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) October 10, 2022
4) The prevalence & incidence of #HeartFailure (#HF) is constantly growing over the last decades, severely impacting expectancy and quality of life. These numbers justify why #HF has been defined as a real pandemic (even before and after the #Covid19 #pandemic) pic.twitter.com/0me31CRDVw
— cardio-met (@cardiomet_CE) October 10, 2022
6) After each #HF hospitalization (#HHF) survival is reduced almost of 50% and after the initial worsening #HF event each subsequent event becomes longer in duration and is separated by shorter intervals. pic.twitter.com/gZDGKFy89v
— cardio-met (@cardiomet_CE) October 10, 2022
8) Patients with #WorseningHF are a distinct population characterized by a 4 times higher mortality when compared to chronic “stable” #HF and higher also to patients with #DeNovoHF. This is true both for #HFrEF and for #HFpEF. See the data of IN-HF outcome. pic.twitter.com/oN6gVzYQBE
— cardio-met (@cardiomet_CE) October 10, 2022
10) The residual risk of #CV_Death+ #HHF + #WorseningHF is high even in both #EMPEROR_Reduced and #DAPA_HF that enrolled a less sick population respect to #GALACTIC_HF. 1 of 7 pts in these #RCTs experienced a primary #EP event despite #ARNI, #BB, #MRA , #SGLT2i
— cardio-met (@cardiomet_CE) October 10, 2022
See pic.twitter.com/DBp8lZaEch
12) #HeartFailure is characterized by an oxidative stress that ➡️ #NO / #cGMP & #PKG deficiency contributing to both #vascular & #myocardial dysfunction. The NO/cGMP/PKG pathway is a regulator of several mechanisms & is also involved in the #PulmonaryHypertension pathophysiology pic.twitter.com/5Xiyt4qjwH
— cardio-met (@cardiomet_CE) October 10, 2022
13b) It’s C. #Vericiguat is a drug with a unique mechanism of action that selectively stimulates and boosts the NO/cGMP/PKG pathway restoring its physiological activity with positive effect on the #heart, the #vessels and the #kidney pic.twitter.com/Vfcae1ro9p
— cardio-met (@cardiomet_CE) October 10, 2022
15) This specific mechanism of action & its positive effect has been tested in the large #VICTORIA RCT. This RCT enrolled >5000 #HFrEF patients with the following inclusion criteria (fig) to take #vericiguat once daily (biweekly uptitrated to the target 10 mg/day dose) vs placebo pic.twitter.com/AMRNok5lCo
— cardio-met (@cardiomet_CE) October 10, 2022
17) The #HFrEF optimal medical therapy of #VICTORIA was comparable to that of #DAPA_HF & #EMPEROR_Reduced and included 14.5% of patients on ARNI, 59.7% on triple therapy (ACE-I/ARB/ARNI, β-blocker, MRA), 27.8% with an ICD and 14.7% with a CRT pic.twitter.com/WjusaSWGwU
— cardio-met (@cardiomet_CE) October 10, 2022
19) The secondary endpoints analysis confirmed the benefit on #HHF, indeed total (first and recurrent) HHF were significantly reduced (p=0.02, RRR 9%) with no significant effect on #all-cause death (p=0.38, RRR:5%) pic.twitter.com/Eu6NM5rgs7
— cardio-met (@cardiomet_CE) October 10, 2022
21) Although at a 1st glance the results achieved in #VICTORIA don't seem remarkable, the understanding of the population characteristics explains the important impact on #HFrEF. Indeed, pts enrolled in #VICTORIA had very severe #HFrEF when compared to all the #HFrEF RCTs pic.twitter.com/Vf8MoYiUYE
— cardio-met (@cardiomet_CE) October 10, 2022
23a) So what have you learned? #Vericiguat showed to be highly beneficial to a specific population with severe #HF, covering an unmet need of patients with #HF with which of the following characteristics?
— cardio-met (@cardiomet_CE) October 10, 2022
24a) Welcome back! We are reviewing HFrEF management with a focus on #Vericiguat. I am @GiuseppeGalati_ & I encourage you to follow @cardiomet_ce for all your #cardiometabolic CE/#CME needs! 👏to @butler @bianchinifra92 @edurontoFF #FOAMed #cardiotwitter
— cardio-met (@cardiomet_CE) October 11, 2022
25) #Vericiguat showed a high level of safety in #VICTORIA. Indeed, there were no significant differences in terms of Adverse Events (AEs) between #vericiguat and placebo. Only 6-7% of pts discontinued the drug because of #AEs . pic.twitter.com/JlM4dHecKC
— cardio-met (@cardiomet_CE) October 11, 2022
27) Furthermore, there were no significant differences in #SystolicBP between the 2 groups during the #VICTORIA follow-up. The #vericiguat dose has been managed as follows: If SBP≥100, ⬆️; if SBP ≥90 <100, maintain, if SBP<90 & no symptoms, ⬇️, if SBP<90 + symptoms, stop pic.twitter.com/iu86JwUOfs
— cardio-met (@cardiomet_CE) October 11, 2022
29) #Vericiguat was safe in terms of renal function. Indeed, there were no significant differences on the #eGRF & #creatinine between the 2 groups. Remarkably #VICTORIA enrolled pts with a more compromised renal function i.e. 52% with a #eGFR<60 & included #eGFR>15 ml/min/1.73m2 pic.twitter.com/6bwpaQAlJF
— cardio-met (@cardiomet_CE) October 11, 2022
31) #Vericiguat showed a ⬆️safety profile in the #VICTORIA RCT regarding hypotension & syncope, renal function & risk of hyperkalemia. Therefore #vericiguat combines good efficacy + very good safety in a population with severe #HFrEF & #WorseningHF characterized by⬆️mortality pic.twitter.com/igRked0EOY
— cardio-met (@cardiomet_CE) October 11, 2022
33) The answer is d. #vericiguat showed to be a safe drug even when used in a sick #HF population in terms of hypotension & syncope risk, renal impairment and hyperkalemia risk.
— cardio-met (@cardiomet_CE) October 11, 2022
35) #Vericiguat has currently a IIb/2b indication in #HFrEF after a 1ST #WorseningHF event across all the principal international guidelines on #HF (ESC/HFA + AHA/ACC/HFSA + CCS/CHFS) pic.twitter.com/AotdZEqnxF
— cardio-met (@cardiomet_CE) October 11, 2022
37) #Vericiguat selectively acts on soluble #GC while #ARNI have a partial activity on particulate #GC. After decades of neurohormonal modulation (ACEi/ARB/ARNI,MRA) we are finally moving beyond & targeting 🫀 with new molecules as #SGLT2i, #Vericiguat & #OmecamtivMecarbil pic.twitter.com/Yc2MGpEg2B
— cardio-met (@cardiomet_CE) October 11, 2022
39) Thanks for following along!!
— cardio-met (@cardiomet_CE) October 11, 2022
👍@GoggleDocs @DrMarthaGulati @mmamas1973 @HanCardiomd @SeguraCardio @ValleAlfonso @gcfmd @purviparwani @hvanspall @mirvatalasnag @gbiondizoccai @SABOURETCardio
40) Now go to https://t.co/h9bNwiqjW3 and collect your 🆓CE/#CME, and FOLLOW US HERE for more #accredited #tweetorials–the ONLY such programs in the #cardiometabolic space! I am @GiuseppeGalati_
— cardio-met (@cardiomet_CE) October 11, 2022