The top trends are the most mentioned terms or concepts among Twitter discussions of more than 150 cardiology experts tracked by GlobalData’s Pharma Influencer platform during the third quarter (Q3) of 2021.

1. Stroke – 543 mentions

The comparison of milrinone and dobutamine in treating cardiogenic shock, examining the use of atrial fibrillation (AF) screening and anticoagulants to prevent stroke, and how exercise can reduce the risk of death in stroke survivors were some of the popular discussions on stroke in Q3 2021.

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Chris P Gale, professor of cardiovascular medicine at Leeds Teaching Hospitals National Health Service (NHS) Trust, shared a study that compared milrinone and dobutamine in treating cardiogenic shock. The study enrolled 192 participants suffering from cardiogenic shock and divided them into two treatment groups of 96 each. The participants were administered either milrinone or dobutamine in a double-blind manner. The primary end-point of the study was in-hospital death, resuscitated cardiac arrest, receipt of a cardiac transplant, nonfatal myocardial infarction, and transient ischemic attack or stroke. The study results indicated no significant difference between milrinone and dobutamine in treating cardiogenic shock.

In another tweet, Afzal Sohaib, cardiologist at Barking, Havering and Redbridge University Hospitals NHS Trust & Barts Healthcare NHS Trust, shared an article on a study that examined the use of anticoagulants and AF screening to prevent stroke in high-risk patients. Implantable loop recorder (ILR) was administered as a screening tool. The study was conducted on 6,004 participants, out of who 1,501 were assigned to ILR and the remaining to usual care. The results of the study indicated that ILR screening helped in three-times higher detection of AF, but did not reduce the risk of stroke or systemic arterial embolism.

Stroke was also mentioned in a tweet by Debbe McCall, a CV patient researcher and advocate,  on the benefits of exercise in reducing the risk of death among stroke survivors. Researchers in a study conducted in Canada among stroke survivors found that activities such as three to four hours of walking and gardening or two to four hours of biking a week can reduce the risk of death from any cause by 54%. Exercise was also found to be effective among young stroke survivors in the study that followed the survivors for five years. A 79% reduction in risk of death among stroke survivors under the age of 75 and 32% reduction of death risk in patients aged above 75 years was observed in the study.

2. Hypertension – 468 mentions

The effect of online social media platforms’ usage on hypertension, intensive blood pressure control to reduce cardiovascular risk in patients with hypertension, and the effectiveness of angiotensin receptor blockers (ARBs) over angiotensin-converting enzyme (ACE) in treating hypertension were some of the trending discussions on hypertension in the third quarter.

Anastasia Mihailidou, senior hospital scientist at Northern Sydney Local Health District, shared a study that evaluated the effect of tweeting/retweeting cardiovascular health content on Twitter by individuals with hypertension on their health and systolic blood pressure (SBP). Participants of the study included 611 patients diagnosed with hypertension who were asked to post content related to health twice a week for a period of six months. The study assessed the change in SBP in the patients and patient activation measure (PAM) that measures patient engagement in healthcare. The results of the study indicated that posting content on Twitter did not have an impact on SBP and PAM among the participants.

Vijay Kunadian, consultant interventional cardiologist at Newcastle University, shared an article on the study of intensive blood pressure control in older patients suffering from hypertension. The study included 8,511 patients aged between 60 and 80 years who were observed for one year. The participants were divided into two groups including 4,243 patients with hypertension who were assigned to a SPB target from 110 to less than 130 millimetres of mercury (mm Hg) intensive treatment group and 4,268 patients to a target from 130 to less than 150mm Hg in the standard treatment group. The primary endpoint of the study included stroke, acute coronary syndrome, acute decompensated heart failure, coronary revascularisation, and AF. The results of the study found lower cardiovascular events in the intensive treatment group compared to the standard treatment group.

Hypertension was also discussed in an article shared by Michael O’Riordan, associate managing editor and senior journalist at TCTMD, a website covering news and information on interventional cardiology, on the effectiveness of ARBs over ACE in treating hypertension. A study conducted on more than three million people receiving hypertension treatment found ARBs to be more effective than ACE inhibitors in reducing the risk of cardiovascular events including acute angioedema and cough. Researchers concluded that the results support the use of ARBs instead of ACE inhibitors as the first-line treatment of hypertension as there is much lower incidence of risks such as angioedema, the article highlighted.

3. Atrial fibrillation – 273 mentions

The accuracy of home blood pressure devices in detecting AF, World Heart Federation’s (WHF) roadmap on AF, and the effects of adiposity measures on the risk of AF in men and women were some of the popular discussions on AF in Q3.

Debbe McCall shared a study on the accuracy of a home blood pressure monitor in detecting AF. An automated home blood pressure device Omron BP785N with an AF detector was used to measure the blood pressure of 99 patients, including their electrocardiogram (ECG) readings at the same time. The device showed an accurate AF detection in 20 patients as well as recognised sinus rhythms as non-AF in 67 patients. Incorrect readings of AF were found in 12 patients with sinus rhythm. The study concluded that a diagnostic accuracy of 87.88% was observed for AF detection using the device.

In another tweet, Adrian Baranchuk, assistant professor of medicine at Queen’s University, shared an article on an update of WHF’s roadmap on AF. The roadmap was first published in 2017 to minimise the burden of cardiovascular disease and propose solutions to address the conditions leading to the disease. The latest update takes into account the technological progress made in the development of therapies and focus on reducing risk of death and disability associated with AF, particularly in low-income countries. The health rewards achieved by implementing the update will be significant, according to the article.

AF also trended in discussions about the effects of adiposity measures on the risk of AF in men and women as mentioned in an article shared by Neil Floch, director of metabolic and bariatric surgery and head of general surgery at Nuvance Health hospital. A review was conducted on more than four million participants from UK Biobank, a biomedical database and research resource. The participants were aged between 40 and 69 years without previous AF condition, out of which AF was found in 14,400 men and 8,734 women. The independent relevance of general adiposity for AF was limited in men than women, the study concluded.

4. Stenosis – 194 mentions

The biomarkers associated with mortality in aortic stenosis (AS), lipoprotein(a) (Lp(a)) being a risk factor for causing AS, and medical technology company Medtronic receiving approval for aortic valve replacement (TAVR) system from the US Food and Drug Administration (FDA) were some of the popular discussions around stenosis in Q3 2021.

Vass Vassiliou, a doctor at NHS hospital, shared a review of studies to assess the blood biomarkers associated with mortality in AS, which could be used for deciding the optimal timing for AVR intervention. A total of 83 studies were reviewed, out of which brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were analysed. The review found that all-cause mortality in patients with AS was associated with the increase in baseline level of BNP, NT-proBNP, Troponin and Galectin-3. A change in biomarker level could be considered as an optimal timing for AVR intervention, and biomarkers serve as an important tool for risk assessment in AS, according to the review.

In another tweet, Philippe Pibarot, director of cardiology research at the Quebec University Institute of Cardiology and Pulmonology – Laval University, shared a study on the risk of AS due to Lp(a). The study analysed the Lp(a) from blood taken from 21 patients with calcific aortic valve stenosis (CAVS) and 22 volunteers. The goal of the study was to detect the proteins that may be related with Lp(a) differently in individuals with and without CAVS. The study discovered that there are new biological routes by which Lp(a) may cause CAVS as well as crucial molecular processes that may cause Lp(a) to trigger the development of CAVS.

Another discussion on stenosis was shared by Burt Cohen, editor-in-chief at a publishing firm Angioplasty.Org, on Medtronic receiving FDA approval for its Evolut FX TAVR system for the treatment of surgical aortic valve replacement (SAVR). The Evolut FX system is designed to provide ease of use and accuracy during the valve deployment procedure. It uses supra-annular valve design that has been proven to be superior in terms of hemodynamic performance in large-scale, randomised clinical trials.

5. Statin – 162 mentions

Coronary artery calcium (CAC) scoring aiding in statin decisions, and the possibility of an app replacing statin prescribing by doctors were some of the popular discussions on statin in Q3.

Yael L. Maxwell, senior medical journalist at Cardiovascular Research Foundation, shared an article on a study conducted to assess whether CAC scoring can help in making statin decisions among patients with risk of atherosclerotic cardiovascular disease (ASCVD). The Multi-Ethnic Study of Atherosclerosis (MESA) studied 1,688 patients at intermediate risk of ASCVD where 42.8% of them had zero CAC score. The study found that CAC scoring was helpful in reclassification and discrimination of the incidence of ASCVD. CAC scoring may, therefore, serve as a supplement to risk-enhancing factors that are used to determine the individuals who are at risk of ASCVD and who would benefit from statin therapy.

Another tweet that mentioned statin was by Michael O’Riordan on the possibility of an app replacing statin prescribing by doctors. A web-based decision tool is capable of detecting whether moderate-risk patients are eligible for statin therapy or not, according to a study conducted by researchers from the Cleveland Clinic in Ohio. Earlier attempts to make statins available for over-the-counter (OTC) use have failed as the FDA rejected such proposals due to safety concerns.

The CREST study examined the efficacy of AstraZeneca’s web-based application using the guidelines issued by the American College of Cardiology/American Heart Association (ACC/AHA) on cholesterol treatment to check patients’ eligibility to use statin medication rosuvastatin. The app uses patients’ details such as their medical history, medication use, blood pressure, and triglycerides, apart from high-sensitivity C-reactive protein (CRP) levels, and CAC score. The CREST study recruited 500 participants and found that the self-selection of statin therapy by patients using the app matched with doctor’s assessment in 96.2% of the participants.