ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research

Can algorithms improve the management of patients with myocardial injury? Is there a tool to aid diagnosing patients faster and more accurately leading to appropriate treatment sooner to optimize results? This study highlights the challenges and opportunities associated with the integration of artificial intelligence (AI) into health care to improve outcomes.    In this interview, Drs. Allen Taylor and Derek Chew discuss the findings of the RAPIDxAI trial: re-engineering the clinical approach to suspected cardiac chest pain assessment in the emergency department by expediting evidence to practice using AI.   Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

The BedMed and BedMed-Frail trials assisted in providing clarity as to the daily timing of prescribed blood pressure medication. The two trials, one conducted in a general primary-care population and the other among nursing-home residents, determined no difference in major cardiovascular events or safety between blood pressure (BP) medication distribution in the evening or morning.   In this interview, Drs. Anthony DeMaria and Scott Garrison review the BedMed and BedMed-Frail trials findings which proved the emphasis to patients is taking BP medication when they are least likely to forget, irrelevant of time of day.   References:  Pigazzani F, Dyar KA, Morant SV, et al. Effect of timed dosing of usual antihypertensives according to patient chronotype on cardiovascular outcomes: the Chronotype sub-study cohort of the Treatment in Morning versus Evening (TIME) study. EClinicalMedicine 2024;72:102633.   Mackenzie IS, Rogers A, Poulter NR, et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022;400:1417-25.   Hermida RC, Crespo JJ, Dominguez-Sardina M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J 2020;41:4565-76.   Hermida RC, Ayala DE, Fernandez JR, et al. Administration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. Chronobiol Int 2013;30:280-314.   Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

The BedMed and BedMed-Frail trials assisted in providing clarity as to the daily timing of prescribed blood pressure medication. The two trials, one conducted in a general primary-care population and the other among nursing-home residents, determined no difference in major cardiovascular events or safety between blood pressure (BP) medication distribution in the evening or morning.    In this interview, Drs. Anthony DeMaria and Scott Garrison review the BedMed and BedMed-Frail trials findings which proved the emphasis to patients is taking BP medication when they are least likely to forget, irrelevant of time of day.   References:  Pigazzani F, Dyar KA, Morant SV, et al. Effect of timed dosing of usual antihypertensives according to patient chronotype on cardiovascular outcomes: the Chronotype sub-study cohort of the Treatment in Morning versus Evening (TIME) study. EClinicalMedicine 2024;72:102633.   Mackenzie IS, Rogers A, Poulter NR, et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022;400:1417-25.   Hermida RC, Crespo JJ, Dominguez-Sardina M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J 2020;41:4565-76.   Hermida RC, Ayala DE, Fernandez JR, et al. Administration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. Chronobiol Int 2013;30:280-314.   Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

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. 

In this interview, Vidhu Anand, MD, FACC, and Alison L. Bailey, MD, FACC, provide a comprehensive exploration of Low Flow-Low Gradient Aortic Stenosis, shedding light on its definition and exploring treatment approaches for patients with HF.   Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

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    

Understanding the etiology of left ventricular hypertrophy is increasingly important due to the increasing number of targeted therapies coming online. This discussion provides a high-level approach to differentiating important causes of increased wall thickness.   In this interview, Timothy C. Wong, MD, MS, FACC and Sidney C. Smith Jr., MD, MACC discuss pitfalls in the diagnosis of HCM.   Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

Incorporating spiritual evaluation into medical science is worth consideration. The presence of edifying emotions can potentially yield positive effects on hypertension treatment outcomes.  In this interview, Maria Emília Figueiredo Teixeira, MD, PhD and Sidney C. Smith Jr., MD, MACC discuss the primary findings uncovered by the Feel Trial.  Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

If there were a pill that could lower blood pressure, lower LDL cholesterol, improve erectile function and lower cardiovascular risk, would you take it? Good, because we already have it, and it comes pre-packaged in plant-based foods.  In this interview, Robert Ostfeld MD, MSc, FACC and Alison L. Bailey, MD FACC explore the vital link between nutrition and cardiovascular health.  Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

Hypertrophic cardiomyopathy (HOCM) often goes unnoticed, yet as awareness grows, patients may find themselves more symptomatic than expected. How do doctors and patients navigate the array of management options, from medications to minimally invasive procedures or open-heart surgery? Discover what options offer the best chance for patients to feel their best, or even achieve a sense of normalcy, with minimal risk and hassle.  In this interview, Srihari S. Naidu, MD, FACC and Cindy L. Grines, MD, FACC, discuss HOCM: Selecting the Right Meds and Procedures.     Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

Premature ventricular contractions (PVCs), commonly experienced as palpitations from occasional skipped heartbeats, are typically benign but can escalate to severe symptoms or heart failure in individuals with a high PVC burden. Understanding the most effective diagnostic tests for quantifying PVCs is crucial for guiding appropriate management strategies.  In this interview, Jim Cheung MD, FACC and Anthony N. DeMaria MD, MACC discuss PVC burden and its temporal variability.  Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

Individuals from lower socioeconomic status (SES) backgrounds face heightened risks of morbidity and mortality, particularly in the context of health conditions such as cardiovascular disease. Despite this increased vulnerability, they often face barriers to accessing crucial secondary prevention programs, such as cardiac rehabilitation. How can we bridge this gap and ensure that these vulnerable patients receive the support they urgently need?  In this interview, Diann Gaalema, PhD and Anthony N. DeMaria, MD, MACC discuss financial incentives to improving cardiac rehab participation.  Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

In this interview, Stephen Greene, MD, FACC and Sidney C. Smith Jr., MD, MACC discuss inpatient initiation of HF GDMT.    Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

Why should we assess plaque burden beyond luminal narrowing for cardiac prevention?    In this interview, Andrew Choi, MD, FACC and Clyde W. Yancy, MD, MSc, MACC discuss insights from data and studies involving plaque burden, morphology and flow.   Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL