Book of Abstracts - New Frontiers 2022

Abstracts of oral presentations

EVIDENCE-BASED CARDIOVASCULAR MEDICINE: PERSPECTIVES AND DISAPPOINTMENTS

F. Šimko 1,2

1 Institute of Pathophysiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia; 2 3rd Department of Medicine, Faculty of Medicine, Comenius University, Bratislava, Slovakia Major clinical trials have changed cardiology over the last thirty years. Although no one doubts that evidence-based therapy saves lives, there is still plenty of room for uncertainty. First, the level of benefit achieved, although statistically significant, is in many cases low. The comparison with placebo is no longer acceptable because the first evidence-based treatment was introduced decades ago; thus it is difficult to achieve additional benefits at the current level of pathophysiological knowledge. Second, in line with the previous point, the overall reduction in mortality is relatively low and is not generally considered as a primary but only a secondary endpoint in the current studies. Instead, the main target is mostly combined endpoint, such as the sum of general and cardiovascular deaths, hospitalizations, fatal and non-fatal cardiovascular events. Third, in order to achieve the required statistical power, a very large number of patients need to be involved and follow-up extended from two / three years to five / ten years or even decades. This is not only expensive but also technically very difficult to implement. Fourth, trial studies are different from population monitoring. The true cardiovascular population consists of rather old patients, who suffer from a number of additional pathologic conditions (eg. mental, motor or oncological diseases), using a number of different drugs that potentially interfere with basic cardiovascular treatment, thus reducing the benefit compared to clinical trials. Given all these conditions in mind, the question arises: how will the future of evidence-based cardiovascular medicine evolve? Evidence from large and well-prepared clinical trials is undoubtedly the best weapon and cornerstone of therapy and will certainly dominate cardiovascular treatment in the near future. However, it should be borne in mind that the negative results of clinical trials will become more and more frequent over the successful trials. And the call for a personalized approach to patient management - "tailor-made treatment" will cease to be an empty slogan, but it could become the basic wisdom of every cardiologist.

Keywords: evidence-based medicine, clinical trial, population

Funding:VEGA 1/0035/19

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