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Moderator

Sunil V. Rao, MD

Professor of Medicine, Duke University Medical Center; Section Chief, Cardiology, Durham VA Medical Center, Durham North Carolina

Disclosures

Disclosure: Sunil V. Rao, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Cardiovascular Systems Inc; Corindus, Inc.; Medtronic, Inc.; Philips Holding USA Inc.; Volcano Corporation

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

Panelists

Anne B. Curtis, MD, MACP

SUNY Distinguished Professor; Charles and Mary Bauer Professor and Chair, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; President and CEO, UBMD Internal Medicine, Buffalo, New York

Disclosures

Disclosure: Anne B. Curtis, MD, MACP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Novartis Pharmaceuticals Corporation; sanofi-aventis
Served as a speaker or a member of a speakers bureau for: Abbott Laboratories; Medtronic, Inc.

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

Gregg Fonarow, MD

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

Disclosures

Disclosure: Gregg Fonarow, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; Bayer HealthCare; Janssen Pharmaceuticals; Medtronic, Inc.; Novartis Pharmaceuticals Corporation; St. Jude Medical; ZS Pharma
Served as a speaker or a member of a speakers bureau for: Novartis Pharmaceuticals Corporation

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.

Editor

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 / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

CME / ABIM MOC / CE

New Guidelines to Prevent SCD: What You Need to Know

Authors: Sunil V. Rao, MD; Anne B. Curtis, MD; Gregg Fonarow, MD
CME / ABIM MOC / CE Released: 1/25/2018
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 1/25/2019, 11:59 PM EST

Start Activity

Target Audience and Goal Statement

This activity is intended for cardiologists, emergency medicine physicians, critical care specialists, nurses, and all clinicians interested in preventing sudden cardiac death (SCD).

The goal of this activity is improved risk stratification and better intervention for those patients at high risk for SCD.

Upon completion of this activity, participants will have:

Increased knowledge regarding the
- Latest guidelines on the management of ventricular arrhythmias and prevention of SCD
- Risk stratification of patients to identify those patients at high risk for SCD
Increased competence regarding
- Effective team-based strategies to implement the latest guidelines into clinical care and optimize SCD prevention for patients at risk

Disclosures

Moderator

Sunil V. Rao, MD

Professor of Medicine, Duke University Medical Center; Section Chief, Cardiology, Durham VA Medical Center, Durham North Carolina

Disclosures

Disclosure: Sunil V. Rao, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Cardiovascular Systems Inc; Corindus, Inc.; Medtronic, Inc.; Philips Holding USA Inc.; Volcano Corporation

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

Panelists

Anne B. Curtis, MD, MACP

SUNY Distinguished Professor; Charles and Mary Bauer Professor and Chair, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo; President and CEO, UBMD Internal Medicine, Buffalo, New York

Disclosures

Disclosure: Anne B. Curtis, MD, MACP, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Abbott Laboratories; Novartis Pharmaceuticals Corporation; sanofi-aventis
Served as a speaker or a member of a speakers bureau for: Abbott Laboratories; Medtronic, Inc.

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

Gregg Fonarow, MD

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

Disclosures

Disclosure: Gregg Fonarow, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Amgen Inc.; Bayer HealthCare; Janssen Pharmaceuticals; Medtronic, Inc.; Novartis Pharmaceuticals Corporation; St. Jude Medical; ZS Pharma
Served as a speaker or a member of a speakers bureau for: Novartis Pharmaceuticals Corporation

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.

Editor

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 / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Lead Nurse Planner, Medscape, LLC

Disclosures

Disclosure: Amy Bernard, MS, BSN, RN-BC, has disclosed no relevant financial relationships.

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Strategies to Reduce the Risk for Sudden Cardiac Death

From Medscape Education Cardiology

CME / ABIM MOC / CE

New Guidelines to Prevent SCD: What You Need to Know

Authors: Sunil V. Rao, MD; Anne B. Curtis, MD; Gregg Fonarow, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME / ABIM MOC / CE Released: 1/25/2018

Valid for credit through: 1/25/2019, 11:59 PM EST

processing....

New Guidelines to Prevent SCD: What You Need to Know
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Slide 1.

Panel
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Slide 2.

Goals
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Slide 3.

SCD -- Hot Topic
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Slide 4.

Key Updates From the New Guidelines^[1]
- The guidelines took a very comprehensive look at every aspect of evaluating patients for the risk of sudden cardiac death (SCD)
- Patients with heart failure (HF), with a reduced ejection fraction (EF), should be taking guideline-directed medical therapy (GDMT)
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Slide 5.

Key Updates From the New Guidelines (cont)^[1]
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Slide 6.

Key Updates From the New Guidelines (cont)^[1]
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Slide 7.

Arrhythmia Suppression^[1]
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Slide 8.

Inadequate Vascular Access or at High Risk for Infection^[1]
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Slide 9.

First-Degree Relatives With SCD^[1]
- In patients with refractory HF or with refractory sustained VA or who are nearing the end of life as a result of other illness, clinicians should discuss implantable cardioverter-defibrillator (ICD) shock deactivation (class I)
[ CLOSE WINDOW ]

Slide 10.

Shared Decision-Making
- Discuss options with patients:
  - When considering implantation of a new ICD
  - When thinking about a generator change for an existing ICD
  - To ensure patients understand their risks and physicians understands patients' personal goals and values
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Slide 11.

Risk Stratification^[1]
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Slide 12.

Risk Stratification and EF^[1]
- Ejection fraction (EF) has been one of the most important criteria for identifying patients at risk used in the clinical trials
- In studies in which patients' EFs were good, there often was no defined benefit in the use of ICDs for primary prevention
- There can be some variability depending on the technique and interpretation
- When a patient's EF is between 34% and 38% and the cutoff in the guidelines is 35%, clinical judgment must come into play
- Take into account other potential ways of risk-stratifying that patient
- Assess using an alternative mechanism such as cardiac magnetic resonance imaging (MRI) or nuclear scanning
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Slide 13.

SCD Is the First Recognized Clinical Event: Vast Majority of Patients^[1]
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Slide 14.

Determining Risk for Ischemic vs Nonischemic Patients^[1]
- Some patients have hibernating myocardium, which may improve, but it is rare to come out of the range of needing an ICD
- Revascularization is considered in conjunction with other therapies
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Slide 15.

2017 AHA/ACC/HRS Guidelines: Risk for Ventricular Arrhythmias^[1]
- Recommendations regarding whether elective physiologic studies should be done are made regardless of whether it is an ischemic or nonischemic etiology
- There is a new 2A class recommendation that cardiac MRI with late gadolinium enhancement may be useful for assessing the risk of SCD in patients with nonischemic cardiomyopathy
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Slide 16.

Primary Prevention of SCD in Patients With NICM^[1]
- There are specific guideline recommendations on when to consider a primary prevention ICD
- Wait at least 40 days post-MI in an ischemic patient who has had an acute coronary event
- Wait at least 90 days postrevascularization in patients when considering a primary prevention device in ischemic patients
- In nonischemic patients, wait for the GDMT to kick in and reassess ventricular function
[ CLOSE WINDOW ]

Slide 17.

Primary Prevention of SCD in Patients With Ischemic Heart Disease^[1]
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Slide 18.

When to Consider a WCD: Patient Types ^[2]
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Slide 19.

WCD: Class IIb Recommendation ^[2]
- Patients who have just been revascularized and have that 90-day waiting period, and are being discharged from the hospital, would benefit from use of the WCD
[ CLOSE WINDOW ]

Slide 20.

Well-Coordinated Multidisciplinary Teams
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Slide 21.

Shared Decision-Making
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Slide 22.

Key Takeaways
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Slide 23.

Thank you
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Slide 24.

This content has been condensed for improved clarity.

CME / ABIM MOC / CE 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

Sunil V. Rao, MD

Panelists

Anne B. Curtis, MD, MACP

Gregg Fonarow, MD

Editor

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

CME Reviewer / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

CME / ABIM MOC / CE

New Guidelines to Prevent SCD: What You Need to Know

Target Audience and Goal Statement

Disclosures

Moderator

Sunil V. Rao, MD

Panelists

Anne B. Curtis, MD, MACP

Gregg Fonarow, MD

Editor

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

CME Reviewer / Nurse Planner

Amy Bernard, MS, BSN, RN-BC

Accreditation Statements

For Physicians

For Nurses

Instructions for Participation and Credit

New Guidelines to Prevent SCD: What You Need to Know

New Guidelines to Prevent SCD: What You Need to Know

Slide 1.

Panel

Slide 2.

Goals

Slide 3.

SCD -- Hot Topic

Slide 4.

Key Updates From the New Guidelines[1]

Slide 5.

Key Updates From the New Guidelines (cont)[1]

Slide 6.

Key Updates From the New Guidelines (cont) [1]

Slide 7.

Arrhythmia Suppression[1]

Slide 8.

Inadequate Vascular Access or at High Risk for Infection[1]

Slide 9.

First-Degree Relatives With SCD[1]

Slide 10.

Shared Decision-Making

Slide 11.

Risk Stratification[1]

Slide 12.

Risk Stratification and EF[1]

Slide 13.

SCD Is the First Recognized Clinical Event: Vast Majority of Patients[1]

Slide 14.

Determining Risk for Ischemic vs Nonischemic Patients[1]

Slide 15.

2017 AHA/ACC/HRS Guidelines: Risk for Ventricular Arrhythmias[1]

Slide 16.

Primary Prevention of SCD in Patients With NICM[1]

Slide 17.

Primary Prevention of SCD in Patients With Ischemic Heart Disease[1]

Slide 18.

When to Consider a WCD: Patient Types [2]

Slide 19.

WCD: Class IIb Recommendation [2]

Slide 20.

Well-Coordinated Multidisciplinary Teams

Slide 21.

Shared Decision-Making

Slide 22.

Key Takeaways

Slide 23.

Thank you

Slide 24.

Key Updates From the New Guidelines^[1]

Key Updates From the New Guidelines (cont)^[1]

Key Updates From the New Guidelines (cont)^[1]

Arrhythmia Suppression^[1]

Inadequate Vascular Access or at High Risk for Infection^[1]

First-Degree Relatives With SCD^[1]

Risk Stratification^[1]

Risk Stratification and EF^[1]

SCD Is the First Recognized Clinical Event: Vast Majority of Patients^[1]

Determining Risk for Ischemic vs Nonischemic Patients^[1]

2017 AHA/ACC/HRS Guidelines: Risk for Ventricular Arrhythmias^[1]

Primary Prevention of SCD in Patients With NICM^[1]

Primary Prevention of SCD in Patients With Ischemic Heart Disease^[1]

When to Consider a WCD: Patient Types ^[2]

WCD: Class IIb Recommendation ^[2]