Josh Jacobs
@joshjpharmd.bsky.social
Cardiovascular Medicine Clinical Pharmacist | Aspiring Clinician-Scientist - Cardiovascular Disease, Pharmacotherapy Optimization, Health Services Research
Dr. Cornelio discusses strategies for how to deprescribe
Some include CDS 💻 & patient decision aids/education 📚
Some include CDS 💻 & patient decision aids/education 📚
November 17, 2024 at 5:02 PM
Dr. Cornelio discusses strategies for how to deprescribe
Some include CDS 💻 & patient decision aids/education 📚
Some include CDS 💻 & patient decision aids/education 📚
Dr. Mehling offers insight into truly how toxic NSAIDs are
- 3x 🫀dz risk
- ⬆️ SBP by 14 mmHg
- 3x 🫀dz risk
- ⬆️ SBP by 14 mmHg
November 17, 2024 at 5:02 PM
Dr. Mehling offers insight into truly how toxic NSAIDs are
- 3x 🫀dz risk
- ⬆️ SBP by 14 mmHg
- 3x 🫀dz risk
- ⬆️ SBP by 14 mmHg
Dr. Orkaby up next with a geriatrician viewpoint!
- We prescribe complex and overwhelming “guideline-based regimen” for patients
- Careful about the prescribing cascade
- we do have a framework for de-prescribing in 🫀💊 to help cardiology clinicians
- We prescribe complex and overwhelming “guideline-based regimen” for patients
- Careful about the prescribing cascade
- we do have a framework for de-prescribing in 🫀💊 to help cardiology clinicians
November 17, 2024 at 5:02 PM
Dr. Orkaby up next with a geriatrician viewpoint!
- We prescribe complex and overwhelming “guideline-based regimen” for patients
- Careful about the prescribing cascade
- we do have a framework for de-prescribing in 🫀💊 to help cardiology clinicians
- We prescribe complex and overwhelming “guideline-based regimen” for patients
- Careful about the prescribing cascade
- we do have a framework for de-prescribing in 🫀💊 to help cardiology clinicians
3️⃣ not clear outcomes or great evidence in de-prescribing so far - huge need for future methodology and research
Some potential high-value targets do exist though!
Some potential high-value targets do exist though!
November 17, 2024 at 5:02 PM
3️⃣ not clear outcomes or great evidence in de-prescribing so far - huge need for future methodology and research
Some potential high-value targets do exist though!
Some potential high-value targets do exist though!
Now Dr. Hernandez talks about some potential issues with de-precribing. Will we make it worse??💊
1️⃣ trust in science 🧪🔬- it’s worsening over time and pretty low in the US
2️⃣ will sending mixed messages delay or prevent important med use like GDMT in HFrEF
1️⃣ trust in science 🧪🔬- it’s worsening over time and pretty low in the US
2️⃣ will sending mixed messages delay or prevent important med use like GDMT in HFrEF
November 17, 2024 at 5:02 PM
Now Dr. Hernandez talks about some potential issues with de-precribing. Will we make it worse??💊
1️⃣ trust in science 🧪🔬- it’s worsening over time and pretty low in the US
2️⃣ will sending mixed messages delay or prevent important med use like GDMT in HFrEF
1️⃣ trust in science 🧪🔬- it’s worsening over time and pretty low in the US
2️⃣ will sending mixed messages delay or prevent important med use like GDMT in HFrEF
What are potential targets in CVD?
- ASA with AC
- HF-exacerbating 💊 (NSAIDs, TZDs)
- Inappropriate DOAC dosing
- 💊 w/o indications (ex: nitrates for angina post PCI, or even BB in HFpEF?)
- 💊 w/ low likelihood of benefit (ex: palliative care)
- ASA with AC
- HF-exacerbating 💊 (NSAIDs, TZDs)
- Inappropriate DOAC dosing
- 💊 w/o indications (ex: nitrates for angina post PCI, or even BB in HFpEF?)
- 💊 w/ low likelihood of benefit (ex: palliative care)
November 17, 2024 at 5:02 PM
What are potential targets in CVD?
- ASA with AC
- HF-exacerbating 💊 (NSAIDs, TZDs)
- Inappropriate DOAC dosing
- 💊 w/o indications (ex: nitrates for angina post PCI, or even BB in HFpEF?)
- 💊 w/ low likelihood of benefit (ex: palliative care)
- ASA with AC
- HF-exacerbating 💊 (NSAIDs, TZDs)
- Inappropriate DOAC dosing
- 💊 w/o indications (ex: nitrates for angina post PCI, or even BB in HFpEF?)
- 💊 w/ low likelihood of benefit (ex: palliative care)
Dr. Goyal talks about complications from polypharmacy 💊💊💊
- Adherence, ADRs, and lack of optimization, especially GDMT in HFrEF 🫀
- Need to focus on practical prescribing ⬆️ and de-prescribing ⬇️ rules
- Adherence, ADRs, and lack of optimization, especially GDMT in HFrEF 🫀
- Need to focus on practical prescribing ⬆️ and de-prescribing ⬇️ rules
November 17, 2024 at 5:02 PM
Dr. Goyal talks about complications from polypharmacy 💊💊💊
- Adherence, ADRs, and lack of optimization, especially GDMT in HFrEF 🫀
- Need to focus on practical prescribing ⬆️ and de-prescribing ⬇️ rules
- Adherence, ADRs, and lack of optimization, especially GDMT in HFrEF 🫀
- Need to focus on practical prescribing ⬆️ and de-prescribing ⬇️ rules
Lots of tools to help with de-prescribing. But where is the sweet “Goldilocks” spot? We don’t quite know yet
November 17, 2024 at 5:02 PM
Lots of tools to help with de-prescribing. But where is the sweet “Goldilocks” spot? We don’t quite know yet
What do we need to focus on de-prescribing on CVD?
Dr. Schwartz gives a good state of the field. Polypharmacy 💊💊 + age = higher complications & 💊🚫 interactions. Huge need to systematically withdrawal low-value “inappropriate” medications #AHA24 #CardioSky
Dr. Schwartz gives a good state of the field. Polypharmacy 💊💊 + age = higher complications & 💊🚫 interactions. Huge need to systematically withdrawal low-value “inappropriate” medications #AHA24 #CardioSky
November 17, 2024 at 5:02 PM
What do we need to focus on de-prescribing on CVD?
Dr. Schwartz gives a good state of the field. Polypharmacy 💊💊 + age = higher complications & 💊🚫 interactions. Huge need to systematically withdrawal low-value “inappropriate” medications #AHA24 #CardioSky
Dr. Schwartz gives a good state of the field. Polypharmacy 💊💊 + age = higher complications & 💊🚫 interactions. Huge need to systematically withdrawal low-value “inappropriate” medications #AHA24 #CardioSky
2️⃣ LLMs can reduce burden for patient eligibility screening in clinical trials, using RECTIFIER. 78% ⬆️ in eligibility determination vs. manual.
November 16, 2024 at 8:01 PM
2️⃣ LLMs can reduce burden for patient eligibility screening in clinical trials, using RECTIFIER. 78% ⬆️ in eligibility determination vs. manual.
1️⃣ NLP potentially helpful in adjudicating HF 🫀 as an outcome. 91% agreement vs. clinical adjudication, with ⬇️⬇️ adjudication burden.
November 16, 2024 at 8:01 PM
1️⃣ NLP potentially helpful in adjudicating HF 🫀 as an outcome. 91% agreement vs. clinical adjudication, with ⬇️⬇️ adjudication burden.
Can health tech 💻like NLP and LLMs help with pragmatic use of clinical trials? Let’s find out! #AHA24 #CardioSky
November 16, 2024 at 8:01 PM
Can health tech 💻like NLP and LLMs help with pragmatic use of clinical trials? Let’s find out! #AHA24 #CardioSky
Important work by Dr. Jennifer Campbell & moderated by @PowellWileyLab on association btw redlining 🏠🛑 and prevalent T2DM 🍫.
Potential direct association 📈(estimate 0.28; P<0.001)
With indirect pathways through healthcare access 🏥, education 📚, & social risk ⚠️ #AHA24 #CardioSky
Potential direct association 📈(estimate 0.28; P<0.001)
With indirect pathways through healthcare access 🏥, education 📚, & social risk ⚠️ #AHA24 #CardioSky
November 16, 2024 at 7:41 PM
Important work by Dr. Jennifer Campbell & moderated by @PowellWileyLab on association btw redlining 🏠🛑 and prevalent T2DM 🍫.
Potential direct association 📈(estimate 0.28; P<0.001)
With indirect pathways through healthcare access 🏥, education 📚, & social risk ⚠️ #AHA24 #CardioSky
Potential direct association 📈(estimate 0.28; P<0.001)
With indirect pathways through healthcare access 🏥, education 📚, & social risk ⚠️ #AHA24 #CardioSky
5️⃣ Dr. Tastsuo Shimosawa talks about NaCl, NCC, and BP. Potential regulation of NCC through CamK2-B
November 16, 2024 at 4:31 PM
5️⃣ Dr. Tastsuo Shimosawa talks about NaCl, NCC, and BP. Potential regulation of NCC through CamK2-B
4️⃣ Dr. Anastasia Mihailidou - new BP 💊 and procedures
For 💊 we have siRNA, non-steroidal MRAs, aldosterone synthase inhibitors, & ERAs
For procedures - renal denervation
New procedures and 💊 on the horizon too!
For 💊 we have siRNA, non-steroidal MRAs, aldosterone synthase inhibitors, & ERAs
For procedures - renal denervation
New procedures and 💊 on the horizon too!
November 16, 2024 at 4:31 PM
4️⃣ Dr. Anastasia Mihailidou - new BP 💊 and procedures
For 💊 we have siRNA, non-steroidal MRAs, aldosterone synthase inhibitors, & ERAs
For procedures - renal denervation
New procedures and 💊 on the horizon too!
For 💊 we have siRNA, non-steroidal MRAs, aldosterone synthase inhibitors, & ERAs
For procedures - renal denervation
New procedures and 💊 on the horizon too!
3️⃣ Dr. Yvonne Commodore-Mensah - leveraging community health workers in our team-based care 👫to improve BP control. They can help with all aspects of BP care, including barriers to SDoH 🚗💵, but we need infrastructure and funding!
November 16, 2024 at 4:31 PM
3️⃣ Dr. Yvonne Commodore-Mensah - leveraging community health workers in our team-based care 👫to improve BP control. They can help with all aspects of BP care, including barriers to SDoH 🚗💵, but we need infrastructure and funding!
2️⃣ Dr. Adam Bress - precision medicine in HTN in true Pecha Kucha format.
Precision medicine 🎯may not be up to par…currently - high signal-to-noise 🎧
There’s still some things we can do to ⬇️ therapeutic inertia 🐌 - accuracy in BP measurement and 💊 adherence
Precision medicine 🎯may not be up to par…currently - high signal-to-noise 🎧
There’s still some things we can do to ⬇️ therapeutic inertia 🐌 - accuracy in BP measurement and 💊 adherence
November 16, 2024 at 4:31 PM
2️⃣ Dr. Adam Bress - precision medicine in HTN in true Pecha Kucha format.
Precision medicine 🎯may not be up to par…currently - high signal-to-noise 🎧
There’s still some things we can do to ⬇️ therapeutic inertia 🐌 - accuracy in BP measurement and 💊 adherence
Precision medicine 🎯may not be up to par…currently - high signal-to-noise 🎧
There’s still some things we can do to ⬇️ therapeutic inertia 🐌 - accuracy in BP measurement and 💊 adherence
1️⃣ up is Dr. Rushelle Byfield- talking about global impact of uncontrolled HTN . Wow! Huge problem worldwide, including the US, and COVID did not help
November 16, 2024 at 4:31 PM
1️⃣ up is Dr. Rushelle Byfield- talking about global impact of uncontrolled HTN . Wow! Huge problem worldwide, including the US, and COVID did not help
Session on best way to achieve BP control
November 16, 2024 at 4:31 PM
Session on best way to achieve BP control
New therapeutic option in the works for ATTR amyloid? Nexiguran ziclumeran (nex-z), a CRISPR/Cas9 therapy that 🛑TTR synthesis, showing promise with rapid ⬇️ in TTR by 89%, with possible stability or improvement in dz progression #AHA24
November 16, 2024 at 3:47 PM
New therapeutic option in the works for ATTR amyloid? Nexiguran ziclumeran (nex-z), a CRISPR/Cas9 therapy that 🛑TTR synthesis, showing promise with rapid ⬇️ in TTR by 89%, with possible stability or improvement in dz progression #AHA24
No difference in all-cause mortality. Amazing ⬇️ in body weight by 11.6%. Do we finally a component of “GDMT” that affects hard outcomes in HFpEF?
November 16, 2024 at 3:28 PM
No difference in all-cause mortality. Amazing ⬇️ in body weight by 11.6%. Do we finally a component of “GDMT” that affects hard outcomes in HFpEF?
N=731, ⬇️ in death and WHF (HR 0.62; 95% CI 0.41-0.94). Results consistent when omission of ⬆️ oral diuretics from endpoint, primarily driven by WHF.
November 16, 2024 at 3:28 PM
N=731, ⬇️ in death and WHF (HR 0.62; 95% CI 0.41-0.94). Results consistent when omission of ⬆️ oral diuretics from endpoint, primarily driven by WHF.
SUMMIT trial presenting now - Tirzepatide in HFpEF (>50 LVEF) w/ BMI>=30 + 1 of following: LA enlargement, ⬆️ LV filling pressure, or ⬆️ BNP. #AHA24 #CardioSky
November 16, 2024 at 3:28 PM
SUMMIT trial presenting now - Tirzepatide in HFpEF (>50 LVEF) w/ BMI>=30 + 1 of following: LA enlargement, ⬆️ LV filling pressure, or ⬆️ BNP. #AHA24 #CardioSky
What are some limitations and implications? Generalizability, cost and feasibility, polypill potential, and implementation!
November 16, 2024 at 3:09 PM
What are some limitations and implications? Generalizability, cost and feasibility, polypill potential, and implementation!
N=12,822. Mean SBP achieved at 48 months: 120 vs 133. 21% ⬇️ in MACE, consistent across subgroups, but ⬆️ in symptomatic hypotension + hyperK+
November 16, 2024 at 3:04 PM
N=12,822. Mean SBP achieved at 48 months: 120 vs 133. 21% ⬇️ in MACE, consistent across subgroups, but ⬆️ in symptomatic hypotension + hyperK+