News in brief: Cardiovascular researcher recognised with AMA’s top honour; No NSAIDs for covid myocarditis; Carotid artery procedures driven by dollars, not evidence

Cardiovascular researcher recognised with AMA’s top honour

Prof. Emily Banks

One of Australia’s top cardiovascular disease researchers has been recognised for her work exposing the health impacts of e-cigarettes, after being awarded the AMA Gold Medal.

Professor Emily Banks received the award – the AMA’s highest accolade – for exceptional contributions to medicine and public health over her career.

It followed three decades of work in the UK and Australia, most recently as Professor of Epidemiology at the Australian National University, in which cardiovascular disease was a major focus.

Presenting the award on Friday, then-AMA president Dr Omar Khorshid said she was one of Australia’s greatest researchers and her work was only becoming more important.

“Her recent research has been extremely important and timely, as the tobacco lobby sought to hook younger generations through vaping; and has been conducted in the face of tobacco company opposition and political pressure,” he said.

“Time and again, Professor Banks has provided evidence to support action to safeguard health, and vaping is no exception.”

“As the industry has unscrupulously marketed to children, teenagers and young people, Professor Banks and her research team at the ANU have provided high-quality data the community, doctors and policymakers need to make truly informed decisions.”

The Cambridge-born epidemiologist and public health physician currently leads a project team of more than 20 researchers who have published multiple studies and papers assessing the global evidence on the risks of e-cigarettes.

Carotid artery procedures driven by dollars, not evidence

Decades of evidence show that lifestyle changes and medication are most effective in preventing stroke yet carotid artery procedures are still commonly undertaken globally, including in Australia, a Melbourne neurologist says.

In a review of  the evidence spanning four decades Professor Anne Abbott, a neurologist from Monash University, Melbourne, noted that carotid artery procedures made up a multi-billion dollar per year international industry.

“Procedural intervention is more common in countries with “fee for service” reimbursement where physician payment is proportional to the number of procedures performed,” she noted.

For example, in Australia it is estimated that 3,200 procedures are performed each year at a cost of $64 million.

“Stroke rates are now so low with non-invasive intervention alone that carotid artery procedures are unlikely to provide benefit to the vast majority of patients and have no current proven benefit for any patient,” she said.

According to Prof. Abbott it was essential that everyone, that included clinicians, keep in mind that not all strokes and other arterial complications can be prevented.

“The best that can be done is to choose the management strategy most likely to give the best chance of a favourable patient outcome (taking patient, intervention and service provider factors into account),” she wrote.

Using the principle of “first do no harm,” medical intervention is the gold standard by which invasive interventions must always be compared, she added.

Caution over NSAIDs for vaccine myocarditis

NSAIDs do not have a role in the treatment of myocarditis associated with COVID-19 and mRNA Vaccination, according to Australian cardiologists

The Queensland-based authors of a narrative review to guide clinical practice said that while widely used in cases of isolated pericarditis the use of NSAIDs in myocarditis is not currently recommended.

They said this advice was based on experimental data from animal studies indicating possible harm from NSAIDs in viral aetiologies of myocarditis. Furthermore, NSAIDs are generally discouraged in acute or chronic cases of heart failure, they added.

“The management of COVID-19 and the complications of specific organ involvement is a rapidly expanding area of medicine, and there are limited data on the treatment of COVID-19 and mRNA vaccination-related myocarditis,” noted Dr David Holland and Dr Tony Stanton of the Cardiology Department, Sunshine Coast University Hospital.

Their review concluded that management of patients with confirmed myocarditis in the setting of a preceding mRNA vaccination is largely supportive.

“Cases should be treated as for myocarditis from other causes, with guideline directed heart failure therapies if indicated, exercise restriction … and cardiology follow-up,” they wrote.

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