Heart Failure, Cardiovascular Disease, Cardiovascular Risk CE/CME ACCREDITED Watch Time: 37 mins

touchMDT Multidisciplinary team insights on the promise of new and emerging treatment options for patients with HFrEF

Watch a multidisciplinary team and a patient discuss new and emerging therapies for HFrEF and their incorporation into daily practice.

Overview & Learning Objectives

Patient with HFrEF

Cardiologist, primary care physician, nurse, patient

A cardiologist, a primary care physician, a cardiology nurse specialist and a patient with HFrEF discuss the role of the MDT in managing patients with HF, including key members of the team and the importance of a collaborative approach, and patient education strategies to help optimize outcomes with HFrEF therapies.

Expert Spotlight
Dr Akshay Desai
Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
Prof. Ahmet Fuat
Carmel Medical Practice, Darlington, UK
Dr Carol Wade
University of Maryland Medical System, Baltimore, MD, USA
Ms Sarah Worsnop
Hull, UK

Dr Akshay Desai, Prof. Ahmet Fuat, Dr Carol Wade and patient Sarah Worsnop discuss the role of the MDT in managing patients with HF and patient education strategies to help optimize outcomes with HFrEF therapies.

Listen on the go

Learn more Back to MDT Hub Time: 11:33
 
Primary care physician, cardiologist, patient

A primary care physician, a cardiologist and a patient with HFrEF discuss established therapies for HFrEF, the mechanism of action of new and emerging therapies and key clinical evidence for their use, and how these therapies have the potential to improve patient outcomes.

Expert Spotlight
Prof. Ahmet Fuat
Carmel Medical Practice, Darlington, UK
Dr Akshay Desai
Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
Ms Sarah Worsnop
Hull, UK

Prof. Ahmet Fuat, Dr Akshay Desai and patient Sarah Worsnop discuss established therapies for HFrEF and key efficacy and safety data for new and emerging therapies.

Listen on the go

Learn more Back to MDT Hub Time: 15:29
 
Nurse, primary care physician, cardiologist

A cardiology nurse specialist, a primary care physician and a cardiologist discuss recommendations for HFrEF therapies in the latest European and US guidelines and how new and emerging therapies may change the treatment paradigm and be incorporated into clinical practice, now and in the future.

Expert Spotlight
Dr Carol Wade
University of Maryland Medical System, Baltimore, MD, USA
Prof. Ahmet Fuat
Carmel Medical Practice, Darlington, UK
Dr Akshay Desai
Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

Dr Carol Wade, Prof. Ahmet Fuat and Dr Akshay Desai discuss recommendations for HFrEF therapies in the latest guidelines and how new and emerging therapies may be incorporated into clinical practice, now and in the future.

Listen on the go

Learn more Back to MDT Hub Time: 10:04
 
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Learning Objectives & Overview
Overview

In this activity, a multidisciplinary team of specialists plus a patient with heart failure with reduced ejection fraction (HFrEF) share their perspectives on the multidisciplinary approach to care, new and emerging therapies for HFrEF and clinical practice guidelines for patients with HFrEF.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of cardiologists, heart failure specialists, cardiology specialist nurses and primary care physicians involved in the management of HFrEF.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity. The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty 

Dr Akshay Desai discloses: Consultancy fees from Abbott, Alnylam, Amgen, AstraZeneca, Bayer, Biofourmis, Boston Scientific, Cytokinetics, DalCor Pharma, Lupin Pharma, Merck, Novartis, Relypsa, Regeneron, Sun Pharma and Verily. Grants/Research support from Abbott, Alnylam, AstraZeneca, Bayer and Novartis.

Prof. Ahmet Fuat has no interests/relationships or affiliations to disclose in relation to this activity.

Dr Carol Wade has no interests/relationships or affiliations to disclose in relation to this activity.

Ms Sarah Worsnop has no interests/relationships or affiliations to disclose in relation to this activity.

Content reviewer

Caitlin Papa, MSN, APRN-C has no financial interests/relationships or affiliations in relation to this activity.

Touch Medical Director

Sola Neunie has no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 0.75 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 0.75 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Nurses

USF Health is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center’s Commission on Accreditation.

A maximum of 0.75 contact hours may be earned by learners who successfully complete this continuing professional development activity. USF Health, the accredited provider, acknowledges touchIME as the joint provider in the planning and execution of this CNE activity.

This activity is awarded 0.75 ANCC pharmacotherapeutic contact hour.

Date of original release: 22 March 2022. Date credits expire: 22 March 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Recognize the importance of a multidisciplinary team approach in the management of HF
  • Summarize the key recent data on new and emerging therapies for HFrEF
  • Discuss how new and emerging therapies for HFrEF can be utilized in clinical practice, with a focus on treatment guidelines and safety considerations
Faculty & Disclosures
Dr Akshay Desai

Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

Dr Akshay Desai is Director of the Cardiomyopathy and Heart Failure Program in the Advanced Heart Disease Section of the Cardiovascular Division, Brigham and Women’s Hospital and an Associate Professor of Medicine at Harvard Medical School (both in Boston, Massachusetts). read more

He received his undergraduate education at Princeton University, where he graduated summa cum laude in 1992 with an AB in Public and International Affairs. He was subsequently awarded a Rhodes Scholarship for study at Oxford University, where he completed an MPhil in European Politics and Society at Balliol College in 1994. Following this, he began his medical training at Harvard Medical School where he was awarded the MD degree in 1998.

Dr Desai completed his internship and residency in internal medicine at Brigham and Women’s Hospital in 2001 and subsequently undertook fellowship training in cardiovascular medicine at the same institution. During his final years of subspecialty training in cardiology, he completed additional fellowship training in heart failure and transplantation and concurrently conducted translational research in vascular medicine and diastolic heart failure. He was awarded an MPH in 2004 from the Harvard School of Public Health. 

Dr Desai currently divides his time between clinical care of patients with advanced heart disease and clinical research in cardiovascular clinical trials, with a focus on the pathophysiology, pharmacologic treatment, and ambulatory management of patients with heart failure.

Dr Akshay Desai discloses: Consultancy fees from Abbott, Alnylam, Amgen, AstraZeneca, Bayer, Biofourmis, Boston Scientific, Cytokinetics, DalCor Pharma, Lupin Pharma, Merck, Novartis, Relypsa, Regeneron, Sun Pharma and Verily. Grants/Research support from Abbott, Alnylam, AstraZeneca, Bayer and Novartis.

Prof. Ahmet Fuat

Carmel Medical Practice, Darlington, UK

Prof. Ahmet Fuat has been a general practitioner (GP) in Darlington, County Durham for 35 years. He has been a GPSI (GP with Special Interest) in cardiology for 20 years, having undertaken a postgraduate diploma in cardiology at Bradford University, graduating with distinction. He started the first one-stop diagnostic and integrated heart failure clinic in the UK 20 years ago with local colleagues. read more

His PhD research on heart failure diagnosis and management, including work on natriuretic peptides, generated several publications that have informed guidelines and led to Prof. Fuat receiving an Honorary Professorial Chair award from Durham University. 

Prof. Fuat holds various roles in cardiovascular disease (CVD) and research, including immediate past president and current education and research lead of the Primary Care Cardiovascular Society, which he was instrumental in reforming; CVD clinical adviser to the Royal College of General Practitioners (RCGP); CVD and research leads for Darlington Primary Care Network and Federation; and clinical lead for heart failure for the North East and North Cumbria Cardiac Network.

He has a passion for medical education and remains an active lecturer, tutor and researcher. He is on the editorial boards of the British Journal of Cardiology and Primary Care Cardiovascular Journal and is a peer reviewer for most high-impact cardiovascular journals and research bodies. Prof. Fuat’s work in community cardiology has been recognized with fellowships from the RCGP, Royal College of Physicians (RCP) London and RCP Edinburgh.

Prof. Ahmet Fuat has no interests/relationships or affiliations to disclose in relation to this activity.

Dr Carol Wade

University of Maryland Medical System, Baltimore, MD, USA

Dr Carol Wade is a nurse practitioner with a focus on advanced heart failure care management and with expertise in the transition of care following hospitalization for heart failure to prevent unnecessary readmission. She also serves as the programme manager for nurse practitioner practice in the Thoracic Transplant, Ventricular Assist Device and Heart Failure Program in the Coordinated Care Center at the University of Maryland Medical Center (UMMC). She holds an adjunct faculty position at the University of Maryland School of Nursing. She completed the Doctor of Nursing Practice programme at the University of Maryland School of Nursing in 2015, where she studied the effects of low health literacy on the heart failure population. read more

Dr Wade has authored book chapters on the nursing care of the heart failure patient and teaches various cardiology-based topics in the nurse practitioner programmes at the University of Maryland School of Nursing. 

Dr Carol Wade has no interests/relationships or affiliations to disclose in relation to this activity.

Ms Sarah Worsnop

Hull, UK

Ms Sarah Worsnop is a patient educator, amateur writer and mother of two, who was diagnosed with heart failure after a viral infection in her early 40s. read more

She strives to live positively with her condition and to help raise awareness whenever she can. 

She takes huge pride in helping to moderate the Pumping Marvellous Foundation (the UK’s heart failure patient-led charity) patient community and likes to stay informed about research and therapeutic advances for heart failure patients. 

Ms Worsnop’s particular areas of interest are in promoting the importance of quality of life in people with heart failure, and in giving patients a voice.

Ms Sarah Worsnop has no interests/relationships or affiliations to disclose in relation to this activity.

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Question 1/4
When selecting treatment for your patients with HFrEF, what should be the primary goal of therapy for the MDT to work towards?

HFrEF, heart failure with reduced ejection fraction; MDT, multidisciplinary team.
Correct

Treatment goals should be agreed with the patient on an individual basis – some patients may express a preference for quality-of-life improvements over survival, while others may value prolonged survival most.

Reference

Lewis EF, et al. J Heart Lung Transplant. 2001;20:1016–24.

Question 2/4
Which of the following would you consider as an important practical safety consideration to discuss with your patients with HFrEF who are switching from an ACE inhibitor to an ARNI therapy?

ACE, angiotensin-converting enzyme; ARNI, angiotensin receptor/neprilysin inhibitor; HFrEF, heart failure with reduced ejection fraction.
Correct

ARNI therapy is associated with an increased risk of hypotension during the initial dose titration period, which can be managed via timing of the dose at bedtime or via dose reduction if necessary (which is preferable to discontinuation). Other side effects include hyperkalaemia, and serious side effects include angioedema and shock (which would prompt discontinuation). ARNI therapy may reduce the need for loop diuretic therapy.1 

Therapy with SGLT2 inhibitors may increase the risk of recurrent genital fungal infections.2 Daily weight monitoring is important for patients receiving diuretic therapy to aid dose adjustment.2 

Abbreviations

ARNI, angiotensin receptor/neprilysin inhibitor; SGLT2, sodium-glucose cotransporter-2.

References

  1. Sauer AJ, et al. Heart Fail Rev. 2019;24:167–76.
  2. McDonagh TA, et al. Eur Heart J. 2021;42:3599–726.
Question 3/4
Your patient is a 78-year-old woman with newly diagnosed HFrEF, for whom you would normally recommend standard therapy with an ARNI, a beta-blocker, an MRA and an SGLT2 inhibitor. However, she also has type 2 diabetes. How would this affect your recommendation when you discuss this patient within your MDT?

ARNI, angiotensin receptor/neprilysin inhibitor; HFrEF, heart failure with reduced ejection fraction; MDT, multidisciplinary team; MRA, mineralocorticoid receptor antagonist; SGLT2, sodium-glucose cotransporter-2.
Correct

According to the ESC guidelines and ACC recommendations, SGLT2 inhibitors can reduce the risk of cardiovascular death and worsening heart failure (including hospitalization for heart failure) in patients with HFrEF when added to ACEi/ARNI/beta-blocker/MRA therapy; SGLT2 inhibitors are recommended regardless of diabetes status.1,2 Renal function should be checked when starting SGLT2 inhibitor therapy and monitored regularly; regular monitoring of glycaemia and fluid balance is also advised.1 Loop diuretics are recommended in patients with fluid overload.1,2 

Abbreviations

ACC, American College of Cardiology; ACEi, angiotensin-converting enzyme inhibitor; ARNI, angiotensin receptor/neprilysin inhibitor; ESC, European Society of Cardiology; HFrEF, heart failure with reduced ejection fraction; MRA, mineralocorticoid receptor antagonist; SGLT2, sodium-glucose cotransporter-2.

References

  1. McDonagh TA, et al. Eur Heart J. 2021;42:3599–726.
  2. Maddox TM, et al. J Am Coll Cardiol. 2021;77:772–810.
Question 4/4
Your patient is a 68-year-old male with recently diagnosed HFrEF (LVEF 38%). He is receiving ACE inhibitor/beta-blocker/MRA/ARNI therapy and has been stable for the past 6 months. During his check-up, he mentions that recently he has been experiencing shortness of breath while climbing stairs, but attributes this to his age. Which of the following actions would you take next?

ACE, angiotensin-converting enzyme; ARNI, angiotensin receptor/neprilysin inhibitor; HFrEF, heart failure with reduced ejection fraction; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonist.
Correct

Mildly symptomatic HFrEF is common and should not be ignored or misread as disease stability. Risk scores should be used to identify patients who might benefit from appropriate early treatment intensification.1 According to the ESC guidelines, adding vericiguat, an sGC stimulator, to standard therapy may be considered to reduce the risk of cardiovascular mortality and hospitalization in patients with worsening HFrEF despite ACE inhibitor/ARNI, beta-blocker and MRA treatment.2  

Abbreviations

ACE, angiotensin-converting enzyme; ARNI, angiotensin receptor/neprilysin inhibitor; ESC, European Society of Cardiology; HFrEF, heart failure with reduced ejection fraction; MRA, mineralocorticoid receptor antagonist; sGC, soluble guanylate cyclase.

References

  1. Arvanitaki A, et al. ESC Heart Fail. 2020;7:1477–87.
  2. McDonagh TA, et al. Eur Heart J. 2021;42:3599–726.
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