Formulary Decisions Matter: 4 reasons to add SGLT2i to your inpatient formulary

Several advances in the pharmacologic treatment of heart failure with reduced ejection fraction (HFrEF) have been made in the past several years. Despite known benefits, use of guideline-directed medical therapy in these patients remains wildly suboptimal. There are several reasons for this, including increasing complexity of HF regimens as well therapeutic inertia. While we may not have control over all components of therapeutic inertia, we feel strongly as a pharmacist that we cannot let our inpatient formulary decisions be one of them. As such, here we discuss 4 reasons why you should add these agents to formulary.

Help or Hype: Vericiguat for Heart Failure with Reduced Ejection Fraction

The recently published VICTORIA study assessed the efficacy and safety of vericiguat, a soluble guanylate cyclase stimulator in patients with heart failure with reduced ejection fraction, and met its primary composite outcome of death from cardiovascular causes or first hospitalization for heart failure. This blog describes four reasons why despite a technically positive study, I’m not sure I see a significant role for vericiguat in this population.

Say It Ain’t (Mostly) So? DOAC therapy for Stroke Prevention in Patients with Liver Disease and Atrial Fibrillation

Use of oral anticoagulation therapy in patients with liver disease is complex. The risks and benefits of therapy need to be considered as those with liver disease can be at heightended risk of bleeding. This blog post will review the literature surrounding the use of oral anticoagulation in patients with atrial fibrillation and liver disease and recommendations on selecting therapy, if any, will be discussed.

Antibiotics and Cardiovascular Adverse Effects: A Focus on Fluoroquinolones and Macrolides

Macrolides and fluoroquinolones (FQs) are two of the most commonly prescribed antibiotics; however, recent studies have revealed that these medications are associated with a higher risk of cardiovascular (CV) adverse events (AEs) including arrhythmias and valvular regurgitation. This blog summarizes recent literature on CV AEs associated with FQs and macrolides and provides recommendations on their use within certain at-risk populations.

TRED Lightly: Should Guideline-Directed Medical Therapy be Continued Indefinitely in Everyone?

The TRED-HF trial considerably narrowed the population deemed as being low risk for heart failure relapse following the withdrawal of guideline-directed medical therapy (GDMT). However, several key subgroups were underrepresented and some patients may still wish to attempt GDMT withdrawal, especially in the setting of adverse effects or excess costs. In this post, we explore three questions that can be used to guide a shared decision-making process regarding GDMT withdrawal.

What’s in the Black Box? Examining the Evidence for Five Cardiac Medications? Part 2

Boxed warnings appear in the product labeling for several cardiac medications. The purpose of a boxed warning is to minimize the risk of harm. In this second part of a two-part series, we’ll review the literature that led to the boxed warnings for edoxaban (Savaysa), prasugrel (Effient) and ticagrelor (Brilinta), along with practical considerations for their use.

What’s in the Black Box? Examining the Evidence for Five Cardiac Medications? Part 1

Boxed warnings appear in the product labeling for several cardiac medications. The purpose of a BW is to minimize the risk of harm. In this two-part blog series, we’ll review the literature that led to the BWs for cilostazol (Pletal), dofetilide (Tikosyn), edoxaban (Savaysa), prasugrel (Effient) and ticagrelor (Brilinta), along with practical considerations for each. Cilostazol and dofetilide will be discussed in this first post of the series.

A Tough Pill to Swallow: Clinical Application of Prasugrel in Patients with ACS

The recent results of The Intracoronary Stenting and Antithrombotic Regimen: Rapid Early Action for Coronary Treatment (ISAR-REACT) 5 trial have, to say the least, brought into question the notion that ticagrelor is a superior P2Y12 inhibitor in patients with ACS. This blog will briefly review the results of ISAR-REACT 5, but more importantly outline key considerations for the use of prasugrel in clinical practice.

3 Clinical Pearls For Acute Management of Atrial Fibrillation in Patients with Heart Failure with Reduced Ejection Fraction

Atrial fibrillation (AF) and heart failure with reduced ejection fraction (HFrEF) often occur concomitantly. Despite this, optimal treatment strategies remain unclear. Current rate and rhythm control pharmacotherapy options present challenges when used in patients with HFrEF. In this blog, we cover 3 clinical pearls to consider for acute management of AF in patients with HFrEF.

3 Things You Should Know Before Throwing in the Towel on Triple Therapy

When it comes to triple therapy, the totality of the evidence strongly suggests “less is more”. While many practitioners have been quick to adopt dual antithrombotic therapy, it is important to consider the external validity of these trials and how we apply them to our patients. In this blog, Dr. Noel offers 3 considerations that require careful reflection before throwing in the towel on triple therapy.