The past few years has witnessed increasing clinician engagement with social media platforms, including Twitter (which, overall, has 300 million active users). Well-known “Tweeters” Mamas A Mamas and Mirvat Anaslag, who were both highly active on Twitter during the recent 2017 Transcatheter Cardiology Therapeutics (TCT) meeting (29 October–2 November, Denver, USA), review how the platform has become a forum for discussion and interaction for the interventional cardiology community.
Previous reports have suggested that there are more than 4.9 million tweets about cardiovascular disease (from people based in the USA),1 with this number increasing exponentially. Engagement of clinicians on Twitter has been particularly evident among interventional cardiologists and this has taken many forms—including conference coverage, case discussions, techniques, scientific dissemination, building peer networks and virtual multidisciplinary team meetings.
The use of social media—and Twitter in particular—has revolutionised both delegate interactions and the transmission of knowledge from medical conferences to the global arena. For example, at this year’s TCT meeting, 12,000 tweets were posted by 2,297 Twitter users with more than 93 million impressions. Social media, therefore, provides a platform to put data from late-breaking trials into the public realm far quicker than was traditionally possible. It is also a novel peer-review platform where trial design, data and implications for clinical practice can be discussed in depth.
For example, the ORBITA (Objective randomised blinded investigation with optimal medical therapy of angioplasty instable angina) trial, which was both presented at TCT and published in The Lancet, received in-depth coverage on Twitter. This coverage was focused around the study design, statistical analysis, conclusions and implications for clinical practice with ongoing widespread engagement amongst the interventional community at large; discussions continued for several weeks after the initial data were presented. This continuing level of active engagement is unprecedented. In fact, at the time of writing, many leaders in the field (including the ORBITA researchers themselves) are still debating issues around the trial publically—making these commentaries accessible to clinicians anywhere around the globe.
However, one has to recognise that such widespread dissemination of both data and discussion across social media platforms are a double-edged sword. Such virtual platforms permit unsolicited abrasive opinions or ill-informed pushbacks that cannot be validated by guidelines or by verified published data. This brings its own challenges and discretion in interpreting these comments becomes the responsibility of the user alone.
The Twitter-radial approach
Twitter has been used to help advocate safer practice within interventional cardiology, such as creation of the #RadialFirst hashtag—providing an environment for an international group of interventional cardiologists to discuss all matters that relate to access-site practice for cardiac catheterisation. Data around use of radial access for cardiac catheterisation is routinely discussed, tips and tricks are shared and cases are studied in a virtual learning environment that is supportive. This discussion, we believe, has contributed to the wider adoption of the transradial approach for percutaneous coronary intervention (PCI) internationally.
New techniques such as distal radial access and sheathless balloon assisted tracking have been posted on Twitter, with widespread international adoption. If a more conventional means had been used, this may have taken much longer.
Developing new communities
Twitter has also been used as a medium to enhance mentorship opportunities. Previously, many societies formed committees to connect fellows in training and early career professionals with mentors. This had limited success with particular challenges around maintaining databases of both fellows in training and mentors. However, social media interaction between established leaders and researchers with young professionals has allowed a natural relationship between mentor and mentee to develop. It also allowed councils to identify and connect both interested leaders and young professionals. For example, the Women in Cardiology Section of the American College of Cardiology has actively recruited women role models via social media platforms and connected them with young graduates applying for interventional cardiology fellowships.
Another avenue for social media has been the development of a virtual multidisciplinary team meeting or “cath conference”. Cardiologists often post a case and propose treatment strategies, technical or procedural tips, providing supportive references and links to guidelines and published trials. These virtual meetings also expose fellows in training to angiograms, operators, treatments, guidelines and discussion of relevant data pertaining to the case. The caveat here is that such processes have not been streamlined. Users must maintain patient privacy, adhere to their institutional regulations, and recognise that patients and industry may partake in the discussions.
Many interventional cardiologists use social media to keep up to date with the rapidly evolving evidence base underpinning interventional cardiology. Twitter and other social media platforms allow dissemination of this ever-expanding scientific literature in an easy to digest format, in which users have direct access to the researchers who published the work for interaction with real-time feedback. On the flip side, academic cardiologists are also using Twitter as a means of highlighting their research outputs, often producing visual abstracts to increase the impact of their work in a social media friendly format. Whilst article citations from other research articles published in journals have traditionally been used as a measure of scientific impact, other markers of recognition including social media attention is increasingly recognised as an important measure of scientific and social impact of research, and is one of the arenas captured by the Altmetric Attention Score that identifies how much and what type of attention a research output has received.
Finally, Twitter has enabled the development of interactions between interventional cardiologists across the globe, expanded networks and increased research opportunities and collaborations amongst individuals that may not have met at conventional meetings. Social media has expanded the boundaries of data sharing, scientific meeting interactions and networking, and is still in evolution. Whilst social media etiquette has not been refined, and remains very much a dynamic organic growth phase, balancing professionalism and recognizing potential medico-legal implications of engagement on a public forum remains the responsibility of the user.
Mamas A Mamas is at Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Stoke-on-Trent, UK, and Mirvat Anaslag is at King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
Sinnenberg et al. JAMA Cardiol.Epub.