2) @GiuseppeGalati_ is at San Raffaele Research Hospital, Milan 🇮🇹 @SanRaffaeleMI. This program is intended for #healthcare professionals & is accredited for 0.75h CE/#CME credit for #physicians #physicianassistants #nurses #nursepractitioners #pharmacists 🇺🇸🇨🇦🇬🇧🇪🇺.
— cardio-met (@cardiomet_CE) May 17, 2022
4) #DiabetesMellitus (#T2DM) is highly prevalent in #HeartFailure patients. In this US registry of patients hospitalized for #AcuteHF the prevalence of #T2DM has been remained constant from 2005 to 2015: 40-45% both in #HFrEF & #HFpEF
— cardio-met (@cardiomet_CE) May 17, 2022
See 🔓https://t.co/w2SYX4A943 pic.twitter.com/T8tHXZUGh6
6) In this Italian cohort 🇮🇹 the prevalence of #T2DM showed to be high, not only in hospitalized patients, but also in #chronicHF. It was nearly 35% both in #HFrEF & in #HFpEF.
— cardio-met (@cardiomet_CE) May 17, 2022
See 🔓https://t.co/YJmrrl4gni pic.twitter.com/Q0AToJbkRT
8) Diabetic patients have a higher risk not only of #AcuteCoronarySindrome but also of #HF, #IschemicStroke and #PeripheralArteryDisease. Despite it is poorly known, the risk of developing #HF is comparable to that of having an #ACS.
— cardio-met (@cardiomet_CE) May 17, 2022
See 🔓https://t.co/1QFQRNJpky pic.twitter.com/51ELXdy7mo
10) However, the major driver of benefit in these trials dedicated to prevention has been the reduction of #HF hospitalizations #HHF & #CV_Death. The developers of these drugs thus decided to test them in #RCT dedicated to #HF +/- #T2DM status.
— cardio-met (@cardiomet_CE) May 17, 2022
See https://t.co/b6RgcFg9eK pic.twitter.com/9LsN9j5Q4l
12) Here you can see the characteristics of the enrolled population. 67% of NYHA II, mean #LVEF: 31%, median #NT-proBNP: 1400 pg/mL, Previous #HHF 47%, #TDM 42%, mean #eGFR 65 ml/min.
— cardio-met (@cardiomet_CE) May 17, 2022
See 🔓https://t.co/4szsNSj0L7 pic.twitter.com/rbabCyxf5m
13b) The pre-specified primary #EP analysis showed that the benefit was significant and with the same magnitude both in diabetic vs non-diabetic pts.
— cardio-met (@cardiomet_CE) May 17, 2022
See 🔓https://t.co/4szsNSj0L7 pic.twitter.com/mIn3xhwZhX
15) The population enrolled in #EMPEROR_REDUCED when compared to that of #DAPA_HF had higher NYHA III 24% , lower mean #LVEF: 27%, and higher #NT_proBNP level: 1900 pg/mL. Previous #HHF 31%, #TDM 50%, mean #eGFR 62 ml/min
— cardio-met (@cardiomet_CE) May 17, 2022
See 🔓https://t.co/4szsNSj0L7 pic.twitter.com/t8Z6BgFWNL
17) As in #DAPA_HF, #EMPEROR_REDUCED showed significant ⬇️in the primary #EP (#CV_Death + 1st #HHF) in #HFrEF patients irrespective of #T2DM status; RRR 25%. Pre-specified primary #EP analysis ➡️benefit was significant & with similar magnitude in diabetic vs non-diabetic pts. pic.twitter.com/OWpO3tYLqP
— cardio-met (@cardiomet_CE) May 17, 2022
19) This metanalysis showed that SGLT2i significantly reduced 1st #HHF when considered alone, Total (1st + recurrent) #HHF + #CV_Death & significantly reduced renal outcomes.
— cardio-met (@cardiomet_CE) May 17, 2022
The benefit on renal outcomes confirmed what was demonstrated in RCTs dedicated to prevention in #T2DM pic.twitter.com/X7v4nhydyP
21) The same benefit of #SGLT2i in #HFrEF on primary EP was independent of #eGFR.
— cardio-met (@cardiomet_CE) May 17, 2022
In particular the benefit was the same in patient with eGFR > or < than 60 ml/min. pic.twitter.com/1IGR94WzWm
22b) Enter your response & return TOMORROW for the correct answer & the remainder of this #accredited #tweetorial! 👍to @GoggleDocs @DrMarthaGulati @mmamas1973 @SABOURETCardio @HanCardiomd @SeguraCardio @ValleAlfonso @gcfmd @purviparwani @DFCapodanno @mirvatalasnag @gbiondizoccai
— cardio-met (@cardiomet_CE) May 17, 2022
23) Welcome back! We are reviewing the #cardiology perspective on the #prevention & #management of #HF in pts with #T2D. I am @GiuseppeGalati_ & I encourage you to follow @cardiomet_ce for all your #cardiometabolic CE/#CME needs! 👏to @ShivangiPraman1 @bianchinifra92 @edurontoFF
— cardio-met (@cardiomet_CE) May 18, 2022
25) After demonstrating sig benefit in #T2DM & #chronic #HFrEF, #SGLT2i was evaluated in a pilot trial dedicated to #acute #HF #AHF. #EMPA_RESPONSE_AHF enrolled 80 patients hospitalized for #AHF & significantly⬆️diuretic response on top of furosemide.
— cardio-met (@cardiomet_CE) May 18, 2022
See🔓https://t.co/hq2iBiFRcI pic.twitter.com/39QvunGuFg
27) The first large RCT dedicated to #SGLT2i + #SGLT1i in #AHF was #SOLOIST_WHF. This #RCT dedicated to #TD2M + #AHF pts enrolled >1200 pts. Here you can see the design of this RCT, led by @cardiomet faculty @DLBHATTMD
— cardio-met (@cardiomet_CE) May 18, 2022
🔓https://t.co/WJ1iHk9Y9U pic.twitter.com/tlGaYpOSQR
29) #SOLOIST_WHF was the first RCT that demonstrated in pts with #AHF + #T2DM a significant ⬇️of the Primary #EP: #Total #CV_death + #HHF + #UrgentVisitForHF, but due to change of the Primary EP because of the #Covid19 & change in sponsorship a further proof was needed pic.twitter.com/ztnYQIqTz6
— cardio-met (@cardiomet_CE) May 18, 2022
31) #EMPULSE enrolled 530 #AHF pts with these characteristics: #T2DM 45%, median #LVEF: 31%; #HFrEF 66%, #HFmrEF + #HFpEF 33%, median #NTproBNP: 3180 pg/mL, median eGFR 52%, de-novo #AHF 33%, worsening #AHF/ decompensated #CHF 66<% pic.twitter.com/GdS2TQxczM
— cardio-met (@cardiomet_CE) May 18, 2022
33) #EMPULSE has a particular design, using a #win_ratio to adjudicate the Primary EP. This was similar to the #ATTR_ACT trial (#tafamidis in cardiac amyloidosis). However, when considered alone the reduction of #All_cause_death + #HFE was significant. pic.twitter.com/Wjgv0XgEOZ
— cardio-met (@cardiomet_CE) May 18, 2022
34b) Mark your best response and return here TOMORROW for the correct answer, a wrap-up of this #tweetorial, & a link to your 🆓CE/#CME! 👉@DjawidHashemi @DrCasanovaPablo @SeguraCardio @edurontoFF @BonanadClara @cpcannon @mvaduganathan @ShelleyZieroth @DrMarthaGulati
— cardio-met (@cardiomet_CE) May 18, 2022
36a) See https://t.co/IzTVr0TZZF for a nice discussion. The answer to the quiz is C, because in fact the components of the composite #EP do NOT have to be similar. For example, the win ratio can combine the time to death with the number of occurrences of a non-fatal outcome …
— cardio-met (@cardiomet_CE) May 19, 2022
37) So, where were we? Oh yes, trials ➡️ benefit of #SGLT2i‘s in #T2DM, #chronic #HFrEF, #AHF, & #CKD (the latter not covered in this edition). #SGLT2i has now been tested in #chronic #HFpEF, in #EMPEROR_PRESERVED.
— cardio-met (@cardiomet_CE) May 19, 2022
Here you can see the trial design (🔓https://t.co/KRB81ldaiY) pic.twitter.com/ft5NcVtVee
39) #EMPEROR_PRESERVED became the 1st RCT to show a significant reduction of the Primary EP: #CV_Death + 1st #HHF in #HFpEF pts (RRR:21%). Moreover, the 2nd secondary hierarchical EP was significantly reduced (Total #HHF) as well as the 2nd secondary hier. EP (eGFR mean change). pic.twitter.com/PPV1fPazkX
— cardio-met (@cardiomet_CE) May 19, 2022
41) The 1st reply of #HFcardiologist was that #KCCCQ was built & validated in #HFrEF pts. Therefore its application to #HFpEF can’t be valued in the same manner. Further analysis of #EMPEROR_PRESERVED showed a significant⬆️of #KCCCQ especially in the domains dedicated to #QoL pic.twitter.com/qm0HuM8WKz
— cardio-met (@cardiomet_CE) May 19, 2022
43) The most important criticism of #EMPEROR_PRESERVED was that in splitting the component of 1st #EP most of the benefit was driven by ⬇️of the 1st #HHF whereas⬇️#CV_Death was not significant. This analysis➡️ IIA rec to #SGLT2i in the last #ACC_AHA_HFSA guidelines pic.twitter.com/itMNPpiT5I
— cardio-met (@cardiomet_CE) May 19, 2022
44b) … (so that Italy was the 1st country in Europe & the 2nd in the globe in this stat). Therefore, from diagnosis to death in the luckiest scenario #HFpEF pts live 7 years after diagnosis. pic.twitter.com/7IQp93vRuA
— cardio-met (@cardiomet_CE) May 19, 2022
46) #CHIEF_HF (#canagliflozin in both #HFrEF & #HFpEF) and #PRESERVED_HF (#dapagliflozin in HFpEF) confirmed (removing all the residual doubts) that #SGLT2i significantly improve #QoL, #KCCCQ, #6mwt in #HFpEF pts pic.twitter.com/yKG87RdItN
— cardio-met (@cardiomet_CE) May 19, 2022
48) Concluding this #tweetorial, #SGLT2i have now (based on the evidence) 6⃣ indications: #TD2M, #CKD, chronic #HFrEF, chronic #HFmrEF, chronic #HFpEF, & #AHF. This justifies the title of “The statins of 21st century”! #FLOZINATE! pic.twitter.com/1y6vuxDSLO
— cardio-met (@cardiomet_CE) May 19, 2022
50) If you want to know more about #SGLT2i and #HF, please check this review in which you can find in detail the contents of this tweetorial. “Women and diabetes preventing heart disease in a new era of therapies”, 🔓 https://t.co/hre9WXcgFq, by yours truly pic.twitter.com/3OJIZ2aRo0
— cardio-met (@cardiomet_CE) May 19, 2022
51) And that’s it! You made it! 0.75h CE/#CME credit 🇺🇸🇨🇦🇬🇧🇪🇺 and you can claim your certificate at https://t.co/kJi0ZM0B08. I am @GiuseppeGalati_. Please join me in following @cardiomet_ce for the best education in #cardiometabolic medicine by expert authors, here on Twitter!
— cardio-met (@cardiomet_CE) May 19, 2022