Dr. Matthew Wanat and CardioScripts co-host, Dr. Liz Sulaica, discuss the ADAPTABLE trial. 

0:00-0:25: Introduction 

0:26-1:32: Introduction of Dr. Matthew Wanat

1:33-6:25: ADAPTABLE Overview 

6:26-10:23: Aspirin Dosing and Overall Thoughts 

10:24-12:06: Trial Limitations

12:07:-14:15: Literature and Guidelines for Aspirin in Primary Prevention (see additional references below)

14:16-18:11: Pragmatic Study Design

18:12-19:24: Final Thoughts 

19:25-19:57: Closing 

References: 

ADAPTABLE: Jones WS, Mulder H, Wruck LM, et al. Comparative Effectiveness of Aspirin Dosing in Cardiovascular Disease. N Engl J Med. 2021;384(21):1981-1990. doi:10.1056/NEJMoa2102137

2019 ACC/AHA Primary Prevention Guidelines: Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. 2020 Jan 28;141(4):e60] [published correction appears in Circulation. 2020 Apr 21;141(16):e774]. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678

ASPREE: McNeil JJ, Nelson MR, Woods RL, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med. 2018;379(16):1519-1528. doi:10.1056/NEJMoa1803955

ARRIVE: Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036-1046. doi:10.1016/S0140-6736(18)31924-X

ASCEND: ASCEND Study Collaborative Group, Bowman L, Mafham M, et al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. 2018;379(16):1529-1539. doi:10.1056/NEJMoa1804988

We are excited to announce our return to regular podcasting starting in June!

Dr. Ted Berei and CardioScripts co-host, Dr. Tracy Macaulay, discuss the EMPEROR-Reduced trial. 

0:00-0:28: Introduction 

0:29-1:05: Introduction of Dr. Ted Berei 

1:06-3:40: EMPEROR-Reduced Overview 

3:41-5:08: Overall Thoughts 

5:09 -11:18: Secondary Endpoints 

11:19-19:04: Considerations for Initiation of SGLT2 Inhibitors 

19:05-21:21: Final Thoughts 

21:22-22:02: Closing 

References: 

• McMurray, John JV, et al. “Dapagliflozin in patients with heart failure and reduced ejection fraction.” New England Journal of Medicine 381.21 (2019): 1995-2008. 
• Packer, Milton, et al. “Cardiovascular and renal outcomes with empagliflozin in heart failure.” New England Journal of Medicine 383.15 (2020): 1413-1424. 
• Vardeny, Orly, and Muthiah Vaduganathan. “Practical guide to prescribing sodium-glucose cotransporter 2 inhibitors for cardiologists.” JACC: Heart Failure 7.2 (2019): 169-172. 
• Das, Sandeep R., et al. “2020 expert consensus decision pathway on novel therapies for cardiovascular risk reduction in patients with type 2 diabetes: a report of the American College of Cardiology solution set oversight committee.” Journal of the American College of Cardiology 76.9 (2020): 1117-1145. 

Dr. John Lindsley and CardioScripts co-host, Dr. Liz Sulaica, discuss cohort A of the POPular TAVI trial.

0:00-0:28: Introduction

0:29-1:04: Introduction of Dr. John Lindsley

1:05-6:12: Cohort A Overview

6:13-10:18: Overall Thoughts

10:19-12:30: Subclinical Valve Thrombosis

12:31-15:05: Management strategies

15:06-15:52: Final Thoughts

15:53-16:31: Closing

References:

• POPular TAVI Trial [Cohort A]: Brouwer J, Nijenhuis VJ, Delewi RS, et al. Aspirin with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 383: 1447-57. DOI: 10.1056/NEJMoa2017815.
• POPular TAVI Trial [Cohort B]: Nijenhuis VJ, Brouwer J, Delewi R, et al.  Anticoagulation with or without Clopidogrel after Transcatheter Aortic-Valve Implantation. N Engl J Med 2020; 382:1696-1707. DOI: 10.1056/NEJMoa1915152.
• ARTE Trial: Rodes-Cabau J, Masson J, Welsh RC, et al. Aspirin Versus Aspirin Plus Clopidogrel as Antithrombotic Treatment Following Transcatheter Aortic Valve Replacement With a Balloon-Expandable Valve: The ARTE (Aspirin Versus Aspirin + Clopidogrel Following Transcatheter Aortic Valve Implantation) Randomized Clinical Trial. JACC Cardiovasc Interv. 2017 Jul 10;10(13):1357-1365.
• GALILEO Trial: Dangas G, Tijssen JG, Wöhrle J, et al. A Controlled Trial of Rivaroxaban after Transcatheter Aortic-Valve Replacement.
• PARTNER Trial: Leon MB, Smith CR, Mack M, et al. Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo Surgery. N Engl J Med 2010; 363:1597-1607.
• Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC Expert Consensus Decision Pathway for Transcatheter Aortic Valve Replacement in the Management of Adults With Aortic Stenosis: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2017;69(10):1313-46.

Dr. Toby Trujillo and CardioScripts co-host, Dr. Tracy Macaulay, discuss the LoDoCo2 trial.

0:00-027: Intro

0:28-1:03: Introduction of Dr. Toby Trujillo

1:04-4:10: LoDoCo2 Trial Overview

4:11-8:10: Overall Thoughts

8:11-9:49: Run-in period and tolerability

9:50-10:28: Monitoring and Infection

10:29-14:00: Fun New Game – Guess That Trial!! (hint – CURE and parallels to LoDoCo2)

14:01-14:59: Polypharmacy and When Colchicine??

15:00-15:35: Final Thoughts

15:36-16:09: Closing

References:

LoDoCo2 Trial: Nidorf SM, Fiolet ATL, Mosterd A, et al. Colchicine in Patients with Chronic Coronary Disease. N Engl J Med 2020; 383: 1838-47.

COLCOT Trial: Tardif J, Kouz S, Waters DD, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med 2019; 381: 2497-505.

CANTOS Trial: Ridker PM, Everett BM, Thuren T, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med 2017; 377: 1119-31.

CLEAR SYNERGY Trial: NCT03048825. https://clinicaltrials.gov/ct2/show/NCT03048825

CURE Trial: Yusuf S, Zhao F, Mehta SR, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001; 345(7): 494-502.

Dr. Dave Dixon and CardioScripts co-host, Dr. Liz Sulaica, discuss the EVAPORATE trial and where icosapent ethyl fits.

0:00-0:27: Intro

0:28-1:09: Introduction of Dr. Dave Dixon

1:10-4:38: EVAPORATE Overview

4:39-6:12: Overall thoughts about EVAPORATE

6:13-9:23: Trial limitations

9:24-11:55: Isocapent ethyl in practice – involve the patient in decision-making!

11:56-14:31: How has practice changed since REDUCE-IT?

14:32-15:31: Final thoughts

15:32-16:09: Closing

References

• Budoff MJ, Bhatt DL, Kinninger A, et al. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: final results of the EVAPORATE trial. Eur Heart J 2020; doi: 10.1093/eurheartj/ehaa652.
• Bhatt DL, Steg PG, Miller M , et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med 2019; 380:11-22.
• Budoff MJ, Muhlestein JB, Bhatt DL, et al. Effect of icosapent ethyl on progression of coronary atherosclerosis in patients with elevated triglycerides on statin therapy: a prospective, placebo-controlled randomized trial (EVAPORATE): interim results. Cadiovasc Res 2020; doi: 10.1093/cvr/cvaa184.

Dr. Robert DiDomenico and CardioScripts co-host, Dr. Tracy Macaulay, discuss the RATE AF trial and all things digoxin: its past role, therapeutic levels, and current and future state!

0:00-0:32 Intro

0:28-1:02: Welcome back and Introduction of Dr. DiDomenico

1:03-4:33: Overview of the RATE-AF trial as presented at ESC 2020 and based on published trial rationale.

4:34-6:40: How did RATE AF confirm or add to our understanding of digoxin use in Atrial Fibrillation

6:41-9:36:  If we use digoxin, what levels are you targeting and what goals are you setting?

9:37-11:50: Digoxin in HFpEF patients

11:51-16:26: Digoxin and Mortality

16:27-17:28: Final thoughts

17:29-18:04: Closing

References:

• Rate Control Therapy Evaluation in Permanent Atrial Fibrillation.  Results presented by Dr. Dipak Kotecha at the European Society of Cardiology Virtual Congress, August 29, 2020.
• Kotecha D, Calvert M, Deeks JJ, et al.  A review of rate control in atrial fibrillation, and the rationale and protocol for RATE-AF trial.  BMJ Open 2017;7:e015099.
• Ahmed A, Rich MW, Fleg JL et al. Effects of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial. Circulation 2006;11397-403.

• Digitalis Investigation Group. The effect of digoxin on mortality and morbidity in patients with heart failure. N Engl J Med. 1997;336:525–533. 11.
• Ahmed A, Rich MW, Love TE, Lloyd-Jones DM, Aban IB, Colucci WS, Adams KF, Gheorghiade M. Digoxin and reduction in mortality and hospitalization in heart failure: a comprehensive post hoc analysis of the DIG trial. Eur Heart J. 2006;27:178–186. 12.
• Massie BM, Abdalla I. Heart failure in patients with preserved left ventricular systolic function: do digitalis glycosides have a role? Prog Cardiovasc Dis. 1998;40:357–369.
• Adams KF Jr, Patterson JH, Gattis WA, et al. Relationship of serum digoxin concentration to mortality and morbidity in women in the digitalis investigation group trial: a retrospective analysis.  J Am Coll Cardiol. 2005 Aug 2;46(3):497-504. 
• Vamos M, Erath JW, Benz AP, et al. Meta-analysis of effects of digoxin on survival in patients with atrial fibrillation or heart failure: An update. Am J Cardiolo 2019;123:69-74.
• DiDomenico RJ, Bress AP, NA-Thalang K, et al. Use of a simplified nomogram to individualize digoxin dosing versus standard dosing practice in patients with heart failure. Pharmacotherapy 2014; 34:1121-31.
• Bauman JL, DiDomenico RJ, Viana M, Fitch M. A method of determining the dose of digoxin for heart failure in the modern era.  Arch Intern Med. 2006 Dec 11-25;166(22):2539-45. 
• Singh S, Moore H, Karasik PE, et al. Digoxin initiation and outcomes in patients with heart failure (HFrEF and HFpEF) and atrial fibrillation. Am J Med 2002:S0002-9343(20)30528-3.

Dr. Ashley Schenk discusses mavacamten and obstructive hypertrophic cardiomyopathy.

0:00-0:28: Intro

0:29-1:09: Introduction of Dr. Ashley Schenk

1:10-5:55: Trial overview

5:56-8:36: Overview of obstructive hypertrophic cardiomyopathy

8:37-10:23: Pharmacological therapy used in patients with obstructive hypertrophic cardiomyopathy and why mavacamten is different

10:24-11:14: Initial thoughts about the trial

11:15-13:30: Beta-blocker subgroup analysis and disopyramide exclusion

13:31-15:05: Adverse effect profile

15:06-16:09: Where do we anticipate mavacamten to fit in this patient population?

16:10-16:49: Final thoughts

16:50-17:26: Closing

References:

Olivotto I, Oreziak A, Barriales-Villa R, et al. Mavacamten for treatment of symptomatic obstructive hypertrophic cardiomyopathy (EXPLORER-HCM): a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2020; 396: 759-69.

0:00-0:58: Intro

0:59-4:47: 1-year after ISAR-REACT 5, does prasugrel reign supreme?

4:48-7:32: Dr. Dunn and Dr. Macaulay dive into the confusing world of DAPT duration.  Who should get shorter and who get longer, based on DAPT trial, PEGASUS, TWILIGHT, TICO, and more. 

7:33-10:46: When de-escalation is indicated, should it be aspirin or P2Y12 inhibitor that goes away?  Remember CAPRIE?

10:47-13:56: ESC meeting and presentation of 2020 Guidelines for NSTE ACS recommend prasugrel, 12-months for most (but lots of wiggle room), and no upfront treatment with P2Y12. 

13:57-15:41: Pre-treatment with P2Y12 inhibitors or not?  Where is the data for what has become widespread practice.

15:42-20:08: A review of switching between P2Y12 inhibitors.  And defining a role for improved pharmacy continuity between inpatient, ambulatory and community pharmacists.

20:09-20:52: Closing 

References:

• Schupke S, et al. Ticagrelor or prasugrel in patients with acute coronary syndromes (ISAR-REACT 5). N Engl J Med 2019. (epub doi 10.1056/NEJMoa1908973):1-11.
• Mauri L, et al. Twelve or 30 Months of Dual Antiplatelet Therapy after Drug-Eluting Stents (DAPT Study). N Engl J Med 2014; 371:2155-2166.
• Bonaca MP, et al. Long-term use of ticagrelor in patients with prior myocardial infarction. N Engl J Med 2015;372:1791-1800.
• Costa F, et al. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trial. Lancet 2017;389:1025-1034.
• Mehran R, et al. Ticagrelor with or without Aspirin in High-Risk Patients after PCI (TWILIGHT). N Engl J Med 2019; 381:2032-2042.

• Kim B, et al. Effect of Ticagrelor Monotherapy vs Ticagrelor With Aspirin on Major Bleeding and Cardiovascular Events in Patients With Acute Coronary Syndrome. The TICO Randomized Clinical Trial. JAMA 2020;323(23):2407-2416.
• Gent M, et al. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet 1996;348:1329-39.
• Montalescot G, et al. Pretreatment with Prasugrel in Non–ST-Segment Elevation Acute Coronary Syndromes (ACCOAST). N Engl J Med 2013;369:999-1010.
• Steinhubl SR, et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention: a randomized controlled trial (CREDO). JAMA 2002; 20;288(19):2411-20.
• COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 2005; 366: 1607–21.
• Bhatt DL, et al. Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events (CHARISMA). N Engl J Med 2006;354:1706-1717.
• Collet JP, Thiele H, Barbato E, et al.2020 ESC Guidelines for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation: The Task Force for the Management of Acute Coronary Syndromes in Patients Presenting Without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J 2020;Aug 29:[Epub ahead of print].
• Navarese EP, Khan SU, Kołodziejczak M, et al. Comparative Efficacy and Safety of Oral P2Y12 Inhibitors in Acute Coronary Syndrome: Network Meta-Analysis of 52,816 Patients From 12 Randomized Trials. Circulation 2020;May 29:[Epub ahead of print].
• Tarantini G, et al. Timing of Oral P2Y₁₂ Inhibitor Administration in Non-ST Elevation Acute Coronary Syndrome. Journal of the American College of Cardiology August 2020:DOI: 10.1016/j.jacc.2020.08.053.
• Classens DMF, et al. A Genotype-Guided Strategy for Oral P2Y₁₂ Inhibitors in Primary PCI (POPULAR GENETICS). N Engl J Med 2019; 381:1621-1631.