Cardiology's Top 10 Stories of 2014: Back-to-Basics Promises Big Advancements

There were many great stories in cardiology this year. Some of the most useful ones stemmed from negative findings. That's OK; finding out what doesn't work is helpful. Other choices are less about specific trials and more about changes in ways of thinking. Here's my list.

1. The Failure of Renal Denervation

Few negative trials teach us as much as the sham-controlled, prospective, single-blinded, randomized clinical trial of renal denervation called SYMPLICITY-HTN-3.^[1]

Before 2014, the excitement at medical meetings surrounding kidney ablation was striking. The unblinded trials that preceded SYMPLICITY HTN-3 declared dramatic blood pressure reductions. Millions of patients have hypertension and millions suffer from its complications. Renal denervation promised an easy solution: We could thread a catheter up to the kidneys, deliver radiofrequency energy, not measure an ablation effect, and voilà—hypertension would be vanquished. Proceduralists and medical device companies were tingling with anticipation.

Then reality hitThe nonsignificant blood pressure reductions in the properly controlled SYMPLICITY HTN-3 trial confirmed the old adage: If something looks unbelievable, it probably is. Other lessons included the power of hype, the misthink of treating systemic lifestyle diseases with focal solutions, the temptation of intervention bias, and the importance of basing clinical practice on sound science.