Medical Grand Rounds featuring Dr. David Conen

Kyla Tozer, MSc Candidate (Translational Medicine)
 

Last week’s medical grand rounds were led by Dr. David Conen discussing a clinical case of perioperative atrial fibrillation. Dr. Conen is an internal cardiologist practicing in Hamilton, Ontario, and a Principal Investigator at the Population Health Research Institute at McMaster University. Dr. Conen obtained a Master of Public Health from Harvard University in Boston, USA, and a 2-year postdoctoral research fellowship in Clinical epidemiology. Currently, Dr. Conan is involved in two multinational clinical trials that focus on the preventing and treating of perioperative atrial fibrillation (AF) (COP-AF and ASPIRE-AF).

AF is the most common cardiac arrhythmia and is caused by an abnormal electrical pulse within the atria [1]. This irregularity can lead to abnormal blood flow within the heart and increases the risk of thrombosis and stroke [1,2]. Irregular heartbeat, shortness of breath, and diaphoresis are symptoms present in people with AF, Dr. Conen explained. AF prevention is similar to other cardiovascular diseases, and regular exercise and a healthy diet are recommended. The incidence of AF is rising in western societies, which Dr. Conen suggested that obesity and increasing cardiovascular survival may be to blame. [2]. Thus far, it has been found that increased inflammatory biomarkers high‐sensitivity C‐reactive protein and interleukin-6 are significantly associated with an increased risk of hospitalization and heart failure in patients with AF [3]. Pharmacological agents such as oral anticoagulants are a well-known preventative treatment for stroke, but how this therapy could help in perioperative AF is unknown.

The “Anticoagulation for Stroke Prevention in Patients with Recent Episodes of Perioperative AF After Noncardiac Surgery (ASPIRE-AF)” trial was a pilot study examining the efficacy of oral anticoagulation in the reduction of stroke and other adverse cardiovascular events, in patients with perioperative atrial fibrillation, after noncardiac surgery. Dr. Conen explained that this trial uses non-vitamin K anticoagulants as a preventative measure in a parallel assessment intervention model. 60mg of Edoxaban daily, 5mg Apixaban twice daily, 110 mg Dabigatran twice daily, or 20mg of Rivaroxaban daily are the pharmacological agents that can be used in this study. The control arm of this study is no anticoagulation unless the patient develops an indication for intervention [4]. Over the duration of this study, Dr. Conen explained patients are followed for up to 24-months and screened for adverse outcomes.

Finally, Dr. Conen’s discussed his clinical trial investigating anti-inflammatory agent, “Colchicine for the Prevention of Perioperative Atrial Fibrillation in Patients Undergoing Thoracic Surgery (COP-AF).” COP-AF is a placebo-controlled clinical control trial that will assess 0.5 mg of colchicine twice daily for 10 days in post-operative thoracic surgy patients. The primary endpoints are reduction of stroke and length of time in hospital.  Colchicine is an effective anti-inflammatory that has the potential to prevent perioperative atrial fibrillation post thoracic surgery [5].

This transitioned into some exciting news for Kingston and the surrounding area. Dr. Conen was excited to announce that as of Monday, November 15th, 2021, Kingston Health Sciences Centre will be a clinical site for the COP-AF clinical trial. This study will provide innovative care to patients in Kingston while expanding on the current research regarding AF. This study will include all patients > 55 years of age who are undergoing thoracic surgery under general anesthesia. Participants must be in sinus rhythm at the time of randomization [4].

After the medical grand rounds, the Translational medicine students had the pleasure of speaking with Dr. Conen about the differences in the Canadian and Swedish health care systems, the challenges and opportunities that accompany moving countries, and setting up his lab group and how he didn’t expect to end up in Hamilton, Ontario, but is happy he did. After the discussion, Dr. Conen gave some parting advice to the TMED students which focused on maintaining a passion for research.

On behalf of the TMED students I want to thank Dr. Conen for presenting at this week’s medical grand rounds and teaching us about the clinical trials currently in place to treat and prevent perioperative AF. We thank you for taking the time out of your busy schedule to speak with us [TMED students] about your journey and your advice on how to navigate in the competitive medical research.

References:

[1] Nesheiwat Z, Goyal A, Jagtap M. Atrial Fibrillation. [Updated 2021 Aug 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526072/?report=classic

[2] David Conen, MD MPH, Epidemiology of atrial fibrillation, European Heart Journal, Volume 39, Issue 16, 21 April 2018, Pages 1323–1324, https://doi.org/10.1093/eurheartj/ehy171

[3] Benz AP, Aeschbacher S, Krisai P, Moschovitis G, Blum S, Meyre P, Blum MR, Rodondi N, Di Valentino M, Kobza R, De Perna ML. Biomarkers of Inflammation and Risk of Hospitalization for Heart Failure in Patients With Atrial Fibrillation. Journal of the American Heart Association. 2021 Apr 20;10(8):e019168.

[4] National Library of Medicine (U.S.). (2019, May - ongoing). Anticoagulation for Stroke Prevention in Patients With Recent Episodes of Perioperative Atrial Fibrillation After Noncardiac Surgery (ASPIRE-AF). Identifier: NCT03968393. https://clinicaltrials.gov/ct2/show/NCT03968393

[5] National Library of Medicine (U.S.). (2017, October – ongoing). Colchicine For The Prevention Of Perioperative Atrial Fibrillation In Patients Undergoing Thoracic Surgery (COP-AF) (COP-AF). Identifier: NCT03310125. https://clinicaltrials.gov/ct2/show/NCT03310125