EP 149: The Placebo-Controlled Revolution: Redefining Evidence in Device Trials

In this week's episode of Parallax, Dr Ankur Kalra welcomes Prof Rasha Al-Lamee, interventional cardiology consultant and professor of medicine/cardiology at Imperial College London, and deputy editor of JACC. Prof Al-Lamee has transformed interventional cardiology through her pioneering work on the ORBITA trial series and coronary sinus reducer device studies, introducing the paradigm-shifting concept of sham-controlled device trials to the field. What makes a clinical assumption worth questioning? How do we design trials that reveal truth rather than confirm bias? When does revascularization truly benefit patients with stable angina? Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Guest: @RashaAlLameeMD Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this episode of Parallax, Dr Ankur Kalra welcomes Dr Sarah Matt, Associate Clinical Professor at Upstate Medical University, health tech strategist, and author of the newly released The Borderless Healthcare Revolution. Dr Matt brings a unique perspective shaped by her experience both in academic medicine and as a former Oracle employee, positioning her at the intersection of clinical care and healthcare technology innovation. https://www.drsarahmatt.com/ This conversation explores the inflection point facing today's generation of physicians—a cohort that has navigated the evolution from paper charts to sophisticated EMRs, and now stands at the threshold of AI-driven healthcare transformation. Dr Matt offers actionable guidance for both healthcare delivery leaders and "builders" creating new technologies, emphasizing that improving access must be integrated from inception rather than retrofitted. She shares her vision for removing financial barriers entirely and provides practical checklists from her book to help clinicians make meaningful impact while combating burnout. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this week's episode of Parallax, Dr Ankur Kalra welcomes Dr Courtney Maxey-Jones, Director of the Coronary Care Unit at Upstate University Hospital and a cardiac anesthesiologist intensivist by training. Dr Maxey-Jones co-founded and serves as Chief Operations Officer of GOMED, a not-for-profit organization transforming how we think about medical device waste and global healthcare equity. Dr Maxey-Jones shares the origin story of GOMED - born from witnessing the staggering waste generated in cardiac operating rooms, where expensive single-use devices are discarded due to expiration dates or changing surgeon preferences. Together with her partners, cardiac surgeon Dr Farhan Nadeem and physician assistant Connor Wasilnak, they recognized an extraordinary opportunity to make use of these waste items. Dr Kalra and Dr Maxey-Jones examine the ethical complexities of equipment reuse, the critical unmet needs for EP devices and cath lab equipment internationally, and GOMED's innovative partnership with Syracuse University biomedical engineering students to develop low-resource autoclaves. This episode reveals how observation of systemic waste evolved into a sustainable model for global cardiovascular care equity. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In the latest episode of Parallax, Dr Ankur Kalra welcomes Dr Martha Gulati and Dr Anu Lala for a groundbreaking conversation about reimagining heart failure prevention across the entire disease spectrum. Their discussion centres on an innovative scientific statement developed collaboratively between the American Society of Preventive Cardiology and the Heart Failure Society of America - a document that challenges conventional approaches to cardiovascular disease prevention. Dr Gulati and Dr Lala make a compelling case for expanding prevention beyond atherosclerotic cardiovascular disease (ASCVD) to encompass heart failure, a condition affecting one in four individuals over their lifetime. They introduce the American Heart Association's Cardio Kidney Metabolic (CKM) health framework as a superior model for identifying at-risk patients, explaining how this approach shifts focus from disease management to health optimization. The conversation explores practical implementation strategies, including the new PREVENT risk score, which integrates critical heart failure risk factors like obesity and chronic kidney disease that traditional assessment tools overlook. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this essential episode of Parallax, Dr Ankur Kalra welcomes Dr Monica Tincopa, Assistant Professor of Medicine at the University of California San Diego, for a crucial conversation about Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and its profound implications for cardiovascular care. Dr Tincopa guides listeners through the recent transformation from NAFLD to MASLD, explaining why this nomenclature change represents more than just terminology, instead reflecting a deeper understanding of metabolic health that directly impacts cardiology practice. The conversation explores practical screening strategies that cardiologists can implement immediately, including the use of FIB-4 risk stratification and recognizing incidental findings on cardiac imaging. Dr Tincopa shares insights on when to refer patients to hepatology specialists and how the shared risk factors between MASLD and cardiovascular disease create opportunities for comprehensive patient care. This episode equips cardiologists with essential knowledge to identify at-risk patients within their existing practice, understand the cardiovascular implications of liver disease, and optimize care coordination for patients with overlapping metabolic conditions. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this evidence-packed episode of Parallax, Dr Ankur Kalra welcomes back Dr Purvi Parwani, Associate Professor of Medicine at Loma Linda University Health, for a comprehensive review of groundbreaking trials presented at the European Society of Cardiology Congress. Dr Parwani guides listeners through what she describes as a "tectonic shift" in post-MI care with the REBOOT and BETAMI-DANBLOCK trials. These studies challenge the routine use of beta blockers after heart attack, revealing that patients with preserved ejection fraction above 50% may not benefit, while those with EF between 40-49% show significant risk reduction from continued therapy. The discussion moves to heart failure management, exploring the POTCAST trial's approach to optimising potassium levels in high-risk patients and the DIGIT-HF trial's examination of digitoxin as a potential option for patients who cannot tolerate modern four-pillar therapy. Dr Kalra and Dr Parwani conclude with the evolving role of aspirin in cardiovascular care. They discuss findings from NEO-MINDSET, TARGET-FIRST, and the AQUATIC trial, which together are reshaping antiplatelet strategies from the immediate post-PCI period through long-term management of stable coronary disease in patients requiring anticoagulation. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this episode of Parallax, Dr Ankur Kalra speaks with Dr Benjamin A D’Souza, Associate Professor of Medicine at the University of Pennsylvania and Section Chief of Cardiac Electrophysiology at Presbyterian Medical Center. Together, they explore the challenges of mitigating sudden cardiac death and the evolving role of guideline-directed medical therapy in optimising patient outcomes. Dr D’Souza reflects on current strategies for risk assessment and prevention, highlighting the importance of medical therapy, careful monitoring and timely use of defibrillators. He stresses that management must be tailored to individual patients, with decisions guided by evidence, imaging and multidisciplinary collaboration. The conversation also turns to women’s cardiac health and representation in electrophysiology. Dr D’Souza highlights the persistent under-enrolment of women in clinical trials and their lower access to ablation and device therapy. He stresses the need for inclusive trial design, mentorship and acknowledgement of systemic bias to improve equity in cardiovascular care. This series is supported by ZOLL and is intended for Health Care Professionals.

In this fascinating episode of Parallax, Dr Ankur Kalra sits down with Dr Alexander Fanaroff, an interventional cardiologist, clinical trialist, and behavioral economist at the University of Pennsylvania. Dr Fanaroff brings a unique perspective to cardiovascular medicine, combining his expertise in interventional cardiology with cutting-edge insights from behavioral economics to transform how we approach patient care and clinical decision-making. Dr Fanaroff demystifies behavioral economics for the medical community, explaining how this field studies real-world decision-making beyond traditional economic models. He introduces key concepts like status quo bias, prospect theory, and the power of defaults in shaping both physician and patient behaviors. Through compelling examples, including Penn's successful intervention that increased 90-day statin prescriptions from 70% to 90% simply by changing EHR defaults, Dr Fanaroff demonstrates how small design changes can yield significant clinical improvements. Looking beyond individual interventions, Dr Fanaroff discusses how behavioral economics can address healthcare disparities by creating system-wide improvements that lift all patients while specifically targeting underserved communities. He envisions a future where AI identifies at-risk patients from routine imaging, and where interventional cardiologists focus not just on procedural excellence but on ensuring optimal long-term medical management through thoughtfully designed care systems. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this essential episode of Parallax, Dr Ankur Kalra welcomes Dr Shelley Zieroth, Professor of Medicine, clinician-scientist, and advanced heart failure and transplant cardiologist in Winnipeg, Canada. As we mark the 10-year anniversary of the landmark EMPA-REG OUTCOME trial, Dr Zieroth provides a comprehensive update on how SGLT2 inhibitors have revolutionized cardiovascular care. Dr Zieroth takes us through the remarkable journey from the initial 2015 trial that transformed SGLT2 inhibitors from anti-diabetic agents into cardiovascular powerhouses, delivering highly significant reductions in cardiovascular death and heart failure hospitalization. She explores how these medications have become fundamental pillars of cardio-kidney-metabolic medicine, with evidence spanning the entire ejection fraction spectrum. Dr Zieroth discusses prescribing these agents in heart failure - including the straightforward 10-mg daily dosing, monitoring strategies, and crucial patient selection criteria. She shares insights from the recent EMPULSE trial on safe in-hospital initiation, addresses important considerations for diabetic patients, and highlights key contraindications like indwelling catheters that clinicians must recognize. Beyond the basics, Dr Kalra and Dr Zieroth examine the evolving role of SGLT2 inhibitors in valvular disease and diastolic dysfunction, tackle the ongoing reimbursement challenges across different healthcare systems, and discuss the critical importance of multidisciplinary collaboration in the cardio-kidney-metabolic space. They also look ahead to exciting combination therapies on the horizon that promise to further advance heart failure prevention and treatment. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

In this compelling episode of Parallax, Dr Ankur Kalra sits down with Dr Anandita Kulkarni, preventive cardiologist at Baylor Scott and White Heart Hospital, for an eye-opening conversation about addressing cardiovascular disparities in South Asian populations through the innovative Dilwale registry. Dr Kulkarni tells the story of returning to her Texas community to serve South Asian patients and her determination to create meaningful change through data. What started as a local initiative grew into something much larger: a comprehensive registry of over 31,000 South Asian patients that's revealing critical insights about heart disease in this underserved population. Beyond the clinical data, this episode delves into the practical challenges of culturally informed preventive care. Dr Kulkarni shares insights on addressing barriers to physical activity within South Asian communities, helping patients navigate dietary changes while respecting cultural food traditions, and the delicate work of motivating lifestyle modifications in a population already facing higher cardiovascular risks. Her patient-centered approach demonstrates how combining population-level research with deep cultural understanding can fundamentally improve both individual outcomes and community health. Questions and comments can be sent to "[email protected]" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts