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October 3rd, 2019
News From Medscape
The following recommended articles on Medscape.com are freely available through the partnership between ABC and Medscape, no registration or login required.
US Study Points Way to Polypill for CVD Prevention
New research shows that a single fixed-dose pill combining a statin and three antihypertensive drugs reduced cardiovascular disease (CVD) risk by about 25% compared with usual care in underserved Americans without CVD, bringing the promise of the polypill for the first time to the land of precision medicine.
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More Women Internists, but Numbers in Subspecialties Drop
The number of women physicians who chose internal medicine (IM) residencies grew from 30.2% in 1991 to 42.4% in 2017, but for subspecialty fellowships, the trend was in the opposite direction, a study has found.
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STOP-CRT: Maybe Withdraw Some Heart Failure Meds if CRT Restores LVEF
Some patients with heart failure (HF) whose cardiac function has improved into the normal range on optimal meds plus cardiac resynchronization therapy (CRT) can potentially stop taking neurohormonal-blocking agents without a relapse, a small randomized study suggests.
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AMA Awards Multiple Innovation Grants to Medical Schools
The American Medical Association (AMA) has awarded grants totaling $370,000 to 15 medical schools and institutions for innovative medical education projects that train physicians to succeed in the rapidly evolving healthcare system.
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Items of Interest
With the Affordable Care Act's Future in Doubt, Evidence Grows That It Has Saved Lives
Around the country, an emerging mosaic of evidence that, nearly a decade after it became one of the most polarizing health-care laws in U.S. history, the ACA is making some Americans healthier — and less likely to die. It is difficult to prove conclusively that the law has made a difference in people’s health, but strong evidence has emerged in the past few years. Compared with similar people who have stable coverage through their jobs, previously uninsured people who bought ACA health plans with federal subsidies had a big jump in detection of high blood pressure and in the number of prescriptions they had filled, according to a 2018 study in the journal Health Affairs.
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Why Do Women Get Cholesterol-Lowering Statins Less Frequently Than Men?
Women are less likely than men to be treated with cholesterol-lowering statins – or get them prescribed at guideline-recommended intensity levels when they do, according to a new study that also explored potential causes for the differences in a study published in Circulation: Cardiovascular Quality and Outcomes.
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Social Media Becomes a Growing Force in Cardiology
Cardiologists have increasingly embraced social media as a tool to disseminate emerging data and guidelines from meetings and journals, to discuss and debate controversial topics, and to collaborate with each other and patients. Twitter has become a hotbed for discussions often organized around hashtags such as #cardiotwitter or #cardiology, and other platforms such as Facebook have become home to growing communities where patients, female cardiologists, or other groups can seek information and support.
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Investigators Present New Heart Failure Nutrition Guidelines at HFSA
During the Heart Failure Society of America (HFSA) 2019 Scientific Sessions in Philadelphia, PA, Amanda Vest, MBBS, MPH, Tufts Medical Center, presented a new nutritional guideline for heart failure patients that focuses on dietary composition and counseling, obesity management, and cachexia malnutrition.
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A Bathroom Scale Could Monitor Millions With Heart Failure
Researchers at the Georgia Institute of Technology envision an experimental device reaching patients someday, and in a new study, they reported proof-of-concept success in recording and processing data from 43 patients with heart failure. A future marketable version of the medical monitoring scale would ideally notify a doctor, who would call [the patient] to adjust [the patient's] medication at home, hopefully sparing [the patient] a long hospital stay and needless suffering.
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Penn Doctor Says Gun Control, Climate Change Don't Belong in Med School; Critics Lash Back
Politics and social justice should not be part of medical school according to the former associate dean of curriculum at the University of Pennsylvania’s Perelman School of Medicine. Stanley Goldfarb, a kidney specialist and longtime faculty member at Penn, made his case in a Wall Street Journal column, saying that med schools should not spend time on gun violence, climate change, and “other progressive causes only tangentially related to treating illness.”
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[First Opinion] A Dangerous View: Why It's a Mistake For Medical Schools to Ignore Social Justice
The recent essay in the Wall Street Journal by Dr. Stanley Goldfarb, former dean of curriculum at Perelman, is both disheartening and dangerous. Goldfarb suggests that medical education is focusing too much on social justice issues “rather than treating illness.” the reality is that in seeing patients, physicians grapple with unemployment, housing instability, and food access; systemic racism, sexism, and LGBTQ rights; immigration reform, climate change, and violence. All of these issues profoundly — not tangentially — affect our patients’ health.
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Featured Articles by Members
ABC Members: We welcome your published research submissions and articles for inclusion in future issues of Clinical Updates and Insights. Email Rachel Williams at rwilliams@abcardio.org and please attach file or include links to the original published work and/or abstract.
Gender Differences in Transfemoral Transcatheter Aortic Valve Replacement
Co-authored by Roxana Mehran (with Wieneke Vlastra, Jaya Chandrasekhar, Bruno García Del Blanco, Didier Tchétché, Fabio S. de Brito Jr., Marco Barbanti, Ran Kornowski, Azeem Latib, Augusto D'Onofrio, et al.)
The CENTER collaboration was a global patient level dataset of patients undergoing transfemoral TAVR (N= 12,381) from 2007-2018. In this retrospective analysis we examined differences in baseline patient characteristics, 30-day stroke and mortality and in-hospital outcomes between female and male patients. We also assessed for temporal changes in outcomes and predictors for mortality per gender.
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TWILIGHT: Ticagrelor with or without Aspirin in High-Risk Patients after PCI
Co-authored by Roxana Mehran, M.D. (with Usman Baber, M.D., Samin K. Sharma, M.D., David J. Cohen, M.D., Dominick J. Angiolillo, M.D., Ph.D., Carlo Briguori, M.D., Ph.D., Jin Y. Cha, B.S., Timothy Collier, M.Sc., George Dangas, M.D., Ph.D., et al.)
In a double-blind trial, we examined the effect of ticagrelor alone as compared with ticagrelor plus aspirin with regard to clinically relevant bleeding among patients who were at high risk for bleeding or an ischemic event and had undergone PCI. After 3 months of treatment with ticagrelor plus aspirin, patients who had not had a major bleeding event or ischemic event continued to take ticagrelor and were randomly assigned to receive aspirin or placebo for 1 year. The primary end point was Bleeding Academic Research Consortium (BARC) type 2, 3, or 5 bleeding. We also evaluated the composite end point of death from any cause, nonfatal myocardial infarction, or nonfatal stroke, using a noninferiority hypothesis with an absolute margin of 1.6 percentage points.
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TCT-294 Clinical Outcomes in Women and Minorities According to the Urgency of Percutaneous Coronary Intervention
Co-authored by Wayne Batchelor, Paul Underwood and Roxana Mehran (with Davide Cao, Rishi Chandiramani, Anastasios Roumeliotis, Moritz Blum, Ridhima Goel, Melissa Aquino, Amir Malik, Marcella Press and Dominic Allocco)
Urgency of percutaneous coronary intervention (PCI) relates to the acuteness of the coronary event as well as the patient’s clinical stability. Whereas women and minorities tend to experience higher rates of adverse events after PCI, it is unclear whether this is observed only in specific clinical settings. This study sought to evaluate the impact of sex and race and/or ethnicity on adverse events according to the urgency of PCI, using PLATINUM Diversity and PROMUS Element Plus prospective, multicenter registries on everolimus-eluting stents.
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TCT-336 Use of a Percutaneous Temporary Mechanical Circulatory Support as a Bridge to Decision in Advanced Heart Failure Patients Listed for Heart Transplantation
Co-authored by Alexis Okoh and Setri Fugar (with Mohammad Thawabi, Nawar Al Obaidi, Swaiman Singh, Justin Gold, Sergio Waxman, Rajiv Tayal and Najam Wasty)
The Impella (Abiomed, Danvers, Massachusetts) is a minimally invasive axial-flow catheter capable of providing full temporary hemodynamic support. This study reports on a national series on the use of this device for bridge to decision in patients listed for heart transplantation. The authors hypothesized that, among patients listed for heart transplantation, an Impella can be used as a bridge-to-decision strategy during acute hemodynamic decompensation.
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TCT-406 Clinical Impact of DAPT Cessation Within 12 Months of Drug-Eluting Stent Implantation in Caucasians and Minorities: Insights From the PLATINUM Diversity and PROMUS Element Plus Post-Approval Study
Co-authored by Roxana Mehran, Paul Underwood and Wayne Batchelor (with Davide Cao, Anastasios Roumeliotis, Rishi Chandiramani, Moritz Blum, Ridhima Goel, Samantha Sartori, John Wang, Islam Othman, Henry Liberman, and Dominic Allocco)
Cessation of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) may increase the risk of recurrent ischemic events. Because patterns of DAPT adherence in minorities might be different than in Caucasians, this study evaluated the impact of DAPT cessation within 1 year of PCI on clinical outcomes according to race.
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TCT-650 Economic Outcomes for Older Adults With Acute Myocardial Infarction Treated With PCI
Co-authored by Kelly Epps and Wayne Batchelor (with Abdulla Damluji, Paul Gurbel, Behnam Tehrani, Matthew Sherwood, Christopher Defilippi, and Christopher O'Connor)
From 2000 to 2016, first AMI admission was identified using the primary admission diagnosis for older adults in the Premier Healthcare Database. The primary outcome was inflation-adjusted cost (in dollars) examined by multivariate linear regression analysis. We evaluated the health care cost for older patients (≥75 years of age) with first observed acute myocardial infarction (AMI) treated with PCI.
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TCT-740 Association Between Surgical Risk Profiles and Total Cost or Resource Utilization After Transcatheter Aortic Valve Replacement
Co-authored by Alexis Okoh (with Nawar Al Obaidi, Mariam Selevany, Swaiman Singh, Christopher Pettit, Chunguang Chen, Bruce Haik, Marc Cohen, Leonard Lee and Mark Russo)
Transcatheter aortic valve replacement (TAVR) has been shown to be valuable independent of surgical risk profiles. The aim of the present study was to investigate the association between pre-operative surgical risk scores and total costs or resource utilization after TAVR.
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MORE HIGHLIGHTS FROM TCT 2019 CONFERENCE
TWILIGHT: Ticagrelor Monotherapy Lowers Bleeding Without Increasing Ischemic Events
Dropping aspirin after 3 months of dual antiplatelet therapy (DAPT) with ticagrelor (Brilinta, AstraZeneca) following PCI among high-risk patients is associated with lower rates of bleeding but no increased risk of death, MI, or stroke, according to the results of the double-blind, placebo-controlled TWILIGHT trial, presented by Roxana Mehran, MD (Icahn School of Medicine at Mount Sinai, New York, NY) in a late-breaking clinical trial session at TCT 2019. Dr. Mehran called the findings “groundbreaking” and told TCTMD the study “gives physicians a very, very good alternative to go to ticagrelor monotherapy [while] feeling confident that you’re not raising the ischemic endpoints.”
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AUGUSTUS: PCI or No PCI, Aspirin Uncalled For in Afib
The route atrial fibrillation (Afib) patients take to needing antithrombotic therapy did not make a difference in the advantage of using a direct-acting oral anticoagulant and safety of skipping aspirin. So found a pre-specified substudy of the AUGUSTUS trial, Stephan Windecker, MD, of Bern University Hospital in Switzerland, reported at the Transcatheter Cardiovascular Therapeutics (TCT) conference and online in Circulation.
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Novel TAVR Valves: Mixed Results in First Head-to-Head Trials
In the first head-to-head trials for novel transcatheter aortic valve replacement (TAVR) devices, Acurate Neo flopped and Portico had mixed results, researchers reported at a late-breaking clinical trial session here at the Transcatheter Cardiovascular Therapeutics meeting.
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Off Script: The New Gatekeepers of Procedural Education
Does the proliferation of simulation training pavilions at cardiovascular conferences signal a shift in cardiology education?
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MitraClip for Functional MR: 'It's Never Too Late'
The advantage of MitraClip (Abbott) in functional mitral regurgitation (MR) continues to grow over time and the procedure is cost-effective, with benefit nearly identical for those who crossover to clipping after 2 years, further analyses of the COAPT trial showed.
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TAVR Improves Health Status Over Surgery in Low-Risk Patients at 1 Year: PARTNER 3
Among patients with severe aortic stenosis at low surgical risk, TAVR is associated with improved disease-specific health status over SAVR at not only 1 month but also 6 and 12 months, according to a PARTNER 3 substudy.
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