Director, Arrhythmia Services, Sunnybrook Health Sciences Centre, Associate Professor, University of Toronto, Department of Medicine – Division of Cardiology
Chairman of the Symposium, Winter Arrhythmia School
After more than 20 years of research, Dr. Eugene Crystal continues to find new ways to re-define the care he provides. He is the founder of the Winter Arrhythmia School, an annual seminar that serves to connect medical professionals to new treatments and issues in cardiology practice. His research has changed the scope of cardiology practice from how strokes are prevented to the way pacemakers are programmed.
When Dr. Crystal is not busy seeing his patients, teaching, or researching, he enjoys walking and running: “mainly cardio exercise.” Anna Nguyen, a journalist with the CCCT caught up with the distinguished cardiologist and invited him to give his opinion on clinical trials.
Anna: Many patients are apprehensive about enrolling in clinical trials, including myself. Why do you think that this prevails despite all the benefits and medical advancements clinical studies have provided?
Dr. Crystal: Well, people are generally apprehensive about any medical treatment because they are increasingly aware of side effects and potential complications. This is especially enhanced when you’re going to be a part of a research project or investigation into a new product or device.
Anna: Now, you’ve noted that many cardiac patients have symptoms that are difficult to catch. Are there some common things you’ve noticed in these patients when they enroll in a clinical trial?
Dr. Crystal: I would say that there are certain differences. Take for example those who are going to receive treatment for skin disorders, and those who are going to receive treatment for heart disorders. It’s obvious that people are more afraid if they’re going to receive treatment for a heart disorder. Heart diseases are associated in people’s mind with the probability of dying or being severely sick.
Anna: Over the past 20 years, what medical changes have you seen with regards to cardiology practices as a result of the clinical trials you’ve conducted?
Dr. Crystal: Let’s focus on the BLOS study. This study was quite dramatic because it involved patients undergoing post-operative cardiac surgery. In addition, they were taking on the added risk of participating in a study. However, the medication that was used in this and other studies is well known and routinely used. The result of the study was that this medication had a bidirectional effect on the patient’s health, which significantly changes medical practices, like how we administer medications before and after a patient’s surgery.
Anna: Let’s discuss one of the trials you’ve conducted in more detail. In the metoprolol prophylaxis study, results from another study (BLOS) were used. Were participants aware that data from one study could benefit another study?
Dr. Crystal: Well, when patients are signing consent to participate in a study, they’re signing consent for us to analyze the data the way we see fit. The data is anonymous more often than not. So yes, patients are aware that the results of one study can be published in different journals and in different places.
Anna: With that being said, do patients know that their participation in one study will have an impact on other studies?
Dr. Crystal: Not necessarily. We’re asking participants for permission to use this data, but it’s possible they don’t know that they’re benefiting another study. It’s a problem that we don’t educate patients in this regard; showing them that even participating in a single trial may actually help out in other studies.
Anna: In this regard, how are patients impacting future research if they participate now?
Dr. Crystal: Patients should know that a small risk in their participation in a study today could significantly change future treatments not only for the next patient but also for themselves. Most of the diseases we treat are chronic, so if you have a heart condition, a liver condition, an orthopaedic condition, these symptoms will stay with you in one form or another. Therefore, by participating in a study today, it could very well mean that you may be treated differently down the road. Patients should also know that we do everything possible to conduct research safely. Most studies include monitoring data in “real time,” which means that as soon as we see some significant negative impact in the study, treatment will be stopped.
Anna: Is there anything else you want to say to people who are contemplating or are skeptical about enrolling in clinical trials?
Dr. Crystal: First of all, I want to encourage people to participate. There is a special type of courage needed in order to take this step. It’s important that they give us a hand because there will be no patients to participate in clinical trials and we would never know what to do next.
Dr. Crystal was a lead investigator in the BLOS (Beta-blocker Length of Stay) trial, with approximately 1000 patients undergoing elective open heart surgery. Patients were randomized to receive metoprolol (a beta-blocker) within 12 hours post-surgery. Patients were followed after surgery for atrial fibrillation (an abnormal heart rhythm), length of hospital stay, and cost of in-hospital care. The study found that only patients who had a history of beta-blocker use prior to surgery benefited from these medications post-surgery.