John Spertus

#outcomesresearch

[John Spertus @jspertus]

@f2harrell @wbaker0531 @AndrewJSauer @JACCJournals @RyanTedfordMD @noshreza @mpsotka @suzannevarnold @hvanspall @AHajduczok @TomCascinoMD @robmentz @JeffTeuteberg @MidAmericaHeart This is more complicated than Twitter allows, but would love to discuss with you. We don't feel change is as problematic when adjusted for baseline and the purpose is not to assess differences, but to interpret mean population differences in a clinical framework.

[John Spertus @jspertus]

@DocStrom @nih_nhlbi @SmithBIDMC @BidmcCvi @rwyeh @rkwadhera @EricSecemskyMD @kardiologykazi @ZimetbaumP @ASE360 @AKrawisz @BIDMCVFellows @BIDMC_IM @BIDMChealth Congrats!!!!

[John Spertus @jspertus]

@SammourMD @SCAI @HMHCardioFellow @SachinGoelMD @tavrkapadia @djc795 @arnoldgehrke @n_kleiman @WilliamZoghbi @SLittleMD @NadeenFaza So proud of you!!!

[John Spertus @jspertus]

@arnoldgehrke @bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD Unlike vague ?s that used to be used (e.g., how much better do you feel now compared with before the trial?), PROs (e.g., KCCQ) ask very concrete questions referring to the last 2 weeks. Seems less likely that patients would have a Rx done a year before influence their answers.

[John Spertus @jspertus]

@arnoldgehrke @bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD Also, i find support that the effect was real in ISCHEMIA (no sham) because no SAQ benefit seen in ISCHEMIA-CKD (why would only those without CKD be susceptible to placebo effect?) and the effect size in ISCHEMIA was remarkably similar to ORBITA's, a sham trial of PCI.

[John Spertus @jspertus]

@arnoldgehrke @bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD Unlike vague ?s that used to be used (e.g., how much better do you feel now compared with before the trial?), PROs (e.g., KCCQ) ask very concrete questions referring to the last 2 weeks. Seems less likely that patients would have a Rx done a year before influence their answers.

[John Spertus @jspertus]

@arnoldgehrke @bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD While there is no doubt that sham trials are better than open label, I (as you would expect) still feel that the QoL benefits are critical outcomes and not as subject to placebo biases as many inherently believe.

[John Spertus @jspertus]

@gcfmd @JeremySussman @ATSandhu @djc795 @HeartBobH @NMHheartdoc @paheidenreich @hmkyale @hvanspall @texhern @JAMACardio The critical need for risk models to have an impact is for there to be a clear difference in management for high vs. low risk pts. How should risk of dying alter care here? Shouldn’t all patients be on GDMT??

[John Spertus @jspertus]

@hvanspall @gcfmd @ATSandhu @djc795 @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF @StanfordMed Today I was approached by our interventionalists on how to risk stratify elective PCI cases in the setting of a severe contrast shortage. They are going to use the SAQ. Amazing!!

[John Spertus @jspertus]

@hvanspall @gcfmd @ATSandhu @djc795 @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF @StanfordMed I definitely think we need to reimburse for the collection, scoring and interpretation of PROs. Insurance pays $35 for a HbA1c. Why not $5 for a PRO??

[John Spertus @jspertus]

@gcfmd @ATSandhu @hvanspall @djc795 @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF @StanfordMed As noted, the costs can be small (much less than what we pay for most tests) and could readily be incorporated into routine care. Once available the advantages for engaging patients, pop health and even triaging btwn virtual and in person visits is limitless

[John Spertus @jspertus]

@djc795 @gcfmd @hvanspall @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF To me, the critical challenge is to have providers value and understand PROs. Patients like to fill them out but are frustrated if providers don’t discuss them. We learned to read ECGs and these are much easier and more useful.

[John Spertus @jspertus]

So Proud of @GreenDirtFarm https://t.co/kLgUToYVgL

[John Spertus @jspertus]

@akcmahi @kaulcsmc @djc795 @mmamas1973 @fischman_david @SVRaoMD @GreggWStone @agtruesdell @DocSavageTJU @aymanka @AGoldsweig @timir_paul @mirvatalasnag @nolanjimradial @Jakeadoll @StephenWaldoMD 2/2: there is no current economic model to incentivize them to improve. Hospitals don't see the 'costs' of complications, don't really care about value, and won't invest in an infrastructure for delivering personalized medicine.

[John Spertus @jspertus]

@akcmahi @kaulcsmc @djc795 @mmamas1973 @fischman_david @SVRaoMD @GreggWStone @agtruesdell @DocSavageTJU @aymanka @AGoldsweig @timir_paul @mirvatalasnag @nolanjimradial @Jakeadoll @StephenWaldoMD 1/2 Very interesting conversation. Key points: 1) Models are useful if you will do something different if they are high or low risk; 2) Clinicians already think they do this intuitively, feel their care is perfect and don't see a need to use a tool to help them and...

[Harlan Krumholz @hmkyale]

Congrats to the #CHIEF_HF investigators…digital first trial, with drug, & for regulatory indication expansion. Canagliflozin improved quality of life in patients with heart failure. But the trial design even bigger news. Heralds new era in trial implementation. @jspertus #AHA21

[John Spertus @jspertus]

@djc795 @DavidLBrownMD @kaulcsmc @GreggWStone @vlgmrc @hect2701 @angioplastyorg @drjohnm @SABOURETCardio @Drroxmehran @ajaykirtane @Hragy @AnastasiaSMihai @JEscaned @MarcoJe80135689 @transradial @DrMarthaGulati @BillONeillMD @DrCindyGrines @webmd11 @DLBHATTMD @rallamee @ProfDFrancis @sbrugaletta @Ortega_Paz @NicolaRyanI1 @DrPascalMeier @w_jyg @AsherElad @ANazmiCalik @aayshacader @ICigalini @guilbon Please Sanjay. Benefits in ISCHEMIA same as ORBITA, but lasted for >3 years. Also, difference >5 points seen in those with SAQ AF Score <=80. We even gave curves you can use for shared decision making to be angina free. You don’t have to judge what is best, let Ur Pts decide!

[John Spertus @jspertus]

@GreggWStone @DavidLBrownMD @vlgmrc @hect2701 @djc795 @angioplastyorg @drjohnm @kaulcsmc @SABOURETCardio @Drroxmehran @ajaykirtane @Hragy @AnastasiaSMihai @JEscaned @MarcoJe80135689 @transradial @DrMarthaGulati @BillONeillMD @DrCindyGrines @webmd11 @DLBHATTMD @rallamee @ProfDFrancis @sbrugaletta @Ortega_Paz @NicolaRyanI1 @DrPascalMeier @w_jyg @AsherElad @ANazmiCalik @aayshacader @ICigalini @guilbon What baffles me is the insistence by many that recasc needs to improve survival to be valuable and the tortured efforts to show it. If patients have angina it improves symptoms and QoL. That is great! Isn’t it enough???

[John Spertus @jspertus]

@thomasjwang1 @UTSWNews So impressive! Great work Will and great for your employees!!

[John Spertus @jspertus]

@KashviGupta @umkcIM @bnallamo @JRGolbus @RamanathanVidya @venkmurthy @RogueRad @JM_Goodrich_EHS @umichsph @samiranmukher93 Speaking on behalf of @umkcIM and @MidAmericaHeart i can say we are so happy to have you joining us. Your reputation precedes you and we are just thrilled to welcome you to Kansas City and see all the great things you will do. Thanks for choosing us!!