Media is too big
VIEW IN TELEGRAM
Physiology of Lipoproteins Cholesterol
@cardiology
@cardiology
@MBmedicalbook 2020 ecg.pdf
8.6 MB
Medical Student Survival Skills : ECG 1st edition
@cardiology
@cardiology
@MBmedicalbook 2020 chronic renal.pdf
17.6 MB
CHRONIC RENAL DISEASE 2nd edition
@cardiology
@cardiology
Chronic_coronary_syndromes_ESC_2019_eng.pdf
2.4 MB
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes.
@cardiology
@cardiology
Acute_pulmonary_embolism_ESC_2019_eng.pdf
2.1 MB
2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).
@cardiology
@cardiology
Diabetes_pre-diabetes_ESC_2109_eng.pdf
1.9 MB
2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD
@cardiology
@cardiology
—Dapagliflozin, when given on top of standard therapy, markedly reduces the risk of worsening heart failure events and cardiovascular death and improves symptoms among heart failure patients with reduced ejection fraction (HFrEF), full results from the DAPA-HF trial show.
Importantly, the relative and absolute risk reductions in death and hospitalizations were consistent across subgroups, which included patients both with and without diabetes, presenter John McMurray, MD (University of Glasgow, Scotland), said here at the European Society of Cardiology Congress 2019, prompting hoots of surprise and scattered applause from the audience. McMurray’s concluding remarks were met with sustained applause and at least one man gave the results a standing ovation.
Marco Metra, MD (University of Brescia, Italy), discussing the results after McMurray’s presentation, pointed out that scale of the benefits—a 26% reduction in the composite endpoint, a 30% reduction on worsening heart failure events, and mortality reductions of 18% for both cardiovascular and all-cause deaths. These, he said, are all equal to or surpass the achievements other landmark trials in this space, dating back more than two decades.
“Also, with respect to quality of life, and this is very important when we treat patients every day, there was a marked improvement in quality of life, again comparable if not numerically larger than what we’ve seen in recent trials,” Metra said.
Commenting on the findings for TCTMD, Darren McGuire, MD (UT Southwestern Medical Center, Dallas, TX), could scarcely contain his excitement. “I had high expectations going into this trial, but never expected this,” he said. “This is just a ‘wow’ finding that will change practice, hopefully quickly."
Also reacting to the full presentation, Subodh Verma, MD, PhD (St Michael’s Hospital/University of Toronto, Canada), Canadian lead investigator for DAPA-HF, called the results “transformative.”
“These . . . mark the beginning of a new day for heart failure—a grievous and recalcitrant problem which is on the rise,” he told TCTMD by email. “The height of the bar was formidable for DAPA-HF to jump over: demonstrating efficacy on top of excellent standard of care, including ARNI is remarkable. The story of SGLT2 inhibitors is truly one of serendipity, science, and research tenacity that has yielded hope for vulnerable patients with poor prognosis.”
The win for a sodium glucose co-transporter 2 (SGLT2) inhibitor in a heart failure population marks a major step for this class of drugs, coming more than a decade after the US Food and Drug Administration first mandated cardiovascular outcomes trials for up-and-coming diabetes medications. Over the last few years, trials of the SGLT2 inhibitors, developed for the treatment of type 2 diabetes, have also been shown to reduce heart failure hospitalizations in diabetic patients. But as McMurray said here, the magnitude of the benefit in diabetes patients seemed greater than what could be expected by the impact on hemoglobin A1c (HbA1c) levels.
Topline results for the trial were released last month by the manufacturer AstraZeneca, as reported by TCTMD.
DAPA-HF Details
DAPA-HF enrolled 4,744 patients with heart failure and reduced ejection fraction in 20 countries. Just under half of these patients were found to have diagnosed or undiagnosed diabetes, which McMurray characterized as typical in a HFrEF population. Importantly, patients randomized to 10 mg daily dapagliflozin (Farxiga; AstraZeneca) or matching placebo were given these pills on top of standard care. Most patients were already being managed with an ACE inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor (ARNI), although this last was taken by just 11%, said McMurray. Nearly all patients were taking a beta-blocker, and 71% were taking a mineralocorticoid receptor antagonist.
The primary outcome, a composite of first episode of worsening heart failure (defined as hospitalization or an urgent care HF visit requiring IV therapy) or death from
Importantly, the relative and absolute risk reductions in death and hospitalizations were consistent across subgroups, which included patients both with and without diabetes, presenter John McMurray, MD (University of Glasgow, Scotland), said here at the European Society of Cardiology Congress 2019, prompting hoots of surprise and scattered applause from the audience. McMurray’s concluding remarks were met with sustained applause and at least one man gave the results a standing ovation.
Marco Metra, MD (University of Brescia, Italy), discussing the results after McMurray’s presentation, pointed out that scale of the benefits—a 26% reduction in the composite endpoint, a 30% reduction on worsening heart failure events, and mortality reductions of 18% for both cardiovascular and all-cause deaths. These, he said, are all equal to or surpass the achievements other landmark trials in this space, dating back more than two decades.
“Also, with respect to quality of life, and this is very important when we treat patients every day, there was a marked improvement in quality of life, again comparable if not numerically larger than what we’ve seen in recent trials,” Metra said.
Commenting on the findings for TCTMD, Darren McGuire, MD (UT Southwestern Medical Center, Dallas, TX), could scarcely contain his excitement. “I had high expectations going into this trial, but never expected this,” he said. “This is just a ‘wow’ finding that will change practice, hopefully quickly."
Also reacting to the full presentation, Subodh Verma, MD, PhD (St Michael’s Hospital/University of Toronto, Canada), Canadian lead investigator for DAPA-HF, called the results “transformative.”
“These . . . mark the beginning of a new day for heart failure—a grievous and recalcitrant problem which is on the rise,” he told TCTMD by email. “The height of the bar was formidable for DAPA-HF to jump over: demonstrating efficacy on top of excellent standard of care, including ARNI is remarkable. The story of SGLT2 inhibitors is truly one of serendipity, science, and research tenacity that has yielded hope for vulnerable patients with poor prognosis.”
The win for a sodium glucose co-transporter 2 (SGLT2) inhibitor in a heart failure population marks a major step for this class of drugs, coming more than a decade after the US Food and Drug Administration first mandated cardiovascular outcomes trials for up-and-coming diabetes medications. Over the last few years, trials of the SGLT2 inhibitors, developed for the treatment of type 2 diabetes, have also been shown to reduce heart failure hospitalizations in diabetic patients. But as McMurray said here, the magnitude of the benefit in diabetes patients seemed greater than what could be expected by the impact on hemoglobin A1c (HbA1c) levels.
Topline results for the trial were released last month by the manufacturer AstraZeneca, as reported by TCTMD.
DAPA-HF Details
DAPA-HF enrolled 4,744 patients with heart failure and reduced ejection fraction in 20 countries. Just under half of these patients were found to have diagnosed or undiagnosed diabetes, which McMurray characterized as typical in a HFrEF population. Importantly, patients randomized to 10 mg daily dapagliflozin (Farxiga; AstraZeneca) or matching placebo were given these pills on top of standard care. Most patients were already being managed with an ACE inhibitor, angiotensin receptor blocker, or angiotensin receptor-neprilysin inhibitor (ARNI), although this last was taken by just 11%, said McMurray. Nearly all patients were taking a beta-blocker, and 71% were taking a mineralocorticoid receptor antagonist.
The primary outcome, a composite of first episode of worsening heart failure (defined as hospitalization or an urgent care HF visit requiring IV therapy) or death from
cardiovascular causes, occurred in 16.3% of patients in the dapagliflozin group and in 21.2% of the placebo group (HR 0.74; 95% CI 0.65-0.85). Analyzed separately, worsening heart failure and CV deaths were both significantly reduced in the dapagliflozin-treated patients. Rates of adverse events, however, were low and no different between groups.
To TCTMD, McMurray explained that the investigators were committed to enrolling a representative population of heart failure patients with reduced ejection fraction, in whom diabetes is rampant, rather than attempting to enroll a population free of diabetes. But risk of the primary endpoint in patients without diabetes (HR 0.7 3, 95% CI 0.60-0.88) were nearly identical to those in patients with diabetes (HR 0.75, 95% CI 0.63-0.85). McMurray’s slide zeroing in on this subgroup produced a fresh wave of clapping from the audience.
Moreover, in separate analyses investigators have looked at drug effects according to baseline HbA1c levels, although these results were not part of today’s presentation, McMurray acknowledged at a morning press conference. Offering a glimpse at that analysis, however, McMurray said: “There is no difference across the range of hemoglobin A1c; it is as effective in people with and without elevated HbA1c.
@cardiology
To TCTMD, McMurray explained that the investigators were committed to enrolling a representative population of heart failure patients with reduced ejection fraction, in whom diabetes is rampant, rather than attempting to enroll a population free of diabetes. But risk of the primary endpoint in patients without diabetes (HR 0.7 3, 95% CI 0.60-0.88) were nearly identical to those in patients with diabetes (HR 0.75, 95% CI 0.63-0.85). McMurray’s slide zeroing in on this subgroup produced a fresh wave of clapping from the audience.
Moreover, in separate analyses investigators have looked at drug effects according to baseline HbA1c levels, although these results were not part of today’s presentation, McMurray acknowledged at a morning press conference. Offering a glimpse at that analysis, however, McMurray said: “There is no difference across the range of hemoglobin A1c; it is as effective in people with and without elevated HbA1c.
@cardiology