Lifting Coronavirus Disease-19 Shelter-in-Place Restrictions: Impact on Heart Failure Hospitalizations in Northeast Georgia

During the coronavirus disease-2019 (COVID-19) pandemic, the heart failure (HF) community witnessed unprecedented decreases in HF-related patient visits and hospitalizations. Studies to date have focused on the impact of the initial phase of the COVID-19 lockdown of HF hospitalization trends across multiple countries.1, 2, 3, 4 It is likely that patients with HF, who are at higher risk for morbidity and mortality from COVID-19, delay seeking care in large part owing to anxiety about contracting the virus. Nevertheless, the concerns may resolve over time with availability of treatment for COVID-19 and overwhelming HF symptom burden. Furthermore, the decision to seek acute HF care may be affected by the announcements of state governments relaxing shelter-in-place restrictions and allowing opening of businesses

Post-Discharge Initiation of Angiotensin Receptor-Neprilysin Inhibitor in an Inotrope-Dependent Patient in the Outpatient Setting: A Case Report

Purpose: Angiotensin receptor-neprilysin inhibitor (ARNI) therapy has been reported to be initiated in patients on vasoactive medications during acute decompensated heart failure. However, there is no report regarding the safety of initiating ARNI therapy in patients receiving inotrope infusion in an outpatient setting. Summary: We described a case of initiating post-discharge ARNI therapy in a 41-year-old man with inotrope-dependent heart failure in an outpatient setting. Two weeks after the initiation of low dose sacubitril/valsartan, milrinone was successfully discontinued without any adverse effects. Conclusion: With close monitoring, ARNI therapy could be safely initiated in hemodynamically stable patients receiving intravenous inotrope, and further investigation is needed to confirm our findings

Impact of Dapagliflozin on Mortality in Patients With Heart Failure and Reduced Ejection Fraction: A Meta-analysis.

The DAPA-HF trial1 demonstrated that dapagliflozin reduced the risk of worsening heart failure and death in patients with heart failure and reduced ejection fraction (HFrEF). In the EMPEROR-Reduced trial,2 empagliflozin also reduced the composite primary endpoint but failed to show any significant reduction of cardiac death or all-cause death. This may be explained by the fact that EMPEROR-Reduced was underpowered regarding cardiac death or all-cause death. A meta-analysis3 of these 2 trials revealed that the estimated treatment effect of cardiac death and all-cause death was modestly significant. In view of this, it would be necessary to revisit the mortality benefits of dapagliflozin, as DAPA-HF was not powered for the mortality endpoints either. Here, we undertook a meta-analysis of DAPAHF and the HFrEF subgroup of DECLARE-TIMI 584 to evaluate the mortality benefits of dapagliflozin in HFrEF patients

Data on coronary artery calcium score performance and cardiovascular risk reclassification across gender and ethnicities

The current guidelines recommend the new risk score, Atherosclerotic Cardiovascular Disease score (ASCVD), to assess an individual׳s risk of future cardiovascular disease (CVD) events. No data exist on the predictive utility of ASCVD score with the incremental value of coronary artery calcium scoring (CACS) across ethnicities and gender. Multi-Ethnic Study of Atherosclerosis (MESA) is a population based study (n=6814) of White (38%), Black (28%), Chinese (22%) and Hispanic (12%) subjects, aged 45–84 years, free from clinical cardiovascular disease. We performed a post-hoc analysis of 6742 participants (mean age 62, 53% female) from the MESA cohort. We evaluated the predictive accuracy for the ASCVD score for each participant in accord with the American College of Cardiology/American Heart Association guidelines using pooled cohort equations. Similar to the publication by Fudim et al. “The Metabolic Syndrome, Coronary Artery Calcium Score and Cardiovascular Risk Reclassification” [1] the analytic properties of models incorporating the ASCVD score with and without CACS were compared for cardiovascular disease CVD prediction. Here the analysis focused on ASCVD score (with and without CACS) performance across gender and ethnicities. Keywords: Risk stratification, Coronary calcium scoring, Gender, Ethnicity, MESA, {C}{C

Inclisiran: A First-in-Class siRNA Therapy for Lowering Low-Density Lipoprotein Cholesterol.

OBJECTIVE: To review the current pharmacology, pharmacokinetics/pharmacodynamics, safety, and efficacy of inclisiran in lowering lipid levels. DATA SOURCES: A PubMed (from December 1, 2014 to April 15, 2022) and ClinicalTrials.gov search was conducted using ALN-PCSsc, ALN-60212, PCSK9si KJX-839, and inclisiran. Additional articles were identified by hand from references. STUDY SELECTION AND DATA EXTRACTION: We included English-language articles evaluating inclisiran pharmacology, efficacy, or safety in humans for lowering low-density lipoprotein cholesterol (LDL-C). DATA SYNTHESIS: Inclisiran is a novel small interfering RNA-based therapy administered as a twice-yearly subcutaneous injection. By binding to the messenger RNA (mRNA) precursor of proprotein convertase subtilisin/kexin type 9 (PCSK9), inclisiran inhibits expression of the PCSK9 gene, resulting in increased recycling and expression of LDL receptors and decreased levels of LDL-C. Like PCSK9 inhibitors, inclisiran was associated with a comparable extent of LDL-C reduction in several phase II/III trials. Compared with placebo, inclisiran was found to have similar adverse events except for injection-site reaction. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE: Currently, inclisiran lacks data on clinical outcome improvement or long-term safety. However, it may play a role in patients with atherosclerotic cardiovascular disease (ASCVD) or ASCVD risk equivalent if optimal LDL-C cannot be achieved by statins and PCSK9 inhibitors cannot be tolerated. The drug may be used for heterozygous familial hypercholesterolemia. CONCLUSION: Inclisiran is an effective and safe medication for lowering LDL-C levels. Additional data regarding efficacy on cardiovascular outcomes and long-term safety profile with inclisiran are needed