Mr. Susman is a freelance medical writer based in Florida, USA. He travels worldwide to report from medical conferences, writing regularly for wire services, internet websites, and medical journals such as the Journal of the National Cancer Institute and AIDS.
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Everyday, it seems, my e-mail box includes a notification that a medical meeting that I attend to report on advances in the field has been canceled due to safety concerns surrounding the coronavirus COVID-19 pandemic.
Among the more recent cancellations: the American Academy of Neurology, scheduled for Toronto, Canada, at the end of April; the American Society of Clinical Oncology, scheduled for the end of May and the Euro Heart Care 2020 scheduled for Seville, Spain, in early June.
But while the meetings may have been canceled, science marches on and some meeting organizers have figured out how to run a virtual meeting, including the American College of Cardiology that canceled its face-to-face meeting in Chicago, but still was able to present key sessions via the Internet.
Cardiologists Feeling Stress
Even before the COVID-19 pandemic hit, cardiologists were feeling the stresses of their job, said researchers at the virtual ACC meeting.
In a survey of cardiologists, Laxmi Mehta, MD, professor of medicine at Ohio State University Wexner Medical Center, Columbus, said the percentages of physicians concerned about burnout was rising when compared with a similar survey done in 2015. Then, Dr. Mehta said, 26.8% of American cardiologists who responded to the survey said they were feeling burned out on the job, but in the latest survey, that percentage had risen to 35.4%.
Of that 35.4%, Dr. Mehta said that 23.9% met one or more of the symptoms of burnout; 9.9% reported they experience chronic burnout and work frustrations and 1.6% admitted they were completely burned out.
The survey that had a 14% response rate among cardiologists also indicated that just 20.7% of these cardiologists expressed no burnout, and were satisfied with their professional choice. The largest group, 43.9% of the cardiologists, said they were feeling stressed on the job, she said.
“Burnout rates are higher in cardiologists who work longer hours or work in a hectic work environment, who plan to leave their current practice and among those reporting medical errors,” she said.
She and colleagues sent surveys to 19,348 members of the American College of Cardiology between September and October 2019, and they received 2,025 responses, a 14% return rate. Dr. Mehta said the low rate of response was one of the limitations of the study, “however, the results are consistent with other national survey.” She also noted that another limitation was the potential for bias among those cardiologists who were stressed or feeling burnout versus those who were not feeling the pressures of their careers. She suggested the less-than-satisfied doctors would be more likely to complete the survey.
“We are all at risk of burnout,” Dr. Mehta said. “Burnout is defined as emotional exhaustion, depersonalization and dissatisfaction with personal accomplishments while working in a self-perceived stressful environment. Burnout and reduced job satisfaction are more prevalent in physicians compared with the U.S. general population.”
In the study, Dr. Mehta said that 45.3% of women fell burnout compared with 33.5% of men (p<.001). She also found that 45.3% of cardiologist in mid-career fell burnout compared with 35.4% of cardiologists in their early career state, and 31.5% of physicians in their late career stage. Burnout was also expressed more often by cardiologist who were putting in 60 hours of work a week, as 41.5% of them expressed burnout symptoms, compared with 17.9% of those who worked less that 40 hours a week and 29.5% of those doctors working between 40 and 59 hours a week (p<.001).
About 8.6% of cardiologist who expressed no burnout, 8.6% were concerned they had made medical errors; 33.1% of the cardiologists who felts stressed said they feared they had made medical errors, and 58.3% of the burnout group suggested they had made medical errors (P<0.001).
Although the study was conducted before the COVID19 outbreak, Dr. Mehta suggested that medical professionals should try to cope with the pandemic by exercising, eating healthy, getting sleep, engaging in hobbies, performing things such as yoga and by staying in contact with others, even while social distancing. She also noted that most employers have assistance programs.
New hope in rare disease
Two monoclonal antibodies showed they were capable of dramatically lowering low density lipoprotein (LDL) cholesterol in people who have rare homozygous familial hypercholesterolemia.
In the ODYSSEY HoFH trial, treatment with the PCSK9 inhibitor alirocumab lowered LDL cholesterol and average of 26.9% in a 12-week period while placebo patients actually had an 8.6% increase in LDL (P<0.0001).
In a separate study, treatment with the investigative agent evinacumab, an angiopoietin-like 3 (ANGPTL3) antibody, reduced LDL cholesterol by 47.1% after 24 weeks while placebo patients LDL had an average increase of 1.9%.
The lead investigator of the ODYSSEY HoFH trial, Dirk Blom, MD, PhD, head of lipidology at the University of Cape Town, South Africa, said, “The addition of alirocumab on top of maximally tolerated lipid lowering therapy helps patients get closer to their LDL cholesterol goal.”
Dr. Blom said that 45 patients diagnosed with homozygous familial hypercholesterolemia had a baseline LDL of 295 mg/dl were treated with alirocumab 150 mg every 2 weeks, and they were compared with 24 patients in the placebo arm with a mean LDL-cholesterol at baseline of 259 .6 mg/dl.
“LDL-cholesterol percent reduction with alirocumab is less pronounced in patients with homozygous familial hypercholesterolemia than in other forms of hypercholesterolemia as homozygous familial hypercholesterolemia is characterized by severely impaired LDL-receptor function,” Dr. Blom said.
Nevertheless, he said, “Substantial and significant absolute reductions in LDL-cholesterol were observed with alirocumab.”
In the evinacumab trial, Frederick Raal, PhD, head of the division of endocrinology and metabolism, at the University of Witwatersrand, Johannesburg, South Africa, and colleagues enrolled 43 patients to receive evanicumab in an intravenous dose of 15 mg/kg every 4 weeks. Their results were compared with 22 patients who were given intravenous placebo infusions.
Evinacumab is a fully human monoclonal antibody designed to reduce LDL-cholesterol independent of whether the patients has functioning LDL-receptors. Raal demonstrated that treatment with evinacumab worked just as well in people with homozygous familial hypercholesterolemia who had some functioning receptors as those without functioning receptors.
In the trial, none of the patients on placebo experienced any serious adverse effects; there were 2 serious adverse events in the evanicumab patients – a bout of urosepsis, and a an unsuccessful suicide attempt. They were not considered treatment related. “Evinacumab safety is being further assessed in the 24-week open-label treatment period of the trial,” Dr. Raal said.
He noted that the effect of evinacumab was evident as early as 2 weeks into treatment, showing about a 40% reduction in LDL-cholesterol at that clinic visit. After 24 weeks, “the mean absolute decrease in LDL-cholesterol was 132 mg/dl, which is remarkable,” he said.
“Evinacumab may provide an effective treatment for patients with homozygous familial hypercholesterolemia who are unable to reach target LDL-cholesterol despite multiple conventional lipid-lowering therapies with or without apheresis,” he said.
E-cigarettes help people quit
Electronic cigarettes and smoking cessation counseling appear to help more people quit than counseling alone, a new clinical trial shows.
At 12 weeks, 22% of 128 people who participated in the study and were given nicotine electronic cigarettes and counseling had quit smoking – defined as not having had even a puff or cigarette smoking within the past week – compared with 9% of 121 people who just had counseling to quit smoking (risk difference 12.8%[95% CI 4.0-21.60]), said Mark Eisenberg, MD, professor of medicine at Jewish General Hospital/McGill University, Montreal, Canada.
Dr. Eisenberg and colleagues also recruited 127 people who received counseling and electronic cigarettes that did not have nicotine, and they had an intermediate, non-significant reduction of 17% compared with just counseling.
“In the E3 study, nicotine electronic cigarettes with individual counseling is efficacious for smoking cessation compared to counseling alone,” he said. “Non-nicotine cigarettes with individual counseling has benefits between those of nicotine electronic cigarettes with counseling and counseling alone.”
“Few serious adverse events occurred,” he said, “however, there remains a need for additional safety data.”
The E3 trial is ongoing and will extend to one year. “Longer-term data from the E3 Trial will determine of benefits persist over time,” Dr. Eisenberg said.