November 29, 2022

Home based program for PAD. STOP-HF and AMPLIFY trials.

Well in this week’s cardiology countdown we have a home based program to improve symptoms in pa d a biomarker adjusted program for heart failure management and a new treatment for dvt and pulmonary embolism with one of the new oral anticoagulants so to begin with we have a publication in jama of a so-called home-based walking exercise intervention for patients

With pa d this was a study of just under 200 patients at an institution where they actually had weekly visits to the hospital for in the control group just lectures about vascular disease but in the active group 45 minutes of a group walking session with instructions on how to do that at home and it was found that that latter intervention program improved symptoms

Significantly where the six-minute walk test distance improved by from 350 up to 400 in meters and the walking time went from eight up to nine and a half minutes and all the other measures that they had that are standardized improved with that home-based walking program and so this gives an alternative to what has not been reimbursed i believe in the united states

A so-called cardiac rehab for pa d did involve coming in for supervised group lessons but one that could improve symptoms in pa d the next up is the stop hf trial also in jama and this was a biomarker adjusted management of heart failure patients so it was a study of about 1,350 patients who were screened for heart failure had some symptoms using bnp and in the

Intervention group the bnp was assayed and if elevated in the case above 50 they were referred to a cardiologist and had an echocardiogram to help manage and this group had significant improvement in their management with better use of ace inhibition i was about forty percent of the screen group ended up being biomarker positive for bnp but they had a lower

Incidence of lv dysfunction or heart failure with an echo done in everybody at six months and so the primary endpoint was significantly reduced and the rate of heart failure was cut in half from two down to one percent over six month period and also interestingly major adverse cardiac events were also reduced in this biomarker referred cardiologist managed to high

Risk group and so i think it’s growing evidence for the usefulness of biomarkers to help triage patients the number one pick this week is the amplify trial that found a benefit of a pic seban for use in acute pe or dvt treatment this study was a very large trial over 5,000 patients that compared the use of a pic seban versus the standard treatment of loma quite

Heparin followed by warfarin over a six-month period for patients with acute pe about a third of the patients or acute dvt two thirds of the patients through over 5,000 patients randomized and what was found was that the oral only with a pic seban from the start had similar efficacy it was 2.3 versus 2.7% for symptomatic recurrent vte or death and the hazard ratio

Was point 8 for a p-value for non-inferiority less than point 01 now the big finding really was that the safety was dramatically improved with two-thirds reduction in the risk of major bleeding went from 1.8 down 2.6 for major bleeding and major or clinically significant non-major went from 9.7 down to 4.3 percent and so a new simpler oral only regimen that had

Significantly better safety for the management acute dvt and pe so for this week’s cardiology countdown on chris cannon

Transcribed from video
Cardiology Countdown | PAD Walking, STOP-HF and AMPLIFY By American College of Cardiology