Crushing ISCHEMIA with Dr. Barbara Wiggins

Dr. Barbara Wiggins joins the CardioScripts team to talk about the ISCHEMIA trial.

0:00-0:40: Intro
0:41-1:22: Introduction of Dr. Barbara Wiggins
1:23-5:26: Introduction of ISCHEMIA
5:27-6:37: Barbara’s Overall Thoughts
6:38-7:33: What does the ISCHEMIA trial add to COURAGE?
7:34-8:27: Patient Baseline Medication Regimens
8:28-10:42: ISCHEMIA Questions
10:43-11:51: ISCHEMIA Implications for Pharmacy Practice
11:52-14:03: Barbara’s Final Thoughts
14:04-14:48: Closing

References:

  • ISCHEMIA Trial: The ISCHEMIA Trial Home (https://www.ischemiatrial.org/)
  • COURAGE Trial: Boden WE, O’Rourke RA, Teo KK, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease. N Engl J Med 2007;356:1503-16.

PIONEERing HF Care with Dr. Van Tassell

Dr. Ben Van Tassell discusses sacubatril-valsartan and the PIONEER-HF trial.

0:00-0:40: Intro
0:41-1:14: Introduction of Dr. Ben Van Tassell
1:15-4:00: Introduction of PIONEER-HF
4:01-5:22: Ben’s Initial Thoughts
5:23-6:40: Sacubatril-valsartan right out of the gate?
6:41-7:50: Thoughts on open-label expansion trial
7:51-11:12: Role of NT-proBNP as a surrogate endpoint
11:13-14:17: Cost considerations with sacubitril-valsartan
14:18-15:33: Patient follow-up in a real-world setting
15:34-16:13: Closing

References:

  • PIONEER-HF: Velazquez EJ, Morrow DA, DeVore AD, et al. Angiotensin-Neprilysin Inhibition in Acute Decompensated Heart Failure. N Engl J Med 2019;380:539-48.
  • PIONEER-HF open-label expansion: DeVore AD, Braunwald E, Morrow DA, et al. Initiation of Angiotensin-Neprilysin Inhibition After Acute Decompensated Heart Failure: Secondary Analysis of the Open-label Extension of the PIONEER-HF Trial. JAMA Cardiol 2020;5(2):202-207.
  • PARADIGM-HF: McMurray JJ, Packer M, Desai AS, et al. Angiotensin-Neprilysisn Inhibition versus Enalapril in Heart Failure. N Engl J Med 2014;371:993-1004.
  • Ibrahim NE and Januzzi JL Jr. Established and Emerging Roles of Biomarkers in Heart Failure. Circ Res 2018;123(5):614-29.

Spironolactone: TOPCAT or underdog?

0:00-0:40: Intro
0:41-1:22: Introduction of Dr. Kathleen Faulkenberg
1:23-5:45: Overview of TOPCAT
5:46-8:28: Kathleen’s Overall Thoughts 
8:29-10:11: TOPCAT Controversy
10:12-11:15: Spironolactone Metabolite Differences Between Regions
11:16-11:59: More Questions Around TOPCAT
12:00-12:51: What do we do with results from TOPCAT?
12:52-15:19: Final Thoughts
15:20-16:01: Closing


References:

  • TOPCAT: Pitt B, Pfeffer MA, Assmann SF, et al. Spironolactone for Heart Failure with Preserved Ejection Fraction. N Engl J Med 2014;370:1383-92.
  • de Denus S, Desai AS, Leclair G, et al. Spironolactone Metabolites in TOPCAT – New Insights into Regional Variation. N Engl J Med 2017;376:1690-1692.
  • Pfeffer MA, Claggett B, Assmann SF, et al. Regional variation in patients and outcomes in the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial. Circulation 2015;131(1):34-42.
  • Cohen JB, Schrauben SJ, Zhao L, et al. Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone. JACC Heart Fail 2020; DOI: 10.1016/j.jchf.2019.09.009.

Plenty of fish [oil] in the sea, have we REDUCEd-IT to one?

Check out this episode as Dr. Dave Dixon talks about REDUCE-IT and REDUCE-IT USA. 


0:00-0:41: Intro
0:42-1:26: Introduction of Dr. Dave Dixon
1:27-5:10: Introduction of REDUCE-IT and REDUCE-IT USA
5:11-6:30: Dave’s Initial Thoughts
6:31-8:21: Why not OTC fish oil or omega-3 fatty acid prescriptions?
8:22-9:54: Were these patients well managed at baseline?
9:55-11:15: Who should we avoid icosapent ethyl in?
11:16-12:19: Labeling Changes
12:20-14:16: Final Thoughts
14:17-15:01: Closing


References:
REDUCE-IT: Bhatt DL, Steg G, Miller M, et al. Cardiovascular Risk Reduction with Icosapent Ethyl for Hypertriglyceridemia. N Engl J Med2019;380:11-22.
REDUCE-IT USA: 
Bhatt DL, Miller M, BrintonE, et al. REDUCE-IT USA: Results from the 3,146 Patients Randomized in the United States. Circulation 2019; doi: 10.1161/CIRCULATIONAHA.119.044440. 
FDA New Release: https://www.fda.gov/news-events/press-announcements/fda-approves-use-drug-reduce-risk-cardiovascular-events-certain-adult-patient-groups 

In Zac Noel we ENTRUST: Double or Nothing?

In this episode, Dr. Zac Noel helps us navigate through the ENTRUST-AF PCI trial as well as dual vs. triple antithrombotic therapy.



0:00-0:40: Intro
0:41-1:42: Introduction of Dr. Zachery Noel
1:43-4:35: ENTRUST-AF PCI Overview
4:36-5:46: Zac’s Overall Thoughts
5:47-6:33: Dual antithrombotic therapy for everyone?
6:34-7:38: Patient population in ENTRUST-AF PCI
7:39-9:03: Other P2Y12 inhibitors
9:04-10:13: Ischemic outcomes
10:14-11:18: Who should receive dual antithrombotic therapy?
11:19-14:28: Zac’s Final Thoughts
14:29-15:38: Closing/New Year’s Resolutions


References:

  • ENTRUST AF-PCI: Vranckx P, Valgimigli M, Tijssen J, et al. Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. Lancet 2019;394(10206):1335-43.
  • AUGUSTUS: Lopes RD, Heizer G, Aronson R, et al. Antithrombotic Therapy after Acute Coronary Syndrome or PCI in Atrial Fibrillation. N Engl J Med 2019;380(16):1509-24. 
  • PIONEER AF-PCI: Gibson CM, Mehran R, Bode C, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N Engl J Med 2019;375(25):2423-34.
  • RE-DUAL: Cannon CP, Bhatt DL, Oldgren J, et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.  N Engl J Med 2017;377(16):1513-1524.
  • WOEST: Dewilde WJ, Oirbans T, Verheugt FW, et al. Lancet 2013;381(9872):1107-15.
  • Dual vs. Triple Antithrombotic Therapy Meta-Analysis: Lopes RD, Hong H, Harskamp RE, et al. Safety and Efficacy of Antithrombotic Strategies in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention: A Network Meta-analysis of Randomized Controlled Trials. JAMA Cardiol 2019;4(8):747-55.

Entering the TWILIGHT Zone

Prepare to dive into the TWILIGHT trial with Dr. Craig Beavers.

0:00-0:22: Intro
0:23-1:01: Introduction of Dr. Craig Beavers
1:02-3:32: TWILIGHT Overview
3:33-6:31: Craig’s Overall Thoughts
6:32-8:39: Excluded Patients
8:40-10:17: Ticagrelor Monotherapy and Ischemic Outcomes
10:18-12:52: TWILIGHT and GLOBAL LEADERS
12:53-14:24: Final Thoughts
14:25-15:22: Closing/Craig’s Upcoming Podcast

References:

  • TWILIGHT: Mehran R, Baber U, Sharma SK, et al. Ticagrelor with or without Aspirin in High-Risk Patients after PCI. N Engl J Med 2019;381:2032-2042.
  • GLOBAL LEADERS: Vranckx P, Valgimigli M, Juni P, et al. Ticagrelor plus aspirin for 1 month, followed by ticagrelor monotherapy for 23 months vs aspirin plus clopidogrel or ticagrelor for 12 months, followed by aspirin monotherapy for 12 months after implantation of a drug-eluting stent: a multicentre, open-label, randomised superiority trial. Lancet 2018;392:940-49.

Episode is Live

Published: Dec. 24, 2019 @ 4AM EditUnpublish

Been there, done that: Expert advice from parting RPDs (Part 2)

In the second of two episodes, Drs. Rob DiDomenico and Kerry Pickworth provide their expertise about PGY2 Cardiology residency training.

0:00-0:40: Intro
0:41-2:46: Physical exam in the cardiology setting
2:47-6:17: Importance of interpreting diagnostic tests
6:18-9:02: Keeping up with literature
9:03-11:29: Importance of self-reflection
11:30-15:00: Final thoughts/Free time (?)

References:

Been there, done that: Expert advice from parting RPDs (Part 1)

In the first of two episodes, Drs. Rob DiDomenico and Kerry Pickworth provide their expertise about Midyear for prospective PGY2 Cardiology residency candidates. 

0:00-0:40: Intro
0:41-2:22: Introduction of Drs. Rob DiDomenico and Kerry Pickworth
2:23-3:17: Overview of PGY2 Cardiology Pharmacy Resident Training Opinion Paper
3:18-4:56: Rob and Kerry’s Overall Thoughts
4:57-9:08: Midyear Advice/What are you looking for in a candidate?
9:09-11:42: What if the candidate has limited cardiology experience?
11:43-13:49: Why ambulatory care if a preference for critical care cardiology?
13:50-14:59: Closing

References:

Episode 3: How sweet it is to be an SGLT2 Inhibitor

0:00-0:46: Intro
0:47-1:20: Introduction of Dr. Ted Berei
1:21-2:57: DAPA-HF Overview
2:58-6:12: Ted’s Overall Thoughts
6:13-7:24: DAPA-HF Patient Population
7:25-9:15: Sacubitril/valsartan or Dapagliflozin First?
9:16-10:47: Considerations Prior to Starting SGLT2 Inhibitors
10:48-12:19: SGLT2 Inhibitors and Cost
12:20-14:43: Final Thoughts
14:44-15:42: Closing/Introduction to Finn


References: 

  • DAPA-HF: McMurray JJ, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; DOI: 10.1056/NEJMoa1911303
  • CANVAS: Neal B, Perkovic V, Mahaffey KW, et al. Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. N Engl J Med2017;377:644-57.
  • EMPA-REG: Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015;373:2117-28.
  • DECLARE-TIMI 58: Wiviott SD, Bonaca MP, Kato ET, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2019;380:347-57.
  • 2018 ACC Expert Consensus Decision Pathway for Type 2 Diabetes and Atherosclerotic Cardiovascular Disease: Das SR, Everett BM, Birtcher KK, et al. 2018 ACC Expert Consensus Decision Pathway on Novel Therapies for Cardiovascular Risk Reduction in Patients With Type 2 Diabetes and Atherosclerotic Cardiovascular Disease. J Am Coll Cardiol 2018;72(24):3200-23.
  • Type 2 Diabetes and Heart Failure: Dunlay SM, Givertz MM, Aguilar D, et al. Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement From the American Heart Association and the Heart Failure Society of America. Circulation 2019;140:e294-e324.
  • Packer MP, Anker SD, Butler J, et al. Effects of Sodium-Glucose Cotransporter 2 Inhibitors for the Treatment of Patients With Heart Failure: Proposal of a Novel Mechanism of Action. JAMA Cardiol2019;2(9):1025-29.
  • Butler J, Hamo CE, Filippatos G, et al. The potential role and rationale for treatment of heart failure with sodium-glucose co-transporter 2 inhibitors. Eur J Heart Fail 2017;19(11):1390-1400.
  • Ha CM and Wende AR. The Growing Case for Use of SGLT2i in Heart Failure: Additional Benefits of Empagliflozin in a HFpEF Rodent Model. JACC Basic Transl Sci 2019;4(1):38-40.

Episode 2: REACT(5)ion from Steve Dunn

In this episode, we review the ISAR-REACT 5 trial and hear Dr. Steve Dunn’s thoughts about how this trial fits into P2Y12 management in patients with acute coronary syndromes. 

Episode:
0:00-0:40: Intro
0:41-1:23: Introduction of Dr. Steve Dunn
1:24-3:42: ISAR-REACT 5 Overview
3:43-6:28: Steve’s Overall Thoughts
6:29-7:59: Context of ISAR-REACT 5
8:00-9:34: Study Funding
9:35-11:25: Study Discontinuation Rate
11:26-12:50: Secondary Safety Outcomes
12:51-15:51: Final Thoughts
15:52-16:50: Closing/Podcast Recording Location Discussion

References:

  • ISAR-REACT 5: Schüpke S, Neumann F, Menichelli M, et al. Ticagrelor or Prasugrel in Patients with Acute Coronary Syndromes. N Engl J Med 2019;381:1524-1534.
  • TRITON-TIMI: Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009;357:2001-2015.
  • PLATO: Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes. N Engl J Med 2009;361:1045-1057.
  • PRAGUE-18: Motovska Z, Hlinomaz O, Miklik R, et al. Prasugrel Versus Ticagrelor in Patients With Acute Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Multicenter Randomized PRAGUE-18 Study. Circulation 2016;134(21):1603-1612.
  • TRILOGY-ACS: Roe MT, Armstrong PW, Fox KA, et al. Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization. N Engl J Med 2012;367:1297-1309.
  • ACCOAST: Montalescot G, Bolognese L, Dudek D, et al. Pretreatment with Prasugrel in Non–ST-Segment Elevation Acute Coronary Syndromes. N Engl J Med 2013;369:999-1010.