Antiplatelet Therapy for Secondary CVD Prevention: So Many Choices; What Should We Do?

Jointly provided by Potomac Center for Medical Education and Rockpointe.

Supported by an independent educational grant from Merck.

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Release date: October 23, 2015

Valid through: October 23, 2016

Specialty: Cardiology, Internal Medicine, Primary Care

Topic: Cardiovascular disease

Media: Internet

Estimated Time to Complete Activity: 60 minutes

Target Audience

Hospital staff members who specialize in cardiology, interventional cardiology, vascular surgery, and interventional radiology, as well as fellows, residents, and other healthcare professionals interested in atherosclerotic cardiovascular disease.

Program Overview

Antithrombotic therapy provides secondary prevention of high-risk patients. Given the enduring and chronic nature of coronary artery disease, appropriate secondary management is necessary to curtail the ongoing mortality risk of repeat acute coronary syndrome (ACS) events. Current guidelines call for dual antiplatelet therapy with indefinite aspirin plus a complementary antiplatelet agent for up to one year. The benefits of longer-term antiplatelet therapy for secondary prevention of ACS are only now being established. In fact, there are now many options for longer-term prevention of CVD recurrences. The question is which antithrombotic therapy should be used to meet the needs of each individual patient.

In addition, secondary prevention of recurrent ACS requires more than just longer-term dual antiplatelet therapy. Successful transition from the hospital to the home rests largely on the quality of communication between the patient, a member of the heart team, and the patient’s primary care physician. This online activity will explore which patients are appropriate candidates for which therapies and which patients need longer-term antiplatelet therapies for secondary prevention. The program will also encourage all members of the heart team and their patients to work in synergy to reduce recurrent ACS events, reduce hospital readmissions, and improve overall outcomes.

Learning Objectives

Upon completion of this activity, participants should be able to demonstrate the ability to:

  • Appraise the clinical data supporting long-term use of antithrombotics in patients with a history of CVD
  • Analyze processes of switching therapies or employing concomitant therapies to achieve optimal balance of anti-ischemic protection vs bleeding risk
  • Customize longer-term therapies to the needs of particular patients, taking into consideration the evolving landscape of additional indications

Credit Available

  • Physicians — maximum of 1.0 AMA PRA Category 1 Credit

All other healthcare professionals completing this course will be issued a statement of participation.

Faculty

DEEPAK L. BHATT, MD, MPH
Executive Director, Interventional Cardiovascular Programs
Brigham and Women’s Hospital Heart and Vascular Center
Professor of Medicine, Harvard Medical School
Boston, MA

Deepak L. Bhatt, MD, MPH is Executive Director of Interventional Cardiovascular Programs at Brigham and Women’s Hospital Heart and Vascular Center and Professor of Medicine at Harvard Medical School. He is also a Senior Physician at Brigham and Women’s Hospital and a Senior Investigator in the TIMI Study Group.

After graduating as valedictorian from the Boston Latin School, Dr. Bhatt obtained his undergraduate science degree as a National Merit Scholar at the Massachusetts Institute of Technology, while also serving as a Research Associate at Harvard Medical School. He received his medical doctorate from Cornell University. He completed a Masters in Public Health with a concentration in clinical effectiveness at Harvard University. His internship and residency in internal medicine were performed at the Hospital of the University of Pennsylvania, and his cardiovascular training was at the Cleveland Clinic. He also completed fellowships in interventional cardiology and cerebral and peripheral vascular intervention, as well as serving as Chief Interventional Fellow at Cleveland Clinic, where he spent several years as an interventional cardiologist and an Associate Professor of Medicine. He served for many years as Director of the Interventional Cardiology Fellowship and as Associate Director of the Cardiovascular Medicine Fellowship. He also served as Associate Director of the Cleveland Clinic Cardiovascular Coordinating Center. He was then recruited to be the Chief of Cardiology at VA Boston Healthcare System, where he served for several years. Dr. Bhatt has been listed in Best Doctors in America from 2005 to 2014.

Dr. Bhatt’s research interests include acute coronary syndromes, preventive cardiology, and advanced techniques in cardiac, cerebral, and peripheral intervention. He has authored or co-authored more than 600 publications. He is the editor of Atherothrombosis in Clinical Practice published by Oxford University Press and of Perpiheral and Cerebrovascular Intervention published by Springer. He was the international PI for the CHARISMA and CRESCENDO trials and co-PI of the three CHAMPION trials. He served as Chair of COGENT and helped lead STAMPEDE. He serves as Co-chair of the REACH registry and chairs REDUCE-IT. He is co-PI of SAVOR-TIMI 53, SYMPLICITY HTN-3, and THEMIS. He is the current Chair of the AHA-GWTG Steering Committee. He is Associate Editor for clinical trials for the ACC’s Cardiosource. Dr. Bhatt has been a visiting lecturer at a number of prestigious institutions throughout the world, and has been interviewed extensively by news agencies on numerous topics. He is the Editor of the peer-reviewed Journal of Invasive Cardiology, Chief Medical Editor of Cardiology Today’s Intervention for healthcare professionals, and Editor-in-Chief of the Harvard Heart Letter for patients.

CHRISTOPHER P. CANNON, MD
Executive Director of Cardiometabolic Trials
Harvard Clinical Research Institute
Professor of Medicine
Harvard Medical School
Senior Physician, Cardiovascular Division
Brigham and Women’s Hospital
Boston, MA

Christopher P. Cannon, MD is a Professor of Medicine at Harvard Medical School, and Senior Physician in the Cardiovascular Division at Brigham and Women’s Hospital. He earned his medical doctorate from Columbia University College of Physicians and Surgeons in New York, then completed his internal medicine residency at Columbia Presbyterian Medical Center and his cardiovascular fellowship at Brigham and Women’s Hospital.

Dr. Cannon has published more than 1000 original articles, reviews, or electronic publications in the field of acute coronary syndromes and prevention and has authored or edited 17 books. He has received numerous awards, including leadership awards from the American College of Cardiology and the American Heart Association.

As a Senior Investigator of the TIMI Study Group, he has been Principal Investigator of more than 15 multicenter clinical trials, including TACTICS-TIMI 18, PROVE IT, and the IMPROVE IT trial. Dr. Cannon also serves as Executive Director of Cardiometabolic Trials at the Harvard Clinical Research Institute (HCRI). He is leading the RE-DUAL PCI trial, studying novel anticoagulant strategies in patients with atrial fibrillation undergoing stenting, and collaborates on many other trials and registry projects in the fields of acute coronary syndromes, atrial fibrillation, diabetes, lipids, and prevention. 

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of the Potomac Center for Medical Education and Rockpointe. The Potomac Center for Medical Education is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

The Potomac Center for Medical Education designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Disclosures of Conflicts of Interest

Potomac Center for Medical Education (PCME) adheres to the policies and guidelines, including the Standards for Commercial Support, set forth to providers by the Accreditation Council for Continuing Medical Education (ACCME) and all other professional organizations, as applicable, stating those activities where continuing education credits are awarded must be balanced, independent, objective, and scientifically rigorous.

All persons in a position to control the content of a continuing medical education program provided by PCME are required to disclose any relevant financial relationships with any commercial interest to PCME as well as to learners. All conflicts of interest are identified and resolved by PCME in accordance with the Standards for Commercial Support in advance of delivery of the activity to learners.

The content of this activity was vetted by an external medical reviewer to assure objectivity and that the activity is free of commercial bias.

The faculty and steering committee reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:

Deepak L. Bhatt, MD, MPH

Research: Amarin, AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Forest Laboratories, Ischemix, Medtronic, Pfizer, Roche, Sanofi Aventis, The Medicines Company

Christopher P. Cannon, MD

Research: Accumetrics, Arisaph, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Janssen, Merck, Takeda; Consultant: Boehringer Ingelheim, Bristol-Myers Squibb, CSL Behring, Essentialis, GlaxoSmithKline, Kowa, Lipimedix, Merck, Pfizer, Regeneron, Sanofi, Takeda

Non-faculty Discloures

Non-faculty content contributors and/or reviewers reported the following relevant financial relationships that they or their spouse/partner have with commercial interests:

Barry Watkins, PhD; Blair St. Amand; Jay Katz, CHCP; Dana Simpler, MD: Nothing to disclose

Instructions for Participation and Credit

There is no fee for this activity. To receive credit, participants must take the pre-test, view this CME activity in its entirety, and then complete the post-test and evaluation. To complete the evaluation online, choose the best answer to each question. To receive their certificates, participants must demonstrate mastery of the presented material via the post-test.  Participant is allowed to take the post-test three times.

Hardware and Software Requirements

This site is best viewed with an HTML5 compatible browser; this list includes the current versions of Microsoft Internet Explorer, Mozilla Firefox, Google Chrome, and Apple's Safari. You can visit the independent (3rd party) site www.whatismybrowser.com to determine if you have the latest version of your browser. Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, and Real Networks Real One Player. Where such software is required it will be indicated.

FDA Disclosure

The contents of some CME/CE activities may contain discussions of non-approved or off-label uses of some agents mentioned. Please consult the prescribing information for full disclosure of approved uses.