#459 DIGEST: Finerenone for Heart Failure, PCV21 and the latest Pneumonia Vaccine Recs, 24-hour vs 15-hour Oxygen Therapy, and PREVENT vs PCE for Cardiovascular Risk Estimation
Oct 28, 2024
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Dive into the latest innovations in heart failure treatment with finerenone, spotlighting its significant findings. Discover updates on pneumonia vaccination, especially the new PCV21, and its impact on risk for older adults. The discussion also covers long-term oxygen therapy strategies and their implications for patient care. Plus, explore critiques of outdated cardiovascular risk calculators and the introduction of the PREVENT equations for more tailored assessments. It's a jam-packed conversation that blends medical insights with a dash of humor!
Finerenone significantly reduces cardiovascular death and heart failure events in patients with mildly reduced ejection fraction but raises concerns about hyperkalemia and renal benefits.
The CDC now recommends the PCV21 pneumonia vaccine for all adults 50 and older, expanding coverage to address rising pneumococcal disease rates.
The REDOX trial shows no significant advantage between 24-hour and 15-hour long-term oxygen therapy, challenging previously held beliefs on continuous oxygen necessity.
Deep dives
Exciting Developments for 2024
The podcast opens with a discussion about the excitement surrounding 2024, encouraging listeners to subscribe to their Patreon for bonus content and community interaction. The hosts, Dr. Matthew Waddo and Dr. Nora Toronto, highlight their enthusiasm for the various medical topics they will explore in this episode. They introduce the idea of discussing cutting-edge medical research, including innovative treatments, new guidelines, and evolving practices. This sets the stage for a deep dive into recent findings that could influence patient care.
Innovations in Heart Failure Treatment
A key focus of the episode is the Fine Arts Heart Failure Trial, which evaluates finarenone, a non-steroidal mineralocorticoid receptor antagonist, for patients with heart failure with mildly reduced ejection fraction. The trial showed a significant reduction in cardiovascular death and new heart failure events when comparing finarenone with placebo. Despite its promise, the discussion raised concerns about the higher rates of hyperkalemia and ambiguous renal benefits associated with finarenone compared to standard treatments like spironolactone. The segment emphasizes the careful consideration needed when integrating new therapies into clinical practice, especially given cost-effectiveness issues.
Updated Pneumonia Vaccination Recommendations
The podcast discusses recent updates from the CDC concerning pneumonia vaccinations, now recommending PCV21 for all adults aged 50 and older, which expands coverage from the previous age of 65. The new vaccine design aims to address rising rates of pneumococcal disease among adults, capitalizing on the success of childhood vaccination strategies. The hosts explain the distinctions between various pneumococcal vaccines and the importance of adapting vaccination strategies based on changes in disease epidemiology. They acknowledge potential confusion among patients due to the evolving recommendations and communicate the significance of these updates for preventive health.
Reassessing Long-term Oxygen Therapy
The episode delves into the findings of the REDOX trial, which explored whether long-term supplemental oxygen for 24 hours a day provided any significant advantage over 15 hours of daily use regarding all-cause mortality and hospitalization rates. The trial concluded no significant difference in outcomes between the two groups, challenging previously held beliefs about the necessity of continuous oxygen therapy for patients with severe hypoxemia. The discussion notes concerns about the study design, including changes to primary outcomes and sample size adjustments, prompting questions about generalizability and applicability to real-world patients. The hosts emphasize the value of patient-centered findings behind such trials, even when adopting new practices could be challenging.
New Insights on Cardiovascular Risk Calculators
The podcast concludes with a conversation about the PREVENT equations, which aim to refine cardiovascular risk assessment compared to the older pooled cohort equations. These new calculations incorporate a broader and more diverse dataset, demonstrating that older models overestimate cardiovascular risk by an average of 20% for certain populations. The discussion highlights the potential for these updates to change treatment recommendations for millions, particularly in terms of statin initiation. However, the hosts caution that more prospective studies are needed to validate these equations before they can fully replace existing guidelines, emphasizing the need for a thoughtful approach to implementing new diagnostic tools in clinical practice.
Join us as we review recent articles and news featured in The DIGEST issues #56 and #57, including finerenone for heart failure, the skinny on pneumonia vaccines and the latest, PCV21, long-term oxygen therapy (the REDOX trial), and the PREVENT vs PCE cardiovascular risk equations. Fill your brain hole with a fully digestible meal! Featuring Alex Chaitoff (@alexchaitoff), Rahul Ganatra (@rbganatra), Nora Taranto (@norataranto), and Matt Watto (@doctorwatto).
Note: **Update on Pneumonia Vaccine from ACIP: After we recorded and just before we published this episode, the CDC updated its vaccine guidance to include pneumonia vaccination for all adults aged 50 years and older to receive either PCV20, PCV21, or the combination of PCV15 followed by PPSV23 one year later (CDC site accessed 24 Oct 2024).**
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