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October 31st, 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.
More Evidence of Worse Outcomes With New-Onset AFib After TAVR
Patients with no history of atrial fibrillation (AF) who develop it within a month of transcatheter aortic valve replacement (TAVR) have worse long-term outcomes than their peers with preexisting AF or no AF, a new study has found. Mary Vaughan Sarrazin, PhD, University of Iowa Institute for Clinical and Translational Sciences, Iowa City, and colleagues identified 72,660 patients, age 65 and older, who underwent nonapical TAVR between 2014 and 2016 using Medicare inpatient claims.
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Maintaining Weight Loss in Diabetes Is Key to Keeping Benefits
Individuals with type 2 diabetes who maintain weight loss after an intensive lifestyle intervention have sustained improvements in cardiometabolic risk factors, and those who regain weight not only miss out on the benefits but may have a worsening of their metabolic profile, say US researchers. In a new analysis of data from the Look AHEAD (Action for Health in Diabetes) trial, Samantha E. Berger, PhD, of Tufts University, Boston, Massachusetts, and colleagues studied almost 1600 individuals who followed an intensive lifestyle intervention.
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CMS Payment Change for Noninvasive Cardiac Tests Backfires
The change in Medicare reimbursement rates for noninvasive cardiac tests (NCTs) that provide higher payments for hospital-based outpatient (HBO) locations than for provider-based office (PBO) settings has led to more testing and increased costs, including patient out-of-pocket costs, according to a new analysis.
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Items of Interest
'Shop Docs' Bring Health Screenings to Barbershops
University of Miami Miller School of Medicine students are visiting barbershops to offer free health screenings to African-American men who otherwise might not seek health care through a program called, The Shop Docs, an outreach initiative launched three years ago by a fourth year student in the Miller School of Medicine’s M.D./M.P.H. program.
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Amgen Escalates PCSK9 Pricing War With Permanent 60 Percent Price Cut On Repatha
Amgen said that as of January, it will sell Repatha exclusively at the $5,850 price. Murdo Gordon, executive vice president of global commercial operations at Amgen, said the company is making the change now primarily to benefit Medicare patients, some of whom still face unaffordable out-of-pocket costs for the drug.
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Racial Bias Found in a Major Health Care Risk Algorithm
As organizations increasingly replace human decision-making with algorithms, they may assume these computer programs lack our biases. But algorithms still reflect the real world, which means they can unintentionally perpetuate existing inequality. A recent study published in Science has found that a health care risk-prediction algorithm, a major example of tools used on more than 200 million people in the U.S., demonstrated racial bias—because it relied on a faulty metric for determining need.
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Tuskegee Study's Medical Exploitation Led to Population-Wide Declines in Health Among Black Men
A new research article co-authored by the University of Minnesota School of Public Health discusses how the well-known U.S. government study that secretly infected African-American men with syphilis may have harmed the health of future generations through what’s known as peripheral trauma, which according to the authors, exists when racially or ethnically targeted, adverse events lead to poor mental and physical health in minority groups — even among members not directly involved in the incident. For example, they cited how recent research shows that the mental health of black men tends to decline in communities where an unarmed black man was recently killed by police.
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Poor Communities Hit Hard By Pharmacy Closures
Low-income urban communities are seeing much higher rates of pharmacy closures than other areas, which researchers worry will widen socio-economic health disparities. According to a new analysis published in JAMA Internal Medicine, 1 in 8 pharmacies closed between 2009 and 2015. Most of those closures involved independently owned pharmacies and providers located in poorer urban areas.
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BMS-Pfizer, Fitbit Partner to Improve AFib Detection in People at Risk for Stroke
The Bristol-Myers Squibb-Pfizer Alliance and Fitbit announced they’d be partnering to improve timely diagnosis of atrial fibrillation in people at an increased risk of stroke. BMS-Pfizer and Fitbit don’t have clearance from the FDA yet, but, according to a statement, once their submission is approved they’ll focus on providing users with an educational platform to encourage and facilitate discussions between patients and their physicians.
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FDA Gives Rivaroxaban Another VTE-Related Indication
Rivaroxaban (Xarelto; Bayer/Janssen) has gained an additional indication, this time for venous thromboembolism (VTE) prophylaxis in acutely ill hospitalized patients at increased risk for thromboembolic complications but not at high risk of bleeding, Janssen announced this month. With the expanded indication, granted by the US Food and Drug Administration late last week, rivaroxaban, at a dose of 10 mg once daily, can be started during the hospital stay and continued for 31 to 39 days.
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Heart-Failure Deaths Rise, Contributing to Worsening Life Expectancy
Deaths from heart failure, one of the nation’s biggest killers, are surging as the population ages and the health of younger generations worsens. The death rate from the chronic, debilitating condition rose 20.7% between 2011 and 2017 and is likely to keep climbing sharply, according to a study published this week in the journal JAMA Cardiology.
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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.
Metabolite Profiles of Incident Diabetes and Heterogeneity of Treatment Effect in the Diabetes Prevention Program
Co-authored by Samuel Dagogo-Jack (with Zsu-Zsu Chen, Jinxi Liu, Jordan Morningstar, Brandy M. Heckman-Stoddard, Christine G. Lee, Jane F. Ferguson, Richard F. Hamman, William C. Knowler, Kieren J. Mather, Leigh Perreault and Jose C. Florez, et al.
Novel biomarkers of type 2 diabetes (T2D) and response to preventative treatment in individuals with similar clinical risk may highlight metabolic pathways that are important in disease development. We profiled 331 metabolites in 2,015 baseline plasma samples from the Diabetes Prevention Program (DPP). Cox models were used to determine associations between metabolites and incident T2D, as well as whether associations differed by treatment group (i.e. lifestyle (ILS), metformin (MET), or placebo (PLA)) over an average of 3.2 years of follow up. Our findings highlight novel markers of diabetes risk and preventive treatment effect in individuals that are clinically at high risk and motivate further studies to validate these interactions.
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Biomarkers of Insulin Action During Single Soccer Sessions Before and After a 12-Week Training Period in Type 2 Diabetes Patients On a Caloric-Restricted Diet
Co-authored by Samuel Dagogo-Jack (with Maysa V. de Sousa, Rosa Fukuik, Peter Krustrup, Hassane Zouhal and Maria Elizabeth R. da Silva)
We investigated the biomarkers of insulin action as well as changes in free fatty acids and lactate concentration after an acute soccer session pre and post training with caloric-restricted diet versus diet alone in type 2 diabetes (T2D) patients.
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CABG Improves Outcomes in Patients With Ischemic Cardiomyopathy: 10-Year Follow-Up of the STICH Trial
Co-authored by Ileana L. Piña MD and Patrice M. Desvigne-Nickens MD (with Jonathan G. Howlett MD, Amanda Stebbins MA, Mark C. Petrie MBChB, Pardeep S. Jhund MBChB, PhD, Serenella Castelvecchio MD and Alexander Cherniavsky MD, et al.)
In the STICH (Surgical Treatment for Ischemic Heart Failure) trial, the authors investigated the impact of coronary artery bypass grafting (CABG) on first and recurrent hospitalization in this population.
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We LOVE to LEARN how our ABC Members are making a difference! Please Share. Giving a keynote speech? Presenting at a Grand Round? Receiving an Award? Interviewed by the Press? Published in a journal? Presenter or Panelist at a Conference? Graduating? Email Rachel Williams at rwilliams@abcardio.org or please tag or DM us on Facebook, Twitter or Instagram with links/details, so we can spotlight your excellence in our newsletter!

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Ask Congress to Ensure Timely Access to Medications

The “Safe Step Act” (S.2546/H.R.2279), a bipartisan bill, is pending in the U.S. Senate and House of Representatives that has the potential to improve patient access to medications for the treatment of cardiovascular disease. The “Safe Step Act” (S.2546/H.R.2279) creates a clear, timely and transparent process for a patient or physician to request an exception to step therapy protocols in certain situations. Step therapy is a tactic used by insurance companies that requires a patient to try and fail on their preferred medications before covering the therapy prescribed by their health care provider.

The “Safe Step Act” is good legislation that deserves Congress' attention. Advancing the bill requires a strong show of support by elected officials. The more cosponsors a piece of legislation has, the more likely it is to receive a vote.

Tell your members of Congress why the “Safe Step Act” is important to patients with heart disease and ask for their co-sponsorship.

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Today, nearly 20 million Americans are living with peripheral artery disease (PAD) and an estimated 200,000 of them – disproportionately from minority communities – suffer avoidable amputations every year.

Fortunately, lawmakers in Congress are taking action. Representatives Donald M. Payne, Jr. (D-NJ-10) and Gus Bilirakis (R-FL-12) have worked together to establish the first Congressional PAD Caucus to educate Congress and communities about PAD while supporting legislative activities to improve PAD research, education, and treatment, with the goal of preventing non-traumatic amputations due to PAD and other related diseases.

Ask your Member of Congress to raise #PADAwareness by becoming a member of the Congressional PAD Caucus.

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