1b) @ValleAlfonso is Jefe Servicio Cardiologia, Área del Corazón, Marina Salud. Denia Servicio de Cardiología Hospital La Salud, Valencia. He is a dedicated #cardiology researcher & #educator & appreciates the value of #SoMe education! #cardiotwitter #medtwitter @MedTweetorials
— cardio-met (@cardiomet_CE) June 15, 2022
2) This program is intended for healthcare professionals and is supported by an educational grant from Bayer. See archived programs, all by expert authors, available for credit at https://t.co/NOg9ub8H2q. Author disclosures are listed at https://t.co/gvXca4G9Xm.
— cardio-met (@cardiomet_CE) June 15, 2022
4) Why does #HF matter? #HHF is a high-risk event & an opportunity to improve care processes & implement trial evidence.
— cardio-met (@cardiomet_CE) June 15, 2022
There are more than 1 million admissions per year in the 🇺🇸 and 🇪🇺, which represent almost 5% of the total hospital admissions. Via @HFPolicyNetwork pic.twitter.com/rvhyx4xzPf
6) With these data, what do the #guidelines tell us about the management of patients with #HFrEF? Use all 4⃣ 🔑drugs early.
— cardio-met (@cardiomet_CE) June 15, 2022
Europe 🇪🇺 @escardio : 🔓https://t.co/x2g2nJmSTA
ACC/AHA 🇺🇸 @American_Heart @ACCinTouch
🔓https://t.co/JVhqxg91Tw pic.twitter.com/ijK1Y1bryW
8) With the same clinical trials as a basis, why is there different evidence: IA or IB? It is a matter of understanding what it means in the “American” and “European” #guidelines. pic.twitter.com/Xv4Wwgm7D7
— cardio-met (@cardiomet_CE) June 15, 2022
10) Given the clear benefits in reduction of total and #cardiovascular #mortality and #HHF, with low #NNT, we have to add other differentiating points such as remodeling and the reduction of sudden death. Fun science!
— cardio-met (@cardiomet_CE) June 15, 2022
🔓https://t.co/8DQxFFtr83 pic.twitter.com/TzRnuxmq6R
12) There is minimal evidence on improvement of reverse #remodeling by #ACEi
— cardio-met (@cardiomet_CE) June 15, 2022
👉https://t.co/a1fEPIehPv
👉https://t.co/q2c9t7yCid
👉🔓https://t.co/GtKKVsDUZb
👉https://t.co/OJXY2dHL94
👉🔓https://t.co/Dq9vj1udGw pic.twitter.com/Ezf4dLka6b
14) Continuing now with #risk of sudden cardiac death (#SCD):
— cardio-met (@cardiomet_CE) June 15, 2022
In previous studies #ACEI not have shown clinical benefit on SCD ⬇️ (#CONSENSUS, #SOLVD trials)
🔓https://t.co/lQvVTBoAxr
🔓https://t.co/MyBJCh8H5k pic.twitter.com/x3xJZaCwlx
16) Second poll: In your clinical practice, is combined treatment important?
— cardio-met (@cardiomet_CE) June 15, 2022
a. Step treatment is best as the 2016 ESC guidelines
b. It is better from the beginning to try to combine all possible drugs
c. Depends, different optimization outpatient vs inpatient
17b) For more on this, see
— cardio-met (@cardiomet_CE) June 15, 2022
👉🔓https://t.co/cvwgHyuzgA
👉🔓https://t.co/QB6eKDK76n
and here on Twitter, from @cardiomet_CE faculty member @mvaduganathan : https://t.co/4pWsThRvlP
18b) with all 4⃣, teamwork makes the dream work! pic.twitter.com/t5nsZZsH8t
— cardio-met (@cardiomet_CE) June 15, 2022
20a) Added beneficial effect, like:#ARNI benefit independent of #Beta_blocker dose or #ICD use
— cardio-met (@cardiomet_CE) June 15, 2022
👉🔓https://t.co/glCjTJ8WAC
👉🔓https://t.co/50MOIWcPT9
👉https://t.co/t2WjNzDRxr pic.twitter.com/fSzi9EyKmH
21) Target dose is the max dose that the pt tolerates
— cardio-met (@cardiomet_CE) June 15, 2022
👉In trials the benefit was independent of mean dose of previous treatments
👉In trials many pts do not achieve objective max dose–the most tolerated milligrams of the drug by patient
🔓https://t.co/UyJZJv4lip pic.twitter.com/70ksKXYO3c
23) Mark your preference, and add any comments supporting it to the thread! And then RETURN TOMORROW for more of this program and a link to your 🆓CE/#CME! pic.twitter.com/nioqRpiBpo
— cardio-met (@cardiomet_CE) June 15, 2022
25) So we closed yesterday with a poll (tweet 22) about YOUR priorities for care during a hospitalization for heart failure #HHF–treating the acute issue (usually congestion) vs improving care at discharge and following guidelines-supported data. pic.twitter.com/XnOEFATvvW
— cardio-met (@cardiomet_CE) June 16, 2022
26b) If a patient is admitted under treatment with #sac_val and the dose is 🛑 or ⬇️, total mortality is multiplied by 4x over 12 months
— cardio-met (@cardiomet_CE) June 16, 2022
In the opposite case, the initiation or ⤴️ #sac_val ⬇️ total mortality at 12 mos in this real practice registry
🔓https://t.co/V8CPFGIksU pic.twitter.com/GlZ9ZE8uzd
28) The early benefit of reducing #NTproBNP in the #TRANSITION and #PIONEER-HF studies has an impact in the medium term (8 weeks) ➡️ 45% reduction in the risk of readmission via @DomingoPascualF @_adevore pic.twitter.com/verJrGGUWo
— cardio-met (@cardiomet_CE) June 16, 2022
29b) We also have clinical benefit shown with #empagliflozin in the #EMPULSE study, 🔓https://t.co/YK55Uwiadq, and we are awaiting the results of #DAPA_ACT_HF_TIMI_68 https://t.co/za2r839hfN pic.twitter.com/whXGFEzUNr
— cardio-met (@cardiomet_CE) June 16, 2022
30a) What is the principal factor to prescribe “foundational” treatment?
— cardio-met (@cardiomet_CE) June 16, 2022
a. Only per #BP levels
b. BP level and renal function
c. BP level, renal function, potassium level
d. #NYHA class
MARK YOUR ANSWER BEFORE SCROLLING ⤵️
31) BLOOD PRESSURE:
— cardio-met (@cardiomet_CE) June 16, 2022
We know how combo's of drugs modestly reduce BP level. #ARNI+#SGLT2i ⬇️SBP by 3.3mmHg at 4 weeks.
Drugs such as #SGLT2i have an “intelligent“ hypotensive effect, actually ⤴️SBP in those with SBP < 110mmHg
🔓https://t.co/JQ2qjrOgun
🔓https://t.co/ydr5Ypzi7i pic.twitter.com/XcxXGbl35Z
33) KIDNEY FUNCTION:
— cardio-met (@cardiomet_CE) June 16, 2022
The evidence tells us how in #CKD stage 3B there is strong evidence for the use of #ARNI, #SGLT2i, #MRA, #BB.
In pts with CKD stage 4, maybe the best combination is SGLT2i, BB and #Vericiguat or #omecamtiv_mecarbilhttps://t.co/gPTNZEotDb pic.twitter.com/1BCPI6ChXm
35) So which approach do you think is a better up-titration schedule?
— cardio-met (@cardiomet_CE) June 16, 2022
a. Conventional schedules (only considered starting a new therapy after the dose of the previous treatment had been maximized)
b. An accelerated up-titration
37) What other options do we have for our HFrEF patients?https://t.co/8phg8yO9nt pic.twitter.com/guQPULGxQ7
— cardio-met (@cardiomet_CE) June 16, 2022
39) Despite improved outcomes with contemporary therapy in patients with #HFrEF, significant residual risk remains pic.twitter.com/LdV1RTkCTe
— cardio-met (@cardiomet_CE) June 16, 2022
41) The #MOA of #vericiguat is complex.
— cardio-met (@cardiomet_CE) June 16, 2022
Soluble guanylate cyclase #sGC stimulation targets an untapped pathway that may impact development & progression of #HF.
👉Improved myocardial function
👉⬇️left ventricular remodeling
👉⬆️ vascular function
👉⬇️fibrosis
👉⬇️inflammation pic.twitter.com/UggjkRaHTx
43) Consider the #VICTORIA study: Vericiguat significantly ⬇️ annualized absolute rate of time to #HHF or #CVdeath by 4.2 events/100 patient-year#Vericiguat changes the disease trajectory by reducing recurrent HF #hospitalization 🏥
— cardio-met (@cardiomet_CE) June 16, 2022
🔓https://t.co/1N6qpVHvng pic.twitter.com/8SSKwKxgls
45a) So there is a 🆕 physiological target in HF
— cardio-met (@cardiomet_CE) June 16, 2022
👉for patients with chronic HF (and LVEF <45%) who had a previous worsening HF event #NNT = 24 with #vericiguat for 1 year to prevent a primary outcome
46) And that's it! You've made it! Go claim your 0.5h CE/#CME at https://t.co/rAIzJTB6kH. And FOLLOW US for more #accredited #education by #tweetorial. I am @ValleAlfonso. Please✔️out our companion CE/#CME feed from @ckd_ce! @MedTweetorials #FOAMed #CardioTwitter @HEI_McMaster
— cardio-met (@cardiomet_CE) June 16, 2022