Murthy Gokula MD,CMD
|
|
- Prudence Elliott
- 6 years ago
- Views:
Transcription
1 Murthy Gokula MD,CMD MEDICATIONS & LIFE EXPECTANCY DON T ROUTINELY PRESCRIBE LIPID-LOWERING MEDICATIONS IN INDIVIDUALS WITH A LIMITED LIFE EXPECTANCY: AAHPM
2 About Choosing Wisely First conceived by the National Physicians Alliance Funded by an ABIM Foundation grant Created 3 lists of steps physicians could take to promote more effective use of healthcare resources As much as 30% of care delivered in the US may be duplicative or unnecessary 1 1
3 An initiative of the ABIM Foundation Choosing Wisely aims to promote conversations between physicians and patients by helping patients choose care that is: Supported by evidence Not duplicative of other tests or procedures already received Free from harm Truly necessary
4 The Choosing Wisely Campaign Leading specialty societies were asked to create a list of Things Physicians and Patients Should Question To date, 56 societies have released lists, some of them releasing a second or third list Consumer Reports has worked with the ABIM Foundation to maximize reach and impact of the Choosing Wisely campaign Engaged coalition of consumer organizations to disseminate content and messages about appropriate use to the communities they serve
5 Multiple medications Increased risk of: Receiving incorrect medications Adverse drug reactions Nonadherence Hajjar ER, et al. Am J Geriatr Pharm. 2007;5:
6 Multiple medications Increased risk of: Cognitive impairment Falls Functional decline Steinman MA, Hanlon JT. JAMA. 2010;304(14):
7 Multiple medications 20% of older adults take 10 medications Practice guidelines Underuse of potential medications Boyd CM, et al. JAMA. 2005;294(6): Steinman MA. Am J Geriatr Pharmacother. 2007;5(4):
8 Medication review Helps identify: Unnecessary medications Potentially harmful medications Underuse of medications Opportunities to reduce medication burden Drenth-van Maanen AC. Drugs Aging. 2009;26(8):
9 Other considerations Goals of care Life expectancy Time to benefit Burden of therapy Values/quality of life Reuben DB. JAMA. 2009;302(24):
10 EVIDENCE Total cholesterol and risk of mortality in the oldest old: Lancet 1997; 350: > 85 years, high total cholesterol concentrations are associated with longevity owing to lower mortality from cancer and infection Cholesterol, statins, and longevity from age 70 to 90 years. J Am Med Dir Assoc Dec;14(12):883-8 Among older people, cholesterol levels were unrelated to mortality between the ages of 70 and 90. The protective effect of statins observed among the very old appears to be independent of TC. PHYSICIANS HEALTH STUDY: No benefit in participants aged >77 years. Consistent with a meta analysis of eight primary prevention trials in older adults (mean age 73)found fewer CV events but not lower mortality
11 EVIDENCE Medications used for primary or secondary prevention may have a time until benefit of years. For example, it can take from 6 months to 2 years for outcomes from statins to be achieved. What are preventive medicines: aspirin, clopidogrel, dipyridamole, warfarin, dabigatran, statins, and bisphosphonates Antithrombotics, statins, and bisphosphonates are most commonly prescribed preventive medicines in the older population Statins, followed by warfarin and aspirin are most common preventive medicines discontinued at end of life or with limited life expectancy(<1year)
12 EVIDENCE A 2013 Cochrane review 18 randomized controlled trials 57,000 patients aged years Primary prevention for at least 1 year, Reduce allcause mortality (OR 0.86, 95% CI ), Combined fatal and nonfatal cardiovascular disease (OR 0.75, 95% CI ) Combined fatal & nonfatal cardiovascular disease events (OR 0.73, 95% CI ) Combined fatal and nonfatal stroke (OR 0.78, 95% CI ).1 Taylor F, Huffman MD, Macedo AF, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2013
13 EVIDENCE The 2013 ACC/AHA Continue statin therapy for secondary prevention> 75 if patients tolerating For patients>75, not receiving statin therapy, consider potential benefits, risks of adverse effects and drug interactions, and patient preferences when evaluating a patient for statin treatment The European Society of Cardiology and the European Atherosclerosis Society use of statins > years is very limited, and is left to clinical judgment
14 WHAT,S THE PROBLEM STATINS CAUSE RHABDOMYOLYSIS MYALGIAS INCREASE ALT/AST LONG TERM USE CAUSES DIABETES Estimated NNT/NNH for primary prevention: 1,2 NNT: ~60 (heart attack), ~268 (stroke) NNH: 10 (for muscle damage)(1. BMJ Jun 30;338:b Cochrane Database Syst Rev Jan 31;(1):CD004816) Kutner JS, Blatchford PJ, Taylor DH, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life limiting illness: a randomized clinical trial. JAMA Intern Med 2015;175:
15 EVIDENCE Kutner & colleagues Multicenter, parallel-group, unblinded, pragmatic clinical trial Eligibility: life expectancy of between 1 month and 1 year statin therapy for 3 months or more for primary or secondary prevention of cardiovascular disease recent deterioration in functional status, and no recent active cardiovascular disease Participants were randomized to either discontinue or continue statin therapy and were monitored monthly for up to 1 year Kutner JS, Blatchford PJ, Taylor DH, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life limiting illness: a randomized clinical trial. JAMA Intern Med 2015;175:
16 EVIDENCE: Kutner & Colleagues OUTCOMES MEASURED: Death within 60 days (primary outcome) Survival Cardiovascular events Performance status Quality of life (QOL) Symptoms Number of nonstatin medications Cost savings
17 EVIDENCE: Kutner & Colleagues 381 patients were enrolled 189 randomized to discontinue & 192 randomized to continue Mean (SD) age was 74.1:22% DEMENTIA;48.8% CANCER Proportion of participants in the discontinuation vs continuation groups who died within 60 days was not significantly different (23.8% vs 20.3%; 90% CI, 3.5% to 10.5%; P =.36) Total QOL was better for the group discontinuing statin therapy (mean McGill QOL score, 7.11 vs 6.85; P =.04). Cardiovascular events (13 in the discontinuation group vs 11 in the continuation group) Mean cost savings were $3.37 per day and $716 per patient.
18 EVIDENCE: Kutner & Colleagues If extrapolated to the US population, cost savings of > $600 million Stopping statin medication therapy is safe Associated with benefits including improved QOL Use of fewer nonstatin medications Reduction in medication costs. Patient-provider discussions regarding the uncertain benefit and potential decrement in QOL associated with statin continuation in this setting are warranted
19 Deprescribing Process Obtain a complete medication list and determine the indication for each medication Evaluate each medication s potential for drug-induced harm Determine if a medication should be discontinued by evaluating the appropriateness of the indication, whether it is being used to treat adverse effects of other medications, efficacy, benefit-to-harm ratio, treatment burden, and if the patient s life expectancy exceeds the time to therapeutic benefit (for preventive medications) Determine a plan for discontinuing medications one at time, starting with medications with the highest burden and lowest benefit Discontinue medications and monitor for withdrawal or return of symptoms Kutner JS, Blatchford PJ, Taylor DH, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life limiting illness: a randomized clinical trial. JAMA Intern Med 2015;175:
20 Scott & Colleagues DEPRESCRIBING STEPS 5 essential steps Ascertain all drugs the patient is currently taking and the reasons for each one Consider the overall risk of drug-induced harm in individual patients in determining the required intensity of deprescribing intervention Assess each drug regimen for its eligibility to be discontinued Prioritize drug treatments for discontinuation Implement and monitor the drug discontinuation regimen
21 STATIN DEPRESCRIBING Strandberg TE Deprescribing Statins-Is It Ethical? J Am Geriatr Soc Sep;64(9): Among patients without existing cardiovascular disease (primary prevention), statins have been shown to reduce the risk of cardiovascular events and mortality In a survey of 180 Australian inpatients > 65 years 95% of patients were willing to discontinue statin IF prescriber agreed 94% had concerns regarding statin adverse effects. Discontinuation of statin therapy is acceptable AND is not associated with adverse effects and may even be beneficial
22 STATIN DEPRESCRIBING Holly M. Holmes; Adam Todd, PhD. Evidence-Based Deprescribing of Statins in Patients With Advanced Illness. JAMA Intern Med. 2015;175(5): % of patients with cancer and a poor prognosis continued to receive statins 31%of patients with cancer filled a statin prescription within 30 days of death. Discusses Kutner & colleagues work
23 Choosing wisely AMDA #5 Don't routinely prescribe lipid-lowering medications in individuals with limited life expectancies
Prevention: When Do Benefits Start and End? What Do They Have in Common?
Prevention: When Do Benefits Start and End? Providence Internal Medicine Spring Symposium April 14, 2016 Mari Kai, MD What Do They Have in Common? 82 year old female 62 year old male Estimated Life Expectancy
More informationHHS Public Access Author manuscript Int J Clin Pharm. Author manuscript; available in PMC 2016 October 01.
Recommendations to support deprescribing medications late in life Adam Todd 1 and Holly M. Holmes 2 1 Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen s Campus, Stockton-on-Tees,
More informationStatins after 80 years old. Pros/Cons symposium. 13 th EUGMS Congress Nice Sept 2017
Statins after 80 years old Pros/Cons symposium 13 th EUGMS Congress Nice 20-22 Sept 2017 Athanasios Benetos Conflict of interest: None The Statinissean War Two fearless fighters Athanasios the Athenian
More informationAppropriate prescribing and deprescribing for older people getting it right. Alan Davis Northland District Health Board
Appropriate prescribing and deprescribing for older people getting it right Alan Davis Northland District Health Board Unused returns Potentially inappropriate medication use in the elderly 15% of older
More informationDeprescribing Unnecessary Medications: A Four-Part Process
Deprescribing Unnecessary Medications: A Four-Part Process Scott Endsley, MD Fam Pract Manag. 2018;25(3):28-32. Abstract and Introduction Introduction www.medscape.com Ms. Horatio is a 76-year-old patient
More informationUpdate in Geriatrics: Choosing Wisely Primum Non Nocere
Joseph G. Ouslander, M.D. Professor of Clinical Biomedical Science Senior Associate Dean for Geriatric Programs Chair, Department of Integrated Medical Science Charles E. Schmidt College of Medicine Professor
More informationAkinbolade O, Husband A, Forrest S, Todd A. Deprescribing in advanced illness. Progress in Palliative Care 2016, 24(5),
Akinbolade O, Husband A, Forrest S, Todd A. Deprescribing in advanced illness. Progress in Palliative Care 2016, 24(5), 268-271 Copyright: This is an Accepted Manuscript of an article published by Taylor
More informationPolypharmacy and Deprescribing for Older People
Polypharmacy and Deprescribing for Older People Sarah Hilmer Head of Department, Clinical Pharmacology and Senior Staff Specialist Aged Care, RNSH Conjoint Professor of Geriatric Pharmacology, Sydney University
More informationImaging-Guided Statin Allocation: Seeing Is Believing
Imaging-Guided Statin Allocation: Seeing Is Believing The New Paradigm in Personalized Risk Assessment & Medication Prescribing Presented by: Michael J. Blaha May 15, 2014 1 General Principles of Talk
More information:{ic0fp'16. Geriatric Medicine: Optimal Heart Health Amid Changing Guidelines. (and the Evidence for When to Stray) Kevin Overbeck, DO
:{ic0fp'16 ACOFP 53 rd Annual Convention & Scientific Seminars Geriatric Medicine: Optimal Heart Health Amid Changing Guidelines (and the Evidence for When to Stray) Kevin Overbeck, DO Optimal Heart Health
More informationMenopausal hormone therapy currently has no evidence-based role for
IN PERSPECTIVE HT and CVD Prevention: From Myth to Reality Nanette K. Wenger, M.D. What the studies show, in a nutshell The impact on coronary prevention Alternative solutions Professor of Medicine (Cardiology),
More information2013 Hypertension Measure Group Patient Visit Form
Please complete the form below for 20 or more unique patients meeting patient sample criteria for the measure group for the current reporting year. A majority (11 or more) patients must be Medicare Part
More informationLDL and the Benefits of Statin Therapy
LDL and the Benefits of Statin Therapy Allan Sniderman McGill University ACC/AHA did not recommend a target-based approach. Right? P 2899 The Expert Panel was unable to find any RCTs that evaluated titration
More informationThis document was created on 07 January 2005 and has been printed from
1 Spontaneous Adverse Event Reporting Information Introduction This document provides information regarding spontaneous adverse event reports received concerning patients taking rosuvastatin, which relates
More informationObservations on US CVD Prevention Guidelines. Donald M. Lloyd-Jones, MD ScM FACC FAHA
Observations on US CVD Prevention Guidelines Donald M. Lloyd-Jones, MD ScM FACC FAHA What are Guidelines? Evidence Base for Guidelines Tricoci, JAMA 2009 Evidence Base for Guidelines Tricoci, JAMA 2009
More informationHealth Outcome Prioritization as a Tool for Decision Making Among Older Persons With Multiple Chronic Conditions
Health Outcome Prioritization as a Tool for Decision Making Among Older Persons With Multiple Chronic Conditions Mary Tinetti, M.D. Canadian Geriatrics Society May, 2013 CFPC CoI Templates: Slide 1 Faculty/Presenter
More informationRegulatory Hurdles for Drug Approvals
Regulatory Hurdles for Drug Approvals William R. Hiatt, MD Professor of Medicine/Cardiology University of Colorado School of Medicine President, CPC Clinical Research 25 min Conflicts CPC Clinical Research
More informationMEDICATION APPROPRIATENESS FOR THE AGING POPULATION. Building Partnerships for Successful Aging
MEDICATION APPROPRIATENESS FOR THE AGING POPULATION Building Partnerships for Successful Aging Learning objectives Appreciate complexities involved in making appropriate clinical decisions in older adults
More informationLet it go! Rationalising medicines for patients with life limiting illness
Let it go! Rationalising medicines for patients with life limiting illness Inga Andrew Senior Clinical Pharmacist Northumbria Healthcare Trust E-mail: inga_andrew@northumbria-healthcare.nhs.uk Welcome
More informationPrimary Prevention of Cardiovascular Disease (CVD) Events with Statins. 1 Primary Prevention of Cardiovascular Disease (CVD) Events with Statins
Primary Prevention of Cardiovascular Disease (CVD) Events with Statins 1 Primary Prevention of Cardiovascular Disease (CVD) Events with Statins 2 Welcome by Michael Pignone, MD, MPH Hi, my name is Dr.
More informationJAMA. 2011;305(24): Nora A. Kalagi, MSc
JAMA. 2011;305(24):2556-2564 By Nora A. Kalagi, MSc Cardiovascular disease (CVD) is the number one cause of mortality and morbidity world wide Reducing high blood cholesterol which is a risk factor for
More informationPsychotropic Medication. Including Role of Gradual Dose Reductions
Psychotropic Medication Including Role of Gradual Dose Reductions What are they? The phrase psychotropic drugs is a technical term for psychiatric medicines that alter chemical levels in the brain which
More informationCHOOSING WISELY TO IMPROVE CARE FOR GERIATRIC PATIENTS
CHOOSING WISELY TO IMPROVE CARE FOR GERIATRIC PATIENTS About Choosing Wisely First conceived by the National Physicians Alliance Funded by an ABIM Foundation grant Created 3 lists of steps physicians could
More informationDo Not Cite. Draft for Work Group Review.
Defect Free Acute Inpatient Ischemic Stroke Measure Bundle Measure Description Percentage of patients aged 18 years and older with a diagnosis of ischemic stroke OR transient ischemic attack who were admitted
More informationSESSION 3 11 AM 12:30 PM
SESSION 3 11 AM 12:30 PM for the Primary Prevention of Cardiovascular Disease: A Personalized Approach SPEAKER Samia Mora MD, MHS Presenter Disclosure Information The following relationships exist related
More informationPreventing Cardiovascular Disease Stroke Primary Prevention Guidelines. John Potter Professor Ageing & Stroke Medicine University of East Anglia
Preventing Cardiovascular Disease Stroke Primary Prevention Guidelines John Potter Professor Ageing & Stroke Medicine University of East Anglia Preventing Cardiovascular Disease Stroke Primary Prevention
More informationChoosing Wisely Campaign. Lynn McNicoll, MD Alpert Medical School of Brown University Division of Geriatrics and Palliative Medicine
Choosing Wisely Campaign Lynn McNicoll, MD Alpert Medical School of Brown University Division of Geriatrics and Palliative Medicine Disclosures None Purpose of Campaign 5 items (tests, medications, procedures)
More informationAntithrombotics in the elderly. Robert Gabor Kiss FESC FACC Budapest
Antithrombotics in the elderly Robert Gabor Kiss FESC FACC Budapest The patient in the elderly You are sitting in Your office prescribing drugs and observing outcome The black box from prescription to
More informationPreventive Cardiology Scientific evidence
Preventive Cardiology Scientific evidence Professor David A Wood Garfield Weston Professor of Cardiovascular Medicine International Centre for Circulatory Health Imperial College London Primary prevention
More informationCholesterol targets and therapy Thomas C. Andrews, MD, FACC
Cholesterol targets and therapy Thomas C. Andrews, MD, FACC 2 Statins in secondary prevention Still first line therapy! First line therapy: high intensity statin Dose individualized based on baseline LDL
More informationSometimes less is more Choosing Wisely Canada IRENE SADEK
Sometimes less is more Choosing Wisely Canada IRENE SADEK Objectives Introduce choosing wisely Canada CSTM process to develop recommendations Review recommendation Future directions Choosing Wisely Choosing
More informationShared decision making for stepdown and stopping decisions. Michael R. Gionfriddo Pharm.D, Ph.D Geisinger Center for Pharmacy Innovation and Outcomes
Shared decision making for stepdown and stopping decisions Michael R. Gionfriddo Pharm.D, Ph.D Geisinger Center for Pharmacy Innovation and Outcomes 1 Disclosures I have had travel and lodging paid for
More informationDyslipidemia: Lots of Good Evidence, Less Good Interpretation.
Dyslipidemia: Lots of Good Evidence, Less Good Interpretation. G Michael Allan Evidence & CPD Program, ACFP Associate Professor, Dept of Family, U of A. CFPC CoI Templates: Slide 1 Faculty/Presenter Disclosure
More informationChoosing Wisely Psychiatry s Top Priorities for Appropriate Primary Care
Choosing Wisely Psychiatry s Top Priorities for Appropriate Primary Care JASON BEAMAN D.O., M.S., FAPA ASSISTANT CLINICAL PROFESSOR CHAIR, DEPARTMENT OF PSYCHIATRY AND BEHAVIORAL SCIENCES OKLAHOMA STATE
More informationUpdate in the Literature 2012
Update in the Literature 2012 Mel L. Anderson, MD, FACP Chief, Hospital Medicine Section Associate Chief, Medical Service Denver VA Medical Center Associate Professor of Medicine University of Colorado
More informationTrends and Variations in General Medical Services Indicators for Coronary Heart Disease: Analysis of QRESEARCH Data
Trends and Variations in General Medical Services Indicators for Coronary Heart Disease: Analysis of QRESEARCH Data Authors: Professor Julia Hippisley-Cox Professor Mike Pringle Professor of Clinical Epidemiology
More information9/3/ AHA/ACC Lipid Guidelines on the Treatment of Cholesterol to Reduce Atherosclerosis. Disclosure
2013 AHA/ACC Lipid Guidelines on the Treatment of Cholesterol to Reduce Atherosclerosis Robert Gleeson MD Preven5ve Cardiology and Lipid Management Froedtert and The Medical College of Wisconsin Disclosure
More informationDeprescribing: A Practical Guide
Deprescribing: A Practical Guide The information in this booklet should be used as a pragmatic decision aid, in conjunction with other relevant patient specific data. Useful resource links http://www.derbyshiremedicinesmanagement.nhs.uk/assets/clinical_guidelines/clinical_guidelines_fr
More informationLipid Panel Management Refresher Course for the Family Physician
Lipid Panel Management Refresher Course for the Family Physician Objectives Understand the evidence that was evaluated to develop the 2013 ACC/AHA guidelines Discuss the utility and accuracy of the new
More informationThe Journey from Evidence to Guidelines to Measures to Comparative Effectiveness
The Journey from Evidence to Guidelines to Measures to Comparative Effectiveness Vincenza Snow MD, FACP Director, Department of Clinical Programs and Quality of Care Who We Are The US s largest medical
More information2/10/2016. Perspectives on the 2013 ACC/AHA Cholesterol Guidelines. Disclosures. ATP-III Update 2004
Perspectives on the 2013 ACC/AHA Cholesterol Guidelines Donald M. Lloyd-Jones, MD ScM Senior Associate Dean Chair and Professor of Preventive Medicine Northwestern Feinberg School of Medicine Disclosures
More informationLipid Management C. Samuel Ledford, MD Interventional Cardiology Chattanooga Heart Institute
Lipid Management 2018 C. Samuel Ledford, MD Interventional Cardiology Chattanooga Heart Institute Disclosures No Financial Disclosures Disclosures I am an Interventional Cardiologist I put STENTS in for
More informationHuangdao People's Hospital
Table of contents 1. Background... 3 2. Integrated care pathway implementation... 6 (1) Workload indicators... 6 A. In eligible for care pathway... 6 B. Care pathway implementation... 7 (2) Outcome indicators...
More informationRole of Clopidogrel in Acute Coronary Syndromes. Hossam Kandil,, MD. Professor of Cardiology Cairo University
Role of Clopidogrel in Acute Coronary Syndromes Hossam Kandil,, MD Professor of Cardiology Cairo University ACS Treatment Strategies Reperfusion/Revascularization Therapy Thrombolysis PCI (with/ without
More informationUpdate in Outpatient Medicine ACP Scientific Session November 12, 2016
Update in Outpatient Medicine ACP Scientific Session November 12, 2016 Robert Gluckman MD, MACP Chief Medical Officer Providence Health Plans Disclosures Stock Holdings Abbott Labs Abbvie Bristol Myers
More informationIntegrating Goals of Care Discussions into Routine Care
Integrating Goals of Care Discussions into Routine Care Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor Department of Geriatrics Florida State University College of Medicine Objectives Define
More informationIan Scott. Director of Internal Medicine and Clinical Epidemiology Princess Alexandra Hospital
National Workshop in Deprescribing Setting the scene Ian Scott Director of Internal Medicine and Clinical Epidemiology Princess Alexandra Hospital Associate Professor of Medicine University of Queensland
More informationRestart or stop antithrombotics after intracerebral haemorrhage (ICH)?
Restart or stop antithrombotics after intracerebral haemorrhage (ICH)? Rustam Al-Shahi Salman professor of clinical neurology & honorary consultant neurologist www.rush.ed.ac.uk @BleedingStroke /bleedingstroke
More information5/2/2016. Outpatient Stroke Management Sheila Smith MD May 5, 2016
Outpatient Stroke Management Sheila Smith MD May 5, 2016 1 Management of Outpatient Stroke Objectives Review blood pressure management post stroke Review antithrombotic therapy Review statin therapy Discuss
More informationPolypharmacy and Polymorbid Patients: Practical Tips and Tricks
Polypharmacy and Polymorbid Patients: Practical Tips and Tricks November 2, 2013 Faculty/Presenter Disclosure Faculty: Chris Fan-Lun, BScPhm, ACPR, CGP Pharmacist - Geriatric Medicine Clinical Practice
More informationDiabetes Mellitus: A Cardiovascular Disease
Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular
More informationGoals for Today s Session Upon completion of this activity, participants should be able to return to their practices with ideas to improve adherence
Improving Care Delivery: Assessing and Addressing the Risk of Cardiovascular Disease for Patients with Diabetes Robert A Crossey, DO Francis R Colangelo, MD Holly Kern, RN March 25, 2017 2 Goals for Today
More informationTo Do or Not To Do? The Annual Physical- Beyond The PAP And Breast Exam
1/27/2015 To Do or Not To Do? The Annual Physical- Beyond The PAP And Breast Exam Fleur Sack, M.D., FAAFP Society of General Internal Medicine Cochrane review of 182,000 people followed for 9 years : the
More informationThe University of Mississippi School of Pharmacy
LONG TERM PERSISTENCE WITH ACEI/ARB THERAPY AFTER ACUTE MYOCARDIAL INFARCTION: AN ANALYSIS OF THE 2006-2007 MEDICARE 5% NATIONAL SAMPLE DATA Lokhandwala T. MS, Yang Y. PhD, Thumula V. MS, Bentley J.P.
More informationGSK Medicine: Study Number: Title: Rationale: Study Period: Objectives: Indication: Study Investigators/Centers: Research Methods: Data Source
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationDual Antiplatelet Therapy Made Practical
Dual Antiplatelet Therapy Made Practical David Parra, Pharm.D., FCCP, BCPS Clinical Pharmacy Program Manager in Cardiology/Anticoagulation VISN 8 Pharmacy Benefits Management Clinical Associate Professor
More informationAnticoagulatie en de oudere patiënt: Terughoudenheid gerechtvaardigd of niet?
Anticoagulatie en de oudere patiënt: Terughoudenheid gerechtvaardigd of niet? 16/06/2018 apr. Julie Hias Satellite symposium supported by the Alliance BMS/Pfizer 432BE18PR03459/ 180570 (Date of Preparation:
More informationLow Dose Rivaroxaban Versus Aspirin, in Addition to P2Y12 Inhibition, in Acute Coronary Syndromes (GEMINI-ACS-1)
Low Dose Rivaroxaban Versus Aspirin, in Addition to P2Y12 Inhibition, in Acute Coronary Syndromes (GEMINI-ACS-1) Caitlin C. Akerman, PharmD PGY2 Cardiology Resident WakeMed Health & Hospitals Raleigh,
More informationDeconstructing Polypharmacy. Alan B. Douglass, M.D. Director
Deconstructing Polypharmacy Alan B. Douglass, M.D. Director Recognize this patient? Mrs. Brown- 82 years young Active Medical Problems Hypertension Hyperlipidemia Type 2 Diabetes Peripheral edema Osteoarthritis
More informationThe who, what, why, where, and when of Clinical Practice Guidelines (CPGs)
The who, what, why, where, and when of Clinical Practice Guidelines (CPGs) Appraisal of Guidelines for Research and Evaluation (AGREE) II DOMAIN 1. SCOPE AND PURPOSE DOMAIN 2. STAKEHOLDER INVOLVEMENT DOMAIN
More informationOptimising Safe & Appropriate Medicines Use and Deprescribing. Katie Smith, Director, East Anglia Medicines Information Service February 2014
Optimising Safe & Appropriate Medicines Use and Deprescribing Katie Smith, Director, East Anglia Medicines Information Service February 2014 Background Objectives How & why the OSAMU document was developed
More informationPrescription Switching and Reduced LDL-C Goal Attainment
Prescription Switching and Reduced LDL-C Goal Attainment JoAnne M. Foody, MD, FACC, FAHA Brigham and Women's Hospital, Boston, MA Disclosures Consultant for Merck and Pfizer Why Address Adherence? Increasing
More informationDiabetes Care begins with Diabetes Prevention. Neha Sachdev, MD Janet Williams, MA
Diabetes Care begins with Diabetes Prevention Neha Sachdev, MD Janet Williams, MA Objectives Describe the clinical practice burden and trends in type 2 diabetes Review evidence for diabetes prevention
More informationTransforming Care for the Elderly
Transforming Care for the Elderly Session 2: Engaging Pharmacists & Interdisciplinary Care Teams to Improve Prescribing of Antipsychotics & to Reduce Polypharmacy January 11, 2017 3 @cfhi_fcass Welcome
More informationClinical Policy Title: Statin use in adults and children
Clinical Policy Title: Statin use in adults and children Clinical Policy Number: 04.02.09 Effective Date: May 1, 2016 Initial Review Date: February 17, 2016 Most Recent Review Date: September 21, 2017
More informationMedication Management. Medications: The Right Balance. Who are we talking about? Geriatric Syndromes 9/19/2016. Older adults are a heterogenous group!
Medication Management Who are we talking about? Older adults are a heterogenous group! Patricia W. Slattum, PharmD, PhD Professor of Pharmacotherapy and Outcomes Science Director, Geriatric Pharmacotherapy
More informationPrimary prevention of Cardiovascular Diseases: Differences between European and United States Guidelines
18 MEDICINSKI GLASNIK / str. 18-23 Vojislav Giga 1,2, Marija Petrović 1 Primary prevention of Cardiovascular Diseases: Differences between European and United States Guidelines Abstract: European Society
More informationProspective Natural-History Study of Coronary Atherosclerosis
Introduction Review of literature from April 2010 to present Concentrated on clinical studies Categories: Atherosclerosis, Lipids, Diabetes and CVD Risk Medical Therapy Statins really could there be anything
More informationReducing Falls Causing Harm in Older People with Dementia. Professor Tony Elliott South Staffordshire and Shropshire FT
Reducing Falls Causing Harm in Older People with Dementia Professor Tony Elliott South Staffordshire and Shropshire FT Project Site 16 bedded Dementia Inpatient Unit Acute admissions from home, DGHs or
More informationCardio-Protective Medication Bundle. Louis H. Carter II, PharmD.
Cardio-Protective Medication Bundle Louis H. Carter II, PharmD. 1 Objectives 1. Discuss cardio-protective medication bundle and the reason it is needed 2. Review medications consisted within the bundle
More information4/26/2016 DISCLOSURES BACKGROUND OBJECTIVES BACKGROUND BACKGROUND
http://thinkprogress.org/health/01/10//1061/how-rising-health-care-costs-impact-the-national-budget/ http://www.firstaidforfree.com/wp-content/uploads/015/09/falls.jpg http://drwills.com/wp-content/uploads/015/05/drugcycle.jpg
More informationHEALTH TARGETS IN PRIMARY CARE
HEALTH TARGETS IN PRIMARY CARE MORE HEART AND DIABETES CHECKS BETTER HELP FOR SMOKERS TO QUIT Better Help for Smokers to Quit 90% of enrolled patients who smoke and are seen by General Practice, will be
More informationAmerican Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida
The 21 st Century Paradigm Shift: Prevention Rather Than Intervention for the Treatment of Stable CHD The Economic Burden of Cardiovascular Diseases Basil Margolis MD, FACC, FRCP Director, Preventive Cardiology
More informationInformed Consent, Goals and Targets
Informed Consent, Goals and Targets Kenneth Brummel-Smith, MD Charlotte Edwards Maguire Professor of Geriatrics Florida State University College of Medicine Objectives Understand the nature of true informed
More informationThe Choosing Wisely Project. Disclosures. Learning Objectives 3/18/2014. Marie Gilbert, PA C, DFAAPA
The Choosing Wisely Project Marie Gilbert, PA C, DFAAPA Disclosures This speaker has no commercial relationships to disclose. Learning Objectives List the five "Choosing Wisely" program items for Otolaryngology.
More informationNeuroPI Case Study: Anticoagulant Therapy
Case: An 82-year-old man presents to the hospital following a transient episode of left visual field changes. His symptoms lasted 20 minutes and resolved spontaneously. He has a normal neurological examination
More informationOutline. What is Evidence-Based Practice? EVIDENCE-BASED PRACTICE. What EBP is Not:
Evidence Based Practice Primer Outline Evidence Based Practice (EBP) EBP overview and process Formulating clinical questions (PICO) Searching for EB answers Trial design Critical appraisal Assessing the
More informationStatins in the elderly : Is there a rationale?
Statins in the elderly : Is there a rationale? Pr B Boland After a communication by Dr. Manfred Gogol EAMA, Sion, June, 2006 1 RCTs with Statins Meta-Analysis, 1999 182 abstracts or research papers 29
More informationDr Julia Hopyan Stroke Neurologist Sunnybrook Health Sciences Centre
Dr Julia Hopyan Stroke Neurologist Sunnybrook Health Sciences Centre Objectives To learn what s new in stroke care 2010-11 1) Acute stroke management Carotid artery stenting versus surgery for symptomatic
More informationPolypharmacy & De-prescribing In Older Adults
Polypharmacy & De-prescribing In Older Adults Maryland Association of Osteopathic Physicians Annual Meeting September 15, 2018 Elizabeth Phung, DO Lead Clinical Associate Physician Beacham Center for Geriatric
More information03/30/2016 DISCLOSURES TO OPERATE OR NOT THAT IS THE QUESTION CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE
CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE Elizabeth L. Detschelt, M.D. Allegheny Health Network Vascular and Endovascular Symposium April 2, 2016 DISCLOSURES I have no
More informationCARING FOR A LOVED ONE AFTER A HEART ATTACK OR STROKE
CARING FOR A LOVED ONE AFTER A HEART ATTACK OR STROKE AFTER YOUR LOVED ONE HAS HAD A HEART ATTACK OR STROKE Heart attack and stroke affects the whole family. If your loved one has had a heart attack or
More informationSESSION 5 2:20 3:35 PM
SESSION 5 2:20 3:35 PM for the Primary Prevention of Cardiovascular Disease: A Personalized Approach SPEAKER Samia Mora MD, MHS Presenter Disclosure Information The following relationships exist related
More informationLeveraging Information Technology for Evidence-Based Design. December 15, 2005
Leveraging Information Technology for Evidence-Based Design December 15, 2005 Introduction ActiveHealth Management Technology Evidence Based Formulary Program Lessons Learned 2 ActiveHealth Management
More informationEpidemiology and Prevention of Stroke
Copyright Information Copyright protected material has been deleted from this presentation. References to the deleted material are provided for each slide. Epidemiology and Prevention of Stroke Larry B.
More informationPlacebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING THE DECREASE
More informationDoes High-Intensity Pitavastatin Therapy Further Improve Clinical Outcomes?
Late Breaking Clinical Trial Session at AHA 2017 Does High-Intensity Pitavastatin Therapy Further Improve Clinical Outcomes? The REAL-CAD Study in 13,054 Patients With Stable Coronary Artery Disease Takeshi
More informationAffordability AMGA - MIPS Webinar
Affordability AMGA - MIPS Webinar Beth Averbeck, MD Senior Medical Director Primary Care, HealthPartners Consumer-governed, non-profit HealthPartners Medical Group Primary Care: 500,000 patients 29 locations
More informationDyslipidemia in women: Who should be treated and how?
Dyslipidemia in women: Who should be treated and how? Lale Tokgozoglu, MD, FACC, FESC Professor of Cardiology Hacettepe University Faculty of Medicine Ankara, Turkey. Cause of Death in Women: European
More informationControversies in Preventative Cardiology
Controversies in Preventative Cardiology Francisco Lopez-Jimenez, M.D., M.Sc, FACC, FAHA Professor of Medicine, Mayo Medical School Chair, Division of Preventive Cardiology Co-Director, Artificial Intelligence
More informationDisclosures No relationships (not even to an employer) No off-label uses. Cholesterol Lowering Guidelines: What now?
Disclosures No relationships (not even to an employer) No off-label uses Cholesterol Lowering Guidelines: What now?, FACP 1 2 65-year-old white woman Total cholesterol 175mg/dL HDL 54 mg/dl LDL 96 mg/dl
More informationNo relevant financial relationships
MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu
More informationHypertension Management Controversies in the Elderly Patient
Hypertension Management Controversies in the Elderly Patient Juan Bowen, MD Geriatric Update for the Primary Care Provider November 17, 2016 2016 MFMER slide-1 Disclosure No financial relationships No
More informationThe Effect of Statin Therapy on Risk of Intracranial Hemorrhage
The Effect of Statin Therapy on Risk of Intracranial Hemorrhage JENNIFER HANIFY, PHARM.D. PGY2 CRITICAL CARE RESIDENT UF HEALTH JACKSONVILLE JANUARY 23 RD 2016 Objectives Review benefits of statin therapy
More informationBest practice in lipid management
Best practice in lipid management Delivering best practice: 5 Steps / Interactive Case Study Dr Chris Harris & Dr Youssef Beaini Chair: Jean Hayhurst In association with Heart UK MAKING BEST PRACTICE EVERYDAY
More informationNew options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital
New options in Stroke Prevention in AF Paul Dorian University of Toronto St Michael s Hospital Disclosures: Honoraria, research support, and consulting f Sanofi, Boehringer-Ingleheim, Portola, BMS, Bayer,
More informationSession Objectives 11/27/2013
Workshop A3 and B3 This presenter has nothing to disclose Clinical and Cost Improvement for Population Health Scott Weingarten, MD Senior Vice President and Chief Clinical Transformation Officer Cedars-Sinai
More informationUnderstanding NNT- Patient s and Physicians Perspective
Understanding NNT- Patient s and Physicians Perspective A K Ghosh, K Ghosh Department of Internal Medicine Mayo Clinic Rochester, Minnesota, USA Number needed to treat - NNT Useful yardstick to describe
More informationShould we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway
Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway The Polypill A strategy to reduce cardiovascular disease by
More informationLong-Term Care Updates
Long-Term Care Updates October/November 2015 By Daniel Kerner, PharmD A stroke occurs when blood flow to the brain is stopped or slowed, resulting in death or damage to brain cells. There are three main
More information