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November 22th, 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.
FDA Panel Recommends High-Dose EPA for CV Event Reduction
Icosapent ethyl (Vascepa, Amarin) was unanimously recommended by the FDA's Endocrinologic and Metabolic Drugs Advisory Committee for approval to reduce cardiovascular events as an adjunct to statin therapy in patients with elevated triglyceride levels.
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DAPA-HF: Heart Failure Toolbox Poised to Add a New Family of Drugs
A generation of clinicians wanting new drug therapies for their patients with heart failure (HF) and reduced ejection fraction (HFrEF) suffered a long drought that only recently ended with the advent of sacubitril/valsartan (Entresto, Novartis).
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ISCHEMIA: PCI, Surgery Strike Out vs Meds
Viewed by many as the last chance to determine the true value of revascularization in stable ischemic heart disease, the ISCHEMIA trial failed to show fewer major cardiovascular events with an early invasive strategy than optimal medical therapy (OMT).
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RECOVERY: Early Surgery Best in Severe Asymptomatic Aortic Stenosis?
New randomized trial results show early aortic valve replacement (AVR) resulted in a lower risk for operative mortality or death from cardiovascular causes compared with conservative care in asymptomatic patients with severe aortic valve stenosis. Secondary analysis also showed a reduced risk for all-cause mortality, the researchers report.
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Items of Interest
Black, Latin People With Heart Failure Less Likely to Receive Specialized Cardiology Care
As part of an initiative by the Department of Medicine Health Equity Committee at Brigham and Women's Hospital, Brigham investigators conducted a retrospective cohort study of patients admitted to the Brigham with a diagnosis of heart failure. They evaluated whether race and other factors, such as age and gender, influenced whether the patient was admitted to either the specialized cardiology service or general medicine service, as well as the subsequent relationship between admission service and outcomes. The team found that patients who self-identified as black, Latinx, female or over the age of 75 were less likely to be admitted to the cardiology service, even after adjusting for demographic and clinical factors. Their results are published in Circulation: Heart Failure.
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Racial Bias Seen in Heart Transplants
Racial bias among health care providers limits black Americans' odds of receiving a heart transplant, a new study finds. Researchers asked 422 U.S. physicians, nurses and other hospital decision-makers to review the hypothetical cases of black men and white men with heart failure and to decide if the patients should be referred for a heart transplant. The hypothetical cases had identical medical and social history. Race was the only difference among them.
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Antithrombotic Therapy After Acute Coronary Syndrome or PCI in Atrial Fibrillation - AUGUSTUS
Dr. Peter Block interviews presenter Dr. Renato Lopes regarding AUGUSTUS: apixaban vs. vitamin K antagonist and aspirin vs. placebo in AFib and ACS, PCI. Visit here for full meeting coverage.
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ORION-10: siRNA Tx Halves LDL in Atherosclerotic CVD
The investigational drug inclisiran can further halve LDL cholesterol in patients with atherosclerotic cardiovascular disease (ASCVD) already on lipid-lowering therapies, according to the ORION-10 trial presented at the American Heart Association's 2019 Scientific Sessions. Safety will need to be proven in the long-term given that inclisiran is potentially a life-long therapy for people, cautioned Karol Watson, MD, PhD, of the University of California Los Angeles, during an AHA press conference. Manufacturer to start filing for FDA approval for inclisiran.
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Challenges in Heart Failure Management
Clyde Yancy, MD, Ileana Piña, MD, and Lynne Warner Stevenson, MD discuss some of the challenges posed by the results of the late breaking heart failure science presented during Scientific Sessions 2019.
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Black Men In White Coats: An Initiative to Increase The Number Of Black Men In Medical School
BMWC was the vision of Dr. Dale Okorodudu, who launched the BMWC website six years ago after seeing a 2013 Association of American Medical Colleges (AAMC) report that the already under-represented percentage of black men in medical school was dropping. On the BMWC website, Okorodudu posts podcasts and short video documentaries from both medical students and physicians–all expressly intended to inspire black youth that they, too, can become doctors. He’s written books for parents and children to further inspire and educate. He’s also created DiverseMedicine.org to increase ethnic and socioeconomic diversity within the field of medicine via mentoring and outreach.
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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.
Identification of Racial Inequities in Access to Specialized Inpatient Heart Failure Care at an Academic Medical Center.
Co-authored by Eldrin F. Lewis (with Lauren A. Eberly, Aaron Richterman, Anne G. Beckett, Bram Wispelwey, Regan H. Marsh, Emily C. Cleveland Manchanda, Cindy Y. Chang, Robert J. Glynn, Katherine C. Brooks, et al.)
As part of an initiative by the Department of Medicine Health Equity Committee at Brigham and Women's Hospital, Brigham investigators conducted a retrospective cohort study of patients admitted to the Brigham with a diagnosis of heart failure. They evaluated whether race and other factors, such as age and gender, influenced whether the patient was admitted to either the specialized cardiology service or general medicine service, as well as the subsequent relationship between admission service and outcomes. The team found that patients who self ­identified as black, Latinx, female or over the age of 75 were less likely to be admitted to the cardiology service, even after adjusting for demographic and clinical factors. Their results are published in Circulation: Heart Failure.
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Does Race Influence Decision Making for Advanced Heart Failure Therapies?
Co-authored by lead author Khadijah Breathett (with Erika Yee, Natalie Pool, Megan Hebdon, Janice D. Crist, Shannon Knapp, Ashley Larsen, Sade Solola, Luis Luy, Kathryn Herrera-Theut, Leanne Zabala, Jeff Stone, Marylyn M. McEwen, et al.)
Race influences medical decision making, but its impact on advanced heart failure therapy allocation is unknown. We sought to determine whether patient race influences allocation of advanced heart failure therapies.
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EDITORIAL COMMENT: Different Lenses for the Same Story — Examining How Implicit Bias Can Lead Us to Different Clinical Decisions for the 'Same' Patient
Co-authored by Alanna A. Morris (with Theresa E. Shirey)
Dr. Alanna Morris and her colleague examine how implicit bias can lead to different and sometimes detrimental clinical decisions as part of an editorial analysis of “Does Race Influence Decision Making for Advanced Heart Failure Therapies?” by Khadijah Breathett et al: "Although any racial differences identified here are subtle, the findings are still compelling and beg the question of whether this study is yet another example of the effect that implicit bias has on clinical decision making in health care."
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Abstract 15999: An Innovative Application of Artificial Intelligence Techniques and Machine Learning in Diagnostic Evaluation of Pulmonary Hypertension
Co-authored by lead author Demi A Adedinsewo (with Elizabeth Lesser, Mohamad H Yamani and Rickey Carter)
Current non-invasive diagnostic modalities (including echocardiography, computed tomography and magnetic resonance imaging) have limited capacity to differentiate the two major hemodynamic pulmonary hypertension (PH) groups: pre-capillary PH and post-capillary PH. Current guidelines thus recommend invasive testing with right heart catheterization (RHC). Our study objective was to explore predictive capabilities of diagnostic discrimination in a PH patient population by leveraging statistical and artificial intelligence techniques.
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Abstract 11735: Subclinical Myocardial Injury and Cardiovascular Mortality: Racial Differences in Prevalence and Risk (From the Third National Health and Nutrition Examination Survey)
Co-authored by lead author Stephen T Broughton (with Jared W Magnani, Elsayed Z Soliman and Muhammad Ahmad)
Subclinical myocardial injury (SCMI) determined from the electrocardiographic Cardiac Infarction/Injury Score (CIIS) is associated with increased risk of cardiovascular disease and mortality. There has been limited assessment of racial differences in the significance of SCMI. We hypothesized that SCMI prevalence and association with mortality would differ by race, categorized here as non-Hispanic White (White), non-Hispanic Black (Black), and Mexican American.
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Abstract 15957: Cancer Survivorship and Incident Cardiovascular Events in the Aric Study
Co-authored by Chiadi E. Ndumele (with Roberta Florido, Natalie R Daya, Silvia Koton, Stuart D Russell, Roger S Blumenthal, Kunihiro Matsushita, Ye Jin Mok, Ashley Felix, Morgan Grams, Josef Coresh, Corinne E Joshu, Elizabeth A Platz, et al.)
Limited retrospective data suggests that cancer survivors may have increased risk of cardiovascular disease (CVD), possibly due to shared risk factors between cancer and CVD, as well as direct toxicities from cancer therapies. However, there is scarce prospective epidemiological data evaluating the association between adult cancers and CVD events.
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Abstract 12013: Trends in Reported Cardiovascular Disease and Hospitalizations in Cancer Patients - Cardio-oncology Patterns Over 14-year From Two Nationally Representative Datasets
Co-authored by Daniel Addison (with Avirup Guha, Amit K Dey, Elliott Miller, Michael G Fradley and Nihar R Desai)
Cancer survival statistics are well documented; however, the true magnitude of cardiac disease among those with cancer remains largely unknown. We sought to estimate the proportion of cancer patients with cardiovascular disease (CVD) relative to the prevalence of cancer over time.
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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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Congratulations to ABC Board Chair Dr. Cheryl Pegus, recipient of the American Heart Association’s Chairman’s Award for outstanding volunteer efforts to reduce health disparities; and to ABC Access to Care Initiative Chair Dr. Keith C. Ferdinand, recipient of the James B. Herrick Award for Outstanding Achievement in Clinical Cardiology. Both received their awards during the American Heart Association Scientific Sessions 2019 in Philadelphia.
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