Heart rhythm doc, writer for @Medscape, host of This Week in Cardiology podcast, editor of Sensible Medicine. The more you see, the harder medicine gets.
Louisville, KY
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Twitter thread coming on what @adamcifu @VPrasadMDMPH @AndrewFoy82 and I think is the BEST approach to pt care. This is ...
The Case for Being a Medical Conservative.
amjmed.com/article/S0002-934…
Thanks to the @amjmed for publishing this.
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To everyone on Twitter -- stop saying myocarditis is mild
From...
...someone who deals w the (sometimes late) complications of inflammation-induced scar in the heart
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Before I ReTweeted the former dean of Harvard medical school, I read every sentence of this paper.
It is persuasive.
Silence of the medical profession regarding the coercion of young people to take a potentially net harmful medical intervention is shocking
Wow. New paper makes strong case that COVID booster mandates in young adults (as in many US universities), caused net harm, and must be judged unethical. This should not have happened, and we should insist on accountability. @KevinBardosh @TracyBethHoeg @VPrasadMDMPH 👇
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As a cardiologist, I liken calling myocarditis 'mild' to the saying about 'minor' surgery.
Minor surgery is surgery on someone else.
Mild myocarditis only occurs in other folks' kids.
I love the COVID vaccine for at-risk adults, but for kids, we need more caution.
To put this into perspective, if we vaccinate 1 million 12-17 year olds, we could see 30-40 MILD cases of myocarditis. In this same 1 million, through vaccination we AVOID: 8,000 cases of COVID-19, 200 hospitalizations, 50 ICU stays & 1 death. The benefits far outweigh the risks.
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Wait
Is this graph wrong?
Cases skyrocketing
Deaths flat—for 4-5 months.
Not poking anyone, just asking.
#covid19
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The more that people ride bikes, the more hip fractures and cranial bleeds we will see.
The pandemic is essentially done.
Human life has to be more than avoiding one pathogen.
With respect...sir, please, stop.
The more people who gather indoors, the greater chance that someone could spread Covid and that someone else, perhaps with an underlying condition they're not aware of, could be infected and get seriously ill.
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There’s plenty to be worried about but the 💯 partisan vote on @DrJBhattacharya for NIH ranks high on the list.
If you want to heal science, how can 47 thinking humans vote against a proven academic and a Stanford professor?
Science should be apolitical. Come on, you all.
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It’s going to be difficult in the coming weeks but I think clinicians should try hard to stay apolitical in the public sphere. We owe it to our patients.
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Another paper chronicling myocarditis after mRNA #covid19 vaccine in 8 young people. 👇🏻
Some were admitted to ICU.
Also … FTR: troponin release = cardiac injury. ahajournals.org/doi/pdf/10.1…
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I seem to remember a time when the observations of doctors seeing patients in the hospital were widely accepted
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Private message from a #COVID19 hot spot. To mainstream media, @nytimes @WSJ @washingtonpost @propublica @charlesornstein This is a huge problem. Healthcare workers need PPE. Note .. many docs not allowed to speak candidly. Hence the private message. @califf001 @EricTopol
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We did not have an efficient healthcare system before ACA, but I believe it is far worse now. Far worse—if you care about actual health care.
I don’t have a sol’n but ACA is terrible. Every line below is reasonable.
The ACA was the greatest piece of legislation ever passed? Spare me.
Such a claim is not merely hyperbolic, it is historically illiterate. The Affordable Care Act passed in 2010, was not a triumph of reform but a masterpiece of political theatre and economic distortion.
It did not fix the American healthcare system; it calcified its worst features.
The ACA entrenched a reimbursement model that favors bloated health systems over independent medicine.
Through CMS, Medicare reimburses more for services rendered in hospitals and HOPDs than independent physician offices.
The consequence?
A wave of acquisitions.
Once nimble and patient-focused, private practices were absorbed by not-for-profit health systems looking to maximize revenue through arbitrage, not outcomes.
This is not reform, it is rent-seeking on an industrial scale.
Second, mandated coverage inflated prices while distorting risk. One of the ACA’s proudest boasts, essential health benefits, became its most economically illogical mandate.
Insurers were forced to cover services like maternity care for men and pediatric dentistry for retirees. Risk pools were distorted. Premiums soared. The healthy were penalized to subsidize the inefficient.
In pre-ACA America, a healthy 30-year-old could purchase catastrophic coverage for a few hundred dollars a month.
Post-ACA, that same individual faces a $1,200 monthly bill for insurance they neither want nor need. The state declared, in effect, that every American must buy a Mercedes, even if they only needed a bicycle.
The claim that “50 million Americans gained coverage” is semantically clever and substantively hollow.
Coverage is not care. The expansion of Medicaid, a key pillar of the ACA, placed millions into a program that few physicians accept and that delivers subpar outcomes.
The middle class, meanwhile, found themselves with narrow networks, enormous deductibles, and unaffordable care, all behind the illusion of a plastic insurance card.
This is the Potemkin village of healthcare: coverage without capacity, access without agency.
Finally, the ACA codified a cartel. Section 6001 of the law effectively banned the creation and expansion of physician-owned hospitals. Why?
Because physician-owned facilities outperformed corporate health systems in terms of quality and cost. The empirical record was clear. So, instead of fostering competition, Congress, lobbied by the AHA and its allies, shut it down.
Imagine a world in which Amazon had lobbied Congress to outlaw any new e-commerce startups after 2010 under the guise of “market stabilization.”
That is precisely what happened in healthcare. The ACA chose incumbency over innovation. It outlawed the insurgents and rewarded the monopolists.
In sum, the ACA is not a monument to progress, it is a monument to protectionism.
It preserved the oligopoly of legacy health systems, empowered insurers by mandating the purchase of their products, distorted prices, crushed physician autonomy, and locked out competition.
To call it the “greatest” legislation of our time is to mistake technocratic complexity for genuine reform.
It was corporate statism painted in the pastel colors of progressive compassion.
#healthcare
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Direct Messages like this feel like a tailwind on the bike. Cc @VPrasadMDMPH @sdbaral
#MedicalConservative
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Can We Discuss Flatten-the-Curve in COVID19? My Eight Assertions drjohnm.org/2020/05/can-we-d…
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If you open casinos, strip-clubs, bars and restaurants, how can you justify closed schools?
It boggles my mind.
Rich kids are in school.
Everyone needs to be in school.
Life is not risk-free. It isn’t March.
#COVID19
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Buzzkill view: the $ spent on this might be better spent on getting and retaining quality people. This is an American phenomenon. You don't see it in anywhere else. Places of healthcare should not look like elite airline lounges
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My Facebook feed is different from my Twitter feed. I rarely mix the two.
Today is different. Here is what I said to my friends on FB:
#aha19
#MedicalConservative
#RCT
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Before anyone gets sideways about cardiac MRI scans after recovery from #COVID19 ask yourself one simple question: how many scans have we done after recovered infections of other viruses? Science 101: YOU NEED A CONTROL GROUP.
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My friends
COVID or not. You must resist.
1+3 is not 13.
School is important.
Rational thinking must remain.
End/
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This is a really important paper. STEMI vs Non-STEMI thinking needs to go. It's "occlusion MI"
Here is the thing though: almost all of the occlusion MI NSTEMI's can be seen on the ECG--if people could read ECGs properly
Table 2 examples seem so obvious to me. Not because I am smart, but because ECG reading was a top priority at Indiana U.
We just published this in The Journal of the American College of Cardiology -- Advances (JACC Advances) "State of the Art Review". It is a REALLY interesting read, using quotes from Thomas Kuhn's book "The Structure of Scientific Revolutions" (the book that coined the word "paradigm" and "paradigm shift"). Here is the first quote: “Scientific revolutions are inaugurated by a growing sense, again often restricted to a narrow subdivision of the scientific community, that an existing paradigm has ceased to function adequately in the exploration of an aspect of nature to which that paradigm itself had previously led the way.” —Thomas Kuhn
Full text pdf: pdf.sciencedirectassets.com/…
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The fastest way to lose trust (in the clinic) is to be overly certain in the face of obvious uncertainty then double down and appeal to authority in the face of reasonable questions
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The problem w mandating masks on toddlers is not so much the harm to toddlers, who, I suspect, are resilient, it's the utter shredding of trust in public health.
People are like: if you truly believe masks in daycare do anything, how am I supposed to believe anything you say?
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Two things about basic medical practice; Interns learn these in their first month:
1) Never do a test if it won’t change what you do post test.
2) Always tailor therapies based on harms/benefits of an individual
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It boggles my mind that seemingly smart people in the CDC think two-year-olds should (or could) wear masks.
Nonsense like that shreds public trust. Why can’t they understand that?
Unfortunately the CDC's guidance is clear that 2 year olds and up must wear a mask.
Apart from heartbreaking stories like this, toddlers still learning to talk also have to wear masks all day in childcare, etc.
I hope this is on the @CDCDirector's list of things to revisit.
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What this shows, with stunning clarity, is the massive divide b/w #COVIDTwitter and regular folk
Huge swaths of people have long ago made their decision on risk tolerance.
To me, it seems bold, but is this not the “public” part of public health?
#vaccineswork
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"Percent of fully vaccinated people who were hospitalized?”
0.0008%
What has happened to risk tolerance and numerical literacy in our country?
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STRONG HF changes everything we do after admission for HF. I mean EVERYTHING!
Look at how they did it> More not less care.
How are we going to do this? #aha22
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If you want the public to trust science, stop citing BS studies. And oppose the Twitter policy of removing Tweets you don’t agree with.
I’m not sure why smart people can’t see that science’s trust problem is hubris. Be honest w people about uncertainty.
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Literally every single stent trial finds that “fixing” this lesion does not reduce mortality or MI. Here is the Courage trial, but there are more. nejm.org/doi/full/10.1056/NE…
We should have @CommunityNotes on this. @DavidLBrownMD @AndrewFoy82 @RFRedberg h/t @bogdienache
Another life saved by the CT scan! This is what 90% blockage looks like. 50, vegetarian, no alcohol, exercise, no symptoms, ldl cholesterol 90 (in the green). Took the scan, got a stent & avoided the silent killer. Do the same. $150 & 15 mins can save your life! 🤍🙏
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Well, well…
Another report of mRNA vaccine-induced Myocarditis in young males.
Incidence low, but more than expected.
Are we sure we should be mandating #COVID19 vaccines in younger age groups? jamanetwork.com/journals/jam…
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Thread: To me, the most stunning report from #ESCCongress thus far: RATE-AF trial
Older pts w/ permanent AF + shortness of breath. (there are lots of these pts).
Rate control is crucial
In 2020, most receive beta-blockers.
But BB can cause dyspnea.
What about dig?
Gulp! 1/
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Many ideas in medicine and science were accepted as true. Until they weren’t.
Lack of humility inside the gates of the institution shock me.
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For those not familiar w medical jargon, torsades-de-pointes is French for polymorphic ventricular tachycardia. Translation: the main “side effect” of hydroxychloroquine/azithromycin is sudden cardiac DEATH. Which is exactly why Fauci says we need proper trials. #COVID
Long time since I’ve seen torsades-de-pointe!Careful out there! Please educate your cummunity on the the use of #Hydroxycloroquine #COVID—19! @drjohnm @EJSMD @PrashSanders @MihailChelu @NazemAkoum @andreanatalemd @aalahmadmd
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EBM 101:
New AF drug given twice daily fails to meet its primary endpoint in pivotal trial.
No worries.
We just approve it at three times daily b/c giving more of something that doesn’t work usually does the trick in
biomedicine
#2+2=5
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Med journal sent me a new editorial:
Reducing the Risks of Nuclear War —The Role of the Health Professional
👆I struggle w this. To me, healthcare people would do well to focus on treating the ill. Journals might focus more on better adjudication of science
Am I wrong?
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This may be one of the most important pieces of content @medscape has ever published. What if we are doing it wrong in the treatment of #COVID19? What if @cameronks is correct? medscape.com/viewarticle/928…
Thread
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Congratulations @VPrasadMDMPH and @US_FDA and @MartyMakary
If you care about evidence-based practice, there’s no better choice than VP.
This is a win for US healthcare and a giant step forward in regaining lost trust
We endorse Professor Prasad 👇🏻
A little breaking news on @Sensible__Med
Vinay Prasad, Director of the Center for Biologics Evaluation and Research (CBER) at the US FDA
sensible-med.com/p/sensible-…
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I am pro-vaccine. I encourage my adult pts to take it.
But the lack of stratification by age and gender, which obviously hides the vax-myocarditis signal, tempts one to be cynical about science adjutication.
While mRNA vax are amazing this study has fooled many.
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Imagine a society that was accustomed to science being presented in apolitical neutral ways.
Imagine a society taught to embrace the uncertainty of science—as the NORM
In this world, there would be no need to fear nor censor anecdotes—from either a disease or its treatment
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Serious question for #COVID19:
Have we moved past the point of counting cases?
Wouldn’t counting hospitalizations be more relevant for decision making?
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Mind-boggling COVID insanity
"All but 8 were vaccinated, and the vast majority are asymptomatic. A small number have minor, cold- and flu-like symptoms, and none have been hospitalized.."
Why are we testing healthy kids?
#DELTA is literally everywhere!
#WeHaveToLiveWithIt
Duke implements an OUTDOOR mask mandate after students test positive with at most mild cold like symptoms
What is the goal? And
Why recommend something that doesn't work for any goal?
google.com/amp/s/amp.newsobs…
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There is no conspiracy among doctors to make people sicker.
We thrive when we treat sick people. It is our job. It is when medicine is most pure.
Everyone gets sick. You are lucky to have a good doctor.
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Sometimes I do Twitter like I did criteriums: I get excited and make mistakes.
Here were two big ones. I regret them but want to own them.
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Asked my Dad if he got #COVID19 vaccine. (He’s in his eighties).
He said a couple weeks. I’ll wait my turn.
Meanwhile I’m surrounded by subspecialists in their 30s/40s who are soon to get second shot.
Is this right?
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News organizations like @propublica will be crucial in sorting out the lessons from the #COVID19 crisis. This report on CDC emails tells a shocking story.
propublica.org/article/inter…
Caroline Chen is smashing it.
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If @US_FDA and @MartyMakary brought back @VPrasadMDMPH it would cause a huge boost of trust.
Nothing helps trust more than recognizing a mistake, adjusting and then changing course.
Fingers crossed.
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Literally … within minutes of the email, the office is almost devoid of face coverings
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I love this essay. Every paragraph. My medical colleagues should also read it.
We are doctors, and that is all.
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Good morning friends.
A reminder that our most amazing therapies in modern Medicine, for instance, insulin, antibiotics, pacemakers, can sometimes cause harm.
That a therapy has an adverse effect does not diminish its value.
Adverse effects are normal.
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I could not agree more with this 👇🏻
Every time a clinician w 20+ yrs experience retires early healthcare loses
About the time that clinicians reach mastery, mid-level managers run them out.
It’s like the exact wrong thing
The hubris of outsiders w solutions is shocking.
This is correct, just training more doctors won't help with the scarcity of physician labor.
So why aren't we discussing ways to keep the active workforce in practice?
With increasing administrative burden and decreasing reimbursement, it's no wonder more and more doctors are taking early retirement. You're burning out the established, high-quality, doctors, the ones who order fewer tests and perform fewer procedures.
Be they retired or in consulting, I've never met a doctor who left clinical medicine and regretted the decision.
The modern healthcare system, run by bureaucrats and administrators, takes young physicians, chews them up, destroys their will to continue practicing, and then wonders why physician labor is so scarce.
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This is what I mean.
It’s damn curious.
If this were a cardiology or cancer issue we could have a rational discussion.
Why not for #COVId19
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PSA for COVID19 Rx
Don’t use flawed observational data to start giving potent anticoagulation to sick pts with COVID19. Even if it is published in a big journal
onlinejacc.org/content/early…
Read Immortal Time Bias.
Here is a COVID pt treated with “preventive AC”
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I had successful neurosurgery last year.
The number of papers my surgeon had published meant exactly ZERO.
Papers as a metric for doctors is a bad idea. Very bad.
No more step 1 scores! Yay
No more clerkship grades! Yay
Wait, now selective programs will use other metrics to choose👇👇.
Who could have seen this coming!
Next we will do away with papers, and students will join 32 clubs to get into nsx.
😉
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I lost the stent debate tonite. I showed evidence. The neg RCTs: Courage, Rita-2 Bari2D, Orbita etc. It didn’t matter. My opponent told scary stories, and then he showed a prox LAD lesion. All the audience wanted the stent. Facts don’t persuade. @ProfDFrancis @ScottAdamsSays
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The AQUATIC trial may be the most definitive trial of #ESCCOngress
The common combo of ASA and OAC for pts with CAD/stent and AF is clearly been harming people. Lots.
MACE worse, Death worse, Bleeding way worse.
STOP THE ASA when on OAC
nejm.org/doi/full/10.1056/NE…
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This beautiful note is on a nurse-manager’s door on one of our wards. #truth cc @AllenFrancesMD @PlenarySessShow @AndrewFoy82
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Ending DTC pharma advertising
Opening outcome databases
Reviewing peer review processes at major medical journals
These are bad ideas?
These seem like good ideas to me. Where am I wrong?
You love DTC ads? Closed data? And peer review is bias-free???
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Really important point, not only about SSRI, but lots of other meds. Good paper.
Our new paper shows Randomized trials of SSRIs run for 8 wks but people take them 8 years. This is an evidence based disaster. We have no idea what the effect is 8 yrs later. @SecKennedy
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Please don’t tell me social media has not upended #MedEd. Twitter, YouTube, Podcasts transformed early #COVID19 care—for the better. Superb, important, piece on stopping the harmful early intubation practice. By @strauss_matt spectator.co.uk/article/vent…
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I can’t explain this observation. Seriously. I can’t.
Most viewed in the last 7 days from @JAMACardio:
Declines in HF-related mortality from 1999 to 2012 have been entirely undone by reversals from 2012 to 2021, meaning that contemporary HF mortality rates are higher than in 1999.
ja.ma/3yduCaX
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Due to research I’m part of, I know this is true👇🏻
Why haven’t we published it? We’ve been trying!!!
Stay tuned.
Also… you can be pro-vaccine (I am) and totally open about the different harm/benefit vax tradeoffs for young people. Thx WG.
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Way to gain followers during the pandemic: bash the US. Promote fear. Consider every #COVID19 case as a stab in the heart. Be certain.
Way to lose followers: accept that this is a dastardly difficult pathogen, consider it as just another disease, be uncertain, ask questions
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What an endpoint!
Sacubitril-Valsartan significantly reduced cardiotoxicity due to anthracycline chemotherapy in high risk pts at 24 weeks clinicaltrialresults.org/wp-…
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Perhaps a controversial opinion —
Dear colleagues in cardiology:
Your pictures celebrating first implants of “procedure X” along w shiny-happy industry peeps are unbecoming
A) It’s borderline re -HIPAA
B) You’re being used as advert
C) It’s tacky
#EPeeps #CardioTwitter
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The more I look under the hood of medical science, the more convinced I become that it is incompatible with profit motive and politics.
It's sad. I wish I didn't feel this way.
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Just want say — cardiology is on the brink of a MAJOR development
Stay tuned. Column coming.
To make it even sweeter: cardiac pacing, yes, bland old pacers, not fancy ablation, or stents, or valves, are a central theme
And … sit down.
Also key: basic physiology!
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Not only in finance— one of my themes in critical appraisal talks is to show how docs were fooled in the past.
Almost always it was hubris. And failure to learn from history.
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When I criticize a flawed #COVID19 study, it is not because I am anti-mask or anti-lockdown or anti-whatever.
It is that publishing and promoting dubious studies further undermines public trust.
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The most shocking trial in modern cardiology continues to find no signal of PCI benefit, despite enrolling pts most likely to benefit.
How the “clogged pipe” frame of thinking persists despite such evidence amazes me.
In an analysis of REVIVED-BCIS2, #PCI did not improve hierarchical composite of death, HHF, & health status at 2 yrs, although did improve short-term KCCQ-OSS (not sustained). PCI should not be recommended to improve long-term health status. bit.ly/3ZH6sBJ
#JACCHF #HeartFailure @DrMattRyan @divaka_perera @markcpetrie
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Grandson # 4.
Baby Georgie
I just told him there was this pricy cardiac drug that looked GREAT in a subgroup but the primary endpoint was nonsignificant. 👇🏻👇🏻
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If every CT scanner in the US broke down for a year, heart disease deaths would not change.
The prevalence of soft thinking amongst doctors is shocking
aafp.org/pubs/afp/issues/201…
Coronary artery calcium scoring has revolutionized cardiovascular prevention. But in women, it sometimes underestimates the risk. Full article linked below.
bit.ly/3IuO3Sp
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What do people think happens in a room of toddlers during nap time and lunch when they are breathing on each other. Does aerosolized SARSCOV2 stop circulating at lunch and nap?
Trust is easy to lose.
Thanks @bergerbell -
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My sister is a principal at a big (public) high school adjacent to a big American city.
How’s virtual school going?
-> 42% of the entire school has F’s.
Teachers—- be like nurses, respir techs, docs, bus drivers, grocery workers— go back to teaching.
You are essential
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IMHO: The masses of medical people on Twitter speculating about the president’s condition with no reliable information is ...kinda sad.
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Really enjoyed this balanced piece from @VPrasadMDMPH on the folly of masking young children.
Thx for being a tireless voice of reason
(Thought you would have mentioned the study showing SARSCoV2 stops circulating during naps and lunch break)
theatlantic.com/ideas/archiv…
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I study medical evidence. And the #COVID19 vaccine data is stunningly strong.
Bayes Factor (PFE) ≈ 30 zeros
So I concur w @VPrasadMDMPH and @NateSilver538
Post-vaccine, let people be normal.
Messaging has to be about more than virus avoidance.
Think #tradeoffs
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I have decided. No cardiology (or EM) trainee should be credentialed unless they can pass a simple ECG reading course. I am sorry, but the ECG read is often a life or death test. It costs a few dollars and is done in seconds. Maybe AI will get there, but it is not there yet. And AI will not be able to use prior Pb distribution;
This is a really important paper. STEMI vs Non-STEMI thinking needs to go. It's "occlusion MI"
Here is the thing though: almost all of the occlusion MI NSTEMI's can be seen on the ECG--if people could read ECGs properly
Table 2 examples seem so obvious to me. Not because I am smart, but because ECG reading was a top priority at Indiana U.
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“He was ultimately diagnosed with SVT”—> a benign non-life-threatening condition.
Shameful marketing/reporting
H/t @cardiobrief
Another life was saved by an #AppleWatch, this time a teen athlete in Oklahoma was alerted to an unusually high heart rate while in class. appleinsider.com/articles/20…
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#Medtwitter
#FOAMed
The most important medical study of the last 50 years is… (and why)
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A really important editorial in JAMA regarding the next big area of low-value, potentially harmful intervention -- on tricuspid regurgitation.
Every paragraph is spot on.
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One of the concepts I try to keep in mind while thinking publicly, and speaking with patients, is that you have to be able to hold opposing viewpoints in your brain and still function
A brief thread
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Agree…clear signal of a rare but serious complication in an age group who has little to fear from SARSCOV2
My gosh … if this were not so polarized it would be a classic case for shared decision making.
That this vaccine could be *mandated* by schools (now) boggles my mind.
ACIP's slides on mRNA vaccines and myocarditis are now available cdc.gov/vaccines/acip/meetin…
Hard to argue this isn't causal
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#Exercise is the most underused intervention in all of Medicine
I’m no expert, but I would have thought the best way to improve exercise tolerance in heart failure, is to increase tolerance of exercise? Rather than a pill....
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Huge respect for EM docs. Perhaps the hardest job in Medicine
Emergency medicine is a lifestyle, not just a job.
You’ll see the sickest patients, the worst luck, and the darkest corners of humanity—& still be expected to smile, move fast, and get it right every time. A thread on what they don’t tell you about EM. 🧵
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The biggest gain from Paxlovid, IMO, ought to be to teach the public the all-important concept of external validity of trials
So often, trials are held up as gold standards but don't necessarily apply to our particular patient
1/n
When you give Paxlovid to someone who's had three or four shots, you have no randomized data to hang your hat on
Then you get rebound. And you have no idea whether to restart, give a longer course, or if it didn't help at all.
Evidence-based medicine failure.
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This week, our hospital (medium sized city in Middle America) has had the lowest numbers of COVID since the pandemic. Period.
Our neighboring hospital system (slightly bigger) had ZERO intubated COVID patients.
I think this is (partly) why 👇
U.S. nursing homes, where penetration with Covid vaccines has been very high, continue to show sharp declines in new cases and bad outcomes.
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I’ve been thinking and reading a lot about the 1- vs 2- shot vaccine debate. I see and understand both arguments.
Truth: I really don’t know.
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Study of the year?
Here… 29 teams of scientists analyzed the SAME dataset asking the SAME research question and came to widely disparate statistical results. Wow. > from @BrianNosek
et al journals.sagepub.com/doi/10.…
#EyesOpen
#BigData
#FOAMed
#EmbraceUncertainty.
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If I had only 1 EP pro-tip for hospital docs >>
In patients w co-morbid conditions, #AFib is often a bystander, not the main problem. AF demands an explanation— and fixing that problem is often the key to making the patient well
#MEDED
#cardiotwitter
cc @medicalaxioms
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