This activity is supported by educational grants from Abbott, AstraZeneca, Bayer, Chiesi, NovoNordisk.
In case you missed the tweetorial on Twitter “real time” you can review the course material here and earn the same credit.
2) . . . Supported by Abbott, AstraZeneca, Bayer, Chiesi, NovoNordisk. Follow this thread for credit. And here is a case . . .
— cardio-met (@cardiomet_CE) February 9, 2021
4) . . . but serum K ↑ from 4.5 to 5.5. ACEi was stopped and pt d/c’d home on loop diuretic. At 4wk f/u, SBP 140s, K 5.1, given new-generation K binder (SZC or patiromer). At 5d f/u, K 4.5 and started on ARB, and 1 wk later K was 5.0 . . .
— cardio-met (@cardiomet_CE) February 9, 2021
6) Does your own practice strategy match that used in the case above when the K bumped to 5.5? Or are you more likely when faced with hyperkalemia in such a patient to
— cardio-met (@cardiomet_CE) February 9, 2021
8) Welcome back! ACC Guidelines for mgt of pt post-MI with HTN and ↓LVEF recommend ACEi/ARB PLUS spironolactone. Pt is started on 12.5 spironolactone and K binder is continued to facilitate guidelines-based therapy with RAASi in face of (expected) hyperkalemia.
— cardio-met (@cardiomet_CE) February 10, 2021
10) Concern is that fear of hyperK may limit HCPs’ use of RAASi strategies, worsening CV and renal outcomes. New K-binding meds (sodium zirconium cyclosilicate and patiromer), unlike old K-binding meds (sodium polystyrene) can be used to facilitate RAASi.
— cardio-met (@cardiomet_CE) February 10, 2021
12) The clinical implications of the increased risk of RAASi-associated hyperK are heightened among patients with CKD in whom disturbances in K homeostasis are already prevalent, predisposing this high-risk patient group to hyperK and subsequent adverse outcomes inc CV events.
— cardio-met (@cardiomet_CE) February 10, 2021
14) . . . while 94% of those randomized to cont patiromer stayed on RAASi. In a larger but uncontrolled study of SZC in hyperK patients followed for 1 yr, 87% of those taking RAASi continued therapy or even ↑d dose, consistent with guidelines.
— cardio-met (@cardiomet_CE) February 10, 2021
16) Answer the poll, come back tomorrow and we’ll continue. @academiccme #medtwitter #cardiotwitter @AAHFN @HFSA #hypertension #cardiology
— cardio-met (@cardiomet_CE) February 10, 2021
18) So our patient had HF. Guidelines from both sides of the Atlantic focus on the importance of MRAs in HF, based on seminal studies such as RALES and EMPHASIS-HF. Of patients new to MRAs, hyperK means almost half d/c MRA and only a few try a reduced dose . . .
— cardio-met (@cardiomet_CE) February 11, 2021
20) . . . adverse cardiorenal outcomes ↑ with RAASi dose reduction or d/c. If target doses of RAASi+MRA aren’t achieved, effectiveness is decreased. So monitoring–especially by PCPs–becomes an issue. One study (Nilsson et al (EHJ Qual Care Clin Outc 2018) found . . .
— cardio-met (@cardiomet_CE) February 11, 2021
20) . . . adverse cardiorenal outcomes ↑ with RAASi dose reduction or d/c. If target doses of RAASi+MRA aren’t achieved, effectiveness is decreased. So monitoring–especially by PCPs–becomes an issue. One study (Nilsson et al (EHJ Qual Care Clin Outc 2018) found . . .
— cardio-met (@cardiomet_CE) February 11, 2021
24) HARMONIZE-HF (Anker et al, Eur J HF 2017): Efficacy findings were consistent among HF patients regardless of continued concomitant RAASi medication. pic.twitter.com/RR3BzDt2lM
— cardio-met (@cardiomet_CE) February 11, 2021
26) Bottom line: New safe, effective, and well-tolerated potassium binders are not simply a better treatment for hyperK, but may facilitate more opportunities to optimize RAASi use in patients with CKD and/or CV disease.
— cardio-met (@cardiomet_CE) February 11, 2021
28) Answer the poll and return tomorrow to claim your free CE credit! #medtwittter #cardiotwitter @academiccme
— cardio-met (@cardiomet_CE) February 11, 2021
30) So you made it! Free CE/CME! Physicians, pharmacists, nurses: go to https://t.co/lLj1lUycV9 and claim your credit! I am @md_pollack. Follow @cardiomet_CE for more tweetorials! #medtwittter #cardiotwitter #ruralhealth
— cardio-met (@cardiomet_CE) February 12, 2021