Sebhat Erqou

[John Mandrola, MD @drjohnm]

Best post on X in weeks. So good👇🏻

[Ash Paul @pash22]

Overuse of diagnostic testing in healthcare: a systematic review
https://t.co/UiYp4cSCDw

[Brian Kolski,MD @bkolskk]

@drjohnm @pash22 How about the Lifevest industrial complex- yikes

[John Mandrola, MD @drjohnm]

Really amazing critique of a terribly flawed paper. What were the editors thinking? Just say no to stuff like this. Or... publish the paper and then another paper explaining the flaws--like below. The flaw-explainer offers 10x the value

[Sky News @SkyNews]

A surgeon in London has performed the UK's first long‑distance robotic operation on a patient located 1,500 miles away in Gibraltar.

Urological surgeon Professor Prokar Dasgupta says this moment is 'good news for patients' in remote areas.

[Circulation @CircAHA]

Among people living with HIV and heart failure, social adversity was associated with 4x higher mortality. Social risk assessment should be part of routine care in these patients.https://t.co/QOjFHgd9t8

[John Mandrola, MD @drjohnm]

Read this. Excellent thoughts on evidence generation—industry vs nonindustry funded science. Superb👇🏻

[Tesfaye A. Telila MD, FACC,FSCAI. @TTelila]

One of the greatest successes of @HeartAEthiopia has been sparking the hard but necessary conversations about access—because lifesaving emergency care should never depend on financial circumstance.

Ethiopia and Africa’s greatest wealth is our human capital, and together we must continue to invest in it by expanding access to advanced emergency cardiovascular care.

🎯 The reports I receive and the videos I watch about what’s being done and planned in the cardiovascular space in Ethiopia (both private and government institutions) truly warm my heart. The momentum is real.

This is not a one-person effort—it’s all hands on deck.

Keep pushing, everyone. Lives depend on it.

Our founder @drmerid delivering that exact message : “In life-threatening emergencies, clinical care must take precedence over financial considerations—patients are treated immediately, and payment is addressed afterward.” ✊🏾

[Sebhat Erqou @ErqouSebhat]

@drjohnm @hahn_rt @theheartorg @drjohnm even a non inferiority margin of 4.8% seemed high for me when I saw the trial presented, given the outcome we are discussing is stroke. Why do you think was the event rate lower?

[John Mandrola, MD @drjohnm]

#acc26 Six reasons why CHAMPION AF should not change oral anticoagulation for AF

I will have a formal post up on @theheartorg but here is a short summary

1) Stroke and Ischemic Stroke went the wrong way.
All S -> 33 vs 50 [HR 1.46 95% CI, 0.94-2.27)]
IS -> 27 vs 45; [HR = 1.61; 95% CI, 1.00-2.59)]
Look at those upper-bounds.

2) NI would not have been met for efficacy had they used a margin with both rate ratio and risk difference, which is standard practice.

The margin of 4.8% is based on event rates at 12%, which is 1.4 in relative terms (40% higher). But when event rates come in lower, as they did: 4.8% vs 5.7%, the 4.8% margin is too lenient.

The 0.9% higher rate of the primary endpoint has a 95% CI of (-0.8-2.6%), so 2.6% is less than the margin of 4.8%. Now do it with relative risk.

It's in table 2. The relative risk is 1.20. The 95% confidence intervals were 0.87-1.66. Note that 1.66> 1.40 so LAAC is not noninferior based on rate ratio margins

3) The primary safety endpoint is flawed because it excludes periprocedural bleeding and uses nonmajor bleeds, such as gum bleeds and bruising. It's open label trial so who which group will complain of more nonmajor bleeding?

4) When counting all events, Watchman barely reduced major bleeds. Also in the main results table is that major bleeds were 83 vs 87 (5.5% vs 5.8%; HR 0.92 95% CI 0.68-1.24)

5) Net Clinical Benefit was also flawed because they used nonprocedural bleeding and nonmajor bleeds.
A normal patient would simply say, there were 17 more strokes and only 4 less bleeds. Hardly a good trade.

6) Bayes: trials don't give answers, they update priors. For Watchman, you have PREVAIL failing against warfarin, CLOSURE AF clearly failing against best med Rx (mostly DOACs) so priors are pessimistic. To go from pessimistic priors to enthusiastic posteriors you'd need hugely positive data. CHAMPION is not that.

Don't believe the stories that CLOSURE failed due to them using other LAAC devices. In the AMULET IDE trial, Watchman and Amulet were similar. Also, if you believe that German operators are worse than US authors, you need to travel more.

Conclusion: Oral anticoagulation for AF is one of the most evidence-based practices in all of medicine. To upend that would take much stronger data.

Don't be bamboozled by this trial, which was designed to be positive before the first patient was enrolled.

#ACC2026

[John Mandrola, MD @drjohnm]

Twitter thread coming on what @adamcifu @VPrasadMDMPH @AndrewFoy82 and I think is the BEST approach to pt care. This is ...
The Case for Being a Medical Conservative.
https://t.co/nZXrnvMQqP
Thanks to the @amjmed for publishing this.

[Sebhat Erqou @ErqouSebhat]

@drjohnm Interesting read @schatz_aa

[Timothée Olivier, MD @Timothee_MD]

This is one of the best pieces I’ve read in a long time. Many thanks to @anish_koka for this superb piece and thoughtful recounting. Those who really know @VPrasadMDMPH know he will do even more good and rise even higher.

[Anish Koka, MD @anish_koka]

https://t.co/pDqo6cETxT

[Martin Plaut @martinplaut]

More like locked in! The most repressive regime in Africa. So sad.

[Fitsum Asnakech Tilahun, MD,FASN @fitse_t]

You Cannot Heal a Nation Through Fear

የቀራቸውን ትንሽ ገንዘብ ፣ ለታካሚዎቻቸው መድሀኒት መግዣ የሚያውሉ የጤና ባለሙያዎችን በማስፈራራት ለማሰራት መሞከር 🤦🏾‍♂️🥲

What a shame.

Ask yourselves what it means to force a physician to work under duress ?

💚💛❤️

[Venk Murthy MD PhD @venkmurthy]

Important insight that applies to most Polygenic Risk Scores!

These are almost all not clinically useful metrics but the scientific community wasted countless dollars and hours due to hypesterism claiming this is how medicine would be practiced.

[Sebhat Erqou @ErqouSebhat]

@gtfinchy @VPrasadMDMPH Harvard is a place where the major innovations and cutting edge technologies are taking place, contributing to America’s dominance in science across the globe. Federal funds are not charities. They are contracts for specific highly selected projects deemed to advance science.