The hypothesis of the EPIC-HF trial (NCT03334188) was that the use of guideline-directed medical therapies could be improved by encouraging patients to engage providers in prescribing decisions. Prof. Larry Allen (University of Colorado School of Medicine, USA) presented the results of the trial, in which 290 HFrEF patients were randomised 1:1 to receive usual care or additional patient-engagement and education tools [1,2]. These tools consisted of a 3-minute video and a 1-page medication checklist, delivered electronically 1 week, 3 days, and 24 hours prior to a visit at a cardiology clinic. The primary endpoint was the percentage of patients with medication initiations and dose intensifications from immediately preceding the cardiology clinic visit to 30 days thereafter. Pre-clinic data showed that no patients were on target doses of beta-blocker, sacubitril/valsartan, and mineralocorticoid-receptor antagonists. The median age was 65 years, 29% were female, and median left ventricular ejection fraction (LVEF) was 32%.
In the 30 days after the visit to the clinic, the percentage of patients who met the primary endpoint was 49% in the intervention group and 29.7% in the control group (P=0.001). Most changes were made during the clinician encounter itself and involved dose uptitrations of HFrEF medications already prescribed. There were no deaths, nor significant differences in hospitalisation or emergency department visits at 30 days between groups.
âThis approach validates and promotes a culture of collaboration between patients and their doctors,â Prof. Allen concluded, âleading to more productive clinic visits with optimised medication prescribing, which can ultimately improve patient outcomes.â
- Allen LA, et al. An Electronically Delivered, Patient-activation Tool for Intensification of Medications for Chronic Heart Failure With Reduced Ejection Fraction: The EPIC-HF Trial. LBS.09, AHA Scientific Sessions 2020, 13â17 Nov.
- Allen LA, et al. Circulation. 2020 Nov 17. Doi: 10.1161/CIRCULATIONAHA.120.051863.
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Table of Contents: AHA 2020
Featured articles
COVID-19 and Influenza
Fewer CV complications than expected in AHA COVID-19 Registry
Worse COVID-19 outcomes in younger obese patients
Effects of CVD in hospitalised COVID-19 patients
Unfavourable outcomes for COVID-19 patients with AF and atrial flutter
High-dose influenza vaccine in patients with CVD
Atrial Fibrillation
Vitamin D or omega 3 fatty acids do not prevent AF
Active screening for AF improves clinical outcomes
AF screening in older adults at primary care visits
CVD Risk Reduction
Clever trial design gets patients back on statins: the SAMSON trial
Polypill plus aspirin reduces cardiovascular events
Lowering LDL cholesterol in older patients is beneficial
No CV benefit from omega 3 in high-risk patients
Safety and efficacy of inclisiran for hypercholesterolemia
Remote risk management programme effective and efficient
Healthy lifestyle lowers mortality irrespective of medication burden
Heart Failure
Omecamtiv mecarbil improves outcomes in HFrEF-patients
IV iron reduces HF hospitalisation
Dapagliflozin reduces renal risk independent of CV disease status
âStrongly consider an SGLT2-inhibitor in most T2DM patientsâ
Additional HFrEF education and patient-engagement tools
Acute Coronary Syndrome
No benefit from omega-3 fatty acids after recent MI
PIONEER III trial: Drug-eluting stents comparable
Coronary and Valve Disease
Extra imaging reveals cause of MINOCA in women
Ticagrelor not superior to clopidogrel after elective PCI
Stroke
Ticagrelor/aspirin reduces stroke risk in patients with ipsilateral cervicocranial plaque
AF monitoring following cardiovascular surgery
Miscellaneous
PAD: Rivaroxaban reduces VTE risk after revascularisation
Sotatercept: potential new treatment option for PAH
Finerenone lowers CV events in diabetic CKD patients
Mavacamten effective in obstructive hypertrophic cardiomyopathy
Children exposed to tobacco smoke have worse heart function as adults
Transgender people have unaddressed heart disease risks
Intensive blood pressure lowering benefits older adults
Longer chest compression pause worsens outcomes after paediatric IHCA
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