Role of Multimodal Cardiac Imaging in Diagnosing a Primary Intimal Sarcoma of the Left Atrial Appendage

Primary cardiac tumors are rare, and most are benign. Intimal sarcomas are among the rarest of the malignant cardiac tumors; they are aggressive and associated with a poor prognosis. Whereas transesophageal echocardiography has been instrumental in evaluating cardiac masses, other imaging methods, such as cardiac magnetic resonance, have proved invaluable in accurately characterizing these masses. We present the case of a 49-year-old woman in whom we diagnosed a primary intimal sarcoma of the left atrial appendage, and we discuss the importance of multimodal imaging in the evaluation and diagnosis of cardiac masses

Primary Prevention of Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death worldwide. This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors. Dietary modification, weight loss, exercise, and tobacco use cessation are specific areas where focused efforts can successfully reduce CVD risk on both an individual and a societal level. Specific areas requiring management include dyslipidemia, hypertension, physical activity, diabetes, aspirin use, and alcohol intake. These preventive efforts have major public health implications. As the global population continues to grow, health care expenditures will also rise, with the potential to eventually overwhelm the health care system. Therefore it is imperative to apply our collective efforts on CVD prevention to improve the cardiovascular health of individuals, communities, and nations

IMPLEMENTATION OF SPECIALTY CLINICAL PHARMACIST IN A PREVENTIVE CARDIOLOGY CLINIC

Disclosure: Justin Joy has received advisory board compensation from Akcea Therapeutics and Pfizer Therapeutic Area: Preventive Cardiology Best Practices Background: PCSK9 inhibitors (PCSK9i) and icosapent ethyl have been shown to significantly improve cardiovascular outcomes in select patients at increased CV risk. Bempedoic acid is a novel adjunct low-density lipoprotein cholesterol (LDL-C) lowering agent for patients at increased risk who require further LDL-C reduction. Many barriers to access exist for these medications resulting in delays in care, and nonadherence. To address these barriers, we incorporated a clinical pharmacist within our academic preventive cardiology clinic to facilitate medication access through enhanced collaboration between the clinic and hospital-based specialty pharmacy. Methods: A single center, retrospective study of patients seen within the preventive cardiology clinic whose medications were triaged by the hospital specialty pharmacy. The aim was to assess the time from prescription order to receipt of first dose for treatment-naïve patients. The medication approval rate, financial assistance use, median LDL-C reduction, and 90-day follow-up LDL-C was collected. Results: A total of 35 patients met inclusion criteria during the pilot period. Prescriptions included: 10 evolocumab, 18 alirocumab, 4 bempedoic acid, and 3 icosapent ethyl triaged by the specialty pharmacy. 19 (35%) patients had a clinical history of atherosclerotic cardiovascular disease (ASCVD). The majority of patients had commercial insurance, a median baseline LDL of 136 mg/dl, 125 mg/dl, and 146 mg/dl for evolocumab, alirocumab, and bempedoic acid respectively, and documented statin intolerance (Table 1). All prescriptions required prior authorization and were approved (4 patients required an appeal). 21 patients (60%) qualified for financial assistance: 15 required manufacture copay assistance cards, 4 required hospital charity care, 1 received foundation support, and 1 received free drug via manufacturer. The median time from prescription order to first dose was ≤ 10 days, and 22 patients (69%) on the LDL-C lowering agents had follow up labs performed within 90 days. Of these patients the median percent LDL-C reduction achieved for evolocumab, alirocumab, and bempedoic acid was 60%, 60%, and 34%, respectively (Table 2). Conclusion: At our institution, our experience highlights the value that a clinical pharmacist and health system specialty pharmacy can have on improving patient care within a multidisciplinary preventive cardiology clinic

Rheumatoid arthritis and cardiovascular complications during delivery: a United States inpatient analysis

Background and aims: Persons with rheumatoid arthritis (RA) have an increased risk of obstetric-associated complications, as well as long-term cardiovascular (CV) risk. Hence, the aim was to evaluate the association of RA with acute CV complications during delivery admissions. Methods: Data from the National Inpatient Sample (2004-2019) were queried utilizing ICD-9 or ICD-10 codes to identify delivery hospitalizations and a diagnosis of RA. Results: A total of 12 789 722 delivery hospitalizations were identified, of which 0.1% were among persons with RA (n = 11 979). Individuals with RA, vs. those without, were older (median 31 vs. 28 years, P \u3c .01) and had a higher prevalence of chronic hypertension, chronic diabetes, gestational diabetes mellitus, obesity, and dyslipidaemia (P \u3c .01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, RA remained an independent risk factor for peripartum CV complications including preeclampsia [adjusted odds ratio (aOR) 1.37 (95% confidence interval 1.27-1.47)], peripartum cardiomyopathy [aOR 2.10 (1.11-3.99)], and arrhythmias [aOR 2.00 (1.68-2.38)] compared with no RA. Likewise, the risk of acute kidney injury and venous thromboembolism was higher with RA. An overall increasing trend of obesity, gestational diabetes mellitus, and acute CV complications was also observed among individuals with RA from 2004-2019. For resource utilization, length of stay and cost of hospitalization were higher for deliveries among persons with RA. Conclusions: Pregnant persons with RA had higher risk of preeclampsia, peripartum cardiomyopathy, arrhythmias, acute kidney injury, and venous thromboembolism during delivery hospitalizations. Furthermore, cardiometabolic risk factors among pregnant individuals with RA rose over this 15-year period

Primary Prevention of Cardiovascular Disease

Cardiovascular disease (CVD) is the leading cause of death worldwide. This article focuses on current guidelines for the primary prevention of CVD and addresses management of key risk factors. Dietary modification, weight loss, exercise, and tobacco use cessation are specific areas where focused efforts can successfully reduce CVD risk on both an individual and a societal level. Specific areas requiring management include dyslipidemia, hypertension, physical activity, diabetes, aspirin use, and alcohol intake. These preventive efforts have major public health implications. As the global population continues to grow, health care expenditures will also rise, with the potential to eventually overwhelm the health care system. Therefore it is imperative to apply our collective efforts on CVD prevention to improve the cardiovascular health of individuals, communities, and nations