From Trials to Bedside: Filling the Gaps in Implementing Evidence-based Care

The mentioned session challenge our thinking about gaps in the guidelines for hypertension and heart failure which address the social determinates of health. -  Current Gaps in Guideline-Based Care for Heart Failure  -  What to Do When Guidelines Conflict? - How Misinformation Steers Patients off Course - The Role of Physician Leaders in Driving Health System Implementation

State of the Science: The Six Pillars of Heart Failure Therapy

Dr. Marc Alan Pfeffer is a cardiovascular medicine specialist at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, Boston, MA.

A Polypill for Primary Prevention of Cardiovascular Disease in Intermediate Risk People: Results of the International Polycap Study (TIPS)-3

It is hypothesized that in individuals without clinical cardiovascular disease (CVD), but at increased CVD risk, a 50% to 60% reduction in CVD risk could be achieved using fixed dose combination (FDC) therapy (usually comprised of multiple blood-pressure agents and a statin [with or without aspirin]) in a single “polypill”. However, the impact of a polypill in preventing clinical CV events has not been evaluated in a large randomized controlled trial.  https://www.sciencedirect.com/science/article/pii/S0002870318302229?via%3Dihub

Prevalence and Prediction of Coronary Artery Disease in the General Population- Results From the Swedish Cardiopulmonary Bioimage Study (scapis)

Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large‐scale ‘omics’ and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started. https://onlinelibrary.wiley.com/doi/10.1111/joim.12384

A Three-arm N-of-1 Trial With Statin, Placebo and Tablet Free Periods, to Verify Side Effects and Identify Their Cause: The SAMSON Trial

Studies showed that more than half of patients stop taking statins within two years of initiation. Yet, in placebo-controlled trials, no more patients stop taking statins compared to patients stopping placebo. A patient suffering from side-effects from statins gains no help from data on thousands of patients in placebo-controlled statin trials Therefore, the SAMSON study was performed to examine this contradiction.

Putting it all Together in Lipid Therapy

Compelling clinical science which may help us better understand the story of lipid therapy. - STRENGTH Trial - SAMSON Trial - OMEMI Trial

3-year Clinical Outcomes in a Nationwide, Randomized, Pragmatic Clinical Trial of Atrial Fibrillation Screening - Mhealth Screening to Prevent Strokes (mstops)

Prof. Steven Steinhubl (Scripps Research Translational Institute, USA) presented the awaited 3-year results of the mSTOPS study of prospective screening for AF [1]. The study involved 5,214 eligible individuals identified through claims data to have risk factors for AF but who had not been previously diagnosed. Via a web-based platform, 1,738 individuals were enrolled to undergo either immediate or delayed active ECG monitoring at home for up to 4 weeks with a Zio XT patch monitor (2-week monitoring periods spaced 4 months apart). Each monitored participant was matched with 2 non-monitored participants with similar stroke-risk CHA2DS2-VASc scores as controls. The study looked at the time to first diagnosis of AF and its clinical consequences, especially with regard to stroke, for the active monitoring cohort as well as the cohort undergoing usual care. Participants have been followed for 3 years at the time of this presentation. https://www.acc.org/education-and-meetings/image-and-slide-gallery/~/media/772D31AD5B554C7681C0C45147C294C1.pdf

High Dose versus Standard Dose Influenza Vaccine in Patients With High Risk Cardiovascular Disease: Results From the Invested Trial

Influenza leads to significant cardiopulmonary morbidity and mortality-particularly in patients with cardiovascular disease-that may be prevented with a standard influenza vaccine. However, patients with cardiovascular conditions have a reduced immune response to influenza vaccine, potentially resulting in reduced effectiveness for preventing clinical events. High-dose vaccine augments immune response in cardiac patients, suggesting that a high-dose influenza vaccination strategy may further reduce morbidity and mortality. Alternatively, broader coverage with an influenza vaccine containing an increased number of viral strains is an alternative strategy without direct evaluation. https://pubmed.ncbi.nlm.nih.gov/29909156/

Rate versus Rhythm Control - lessons learned from EAST

Despite improvements in the management of atrial fibrillation, patients with this condition remain at increased risk for cardiovascular complications. In 135 centers, 2789 patients with early atrial fibrillation (median time since diagnosis, 36 days) underwent randomization. The trial was stopped for efficacy at the third interim analysis after a median of 5.1 years of follow-up per patient. Prof. Kirchhof summarize the main findings.

The Vital Rhythm Trial: Omega-3 Fatty Acid and Vitamin D Supplementation in the Primary Prevention of Atrial Fibrillation

Supplements containing omega-3 fatty acids or vitamin D3 are not the answer for the primary prevention of A-fib in middle-age men and women with no history of CV or cancer, results from the placebo-controlled VITAL Rhythm trial show. https://www.acc.org/clinical-topics/arrhythmias-and-clinical-ep/~/media/67142EC297834666B0CF741690027D9D.pdf

The AHA COVID-19 Cardiovascular Disease Registry: Design, Implementation, and Initial Results

This abstract details the structure, implementation and initial results of the new American Heart Association COVID-19 Cardiovascular Disease Registry. Identifying a need to rapidly collect and provide insights into patients hospitalized with the novel coronavirus, volunteer leaders and staff of the American Heart Association created the registry within weeks of the declaration of the global pandemic. Hospitals began uploading patient records into the registry before the end of April. As of September 9, 2020, health data for more than 17,000 patients from 101 U.S. health care centers in 33 states have been saved in the registry. https://newsroom.heart.org/news/covid-19-cardiovascular-registry-details-disparities-among-patients-hospitalized-with-covid

Early Invasive Intervention for Atrial Fibrillation

Doctors from the Montreal Heart Institute (MHI) presented new data that shows catheter ablation as first-line treatment may be better than anti-arrhythmic drugs in preventing the recurrence of abnormal heart rhythm (atrial tachyarrhythmia, atrial fibrillation), and improve patient well-being.

Aspirin Alone and in Combination With a Polypill in Cardiovascular Disease Primary Prevention: Results From the International Polycap Study (TIPS)-3

It is hypothesized that in individuals without clinical cardiovascular disease (CVD), but at increased CVD risk, a 50% to 60% reduction in CVD risk could be achieved using fixed dose combination (FDC) therapy (usually comprised of multiple blood-pressure agents and a statin [with or without aspirin]) in a single “polypill”. However, the impact of a polypill in preventing clinical CV events has not been evaluated in a large randomized controlled trial. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6299262/

The Efficacy and Safety of Evinacumab in Patients With Refractory Hypercholesterolemia

Patients with refractory hypercholesterolemia, who have high low-density lipoprotein (LDL) cholesterol levels despite treatment with lipid-lowering therapies at maximum tolerated doses, have an increased risk of atherosclerosis. In such patients, the efficacy and safety of subcutaneous and intravenous evinacumab, a fully human monoclonal antibody against angiopoietin-like 3, are not known. https://www.nejm.org/doi/full/10.1056/NEJMoa2031049

State of the Art in Anti-Coagulation Management for Difficult Cases

Professor Hylek focused on the areas were there still uncertainties on regarding use of the direct oral anticoagulants.

2020 AHA Guidelines on ECC and CPR - Adult Basic and Advanced Life Support

These guidelines are based on the most current and comprehensive review of resuscitation science, systems, protocols, and education. This interview provides a summary of the full 2020 guidelines.