ACC leaders point to wearable technology, possible changes in stenting practices, national legislation for energy drinks, expanded use of minimally invasive cardiac repair, and a new cholesterol-lowering drug as expected to be the big news in the cardiovascular field in 2015. Let’s wait and see if the following events will occur in 2015. Wearable Technology for Healthcare Monitoring As wearable technology devices and software become more sophisticated and their use increases, the use of such technology to monitor an individual’s health outside the office will play an increasingly important role in healthcare, allowing medical staff to integrate readings from the device into the patient’s office visit. The Apple Watch was announced in September. The watch measures pulse and tracks the duration and type of movement through its sensors. Paired with a new app, it integrates data from different wearable devices and shares it directly with the patient’s doctor. Microsoft Band, Fitbit and Garmin are already popular with consumers to better track their health, and their use will continue to grow as the field continues to innovate. Changes in Stenting Practices The risks, benefits and timing of complete revascularization after myocardial infarction will continue to be a topic of debate and discussion, and this treatment strategy may involve the practice of stenting multiple arteries. Two recent studies – PRAMI in 2013 and CvLPRIT in 2014 – showed a better prognosis for stenting of all obstructed vessels to open the vessel at the time of myocardial infarction treatment. The latest guidelines, based on previous studies, recommend initial treatment only for myocardial infarction-related obstructed vessels. The guideline writing panel will consider the latest research on complete revascularization and other related issues. Eligibility Recommendations for Athletes with Cardiac Problems The long-awaited recommendations for athletic participation in young athletes with cardiac problems will likely be updated as early as mid-2015. Recommendations for eligibility and disqualification of competitive athletes with cardiovascular abnormalities were first published in 2005 in the 36th Bethesda Congress Report. This document provides recommendations for eligibility, provisional or permanent disqualification of athletes with cardiac problems from competitive sports; it also discusses doping and dietary supplements, diagnostic testing strategies, legal considerations and other topics. Expanded Use of Minimally Invasive Cardiac Repair As an alternative to direct cardiac surgery, transcatheter aortic valve replacement has been available in the United States for non-surgical patients since 2011 and for high-risk patients since 2012. This procedure involves inserting a catheter into an artery and implanting a new valve into the heart to replace the stenosed aortic valve, and in 2013 MitraClip was approved for a similar treatment to repair mitral regurgitation. To date, these new cardiac repair options are only available for high-risk patients, including those deemed too weak to undergo surgery. All patients who received these treatments have been followed in the STS/ACC TVT registry. Regulatory agencies and physicians will review patient-related information and may use minimally invasive treatments for more patients. Other devices for other heart problems may become available. Another new anticoagulant The FDA is expected to decide in early 2015 whether to approve edoxaban for use. This would be the fourth drug on the market that could replace warfarin. Warfarin has been widely used for decades for stroke prevention in patients with atrial fibrillation. The FDA advisory panel recommended approval of edoxaban in October. PCSK9 inhibitors This family will continue to bring new cholesterol-lowering drugs to the market. PCSK9 inhibitors are a class of experimental drugs that have been shown to significantly lower low-density lipoprotein cholesterol (LDL-C) levels, particularly in patients with very high cholesterol levels that have not responded to other treatments. Amgen applied to the FDA for approval of its PCSK9 inhibitor evolocumab in August, and Sanofi/Regeneron announced plans to seek priority review of its drug alirocumab. This means that the FDA could make its first decision on this class of drugs as early as summer 2015. Meanwhile, PCSK9 inhibitor-related studies will continue to be released as drug makers scramble to make their drugs the first available to patients with very high levels of inherited “bad” cholesterol. Diet and exercise are not just about prevention The cardiovascular team has expanded its focus on lifestyle management as a tool for reversing and preventing cardiovascular disease. Studies have shown that comprehensive exercise-based cardiac rehabilitation can reduce mortality in post-myocardial infarction patients. Both diet and physical activity can prevent and help treat many known atherosclerotic risk factors, including elevated blood pressure, insulin resistance and glucose intolerance, increased triglyceride levels, and obesity. Exercise combined with weight loss can lower LDL or total cholesterol. Team-Based Care As the concept of team-based care becomes widespread, state legislatures may weigh issues of training adequacy, reimbursement and patient safety. A growing number of cardiologists and other specialists are adopting a physician-led model of team-based care. This strategy is designed to promote collaboration and the full use of each team member’s strengths, knowledge and training. Energy Drinks Legislatures may be addressing the increasing abuse of energy drinks by children and school athletes at the state level. Emergency rooms have reported an increase in young people presenting with irregular and increased heart rates, anxiety and sleep deprivation. Existing studies are insufficient to assess the potential long-term damage caused by energy drinks, but many in the medical community believe that the increase in the number of children seen in the office and emergency room after consuming energy drinks warrants public policy changes to reduce underage consumption. Bills have been introduced in several states in recent years that may raise concerns through the legislative process, particularly with regard to the sale and marketing of energy drinks to children.