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Moderator(s)

Gregg C. Fonarow, MD

Professor of Medicine Director, Ahmanson-UCLA Cardiomyopathy Center; Co-Chief, UCLA Division of Cardiology, University of California Los Angeles, Los Angeles, California

Disclosures

Disclosure: Gregg Fonarow, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; Medtronic, Inc.; Novartis Pharmaceuticals Corporation; St. Jude Medical; ZS Pharma

Dr Fonarow does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Fonarow does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Panelist(s)

Barry H. Greenberg, MD

Distinguished Professor of Medicine; Director, Advanced Heart Failure Treatment Program, University of California San Diego, La Jolla, California

Disclosures

Disclosure: Barry Greenberg, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Mast Biosurgery; Novartis Pharmaceuticals Corporation; Stealth BioTherapeutics Inc.; Teva Pharmaceuticals USA; Zensun USA Inc.
Served as a speaker or a member of a speakers bureau for: Novartis Pharmaceuticals Corporation; Otsuka Pharmaceutical Co., Ltd.; Relypsa, Inc.

Dr Greenberg does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Greenberg does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

Joy P. Marko, MS, APN-C, CCMEP

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Joy P. Marko, MS, APN-C, CCMEP has disclosed no relevant financial relationships.

CME Reviewer(s)

Robert Morris, PharmD

Associate CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Robert Morris, PharmD, has disclosed no relevant financial relationships.

CME

Optimizing SCD Prevention: What Do the Guidelines Suggest

Authors: Greg C. Fonarow, MD; Barry H. Greenberg, MD
CME Released: 11/1/2016
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 11/1/2017, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for cardiologists, primary care physicians, critical care specialists, emergency medicine physicians, and all clinicians interested in preventing SCD in at-risk patients.

The goal of this activity is to improve the management of patients at high risk for sudden cardiac arrest (SCA)/sudden cardiac death (SCD) by educating clinicians about SCA/SCD guidelines risk assessment tools and prevention measures.

Upon completion of this activity, participants will:

Have greater competence related to the use of current guidelines for prevention of SCD/SCA in patients who have experienced an MI
Have increased knowledge regarding the role of the care team in integrating new recommendations into clinical practice

Disclosures

Moderator(s)

Gregg C. Fonarow, MD

Professor of Medicine Director, Ahmanson-UCLA Cardiomyopathy Center; Co-Chief, UCLA Division of Cardiology, University of California Los Angeles, Los Angeles, California

Disclosures

Disclosure: Gregg Fonarow, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; Medtronic, Inc.; Novartis Pharmaceuticals Corporation; St. Jude Medical; ZS Pharma

Dr Fonarow does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Fonarow does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Panelist(s)

Barry H. Greenberg, MD

Distinguished Professor of Medicine; Director, Advanced Heart Failure Treatment Program, University of California San Diego, La Jolla, California

Disclosures

Disclosure: Barry Greenberg, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Johnson & Johnson Pharmaceutical Research & Development, L.L.C.; Mast Biosurgery; Novartis Pharmaceuticals Corporation; Stealth BioTherapeutics Inc.; Teva Pharmaceuticals USA; Zensun USA Inc.
Served as a speaker or a member of a speakers bureau for: Novartis Pharmaceuticals Corporation; Otsuka Pharmaceutical Co., Ltd.; Relypsa, Inc.

Dr Greenberg does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Greenberg does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Editor(s)

Joy P. Marko, MS, APN-C, CCMEP

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Joy P. Marko, MS, APN-C, CCMEP has disclosed no relevant financial relationships.

CME Reviewer(s)

Robert Morris, PharmD

Associate CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Robert Morris, PharmD, has disclosed no relevant financial relationships.

Accreditation Statements

Medscape, LLC is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the healthcare team.

For Physicians

Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact [email protected]

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 70% on the post-test.

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From Medscape Education Cardiology

CME

Optimizing SCD Prevention: What Do the Guidelines Suggest

Authors: Greg C. Fonarow, MD; Barry H. Greenberg, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 11/1/2016

Valid for credit through: 11/1/2017, 11:59 PM EST

processing....

Optimizing SCD Prevention: What Do the Guidelines Suggest?
[ CLOSE WINDOW ]

Slide 1.

Goals
[ CLOSE WINDOW ]

Slide 2.

Prevalence of SCA/SCD^[1,2,3]
[ CLOSE WINDOW ]

Slide 3.

Prevalence of SCD^[1,2,3]
[ CLOSE WINDOW ]

Slide 4.

Risk Is Time-Dependent^[4]
- In the VALIANT trial, the risk of sudden cardiac arrest after myocardial infarction (MI) was examined as a function of time, as well as ejection fraction
- The greatest risk is in the first few months after MI, and then the risk declines
[ CLOSE WINDOW ]

Slide 5.

UPDATE: Pharmacologic Treatment for HFrEF^[5]
- Many therapies are designed to prevent progressive remodeling
- HRS has strong recommendations for the use of an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin receptor blocker (ARB), in combination with beta-blocker therapy, in the post-MI patient population
[ CLOSE WINDOW ]

Slide 6.

Guidelines Recommend Waiting Period Before Implantation^[6]
- Time is needed to see that patients can tolerate drug therapy
- For those individuals who are post-MI and who have been revascularized, either percutaneously or surgically; there is a waiting period of 3 months, during which time the neurohormonal blocking agents are initiated and uptitrated
- For patients who are not revascularized, the guidelines currently recommend a waiting period of greater than 40 days
[ CLOSE WINDOW ]

Slide 7.

WCD: Window of Vulnerability: Class IIb Recommendation^[7]
- The American Heart Association makes a class IIb recommendation for patient protection during the waiting period window following an MI
- Physicians and nurses can exert judgment in this patient population during this period of vulnerability
[ CLOSE WINDOW ]

Slide 8.

WCD: Patient Types^[7]
- A wearable cardioverter-defibrillator (WCD) is a treatment option for patients during the period of time while waiting for optimal dosing
- Patients can be a candidate for an implantable cardioverter-defibrillator (ICD) should there not be further improvement in their ejection fraction
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Slide 9.

WEARIT-II: ICD Implantation Rate by Disease Etiology^[8]
- Now clinicians can be much more selective in deciding who needs an ICD
- Reevaluate patients over a period of time
- WCD provides assurance during this time that these patients are not going to experience sudden cardiac death (SCD)
[ CLOSE WINDOW ]

Slide 10.

Heart Rhythm Society Guidelines^[6]
- The Heart Rhythm Society guidelines
  - Emphasize the administration of neurohormonal blocking agents and their uptitration
  - Recommend assessing patients over time to determine if their ejection fraction has improved
  - Recommend considering the use of the implantable ICD
  - Note that the WCD provides a level of safety during the waiting period
[ CLOSE WINDOW ]

Slide 11.

Timing Is Everything: WCD^[9]
- We do not want to prematurely put a device into individuals whose ejection fraction may come up to the 35% level or above
[ CLOSE WINDOW ]

Slide 12.

Well-Coordinated Multidisciplinary Teams
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Slide 13.

Take-Home Points
[ CLOSE WINDOW ]

Slide 14.

Thank you
[ CLOSE WINDOW ]

Slide 15.

This content has been condensed for improved clarity.

CME Information Download Slides

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Disclaimer

The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Moderator(s)

Gregg C. Fonarow, MD

Panelist(s)

Barry H. Greenberg, MD

Editor(s)

Joy P. Marko, MS, APN-C, CCMEP

CME Reviewer(s)

Robert Morris, PharmD

CME

Optimizing SCD Prevention: What Do the Guidelines Suggest

Target Audience and Goal Statement

Disclosures

Moderator(s)

Gregg C. Fonarow, MD

Panelist(s)

Barry H. Greenberg, MD

Editor(s)

Joy P. Marko, MS, APN-C, CCMEP

CME Reviewer(s)

Robert Morris, PharmD

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Optimizing SCD Prevention: What Do the Guidelines Suggest

Optimizing SCD Prevention: What Do the Guidelines Suggest?

Slide 1.

Goals

Slide 2.

Prevalence of SCA/SCD[1,2,3]

Slide 3.

Prevalence of SCD[1,2,3]

Slide 4.

Risk Is Time-Dependent[4]

Slide 5.

UPDATE: Pharmacologic Treatment for HFrEF[5]

Slide 6.

Guidelines Recommend Waiting Period Before Implantation[6]

Slide 7.

WCD: Window of Vulnerability: Class IIb Recommendation[7]

Slide 8.

WCD: Patient Types[7]

Slide 9.

WEARIT-II: ICD Implantation Rate by Disease Etiology[8]

Slide 10.

Heart Rhythm Society Guidelines[6]

Slide 11.

Timing Is Everything: WCD[9]

Slide 12.

Well-Coordinated Multidisciplinary Teams

Slide 13.

Take-Home Points

Slide 14.

Thank you

Slide 15.

Prevalence of SCA/SCD^[1,2,3]

Prevalence of SCD^[1,2,3]

Risk Is Time-Dependent^[4]

UPDATE: Pharmacologic Treatment for HFrEF^[5]

Guidelines Recommend Waiting Period Before Implantation^[6]

WCD: Window of Vulnerability: Class IIb Recommendation^[7]

WCD: Patient Types^[7]

WEARIT-II: ICD Implantation Rate by Disease Etiology^[8]

Heart Rhythm Society Guidelines^[6]

Timing Is Everything: WCD^[9]