2) This is an international perspective, from @gabrielsteg, #Stefan_James, @SanjitSJolly, @MkosiborodMD, & @MarcBonaca. Their #roundtable discussion, moderated by @md_pollack, will be published in #Critical_Pathways_in_Cardiology, whose #EIC is @cardiomet_CE faculty @cpcannon pic.twitter.com/9WZ20ogxII
— cardio-met (@cardiomet_CE) August 11, 2022
4) This program is intended for healthcare professionals. See archived programs, all by expert authors, still available for 🆓CE/#CME credit, at https://t.co/NOg9ub9eRY. Programs focused on #antipletelet therapy can be found at https://t.co/WfqOL6APr4
— cardio-met (@cardiomet_CE) August 11, 2022
6) The impact of the pandemic has been particularly damaging, increasing risk of cardiac events in multiple ways, while simultaneously generating a novel apprehension about contagiousness that affected patients’ willingness to seek acute care, even in the face of dire symptoms. pic.twitter.com/DrZbECaqdH
— cardio-met (@cardiomet_CE) August 11, 2022
7b) (cont)
— cardio-met (@cardiomet_CE) August 11, 2022
👉emotional, social, financial stress
👉disruption of regular fitness/activity
👉 changing patterns of substance abuse/use (esp #tobacco)
👉over-stressed resources at receiving hospitals where pts did seek acute care
👉time-dependency of acute cardiac interventions.
8b) Consistent #adherence relies on #patient_education & #collaboration with the #healthcare team. Given that the pandemic disrupted this relationship, the likelihood of nonadherence might be assumed to increase, as well as the risk of acute events. pic.twitter.com/xs5VhB6qU1
— cardio-met (@cardiomet_CE) August 11, 2022
9a) You see, the importance of adherence to prescribed #P2Y12i therapy in at-risk patients is inarguable; debate persists only about the optimal length of #DAPT treatment after #PCI or #ACS.
— cardio-met (@cardiomet_CE) August 11, 2022
9c) A subsequent study, however, showed that
— cardio-met (@cardiomet_CE) August 11, 2022
DAPT continued for >1 year after placement of a drug-eluting stent #DES, compared with #ASA monotherapy, significantly ⬇️risk of stent thrombosis + #MACE + #cerebrovascular events (🔓https://t.co/XYpmpcoRJF).
10) Early discontinuation of DAPT (variably defined as after 1–9 mo; see 🔓https://t.co/1XwShPwy8b) is the most powerful predictor of #stent_thrombosis for patients treated with #DES.
— cardio-met (@cardiomet_CE) August 11, 2022
See 🔓https://t.co/neDIpglkiD and https://t.co/ookJZCgQZH). pic.twitter.com/gs93YyKDXW
12a) Disruption in continuity of care adversely impacts the consistency of education delivery. The effects of #DAPT go well beyond ⬇️in risk of in-stent thrombosis to include secondary prevention of atherothrombotic #MACE.
— cardio-met (@cardiomet_CE) August 11, 2022
13) It is against this background that our expert panel 🇺🇸🇫🇷🇸🇪🇨🇦considered the impact of the COVID-19 pandemic on cardiovascular care and research in general, and potentially on #DAPT #adherence and the concerns for poor outcomes that could result from #nonadherence.
— cardio-met (@cardiomet_CE) August 11, 2022
14b) Which of the following factors has NOT been shown to be associated with early (within 30d) #stent_thrombosis?
— cardio-met (@cardiomet_CE) August 11, 2022
a) suboptimal antiplatelet administration
b) insulin-requiring diabetes
c) tobacco abuse
d) baseline renal insufficiency
16) But first, the correct answer to yesterday's quiz? If you didn't already answer, go⬆️to tweet 14b of this 🧵& commit! While 🚬is bad for pts post ACS & PCI, smoking is not independently predictive of early #stent_thrombosis, so the correct answer is C.
— cardio-met (@cardiomet_CE) August 12, 2022
Now, VIVE LA FRANCE!
18a) In my center, the #cardiology department, & a substantial proportion of #CCU beds & standard beds were allocated to #COVID19 units. After receiving a crash course in COVID care from a #multidisciplinary team of #intensivists #pulmonologists & #ID specialists . . . pic.twitter.com/3uBtZpvMR3
— cardio-met (@cardiomet_CE) August 12, 2022
18c) Additionally, approximately 25% of our medical & nursing staff were reallocated, on a volunteer basis, to COVID units outside of cardiology. Older doctors (semi-retired or retired) volunteered to man telephone lines handling patient advice.
— cardio-met (@cardiomet_CE) August 12, 2022
19) Cardiology trials were obviously directly affected, as was cardiology patient care. But demand also changed: the COVID-19 pandemic peaks resulted in a dramatic ⬇️in the number of pts admitted with #AMI across France (🔓https://t.co/9Y8Ovp6CYj)
— cardio-met (@cardiomet_CE) August 12, 2022
20b)
— cardio-met (@cardiomet_CE) August 12, 2022
🫀 patient reluctance to go to hospital
🫀concerns about availability of staff & hospital beds
🫀a desire not to add to the healthcare system burden
🫀 true⬇️in #AMI rates during lockdown, due to⬇️air pollution (below) &⬇️work & commuting stress. pic.twitter.com/c9ZrpgBTPe
22a) An issue that emerged after the lockdown was the problem of patient #adherence to prescribed #CV treatments including, but not limited to, #antiplatelet therapy in pts with recent #ACS or #PCI and #stents.
— cardio-met (@cardiomet_CE) August 12, 2022
22c) Indeed, there have been case series of stent thrombosis occurring during lockdowns in other countries (🔓https://t.co/hRhfPqgxbV ). pic.twitter.com/j69OCUfWdu
— cardio-met (@cardiomet_CE) August 12, 2022
24) Be sure to see @gabrielsteg's overall review of lessons learned during COVID in France (https://t.co/5BCb5KLja2). As to the specific issue of #P2Y12i #adherence, he points out the true necessity of communication with patients.
— cardio-met (@cardiomet_CE) August 12, 2022
25b) Many patients facing major issues, including signs of #myocardial #ischemia or #arrythmias, did not contact the healthcare system and seek help. This implies that physicians need to contact patients proactively on a regular basis & must publicize the pathways for contact.
— cardio-met (@cardiomet_CE) August 12, 2022
25d) … regarding their health or treatment had made decisions on their own, including decisions to discontinue some important chronic treatments. #Antiplatelet therapy is a case in point. For many patients, #DAPT is only a nuisance, resulting in mild bleeding . . .
— cardio-met (@cardiomet_CE) August 12, 2022
26) What do you think? Which of the following factors is associated with a LOWER risk of nonadherence to #DAPT?
— cardio-met (@cardiomet_CE) August 12, 2022
a. younger age
b. live in rural areas
c. more severe symptoms
d. less educated
28) So now, #physicians #PAs #nurses #NPs #pharmacists can go to https://t.co/03sU9t5n7H & collect 0.5h CE/#CME. Follow us here to be sure you don't miss the next installment of our "#COVID vs #DAPT" international perspectives series! Thanks to @md_pollack & @gabrielsteg! #FOAMed
— cardio-met (@cardiomet_CE) August 12, 2022