@iamcrsmith 1) It’s questionable to pool the results of trials with totally different pt populations
2) all cause mortality reduction doesn’t make sense when CV death and renal failure were not different if the proposed benefit is for HFpEF/CKD
3) Still need outcomes vs alt MRA IMO
A surrogate outcome does not mean a new age. This type of study leads to over prescribing based on a soft endpoint with financial detriment to the patient with no proven benefit in hard outcomes. Does the next drug that reduces BNP create a new age for heart failure?
🔥 #CONFIDENCE in @NEJM
Simultaneous initiation of #SGLT2i + #nsMRA safely and rapidly delivers in patients with CKD & T2D
A new age of combination therapies has arrived in #CKM care #ERA25
https://t.co/UClYe6WBrn
@iamcrsmith Finerenone has not shown mortality benefit in any of these trials or any of these disease states. Spironolactone is the only drug for HFpEF with data to suggest possible mortality benefit. It’s already been established that MRA + SGLT2i is safe in the 4 landmark SGLT2i HF trials.
@iamcrsmith Yes, but the premise is not that finerenone improves outcomes. It’s that finerenone + SGLT2i is superior to either agent alone based on a surrogate marker. Not to mention finerenone has only shown benefit against placebo but not against existing (cost effective) MRAs.
So that statistically significant ~1.5% reduction of a composite endpoint driven by the weakest of the endpoints in COLCOT was actually just noise? Who would have thought? #colchicine
https://t.co/VvB0gTHSn8
@StevenMathern TAVR is an important and amazing option in the correct patient. But Early TAVR was nothing more than industry marketing
disguised as a trial
New: Either ACEi or ARB therapy protect against kidney failure in those with advanced CKD. Neither therapy provided a death benefit for those with late-stage CKD: https://t.co/IDZJrIbtNd
Analogous to LVAD ramp studies, a trial assessing RHC to guide optimal pacing rates for HFpEF may allow for further individualization of pacer settings beyond the algorithm used in MyPace
https://t.co/P1JwliIeCA
Patient with ACS found to have new AF.
Something commonly overlooked is in Pioneer AF-PCI, rivaroxaban was reduced to 15 mg daily in pts otherwise indicated for 20 mg daily.
Make things simple and use apixaban which was studied at the same dose as used in its landmark AF trial.
@STL_Biotech It is fascinating in principle, but we need RCT data assessing hard outcomes with genotype guided therapy. Oncology has been the most proactive field.
A scientific statement on CYP2C19 testing to guide anti platelet therapy that I have to respectfully disagree with.
A 🧵 on why genomic testing a misguided solution to a complicated problem
https://t.co/oCg8c1COvw
When to suspect cardiac amyloidosis?
Echo features:
🔹Nondilated LV with thickened walls
🔹E/A > 2 and E/e’ > 14
🔹Biatrial enlargement
🔹Valvular thickening
🔹Apical sparing strain pattern
…and the following clinical features, 🖼️ via British Society of Echocardiography: