Heart Association Meeting Research From Johns Hopkins

11/11/2018
What: The 2018 American Heart Association Scientific Sessions
When: Nov. 10–12, 2018
Where: McCormick Place, 2301 S. Martin Luther King Drive, Chicago, Illinois 60616


Keynote Speech: Machine Learning and Simulations Guide Therapies for Arrhythmias

When: Saturday, Nov. 10, 9:01–9:15 a.m. CST (10:01-10:15 a.m. EST)
Where: Room S105abc

Session: Arrhythmia Research Summit: Overcoming Arrhythmogenicity by Understanding Mechanisms

About 3 million people in the U.S. have potentially life-threatening arrhythmia—an irregular heartbeat. When medication fails to control the heart’s beating, surgery to burn away the tissue of the heart that generates the rogue beats can be an option. But the surgery isn’t always precise, and sometimes multiple procedures are needed.

Biomedical engineer Natalia Trayanova, Ph.D., M.S., the Murray B. Sachs Professor of Biomedical Engineering and Medicine at The Johns Hopkins University, has trained computers to predict which cells in a patient’s heart are the culprits underlying irregular heartbeats. Her personalized approach computationally models a heart’s movement and electrical function from a patient’s cardiac MRI. This modeling promises improved success rates for predicting where in the heart physicians could ablate tissue to stop the arrhythmias. Arrhythmias happen when cells that normally aren’t supposed to initiate heartbeats fire electrical pulses starting new, rogue heartbeats. The best way to stop these cells is to kill them through ablation.

The Virtual heat Arrhythmia Ablation Technique (VAAT) is currently in clinic trials. During her presentation, Trayanova will describe case studies in which she applied her computer modeling and in which cardiologists were able to more effectively treat their patients with atrial fibrillation.

She will also discuss how she is using artificial intelligence and machine learning to develop applications for diseases that cause ventricular tachycardia, which can lead to sudden cardiac death. These conditions include myocarditis (inflammation of the heart’s wall), the congenital heart defect Tetralogy of Fallot and sarcoidosis (white blood cell clumping in the heart’s walls).

Disparities in Afib Treatment

When: Saturday,
Nov. 10, 4:15–4:25 p.m. CST (5:15-5:25 p.m. EST)
Where: Room S102a
Session: Katharine A. Lembright Award/Lecture and Martha N. Hill New Investigator Award Competition

Johns Hopkins nurse researcher Kelly Gleason, Ph.D., R.N., is one of three finalist speakers in a competition for the Martha N. Hill New Investigator Award. The New Investigator Award, sponsored by the Council on Cardiovascular and Stroke Nursing and the Johns Hopkins University School of Nursing, recognizes outstanding contributions in understanding, preventing and treating cardiovascular diseases.

Gleason, an assistant professor at the Johns Hopkins School of Nursing, is an expert on diagnostic errors and informatics. The study she will present focuses on why certain groups of people may not be treated properly for atrial fibrillation and aren’t reporting good outcomes. Atrial fibrillation (Afib), an irregular heartbeat disorder, affects 200,000 people in the U.S. each year. Afib can cause fatigue, shortness of breath, palpitations and sudden cardiac death. Afib can be managed with medication, shocking the heart back into rhythm and minimally invasive surgery. But Gleason says there is a gap between those who receive successful treatment and those who don’t. She wanted to find out who wasn’t getting the appropriate treatment, so clinicians can find ways to better reach this underserved population.

Her study followed the outcomes of 953 people with Afib. She found that many people on heart-rhythm medications, primarily women and people with less education, weren’t as likely to have control of their symptoms and more likely to have depression, anxiety and overall worse outcomes.

Gleason says that now researchers need to look into why these disparities exist. For example, are physicians less likely to listen to women or the less educated when they describe their symptoms? Are these patients less likely to follow up and let their physicians know that the medication isn’t working? Or, alternatively, perhaps these heart-rhythm medications don’t work as well in women. Many of the clinical trials testing the medications only looked at effectiveness in men. Women have different heart electrophysiology, which may be why they have very different heart attack symptoms than men and why the medications may be less effective.

Disparities in Smoking Cessation Counseling and Using Smoking Cessation Medications for Low Income, Uninsured People with Heart Disease

When: Sunday, Nov. 11, 2–3:15 p.m. CST (3-4:15 p.m. EST)
Where:  Zone 1, Science and Technology Hall, Poster SU1280
Session: Assessing and Addressing Risk Factors II

When: Sunday, Nov. 11, 3:35–3:40 p.m. CST (4:35-4:40 p.m. EST)
Where: Moderated Posters 1, Science and Technology Hall, Poster SuMDP59
Session: Best of QCOR Abstracts: Moderated Digital Posters

Smoking is one of the leading causes of heart disease, and quitting smoking is one of the most effective ways to reduce the risk of complications or death from cardiovascular disease. Physician advice and counseling is a successful way to get people to quit smoking. There are also medications proved effective by the Food and Drug Administration for smoking cessation. Although public smoking laws and new medications to quit have caused smoking rates to fall, almost 38 million people in the U.S. still smoke, according to the Centers for Disease Control and Prevention. Minorities and people with lower incomes smoke at a higher rate.

For two related abstracts being presented at the American Heart Association meeting, Martin Tibuakuu, M.D., M.P.H., a former research fellow at the Ciccarone Center for Cardiovascular Disease and current medical resident at St Luke’s Hospital in Missouri, and Erin Michos, M.D., M.H.S., associate professor of medicine at the Johns Hopkins University School of Medicine, reviewed national survey data collected over 10 years on more than 4,000 U.S. adult smokers with heart disease to analyze smoking trends. Because of the survey’s nationwide coverage and thoroughness, the researchers say this data translates to being representative of 4.2 million current smokers with heart disease in the U.S.

The researchers found that overall, the rate of physician counseling hasn’t changed in the last decade and still hovers around 80 percent. The researchers also found that people who were uninsured were 88 percent less likely to be counseled by a physician about smoking, and people who had lower incomes were 50 percent less likely to be counseled. The researchers also found that smoking cessation medications were underused, and their use was decreasing over time (they were used by 6.4 percent of people in 2015, down from 9.3 percent in 2006).  Adult smokers with heart disease who had lower incomes and were members of ethnic minorities were less likely to use these medications. 

The findings suggest that many people who need counseling the most aren’t getting it, and that the majority of smokers with heart disease aren’t using proven cessation medications. The researchers suggest that more research is needed to determine the cause of these disparities—for example, are physicians less likely to offer the counseling or to prescribe cessation medications to certain patients, or are some underserved patients less likely to ask or want to be treated? Knowing what is contributing to the disparities can help inform the best way to initiate public health-targeted outreach to these vulnerable populations by reducing smoking rates and thus lowering rates of heart disease complications.