The final day of the 17th annual conference from Cardiometabolic Health Congress (CMHC) focused on cardiorenal considerations in patients with heart failure, racial and gender disparities in the diagnosis, treatment, and burden of cardiovascular disease, and overcoming treatment resistance and therapeutic inertia in hypertension. Read on for highlights from the last day of the most anticipated event in evidence-based education for the diagnosis, treatment, and management of cardiometabolic disease.
Sunrise CME Breakfast Symposium: Navigating the Diagnosis and Management of Heart Failure in Women
7 a.m. EST — As the final day of of the 17th Annual CMHC began, any attendees who may have tempted to oversleep were reminded via notification from the event’s mobile app (powered by eventScribe) that the sessions were about to commence. Ileana L. Piña, MD, MPH, and Alanna B. Morris, MD, MSc, led the Breakfast CME Symposium on important considerations in managing a spectrum of cardiovascular conditions in women. Dr. Piña, cardiovascular researcher, clinician, and professor of medicine at Thomas Jefferson University, discussed the concept of frailty in her female patients with cardiovascular decline. She noted that light weights and resistance bands can be used to build strength, but only after balance is established in order avoid falls. Not only does decreasing frailty improve physical health, but the psychosocial impacts of regaining independence through improved mobility are significant and contribute to better overall outcomes in women.
“Frailty is one of those things that is easy to recognize but hard to define.” – Dr. Piña
Primetime CME Symposium: The Disproportionate Burden of Atrial Fibrillation in High-Risk African American Patients with Cardiometabolic Comorbidities
9:50 a.m. EST — After Keith C. Ferdinand MD, introduced the faculty and topic for the morning’s symposium, Duke University Medical Center’s Larry R. Jackson II, MD, reminded the audience that all irregular heartbeats are not atrial fibrillation (A-fib), but that even minutes of true A-fib can lead to stroke weeks later; clinicians must accurately diagnose it and counselling patients on both risks and benefits of anticoagulation therapy. When Dr. Jackson posed the question to fellow faculty member Laura C. Ross, PA-C, regarding whether or not to initiate anticoagulation therapy in patients with A-fib, she said that in her experience “patients are much more scared of having a stroke than a bleed, so I keep that in mind when considering anticoagulation therapy.” Drs. Ross, Ferdinand, and Jackson had a lively discussion on the use of Warfarin versus DOACs; due to their efficacy, consistent dosing, reduced monitoring, fewer drug interactions and generally lower rate of adverse effects, Drs. Ferdinand and Ross were firmly in favor of DOACs, but Dr. Jackson cautioned that the affordability and adherence rates of Warfarin should be considered before completely ruling out its use.
In terms of extended remote monitoring, Dr. Ferdinand commented that newer technology to replace the Holter monitor benefits patients with transportation, time, or care delivery barriers. Dr. Laura Ross agreed, saying that in her clinic they don’t use Holters anymore either, and that “for patients with social determinants of health, newer remote-monitoring devices that look like a bandaid are easier methods we can mail to the patient, they wear it, and mail it back.”
“Encourage clinicians with patients that are non-native English speakers to use the tools at their disposal. Plug your notes into Google translate, it’s free, quick and patients are much more likely to take their medications if they understand why and how to take them, and if they are warned about possible side-effects so they aren’t taken by surprise.” – Dr. Ross
For more on racial disparities in cardiometabolic disease, please listen to Dr. Ferdinand’s award-winning webinar, Looming Cardiometabolic Crisis: A Conversation About Race
Nonsteroidal MRAs: DKD and Beyond
10:50 a.m. EST — Indiana School of Medicine’s Rajiv Agarwal, MD, MS, discussed the deliberate discovery and ongoing development nonsteroidal mineralocorticoid receptor antagonists (MRAs) to address the need for safer treatments that protect the kidney and heart in patients with diabetic kidney disease (DKD). There are several drugs within this class at varying stages of clinical development, but one of the only approved nonsteroidal MRAs, finerenone, has beneficial renal and cardiovascular properties. Dr. Agarwal posed the question, “What’s wrong with steroidal MRAs like spironolactone?” He explained that spironolactone reduces mortality but is underprescribed due to the perceived risk of hyperkalemia and hormonal side effects. Although the blood pressure reduction with finerenone is less significant, so is the risk of hyperkalemia, according to the FIDELITY-TRH study.
Finerenone is THE drug for the patient shared by the cardiologist and the nephrologist. – Dr. Agarwal
Importance of Assessment and Potential Treatment for Masked Hypertension
11:20 a.m. EST — For the purpose of his lecture, Raymond R. Townsend, MD presented a working definition of masked hypertension as normal blood pressure (BP) in office, but elevated BP outside of the office. There are a number of potential confounding factors in managing masked hypertension, such as the definition of “normal,” the incidence of occasional high BP in normotensive individuals, and the phenomenon of “white coat syndrome,” which is essentially the opposite of masked hypertension – high BP in the office but normal BP out-of-office. Dr. Townsend discussed masked hypertension findings in studies of three patient populations, concluding that masked hypertension is more prevalent than previously estimated, particularly episodes of asleep hypertension which has serious cardiovascular implications.
Challenging Cardiorenal Cases & Expert Panel Discussion
12 p.m. EST — Many of Friday’s faculty returned to the stage to discuss challenging diabetes management case from their practice, discussed treatment options and pitfalls, and then fielded questions from the audience.
Congratulations to our Passport to Prizes winners! During Friday night’s Happy Hour drawing, Juan won the AirPods, Steve won the Apple Watch, and Stephen won the grand-prize Peloton! We’ll see you again next year for the 18th Annual CMHC, back at the Boston Park Plaza on Oct. 11-14, 2023.