Dr. Bakris and CMHC from the AHA’s Scientific Sessions

The Cardiometabolic Health Congress (CMHC) was pleased to be present at the American Heart Association’s Scientific Sessions at the McCormick Place Convention Center in Chicago this November 5-7, 2022. Not only did CMHC debut an exciting Virtual Escape Room educational activity at booth #608 in the Exhibit Hall, but their expert faculty also presented a CME Dinner Symposium on Sunday, November 6, at the Marquis Marriott.

Virtual Escape Room

By presenting an innovative virtual activity during the AHA’s 2022 Scientific Sessions, CMHC brought a fun and stimulating learning environment directly to vested providers of cardiovascular medicine. A Virtual Escape Room experience enhances learning and retention using gaming elements of strategy, challenge, and reward. Simulating clinical practice and the challenges presented therein, the virtual experience presents a wide range of scenarios in rooms mimicking practice environments (doctor’s office, exam room, pharmacy, clinical laboratory, conference room) to provide appropriate context and support immersion in the learning experience. Learners access challenges or puzzles aligned with learning objectives via hotspots shown in their digital room space. Behind each hotspot is a game loop presented as information, a challenge, a solution, and a reward – which is a clue. When all clues behind the hotspots are collected, the learner may decipher a code in order to escape that room and proceed to the next stage. Participants’ scores are presented at the end of the activity, and they may be presented with the opportunity to revisit some of the contents included within the escape room activity. Live participants of the Escape Room at the meetings will be emailed their results and sent additional education and information on the topic.

CME Dinner Symposium

On Sunday, November 6, CMHC faculty led What You Need to Know About Optimizing Cardiorenal Outcomes With Nonsteroidal MRAs, a dinner symposium informed by a timely clinical topic. In addition to a complimentary dinner of red quinoa salad, herb farro risotto, braised short rib, and passionfruit meringue tart, attendees of the CME Dinner Symposium heard from four of CMHC’s esteemed faculty about the use of nonsteroidal MRAs.

The coexistence of type 2 diabetes (T2D) and chronic kidney disease (CKD) significantly exacerbates cardiovascular and renal morbidity and mortality compared to the outcomes from either condition alone. Despite advances in therapy, many patients with DKD progress to kidney failure and have significant cardiovascular adverse events, and current strategies to address cardiorenal risk in these patients are inadequate. Recent developments regarding novel nonsteroidal MRAs can help address some of these gaps, particularly by targeting mineralocorticoid receptor (MR) overactivation, a key pathophysiological driver that remains unaddressed with current treatment options, including SGLT-2 inhibitors.

Novel Nonsteroidal MRAs in Patients with CKD and T2D. Renowned nephrologist Rajiv Agarwal, MD, MS, reviewed current CKD treatments and their limitations, as well as the pathophysiology and role of MR overactivation in CKD progression. He explained that emerging SGLT-2 inhibitors do not address the pathophysiology and residual cardiorenal risk and wrapped up his session by acknowledging the limitations of steroidal MRAs when compared to nonsteroidal MRAs such as finerenone.

The Role of Nonsteroidal MRAs in Cardiovascular Care. Sylvia E. Rosas, MD, MSCE, associate professor of medicine at Harvard Medical School, addressed how nonsteroidal MRAs fit in with other cardioprotective therapies, provided an overview of guideline updates, and gave some insights for patient selection. Dr. Rosas cited evidence from clinical trials such as FIGARO-DKD, FIDELIO-DKD, and FIDELITY, and discussed the concomitant use of finerone and SGLT-2 inhibitors. In conclusion, she covered the updated 2022 ADA Standards of Care and the 2022 AHA Scientific Statement on Comprehensive Management of CV Risk Factors in Adults with Type 2 Diabetes, both of which now include the use of finerenone.

The approval of finerenone for managing CKD in T2D patients has been welcomed by experts in the field, but how to properly integrate this agent into the current treatment landscape needs to be addressed. The CMHC symposium offered clinicians a better understanding of the pathophysiology, screening, diagnosis, and current management options in CKD, as well as a comprehensive review of the data to translate this clinical evidence into better patient care.

Challenging Patient Case. Founder of the Step Family Foundation Cardiac Rehabilitation and Wellness Center at UC San Diego, Pam R. Taub, MD, took the stage to present a patient case of a 54-year-old woman referred by her primary care provider for increasing creatinine with a history of diabetes. After disclosing the patient’s lab results, current medications, and physical exam results, Dr. Taub explained that the patient was on optimized RAAS therapy and an SGLT-2 inhibitor, but there is concern about cardiorenal risk based on the most recent lab results. She then challenged the audience to consider:

• Is the patient at risk of disease progression?
• What tests should be used to evaluate the patient?
• What other options should be considered in this patient to further decrease cardiorenal risk?

Panel Discussion, Q&A, and Conclusions. Using Dr. Taub’s patient as a point of discussion, the symposium faculty engaged in a roundtable exchange involving the audience to offer some additional clinical pearls regarding:

• Clinical practice implications of the FIDELIO and FIGARO trials
• Where this evidence fits with existing conventional DKD treatments, as well as SGLT-2 inhibitors
• How finerenone different from steroidal MRAs
• Safety of finerenone, particularly as it relates to hyperkalemia
• Integrating nonsteroidal MRAs into the DKD treatment algorithm in the near future
• Ongoing studies with nonsteroidal MRAs and what areas need additional investigation

The evening concluded with acknowledgment of the educational grant from Bayer that made the symposium possible, a nod to the staff of CMHC, and gratitude for the AHA in their pursuit of providing world-class education via the 2022 Scientific Sessions.

SYMPOSIUM FACULTY

George L. Bakris, MD

Sylvia E. Rosas, MD, MSCE

Rajiv Agarwal, MD, MS

Pam R. Taub, MD, FACC, FASPC