Doctors Helping Doctors (and Their Patients) Via Social Media

It was supposed to be a closed meeting attended by doctors who had a large amount of experience dealing with patients with St. Jude Riata leads, a defibrillator lead that recently garnered an FDA Class I advisory (recall) status due to it's high failure rate. Only 55 doctors and a few industry personnel were brought together to try to determine what to recommend to the rest of us who must deal with this problem in the outside (real) world.

It was 20 January 2012. I was doing an EP case at the time. When I emerged from the room to begin typing my orders, a tech said to me: "Hey, did you see this?"

It was a live Twitter feed from the meeting of one of the attendees - an electrophysiologist from Christ Hosptial in Cincinnati, Edward J Schloss, MD. In those tweets were a play-by-play of important discussions and the results of opinion polls fielded during the meeting. Here's what I saw:

20 Jan Edward J Schloss MD @EJSMD
At Riata ICD Lead Summit in Minneapolis.

20 Jan Edward J Schloss MD @EJSMD
35% of #StJude #Riata Summit attendees think this is a worse problem than MDT Fidelis.

20 Jan Edward J Schloss MD @EJSMD
41% of #StJude #Riata Summit attendees are concerned about Durata and are not implanting it.

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata US Multicenter Retrospective Trial Riata/ST. Overall failure rate intermediate between Quattro and Fidelis.

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata bench testing model shows good performance of externalized conductors with or without ETFE insulation breach.

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata Panel discussants repeatedly emphasize lack of data on natural history of lead. Difficult to reach expert consensus.

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata Lunchtime conversation: Concern that we're on the leading edge of failures with these leads. Problem apt to get worse.

20 Jan Edward J Schloss MD @EJSMD
#StJude #RIata Ellis-Vanderbilt series of Riata: 26% of leads had externalitzation flouro abnormalities.

20 Jan Edward J Schloss MD @EJSMD
#StJude @Riata 5 of 10 members of one expert panel use flouro screening routinely (in spite of HRS recommendation against this).

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata Epstein lecture on extraction points out the unique difficulties associated with this lead. Harder than Fidelis.

20 Jan Edward J Schloss MD @EJSMD
@DeltaAssist I'm booked on flight 3104 MSP to CVG tonight and Delta APP indicates delay with no alternative. Help?

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata Summit poll at completion: Concern went up - now 58% say Riata problem is worse than Fidelis (up from 35%).

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata Summit poll at completion: Concern went up - now 44% would not implant Durata (up from 41%)

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata Summit poll at completion: Concern went up - now 55% favor routine flouroscopy (up from 42%)

20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata Summit poll at completion: More conservative philosophy with externalized conductors 76% would not replace (up from 69%)

In reply to Paul Verrastro 20 Jan Edward J Schloss MD @EJSMD
#StJude #Riata Hauser wrap up: We need to look at Durata very closely "put it under the microscope." Calls on SJM to create trials

Edward J Schloss MD @EJSMD
@pjv2217 heading to airport.

(Dr. Schloss's full account of the meeting, with a link to the meeting's slides and St. Jude's response to the report, was published recently at the Cardiobrief blog.)

But what was remarkable to me about this whole affair is that a doctor took it upon himself to help report this important information to his colleagues. By doing so, he likely helped many more patients about to receive a new defibrillator system. After all, it is the doctors in concert with their patient, who ultimately must choose which ICD lead gets implanted when a defibrillator is installed.

My hat's off to Dr. Schoss.

-Wes