@SJGreene_md @hragy @pabeda1 @heartOTXHeartMD @mmamas1973 @RRBaligaMD @datsunian @AndrewJSauer @mvaduganathan @jlauffen @VietHeartPA @Lross246 @EricAdler17 @rachkataria @drrajivsankar @aayshacader @kfarooqi @pedschwartzmann @ToddVillinesMD @LucySafi @alinsairMD @MaryjaneFarrMD
— cardio-met (@cardiomet_CE) January 11, 2022
3) In this program we will consider evidence-informed strategies to optimize #medicaltherapy & #healthcare #services after #HHF. We'll discuss #gaps in #heartfailure care …
— cardio-met (@cardiomet_CE) January 11, 2022
5) 🔓https://t.co/Oc55suDArR: Heart failure (HF) affects nearly 6.2 million Americans, is the primary diagnosis in about 1 million hospitalizations and a secondary diagnosis in about 2 million hospitalizations annually. pic.twitter.com/vHY9hB7JxT
— cardio-met (@cardiomet_CE) January 11, 2022
7) … hospitalizations account for > 70% of direct costs of care. Inpatient mortality is 4-8% or higher in some cohorts. Age-adjusted risk for all-cause mortality is 3x non–HF patients. The HHF itself is a signal event in a patient's #HF course: pts admitted with HF have …
— cardio-met (@cardiomet_CE) January 11, 2022
9) Guidelines suggest a daily "trajectory check" for inpatients w/#HF: checking perfusion and clinical symptoms & signs of HF, addressing underlying causes, and assessing lab values to help define next steps for management, care coordination, prognostication, & disposition.
— cardio-met (@cardiomet_CE) January 11, 2022
11) Aggressive #vasodilation during #hospitalization does not appear to provide a reduction in all-cause death or rehospitalization at 3 months compared to usual care: see #GALACTIC (🔓https://t.co/PkBvwkG1AX) pic.twitter.com/1MnGnwHwfQ
— cardio-met (@cardiomet_CE) January 11, 2022
12b) The pillars of medical therapy that improve outcomes across the range of #LVEF: #ARNI or #ACEi/#ARB (then substitute ARNI), #betablockers, #MRA, and #SGLT2i. See also updated @escardio guidelines at 🔓https://t.co/8fHBv9efZg. pic.twitter.com/lcgUDg5WB4
— cardio-met (@cardiomet_CE) January 11, 2022
14) The benefit of #ARNI over ACE-I on the surrogate endpoint of NT-proBNP in inpatients w/ #HFrREF – along with safety – was demonstrated in #PIONEER-HF (🔓at https://t.co/UQI6Y7z2Gg). pic.twitter.com/956b3b6cdT
— cardio-met (@cardiomet_CE) January 11, 2022
16) PARADISE-MI demonstrated no significant benefit of #ARNI over #ACEi in patients with acute #MI with reduced LVEF and/or pulmonary congestion (https://t.co/XtZJ5pBREd). Thus, evidence to date does not support using ARNI over ACEi to reduce CV death or incident HF in acute MI. pic.twitter.com/dw6hzm8X52
— cardio-met (@cardiomet_CE) January 11, 2022
17b)
— cardio-met (@cardiomet_CE) January 11, 2022
– among diabetics, #sotagliflozin a combined SGLT1i/SGLT2i (SOLOIST,🔓https://t.co/GF5s6MSJXW) from @DLBHATTMD et al. pic.twitter.com/d6VZuAJrjG
19) In #SOLOIST, diabetic pts treated with sotagliflozin vs placebo before or shortly after discharge had a 16% reduction in composite CV deaths, HHF, and urgent HF, driven by a reduction in worsening HF.
— cardio-met (@cardiomet_CE) January 11, 2022
21) Renal function is a particularly vexing issue as these patients are followed & GDMT is titrated; #RAASi down-titration or even abandonment is often accelerated unnecessarily in response to #hyperkalemia (for more education [and CE/#CME] on this, see https://t.co/mt1n5Aeq4S).
— cardio-met (@cardiomet_CE) January 11, 2022
23) With worsening renal function, check volume status (treat congestion, volume depletion) and monitor #bloodpressure. Modest ⬇️in eGFR is to be expected after starting #RAASi and #SGLT2i, continue to titrate. Renal outcomes improve with SGLT2i & RAASi (#ACE/ARB & #MRA)
— cardio-met (@cardiomet_CE) January 11, 2022
25) Make your choice & return TOMORROW for the correct answer, more education, & a link to your FREE CE/#CME! Hello to @ferbotto @DrJaarsma @GoggleDocs @MarkBelkinMD @JamalRanaMD @Derek_Leong_RPh @SnayCardsPharmD @beaverspharmd @bmorecardiology @jennybnp @PeterPLiu_MD @modeldoc
— cardio-met (@cardiomet_CE) January 11, 2022
27) So re yesterday’s poll (tweet 24), the correct answer is (a). In fact, two interventions may help improve clinician prescription of #GDMT for #heartfailure. (🔓https://t.co/5LvArKotBq): pic.twitter.com/jZ9QTpzlSl
— cardio-met (@cardiomet_CE) January 12, 2022
29a) Many patients hospitalized for HF do not know the prognosis associated with the diagnosis. There are many prognostic tools in HF but these are complex and impractical to use. The 2-variable "LE index" (length of stay + emergent visits) offers practical point-of-care …
— cardio-met (@cardiomet_CE) January 12, 2022
30a) In fact, #LVEF class is inadequate in stratifying risk. In 🔓https://t.co/k6zNWP2xaD we see "clinical phenogroups" established by #MachineLearning can stratify risk (all-cause death or hospitalization) …
— cardio-met (@cardiomet_CE) January 12, 2022
31a) The weeks following hospitalization is particularly high risk, and patients experience care gaps during this #TransitionCare period, when patients transition between settings and clinicians.
— cardio-met (@cardiomet_CE) January 12, 2022
32a) What service intervention/s decrease mortality compared to standard care in the months following #HHF?
— cardio-met (@cardiomet_CE) January 12, 2022
a. nurse case management
b. telemonitoring
c. disease management clinics
d. a & c
Don’t scroll down before you vote!
32c) Now you can look; for tweet 33a, the answer is (d), and for 33b, the answer is (a). Disease management clinics—that is, in this discussion, multidisciplinary #HF clinics, are really beneficial.@drdargaray @DVervoort94 @vass_vassiliou @StefanoNistri @shahrukh_bakar
— cardio-met (@cardiomet_CE) January 12, 2022
34a) We combined services & tested their effect in our public healthcare system in the #PACTHF #steppedwedge cluster #RCT in 🇨🇦.
— cardio-met (@cardiomet_CE) January 12, 2022
The intervention comprised
– pre-discharge nurse-led education & patient-centered discharge summary
– post-discharge #nurse #homevisits & #HFclinics
35a) In exploratory analysis, there were sex differences in clinical benefit: adjusting for age and other differences, women had improved clinical outcomes at 6 months – driven by a reduction in ED visits – while men did not.
— cardio-met (@cardiomet_CE) January 12, 2022
36) Women had worse #QOL at hospital discharge than men (see https://t.co/03Bgyj6wBx). Both women and men experienced improvement in #PROs with the PACTHF intervention. @Vbluml (https://t.co/3fhO1YW0ip): pic.twitter.com/x4qjlz3F22
— cardio-met (@cardiomet_CE) January 12, 2022
37a) We must address #disparities in care and outcomes in women, low #SES, #BIPOC groups.
— cardio-met (@cardiomet_CE) January 12, 2022
Low SES groups have ⬆️ adjusted mortality and receive ⬇️ cost care during #HHF than higher SES groups due to less invasive procedures. Black patients had lower length of stay …
38) #EndOfLife is another period in which there are care disparities in HF. Women receive less invasive & intensive care in last months of life than men & are more likely to die at home than in hospital. See https://t.co/f4AMYkdLct
— cardio-met (@cardiomet_CE) January 12, 2022
40a) To improve care & estimate the effect & safety of treatments accurately, we must ⬆️enrolment of ♀️, BIPOC participants (https://t.co/xoDskW0qsz), & those from Africa, Asia, South America in #HF #RCTs @zhennyju
— cardio-met (@cardiomet_CE) January 12, 2022
(https://t.co/5ySSUg28cr).
40c) The evidence for diversity gaps among enrolled participants and strategies to close them are outlined here. @ErinMichos https://t.co/BjxB8cZYDlhttps://t.co/km0MTdpLDLhttps://t.co/5YlzanRzJ9 pic.twitter.com/QcOdpUdVOh
— cardio-met (@cardiomet_CE) January 12, 2022
42) Outcomes after HHF can be improved, but "it takes a village": pic.twitter.com/8wmL1hsQvm
— cardio-met (@cardiomet_CE) January 12, 2022
43) And that's it! You've made it! Go and claim your 0.5h CE/#CME at https://t.co/we4o5h6Pwp. And FOLLOW US for more #accredited #education by #tweetorial. I am @hvanspall. And ✔️out our companion CE/#CME feed from @ckd_ce! @MedTweetorials #FOAMed #CardioTwitter @HEI_McMaster
— cardio-met (@cardiomet_CE) January 12, 2022