Some of the BWH Pharmacy cardiology team attended ACC.23. In attendance (left to right): Mohsen Al Zaria, PharmD (resident); Liriany Pimentel, PharmD (resident); Ju Hee Kim, PharmD (resident); Danielle Knowles, PharmD, BCPS, BCCP, CACP (clinical pharmacy specialist – coronary care unit preceptor, PGY2 cardiology pharmacy residency director); Delaney Corcoran, PharmD, BCCP (senior clinical pharmacist – general cardiology and hemostatic/anti-thrombotic stewardship preceptor, and PGY2 cardiology pharmacy program coordinator); Omar Alkhezi, PharmD (resident).

Top experts from the Brigham presented new research and outcomes from major clinical trials in cardiology at this year’s American College of Cardiology (ACC) 2023 Scientific Session & Expo. The ACC, together with the World Congress of Cardiology (WCC), hosted the ACC.23/WCC event from March 4 to 6, 2023, in New Orleans, LA. In Late-Breaking Clinical Trial presentations and Featured Clinical Research sessions, cardiologists from the Brigham shared new insights on “nudges” to increase flu vaccine uptake, residual inflammatory risk, the efficacy of a virtual care team in optimizing treatment for patients with heart failure, and more.

Check out a full list of Brigham presenters on the Brigham on a Mission blog; TIMI Study Group presentations and abstracts; and highlights from three presentations below.

Residual Inflammation Predicts Cardiovascular Risk

Paul Ridker

Inflammation may be a more powerful predictor of risk of future cardiovascular events—such as heart attack and stroke — than “bad” cholesterol, according to a study led and presented by Paul Ridker, MD, a preventive cardiologist at the Brigham. The study, which analyzed data from three randomized clinical trials that included more than 31,000 patients, was published simultaneously in The Lancet.

Treatments that aggressively lower vascular inflammation need to be incorporated into daily practice if doctors are to maximize patient outcomes, Ridker explained.

“The new data should be a wake-up call for preventive cardiologists and their patients,” said Ridker. “Virtually all patients with or at risk for atherosclerotic disease are appropriately treated with aggressive statin therapy. Yet, in our study of patients already taking a statin, hsCRP — a measure of residual inflammatory risk — was a more powerful determinant of having a future heart attack or dying from cardiovascular disease than LDL- cholesterol – a measure of residual cholesterol risk. The data are a powerful demonstration that to beat heart disease, we need to lower both cholesterol and inflammation, not just cholesterol alone.”

Ridker and colleagues examined data from three recently conducted clinical trials (PROMINENT, REDUCE-IT and STRENGTH) of patients with or at high risk for atherosclerotic disease to understand the relative importance of “residual inflammatory risk” as compared to “residual cholesterol risk” among contemporary statin-treated patients. All patients received aggressive, guideline-directed medical care including statins, usually at high doses. But cardiovascular event rates in all three trials approached 10 percent at five years. In all three trials, blood levels of high-sensitivity C-reactive protein (hs-CRP, a measure of vascular inflammation) were significantly associated with major adverse cardiovascular events (MACE), cardiovascular mortality and all-cause mortality.

Read more in a Brigham press release and in news coverage in The Wall Street Journal and MedPage Today.

Electronic “Nudges” Increased Flu Vaccine Uptake

Muthiah Vaduganathan

Researchers from the Brigham collaborated with Danish researchers to develop and implement a nationwide trial in Denmark testing nine different electronic messaging tactics to increase flu vaccine rates among adults over age 65. Their findings, published in The Lancet and presented at ACC, identified two types of electronic letters that resulted in modest but statistically significant increases in vaccination rates, especially among patients who had not received the flu vaccine the previous year.

“This was a first-of-its-kind nationwide implementation trial to help address the very topical issue of overcoming vaccine hesitancy at a national level,” said co-author Muthiah Vaduganathan, MD, MPH, of the Division of Cardiovascular Medicine. “Electronic letters are a low-cost intervention that can reach across a population and have meaningful implications. Our efforts show that mass communication systems are feasible and can be rigorously tested, and we believe similar models should be tested in the U.S. and other countries as well.”

In particular, the trial found that emphasizing the potential cardiovascular benefits of vaccination and a repeat-letter strategy with a 14-day follow-up letter resulted in 0.89 and 0.73 percent increases in vaccinations, respectively, compared with a usual-care group. The usual-care group received a letter typically sent by the Danish Health Authority under Denmark’s universal health system, which provides free influenza vaccines. Notably, those without influenza vaccination in the prior season had a 2.46 percent absolute increase in vaccine uptake with the cardiovascular-themed letter, highlighting that this messaging strategy could be an effective intervention in a vaccine-hesitant group.

Read more in a Brigham press release and in news coverage in HealthDay,  Medscape and HCP Live.

Virtual Care Team Improved Treatment for Heart Failure Patients

Dale Adler

Muthiah Vaduganathan

Recent studies have provided strong evidence that patients with heart failure can benefit from medical therapies that can reduce risk of worsening symptoms and extend patients’ lives. But, despite new guidelines, adoption of these therapies has been slow, incomplete and inequitable. A prospective clinical study by investigators from Mass General Brigham evaluated a new approach to improve use of these therapies by assembling a virtual care team consisting of physicians and pharmacists to help guide treatment strategies for patients seeking care at three Mass General Brigham hospitals.

The virtual care team strategy was both safe and effective, improving uptake of life-saving therapies during hospitalization compared with usual-care. Results were presented at the American College of Cardiology meeting and simultaneously published in the Journal of the American College of Cardiology.

The quality improvement effort, known as Implementation of Medical Therapy in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction (IMPLEMENT-HF) began as a pilot study at BWH but expanded to include patients admitted to BWFH and Salem Hospital.

“When we took this to the community hospitals, we learned that cardiologists were eager to work with us to improve adoption of guideline-directed medical therapy to help their patients,” said co-author Dale Adler, MD, executive vice chair of the BWH Department of Medicine and a specialist in Cardiovascular Medicine. “Many physicians had read recent studies about therapy for heart failure and knew the ideal therapy combinations, but they hadn’t had the chance to implement them with supervision. This study and the virtual care team we assembled gave them the opportunity to do so.”

Read more in a Mass General Brigham press release and in news coverage in HCP Live, MedPage Today and Becker’s Hospital Review.