ASKED AND ANSWERED: What has cardiology gotten spectacularly right, and spectacularly wrong, over the past 30 years?

The treatment of acute coronary syndrome and MI. Young clinicians may not be able to remember how MI care was transformed with emergency PCI and stents but it is amazing. People with MIs often leave the hospital the next day with only a band-aid on their wrist. The heart and person saved.

This has led to fewer cases of heart failure and arrhythmia. I live in a city of million people and rarely do primary prevention defibrillators for ischemic-related cardiomyopathy—because of all these fixes.

The corollary to acute care has also been disease-modifying therapy for CAD. When I started my career, an MI was often followed by another and another. Now, with optimal medical therapy, recurrent events are much lower. Patients with MI usually live long enough to die of something else.

Heart failure care has also been transformed with the four classes of HF medicines. What was once a miserable death sentence has been transformed into a livable chronic condition. Of course, the challenge in HF care is using it wisely, because most cases of HF are not in ambulatory males with solid blood pressure, but in older patients with many co-morbidities.

Catheter ablation technology has been a spectacular success for every arrhythmia except AF. Ablation renders patients with arrhythmias from focal areas like surgical patients: cured. We still have a huge knowledge deficit in AF pathophysiology. More on that below.

In structural interventions, TAVI is nothing short of spectacular. We can extend the quality and quantity of life for many older adults who faced certain death from aortic stenosis—without open heart surgery.

Much more at the link.