ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research

Recent trials have clarified that the timing of antihypertensive medication—whether morning or evening—has no significant impact on major cardiovascular events. Drs. DeMaria and Garrison discuss the unique challenges faced by general and frail populations in clinical trials. They emphasize the importance of medication adherence over timing and how individual patient preferences should shape dosing schedules. Additionally, the role of circadian rhythms in blood pressure management is explored, indicating that personalizing treatment may yield better outcomes.

The goal of the TIGHT K trial was to evaluate if prescribing relaxed control of potassium levels and only giving supplements in the rare event that levels became pathologically low was equally as effective in preventing atrial fibrillation (AFib) after cardiac surgery as tightly controlling levels. In this interview, Drs. Steven Nissen and Benjamin O'Brien discuss the TIGHT K trial results which proved that practitioners can safely cease the widespread practice of maintaining high-normal potassium levels after isolated coronary artery bypass grafting surgery. Additional benefits include improved tpatient experience and reduced patient cost. References: O'Brien B, Campbell NG, Allen E, et al; TIGHT K Investigators. Potassium supplementation and prevention of atrial fibrillation after cardiac surgery: the TIGHT K randomized clinical trial. JAMA 2024;332:979-88. Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL

The goal of the SENIOR RITA trial was to evaluate routine invasive therapy compared with conservative therapy among older patients with non–ST-elevation myocardial infarction. Additionally, the trial assessed whether optimal medical therapy or coronary angiography and stents are beneficial in older adults with heart attacks. In this interview, Drs. Nanette Kass Wenger and Vijay Kunadian discuss the SENIOR RITA trial results and the importance of individualizing routine invasive therapy in individuals ≥75 years of age. References: Kunadian V, Mossop H, Shields C, et al., for the British Heart Foundation SENIOR-RITA Trial Team and Investigators. Invasive Treatment Strategy for Older Patients With Myocardial Infarction. N Engl J Med 2024;Sep 1:[Epub ahead of print]. Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL

Fasting is a routine part of preparing for a heart procedure. Research found through the SCOFF trial suggests that for certain procedures, removing the need to fast is safer and more comfortable for patients. In this interview, Drs. Roxana Mehran and David Ferreira discuss new evidence from the SCOFF trial and the possibility of reconsidering fasting requirements in clinical guideline. References: Ferreira D, Hardy J, Meere W, et al. Safety and care of no fasting prior to catheterization laboratory procedures: a non-inferiority randomized control trial protocol (SCOFF trial). Eur Heart J Open 2023;3:oead111. Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL

The RESHAPE-HF2 (Randomized Investigation of the MitraClip Device in Heart Failure [HF]: Second Trial in Patients With Clinically Significant Functional Mitral Regurgitation [MR]) trial assessed the safety and efficacy of mitral transcatheter edge-to-edge repair (M-TEER) using MitraClip among symptomatic HF patients with secondary MR. The results of this trial indicate that M-TEER using the MitraClip on a background of maximally tolerated guideline-directed medical therapy (GDMT) was superior to GDMT alone in reducing HF hospitalization and mortality at 2 years in symptomatic HF patients with grade 3-4+ MR. In this interview, Drs. Sidney Smith and Stefan Anker discuss the benefits of RESHAPE-HF2, including reduction in HF hospitalization (particularly among those with a history of HF hospitalization within the past year), significant quality-of-life improvements, and other patient-centered outcomes. References: Anker SD, Friede T, von Bardeleben RS, et al., for the RESHAPE-HF2 Investigators. Transcatheter Valve Repair in Heart Failure With Moderate to Severe Mitral Regurgitation. N Engl J Med 2024;Aug 31:[Epub ahead of print]. Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL

The goal of the ABYSS (Assessment of Beta-Blocker Interruption 1 Year After an Uncomplicated Myocardial Infarction on Safety and Symptomatic Cardiac Events Requiring Hospitalization) trial was to evaluate beta-blocker interruption compared with beta-blocker continuation after an uncomplicated myocardial infarction (MI). Although the efficacy of beta blockers on decreasing mortality has diminished in the reperfusion era in patients without heart failure, this class of well tolerated drugs remain useful to decrease the rate of rehospitalization in patients who have suffered MI. In this interview, Drs. Deepak Bhatt and Johanne Silvain discuss the results of ABYSS and beta blocker interruption in patients with prior MI. References: Silvain J, Cayla G, Ferrari E, et al., for the ABYSS Investigators of the ACTION Study Group. Beta-Blocker Interruption or Continuation After Myocardial Infarction. N Engl J Med 2024;Aug 30:[Epub ahead of print]. Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL

It is imperative that clinicians understand the differences in each patient and how effective therapies must be individualized and often combined to treat patients with varying profiles. Efforts to unify heart failure across the ejection fraction and rebrand "heart failure" to "heart success" may be achieved by better understanding patients to prevent progression to stage C or D. In this episode, Dr. Jim Januzzi interviews guideline author Dr. Lynne Stevenson on the importance of understanding the optimal evaluation and management of patients with heart failure. This podcast is part of the Heart Failure & SGLT2is: The New Pillar in Care grant initiative.

Vidhu Anand, MD, FACC, and Alison L. Bailey, MD, FACC, dive into Low Flow-Low Gradient Aortic Stenosis and its implications for heart failure patients. They clarify the complexities of diagnosing this condition, highlighting the critical need for precise measurements. The conversation includes the role of dobutamine echocardiography and calcium scores in evaluation and treatment strategies. They also touch on gender differences in disease presentation, emphasizing timely interventions for better patient outcomes.

With EMPACT-MI being presented at ACC, the definitive study of an additional agent (empagliflozin) will allow for a great discussion on options for patients who have acute MI and evidence of heart failure. In this interview, Schuyler Jones, MD FACC, and Purvi Parwani, MBBS, MPH, FACC discuss Not the Same Old 5 Medications: Contemporary GDMT Algorithm in the Post-MI Patient. Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL

High levels of Lp(a) impact approximately 1 in 5 individuals globally, signaling an elevated risk of heart attacks, strokes, and valve disease. How should clinicians navigate this challenge, given the current lack of specific treatment options? In this interview, Raul Santos MD, PhD, and Sun Moon Kim MD, FACC discuss strategies to lowering an elevated Lp(a) based on current evidence and available treatments. Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL