The reversal of cardiology practices: interventions that were tried in vain

Vinay Prasad, Adam Cifu


Medical reversal happens when new trials—better powered, designed or controlled than predecessors--contradict current standard of care. The Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial and CAST study are notable examples of investigations that overturned current practice by demonstrating that these interventions offered no survival benefits. In this mini-review, we summarize our experience reviewing a decade of original articles in the New England Journal of Medicine with an eye towards investigations that reversed cardiology practice. From the management of arrhythmias to lipids to percutaneous coronary intervention (PCI) and finally, hemodynamics, reversals in the cardiology literature cover a broad set of practices. These reversals are instructive in that many of the therapies overturned were widely adopted and based on either sound physiologic reasoning or observational trials.