Cardiovascular effects of diabetes medications: Lessons learned from cardiovascular outcomes trials

Speaker: Professor Darren K.McGuire

Since 2008, drugs for diabetes have been required to undergo formal cardiovascular safety assessment in clinical trials. In response, numerous trials of diabetes medications have now been completed with numerous others ongoing. The accumulated data from completed trials will be summarized and the impact of these data on contemporary professional society recommendations and their impact on cardiovascular clinical care will be reviewed with specific focus on recommendations for cardiologists with regard to prescribing selected medications for cardiovascular risk mitigation.

Stroke prevention where are we at?

Speaker 1:  Prof Vincent Thijs, Head of Stroke, Austin Health; Co-head of the Stroke Division at the Florey Institute of Neuroscience and Mental Health

Is there a place for empiric anticoagulation in embolic stroke of unknown source (ESUS)? 

• RESPECT ESUS and NAVIGATE ESUS: What have we learned?
• Does the ESUS concept survive?
• Do the results from the ESUS trials change management?
• Latest evidence – Prolonged cardiac monitoring reduces recurrent stroke

Speaker 2:  Prof Prash Sanders, Director of Cardiac Electrophysiology and Pacing at the Royal Adelaide Hospital; Director of the Centre for Heart Rhythm Disorders at the University of Adelaide

A Need for a New Paradigm

• The need for protocols and pathways to detect atrial fibrillation in patients following embolic stroke of unknown source (ESUS)

FH reality check: is your perception patient-centred?
- A practical approach to optimising patient outcomes for high-risk CV patients

Speakers: Dr Karam Kostner and Professor Stephen Nicholls 

Chair: Professor Gerald Watts

Despite advances in CV care, many patients fail to achieve their LDL-C target, leaving them at risk. Furthermore, FH patients are at even greater risk of CV events at an earlier age due to life-long cumulative LDL-C exposure, yet >90%remain undiagnosed and under-treated.  

So, are you doing enough to identify and treat your high-risk patients?

We will provide a practical, evidence-based approach to identifying the gaps in diagnosis and management of your FH patients, and discuss the impact of treatment with PCSK9 inhibitors on FH patients in Australia.

Safety of SGLT-2 inhibitors – practical considerations for cardiologists

Speakers: A/Prof John Amerena and Professor Sophia Zoungas

The prevalence of type 2 diabetes has become a global emergency despite increased awareness of the need for diabetes prevention however this knowledge is not translated into action that effectively reduces diabetes prevalence. Safe management of patients with diabetes by utilising different medications is important to physicians and patients.

Previous concerns around the safety of several classes of diabetes medications have now been addressed through numerous studies providing reassurance of the safety profile of different diabetes management medications.

Please join us for an information session on the practical considerations of newer diabetes medications for your patients.

No second chances – frontiers in preventative medicine

Speakers: Martin Cowie, Professor of Cardiology, Imperial College London and Honorary Consultant Cardiologist, Royal Brompton Hospital, London, UK, Chris Hammett (Interventional Cardiologist, Royal Brisbane and Women’s Hospital), Andrew Lee and Tom Marwick

Chair: Tom Marwick, Director and Chief Executive of the Baker Heart and Diabetes Institute

“In just 7 days, about 10% of people who have a stroke will have another”.1 There is a significant unmet need in high risk patients with cardiovascular disease resulting in disabling stroke or mortality.2 These patients may not have a second chance and there is an urgency to intervene. Join us as we explore frontiers in preventative medicine and challenge the paradigm to provide tailored protection for patients with cardiovascular disease.

<sup>References: 
1. Coull AJ et al.Population based study of early risk of stroke after transient ischaemic attack or minor stroke: implications for public education and organisation of services. BMJ. 2004;328:326.
2. No Second Chances. The Baker Heart and Diabetes Institute. February 2019</sup>

Impella percutaneous LVAD: Global best practice and cost-effectiveness in an Australian setting 

Speakers: Dr William Lombardi, University of Washington Medical Center, USA and Dr Sidney Lo from Liverpool Hospital, Sydney, Australia

Chair: Scott Harding, Wellington Hospital 

Dr. William Lombardi from University of Washington Medical Center, USA will share the principles and best practice of Impella Percutaneous LVAD. Dr. Sidney Lo from Liverpool Hospital, Sydney will share Protected PCI cost-effectiveness and outcomes insight based on Liverpool Hospital Case Series, a single-center experience in using both VA-ECMO and Impella Percutaneous LVAD in an Australian setting. Both Impella and Veno-Arterial extracorporeal membranous oxygenation(VA-ECMO) provide cardiac output support during high-risk PCI (HR-PCI).  This analysis compared the clinical and economic impact for high-risk patients undergoing Protected PCI for the total episode-of-care expenditure reflecting the patient comorbidities, consumable costs, hospital and ICU length-of-stays and management of any device-related complications.

Cardiology innovation symposium: Addressing the quadruple aim

Speakers: Karen Lamble (USA), Jeff Lui (NSW), Aniket Puri (NZ)

Chair: Robert Petersen (NSW)

Philips has the depth of perspective across hospital and home needed to break the boundaries standing in the way of organizing healthcare around the patient. We collaborate on designing innovations to seamlessly bring together people, data and technology to help our customers achieve their quadruple aim: improving the patient experience of care (including quality and satisfaction), improving the health of individuals and populations, improving the work life of health professionals, and reducing the per capita cost of healthcare. This session will focus on some of the innovations that contribute to this aim in cardiology.

Presentations

• Robust quantification, proven performance – with Philips EPIQ CVx Release 5.0, presented by Karen Lamble, Philips                                                   
• Next generation real-time fusion imaging  of echo and X-ray for SHD: EchoNavigator with Anatomical Intelligence, presented by Jeff Lui, Philips
• Azurion 7 C20 with FlexArm ‘The advanced suite that works around you’, presented by Jeff Lui, Philips
• Co registration: A GPS for Physiology in Complex Intervention, presented by Dr. Aniket Puri, Christchurch Hospital

Overcoming the challenges of treating HeFH and ACS with available PCSK9 inhibitors

Speakers: Professor Phil Aylward (SA), Associate Professor David Colquhoun (QLD), Dr Sam Mirzaee (VIC)

Chair: Professor David Sullivan (NSW) 

Heterozygous familial hypercholesterolaemia (HeFH) is the most common autosomal dominant genetic disorder characterised by elevated levels of LDL-C¹. 

An LDL-C < 1.8 mmol/L is recommended for patients with HeFH who are at very high CV risk¹, however up to 80% of these patients do not achieve an LDL-C level of 2,3.

Treatment with PCSK9 inhibitors in addition to lipid lowering therapy enables more patients with HeFH and high CV risk to achieve specific LDL-C goals^4,5,6 but access to PCSK9i therapy is highly dependent on successful HeFH diagnosis and optimisation of background agents.  This symposium addresses such challenges in identifying high CV risk HeFH patients and navigates pathways for implementation of PCSK9i therapy in those with high CV risk.

^References:

1. ^{Nordestgaard BG et al. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease: consensus statement of the European Atherosclerosis Society. Eur Heart J 2013; 34: 3478–3490a.}
2. ^{Huijgen R et al. Two years after molecular diagnosis of familial hypercholesterolemia: majority on cholesterol-lowering treatment but a minority reaches treatment goal. PLoS One 2010; 5: e9220.}
3. ^{Pijlman AH et al. Evaluation of cholesterol lowering treatment of patients with familial hypercholesterolemia: a large cross-sectional study in the Netherlands. Atherosclerosis 2010;209:189–194.}
4. ^{Kastelein JJP et al. ODYSSEY FH I and FH II: 78 week results with alirocumab treatment in 735 patients with heterozygous familial hypercholesterolaemia. Eur Heart J 2015; DOI:10.1093/eurheartj/ehv370}
5. ^{Robinson JG et al. Efficacy and Safety of Alirocumab in Reducing Lipids and Cardiovascular Events. NEJM 2015; DOI: 10.1056/NEJMoa1501031}
6. ^{Raal et al. PCSK9 inhibition with evolocumab (AMG 145) in heterozygous familial hypercholesterolaemia (RUTHERFORD-2): a randomised, double-blind, placebo-controlled trial. The Lancet. 2015;DOI:10.1016/S0140-6736(14)61399-4}