Tweeting the Meeting: Rapid Growth in the Use of Social Media at Major Cardiovascular Scientific Sessions From 2014 to 2016

The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure. Three annually occurring cardiovascular scientific sessions were chosen for analysis based on that meeting’s acceptance and promotion of social media use during their respective meeting: The American College of Cardiology, Heart Rhythm Society, and Transcatheter Cardiovascular Therapeutics. Each conference had a predetermined official Twitter hashtag that was promoted before and during the meeting. Hashtags were registered with Symplur Signals, a healthcare social media analytics platform which curates all publicly posted data related to the official hashtag. Twitter activity from each scientific session from 2014 to 2016 was analyzed starting on 12:01 am of the first day of the conference through 11:59 pm of the conference end date. Tweet activity in the 3 days preceding and following conferences was not included as they represented an insignificant portion of the conference total. Data inclusion and analysis were adjusted based on the time zone of the city where the conference was held.

Symplur Signals database was accessed to determine the total number of users, tweets, and impressions (tweets × number of followers). Users were categorized into professional groups including physician, other healthcare professional, patient/advocate, researcher/PhD, journalist/media, provider organization, government organization, pharma/industry, and unknown, based on information extracted from individual Twitter biographies. Qualitative tweet content analysis was performed manually for all tweets by 2 independent physicians to ensure internal reliability and was categorized as scientific (educational, related to meeting content), administrative (used to direct attendees to meeting sessions or locations), industry (related to product advertisement), social (references to conference unrelated to meeting content), or uninformative. Tweets were further categorized according to their country and continent of origin to assess their potential range and influence. Absolute values and percent change were determined to compare across years.

Institutional review board approval for this study was deemed unnecessary because of the public availability of the data and noninvolvement of human or animal subjects.

In 2014, a total of 3212 users participated in Twitter during the 3 prespecified conferences using the official conference hashtags #ACC14, #HRS2014, and #TCT2014. From 2014 to 2016, the number of conference Twitter users increased from 3212 to 10 362, whereas the number of conference attendees mildly decreased from 42 764 to 40 954 (Figure [A] and [B]). This represented a 193%, 436%, and 223% increase in Twitter users at American College of Cardiology, Heart Rhythm Society, and Transcatheter Cardiovascular Therapeutics, respectively over the 3-year period.

The number of tweets increased significantly over the study period from 12 018 to 41 016 representing a 241% rise (Figure [C]). This growth was also observed on an annual basis, from 12 018 to 26 762 (123% increase) for the years 2014 to 2015 and from 26 762 to 41 016 (53% increase) for the years 2015 to 2016. In addition, the number of impressions increased significantly over 3 years from 104 525 154 to 244 220 328 (Figure [D]). This 134% growth was observed despite a nonsignificant decrease in conference attendance.

Scientific tweets represented a significant majority of all tweets during the study period relative to all other types of tweets (72%). Administrative and social tweets accounted for 10% and 13%, respectively. Tweets that were uninformative or industry related accounted for the remaining minority.

The majority of Twitter users were physicians who were the most active by a significant margin relative to other groups (48%) and were responsible for nearly half of the tweets throughout the period studied. In addition, nonphysician participants including other healthcare professionals, patient caregivers and advocates, and researchers demonstrated increased growth.

Of the 62% of the tweets that could be localized, North America and Europe had the strongest representation (36% and 11%). The number of countries represented during 2014 to 2016 significantly increased from 184 to 315 representing a 72% rise. Individually, there was a 42% and 66% rise in the number of countries represented during American College of Cardiology and Transcatheter Cardiovascular Therapeutics, respectively; Heart Rhythm Society had a near 2-fold increase.

Our analysis of Twitter activity during 3 major cardiology scientific sessions from 2014 to 2016 demonstrates a significant increase in Twitter users and tweet volume. Impressions, a marker of overall reach, also increased significantly and was validated by an in-parallel significant rise in the number of tweets per continent and countries represented. Furthermore, qualitative analysis revealed that the significant majority of tweets were scientific in nature. These findings suggest that Twitter use during national meetings not only enhances communication but could also promote educational and research endeavors in medicine.

Twitter was created as an short message service-based platform for communication between friends based on status updates. Today, it is primarily used as a vehicle for dissemination of personal thoughts and information and has become one of the largest sources of late-breaking news.³ Despite initial resistance from select medical societies, Twitter use during national medical conferences has become an important, and almost necessary, means by which late-breaking science is broadcasted between physicians, medical colleagues, and interested nonphysician individuals.^4,5

Numerous studies have documented the exponential increase in social media use at major medical and surgical conferences^1,2,6 and have recognized Twitter’s potential for amplifying the educational reach of various medical specialties, for disseminating research, and as a possible data source for cardiovascular disease research.^1,7,8 Studies have also highlighted the need for social media portfolios and its potential role in enhancing academic promotions and tenure, as well as for the study of Altmetrics —a measure which aims to capture the true impact factor of academic work as it is shared not only through traditional outlets but also via various nontraditional outlets, social media included.⁹

Our study is the first to report the recent and dramatic increase in Twitter use during major cardiovascular conferences. Activity was driven by physicians and occurred despite a static number of in-person conference attendees. This corroborates results from the 2013 Society of Family Medicine Teaching Conference which showed that the increase in conference Twitter use did not negatively impact yearly attendance, but made attendees feel more connected to the conference, enhanced networking, and in turn, increased desire to attend future conferences.¹⁰ Further echoing this sentiment is a recent editorial published in Circulation: Cardiovascular Quality and Outcomes discussing Twitter’s utility as a medium for debate, community building, and postpublication critical analysis of scientific research including the recent Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina (ORBITA), Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment with Alirocumab, International Study of Comparative Health Effectiveness with Medical and Invasive Approaches, and Vest Prevention of Early Sudden Death trials.⁵ Our results illustrate that meeting content is being discussed in real time independent of conference location and bring to light social media’s potential educational value via the dispersion of predominantly scientific content, especially to those who cannot, or choose not to attend academic conferences in person. Taken together, social media may be a realistic educational platform with the ability to facilitate real-time change in the way care is delivered worldwide.

This study had several limitations. First, conference-related Twitter activity may be underestimated because of inaccurate use or underuse of official conference hashtags. Second, the number of impressions does not account for activity generated by bots and other fake accounts. Although Twitter’s recent efforts to purge these false accounts may decrease the number of conference-related impressions going forward, it would also lead to a more accurate assessment of reach. Third, qualitative categorization of tweets was subjective as tweeting authors’ intent could not always be accurately determined. Last, dissemination of erroneous information is a major concern of using Twitter during scientific sessions. Fortunately, a cohort of meeting attendees including academicians, researchers, and statisticians, among others who are well regarded as leaders in their respective fields, have a strong Twitter presence. This online peer-review crowd often oversees, comments and corrects factual errors in real time, making propagation of incorrect data less likely.

Our data show an explosive growth of Twitter use by physicians during major cardiovascular scientific meetings, with dispersion of predominantly scientific content to a growing global audience. Widespread, international use of Twitter should translate into facilitation of real-time scientific discussion as well as immediate dissemination of potentially practice-changing information to a large global audience. Future studies to explore and better characterize user demographics, as well as educational content and value of tweets, are warranted as routine use of these platforms by physicians could have significant impact on patient education, disease awareness, and research.