Ryan Caputo, PharmD, BCCP

Cardiology Pharmacy Specialist @IU_Health | PGY1/PGY2 cardiology @OSUWexMed | @Waynestatepharm | Tweets are my own opinion |

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@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

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

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?

[Muthu Vaduganathan @mvaduganathan]

🔥 #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

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@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.

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@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.

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@IsgittJohn Both

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

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

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@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

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@blais_danielle 2.5 years ago and I remember it like yesterday 🥺

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@IsgittJohn Yes, why wouldn’t I want to know if a drug is effective or ineffective?

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

If you think finerenone is good, just wait until you hear about this drug called spironolactone.

[Julieta Rosales @J_Rosales_MD]

🚨When it is a YES ✅ and not 🚫in DOACS 💊

👉🏻 J Am Coll Cardiol 2024;83:444-465.

[Annals of Int Med @AnnalsofIM]

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

[Brad Spellberg @BradSpellberg]

Hence my Antibiotic Stewardship for the 21st Century Lecture: slides

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

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

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

If there was half as much enthusiasm about initiating spironolactone as there is about sacubitril/valsartan, the world would be a better place 😌

[Daniel J Drucker @DanielJDrucker]

Clinical strategies for mitigating adverse events with GLP-1 medicines @BevTchangMD #ADA2024 https://t.co/BwRfwYRFa0

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@Dokutah_Vyew Ostensibly to reduce bleeding risk with concomitant anti platelet therapy

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

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.

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

@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.

[Ryan Caputo, PharmD, BCCP @RyanCaputo1]

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

[Cardiac Trials @CardiacTrials]

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: