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. 2024 Mar;17(3):e010664.
doi: 10.1161/CIRCOUTCOMES.123.010664. Epub 2024 Feb 16.

Why Does a Cardiologist Believe in a Therapy? The Role of Intuitiveness and Understanding the Mechanism

Michael J Foley  1   2 , Christopher A Rajkumar  1   2 , Fiyyaz Ahmed-Jushuf  1 , Alexandra N Nowbar  1 , Florentina Simader  1 , Olamide Bello  1 , Rasha Al-Lamee  1   2
Affiliations

Why Does a Cardiologist Believe in a Therapy? The Role of Intuitiveness and Understanding the Mechanism

Michael J Foley et al. Circ Cardiovasc Qual Outcomes. 2024 Mar.
No abstract available

Keywords: United Kingdom; cardiologists; myocardial infarction; percutaneous coronary intervention; randomized controlled trials.

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Conflict of interest statement

Disclosures M.J. Foley, C.A. Rajkumar, and Dr Al-Lamee have received speakers’ honoraria from Philips Volcano and Menarini Pharmaceuticals. Dr Simader has received speaker’s honoraria from Servier Pharmaceuticals. The other authors report no conflicts.

Figures

Figure 1.
Figure 1.
The relationship between intuitive mechanism score and subjective efficacy score for the interventions in the study. The blue line represents the trend line for the relationship and the pink shaded area represents the 95% CI. Points are shaded green if the intervention has been tested in at least 1 phase 3 randomized controlled trial, which was positive in favor of the intervention for the prespecified primary end point. Superiority trial designs and a placebo-control group if the measured outcome was subjective were required. If these data are not available, the points are shaded red. This survey was conducted in 2021 that predated the recent publication of ORBITA-2 showing placebo-controlled evidence of angina relief with PCI. AF indicates atrial fibrillation; AS, aortic stenosis; AVNRT, AV nodal reentrant tachycardia; AVR, aortic valve replacement; CABG, coronary artery bypass grafts; CRT, cardiac resynchronization therapy; CSR, coronary sinus reducer; EECP, enhanced external counterpulzation; HCM, hypertrophic cardiomyopathy; HFrEF, heart failure with reduced ejection fraction; HTN, hypertension; ICD, implantable cardioverter defibrillator; LAO, left atrial appendage; MR, mitral regurgitation; PCI, percutaneous coronary intervention; PFO, patent foramen ovale; PPM, permanent pacemaker; Revasc, revascularization; STEMI, ST-segment–elevation myocardial infarction; TAVI, transcatheter aortic valve implantation; and VE, ventricular ectopic.
Figure 2.
Figure 2.
A graphic representation of the postulated interaction between mechanistic intuitiveness and efficacy. The green upper right-hand panel represents interventions, which are both mechanistically intuitive and have been demonstrated to work in an RCT with an appropriate control. An example of such a therapy is primary percutaneous coronary intervention (PCI) in ST-segment–elevation myocardial infarction (STEMI). The red lower left-hand panel represents unintuitive therapies which have not been demonstrated to work. These therapies have been abandoned in most cases, an example being laser myocardial revascularization for angina. The amber panels represent therapies where the mechanistic intuitiveness of the therapy and the randomized data to support it are discordant. Contemporary examples are embolic protection devices for prevention of stroke in transcatheter aortic valve implantation (TAVI) and Coronary Sinus Reducer for angina.
See this image and copyright information in PMC

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