Presidential Address 2019

Watch the entire presidential session on YouTube.

AHA President Bob Harrington, MD reviewed his career in cardiology and involvement with the AHA. Known worldwide for his work in the design, execution and review of randomized clinical trials, Dr. Harrington spoke on the theme that “evidence matters” and said that truth has shaped the evolution of cardiovascular and stroke science and patient care. He also noted that he was raised by a hard-working single mother who passed away too soon, at age 42, to sudden cardiac arrest. Along with that, a desire to figure out clinical problems sparked his career interests.

You are the future of our profession, Dr. Harrington said of the early career professionals attending the conference. An early adopter and eager user of social media, Dr. Harrington said conference organizers wanted #AHA19 to be an interactive experience for those professionals and all attendees. Appropriately, the session included a series of questions to the audience with answers given by phone and results promptly shown in a word cloud.

Funding is a perpetual challenge in the pursuit of evidence, Dr. Harrington said, and the AHA stands in that gap as the largest nonprofit funder of CV and stroke research outside the federal government. The AHA last year invested more than $180 million in more than 830 new research projects, with more than 75% of those going to early career investigators.

Reflecting on both his career and the evolution of CV research, Dr. Harrington noted that clinical trials involving medical products require the collaboration of industry. At Duke, he and his colleagues developed a system to coordinate global trials with appropriate independence in trial design, implementation and analysis of evidence, while still being collaborative with industry. He called for the creation of a nationwide healthcare learning system to address funding challenges and further advance research practices.

Dr. Harrington reviewed the AHA’s pursuit of its long-term goals, which resulted in a focus on the development of practice guidelines and quality improvement initiatives such as Get With The Guidelines, a program now in place in more than 2,500 hospitals in the US and hundreds more worldwide. These and other AHA initiatives were successful, Dr. Harrington said, though recent statistics reveal a plateau in CV and stroke-related deaths that began in 2014. While renewing its commitment to put those trends back in the right direction, the AHA is also embracing health equity and diversity goals, Dr. Harrington said. He noted that the male-female ratio in the CV field is unacceptably low, with fewer than 20% of US cardiologists being women and the numbers similarly imbalanced in the rest of the world. The AHA wants to change that and is pursing progress both externally and internally. The AHA’s Go Red for Women Science and Medicine Committee has set goals to identify and eliminate biases against women. At #AHA19, there were no “manels” (panels composed only of men), Dr. Harrington observed.

Returning to his main theme, he said evidence and the people producing it matter. While noting that technology advances have facilitated great progress in gathering data, technology-driven approaches need to be held to the same level of scientific scrutiny as drugs and devices. He said this is the most exciting time ever to be engaged in science because there are unprecedented ways to gather data at a scale and speed previously unimagined. His take-home message was that evidence matters in all aspects of treating CV disease and should be the basis for decision making.

Following Dr. Harrington’s speech, AHA CEO Nancy Brown provided a moving tribute to Kaiser Permanente Chairman and CEO Bernard J. Tyson; he passed away November 10 at age 60. When that occurred, Kaiser lost its leader, and the AHA lost a board member, Nancy Brown said. She added, “And I lost a dear friend.” She said she learned much from working with him and appreciated his many accomplishments; he is especially known for advancing preventative care. He will be missed for that and for the type of person he was.

"Bernard had a laugh and a smile that warmed every room he entered," she said, adding he "applied his powerful voice to address everything he considered unjust." He did that, she said, because he knew people needed him. With his words and actions, he left the world of healthcare better than he found it, and the fruit of his labors will be reaped for generations. She offered condolences to Mr. Tyson’s family and colleagues and paused with the audience in a moment of silence for her friend; this part of the session closed with her calling attention to presentation screens that listed the names and roles of AHA employees who have passed away over the past year.

Providing the keynote speech for the Presidential Session was Muratz Sönmez, head of the Center for the Fourth Industrial Revolution Network and a member of the managing board of the World Economic Forum. AHA CEO Nancy Brown is also a member of the Forum’s advisory board.

Mr. Sönmez told the audience that advances in artificial intelligence (AI) are transforming more than technology. AlphaGo Zero marks an important AI milestone. By playing games against itself, AlphaGo Zero surpassed the strength of AlphaGo Lee in three days by winning 100 games to 0, reached the level of AlphaGo Master in 21 days, and exceeded all the old versions in 40 days. Meanwhile, the OpenAI initiative backed by Elon Musk has attracted a $1 billion investment from Microsoft.

These advances have ushered in what’s called the AI blackbox problem. The algorithms generated from AI are not written by a human, but by machines. When these systems are implemented in many human activities, key questions emerge, such as ownership of intellectual capital and liability if the system creates problems. Governance mechanisms to harness AI are falling behind; we are working in a gray area called the “too late zone.”

There is risk a privileged few will take advantage of these developments. The gap between the privileged and others has been widening for 40 years. When people feel left behind, it is not right morally, socially or economically. The Fourth Industrial Revolution Network wants to ensure that benefits accrue to everyone.

AI needs data. By 2020, there will be 20 billion things - embedded devices in hearts, wearables, sensors, cars, drones, transformers, and satellites - providing data. There is an opportunity to combine lifestyle, environment and personal data to accelerate development and delivery of precise medical solutions.

When we are no longer constrained by the limits of human knowledge, there are opportunities and challenges. In medicine, does this put the scientific method on steroids, or provide an alternative mechanism? The advances and questions also apply in genetic engineering, synthetic biology, and in physical technologies such as drones.

Drones used in Rwanda saved the lives of more than 1,000 women by delivering blood supplies urgently needed in a geographically challenging region. However, regulatory and policy barriers initially prevented scaling this solution. It was difficult to monitor an industry where a new drone model emerges every 10 days. Two staff members from the Center for the Fourth Industrial Revolution, over only five months, worked with authorities in Rwanda to craft a performance-based drone regulatory framework that is now implemented in a dozen African countries and a model for other nations, including India and the US. Rwanda has become the first country to achieve zero loss rate in blood delivery. They have the largest network of civilian drones and their next frontier is AI.

Solving health problems requires sharing data from around the world. The Center for the Fourth Industrial Revolution is working with partner organizations, including the AHA, to address data access and sharing issues. A forward-looking data policy is in development where data remains where it’s collected and data owners decide what it's used for. Ethics must also be addressed and can be with an approach modeled after how insurance companies alleviated risk from fires with the advent of electricity. Circuit breakers were mandated. Smart contracts and block chain technology can perform a function like that to implement ethical frameworks that vary throughout the world.

Mr. Sönmez invited the audience to learn more and join in his organization's efforts.

In closing comments of the Presidential Session, AHA CEO Nancy Brown described current initiatives that are helping the AHA achieve its mission of being a relentless force for a world of longer, healthier lives:

• By engaging consumers in the effort to use wearable devices to capture health information, the AHA is accelerating medical discovery. In collaboration with Apple, Dr. Calum A. MacRae and Brigham and Women’s Hospital, the AHA recently launched the Apple Heart and Movement Study. The Apple Heart Study app uses data from Apple Watch to identify irregular heart rhythms, including those from potentially serious heart conditions.
  
  
• The AHA has launched a new Strategically Focused Research Network (SFRN) focused on understanding the link between CVD and diabetes.
  
  
• The AHA soon will fund $15 million in research in the field of cardio-oncology because the risk of death from heart disease is eight times higher in cancer survivors than in the general population.
  
  
• Edwards Life Sciences has committed $10 million to help the AHA improve the patient experience through quality improvement programming.
  
  
• Research Goes Red, a collaboration with Verily, will empower more women to participate in scientific research.
  
  
• The AHA announced a new $20 million research investment to study teen vaping and, at #AHA19, launched a campaign against the vaping industry called #QuitLying. An invited speaker was 16-year-old former vaper Katelyn Quezada; she read her open letter to “Big Vape,” in which she described her experiences with vaping, called for honesty from companies deceiving a new generation of smokers, and asked the audience to send a tweet to support the campaign. The National Football League is also joining the initiative.