anything…”
-Barry Maron, MD

“I think it’s been an evolving process and I think it’s a good one. Moreover, transparently acknowledging a medical writer’s contributions clearly highlights the fact that this is a legitimate area of scientific endeavor.”
-Carol Sanes-Miller

"It seems like the biggest change in the guidelines is the addition of ticagrelor, or BRILINTA®.… a new antiplatelet therapy that has been shown to be effective in ACS. Actually, based on the PLATO trial and the current [US FDA] rulings, it’s the only antiplatelet agent that is superior to clopidogrel for reducing cardiovascular death following ACS.…"

Carl J. Lavie, MD

“We need to differentiate real life from what goes on in the clinical trials, because so often in the clinical trials patients with a history of myopathy … are excluded from the trials.”
~ Peter Toth, MD

“Most of the time we’re talking about an absolute difference in diabetes incidence within these trials of a couple percent.”
~ Bill Cushman, MD

“There is no question that these drugs have a major role to play in therapy. In every clinical trial over the past 50 years, where they have been used as monotherapy or in combination with other therapies they not only effectively lowered blood pressure, but morbidity and mortality were reduced not just from stroke, but from heart failure, progression of kidney disease, and coronary disease.”
~ Marvin Moser, MD

“If you show up in the ED and you have either an elevated troponin or an elevated adrenomedullin, your risk of death in the next two weeks is exceedingly high and you ought to get aggressive care.”
~ Alan Maisel, MD

"Mitral valve repair has been the gold standard for patients with mitral regurgitation (MR) for approximately 30 years. What is the likelihood that percutaneous procedures will be able to achieve the same sort of efficacy for MR in the future?"
~ Michael A. Borger, MD

But for now, I would agree that this intermediate or low-to-intermediate risk group is the best group to target for coronary CT scanning.
-Allen Taylor, MD

"Guidelines [for heart failure with preserved ejection fraction] don’t have much to say…Treatment remains relatively empiric, and different clinicians have different biases that affect the treatment that they provide…Several small studies have shown that some agents seem to work…[but] there hasn’t been a lot of evidence of benefit."

Barry Massie, MD

"Knowing that efficacy is not 100% and that comorbidities can add to a poor response, we realize that some patients need to move on to second-line therapies."

Charles Butrick

“Reversing obesity prevalence in the United States to that of a decade ago has been estimated to save US adults 111,206 total knee replacements."
~ Gary Williams, MD

"This technology helps to facilitate a conversation with the patient to say, 'Maybe there are different changes in either your medication therapy or self-care that we could help you implement.'"

Pamela R. Kushner, MD

“I always worry that we haven’t had the patients in there long enough to finally tidy up their drugs, particularly the diuretics, to make sure they understand instructions.”
~ Ileana Piña, MD

"We know the younger the patient is with thoracic aortic disease, the more likely there is to be an underlying genetic cause for the disease. The older the patient is … the less likely they are to have genetic risk factors and the more likely they are to have chronic wear and tear on the aorta over a lifetime causing the thoracic aortic disease."
~Dianna Milewicz

"One of the more controversial issues in medicine has been that of hypertension in pregnant women. The guidelines have not changed much in the last 50 years, although some effort to update these guidelines has been made recently."

Marvin Moser, MD

"These are guidelines created to guide people in decision making, but there is latitude based on patients’ underlying medical conditions, underlying psychiatric conditions, and other issues that may come into play, and all of these things need to be considered."
~ John D. Fisher, MD

“Various studies have shown that [with complementary and alternative therapies] the patient’s satisfaction is markedly increased, and there is a shortening of the length of the hospital stay.”
~ Gulshan Sethi, MD

“I think what’s difficult is to take observational data and to say, well, because there’s a relationship … then lower the levels of all these things … but I really think that to decide whether to treat those particular risk factors, and how low to go with those, we … need clinical trial data.”
-William Cushman, MD

“We have two studies, the randomized trial and the observational study that suggest that ACE inhibitors and ARBs … may not be useful, [and] may actually be harmful in patients with AR…”
~ Jeffrey Borer, MD

"One thing that I notice…is the lack of attention to IBS compared to Crohn’s disease and other GI disorders.…The unpredictability of IBS and its symptoms really affects the quality of life more than we give it credit for, in comparison to diseases that may have a greater impression on the doctor because they are associated with inflammation."

Mark Pimentel

“The new finding was that an elevated heart rate above 70 beats per minute was also associated with an increase in hospitalization for fatal and non-fatal myocardial infarction.”
~ Kim Fox, MD

"If you look at the curve of the decrease in mortality from heart disease for the past 50 years in this country, there is a steady downtrend. But when we break up the data … it indicated that women did not benefit until the last decade."
Ezra A. Amsterdam, MD

"With the improved respiratory flow monitoring that we have nowadays using a pressure transducer technique, the accuracy of detecting obstructive events— particularly when we speak about apneas— really has improved."
~ Ana Krieger, MD, MPH

"I believe there has been a natural progression to spiraling costs. Despite what has or has not been achieved up to this point with reform, we have reached a crisis regarding out-of-control costs, and something must be done about it."

Christopher Pastore, MD

“Because of socioeconomic limitations [our patients] are not always compliant about their medicines and follow-up, so we tend to err on the side of implanting sooner.”
-Richard Trohman, MD

"That’s ... one way of using what appears to be an unsophisticated maneuver to gain fairly sophisticated insight into the volume status of the patients."
~ Douglas Schocken, MD

"I think everyone knows that there are chronic risk factors such as high blood pressure, dyslipidemia, diabetes, smoking, lack of exercise, and others that contribute to coronary artery disease. We’ve only become aware recently of the issue that there are other kinds of risk factors, including what might be called acute risk factors."
~ Robert A. Kloner, MD, PhD

"We know that celiac disease is a genetic autoimmune disease, and we know that non-celiac gluten sensitivity is not considered an autoimmune disease… In order to obtain a diagnosis of non-celiac gluten sensitivity, celiac disease and a wheat allergy would both need to be ruled out."

Melinda Dennis

"The difference between a prevalence of disease in patients with normal results or normal testing was in the order of 15% to 20%, which really questions how much better testing is than just flipping a coin and whether it might be just as well to proceed with angiography."
~ Mario Garcia, MD

"HIV clinicians often spend more time addressing comorbid chronic illnesses such as diabetes, cardiovascular disease, mental health and substance disorders, liver disease, and cancer than managing antiretrovirals or opportunistic infections."

Todd Korthuis

“…patients who are device candidates are far and away most interested in receiving a device that will make them feel better rather than live longer…”
~ Jonathan Steinberg, MD

"Scientific advances in acupuncture research, coupled with the side effects of treating pain by conventional drugs, have promoted the use of acupuncture dramatically in the past 20 years. It is estimated that over 1 million practitioners outside China administer acupuncture treatments for chronic pain. Of these practitioners, over 300000 are physicians."

Brian Berman