reachmd.com Open in urlscan Pro
52.72.215.43 Public Scan

Back to summary

Submitted URL:
http://link.email3.reachmd.com/ls/click?upn=rrykUvp00SDw37MpVWhV-2Fu-2BL0sjRMHh794krKRxVunYXuXXWkaIF9mc-2FrbrfP0ESEoGd7Jg5W8ecb...
Effective URL:
https://reachmd.com/programs/cme/synergy-of-guideline-directed-medical-therapies-in-heart-failure-to-optimize-patien...
Submission: On September 19 via api (September 19th 2022, 11:09:21 am UTC) from US — Scanned from DE

Form analysis
4 forms found in the DOM

GET /search/

<form class="form form-search pjax-form" method="get" action="/search/">
  <div class="field field-text"><input id="form-search-field" type="text" placeholder="Search" name="q" gname="storesearch"><input type="hidden" name="order_by" value="1"></div>
  <div class="field field-actions"><button type="submit">Search</button></div>
</form>

<form id="create-playlist">
  <div class="clearfix"><input type="text" name="playlist_name" placeholder="New Playlist Name" class="create-input" value="">
    <div class="privacy">
      <ul class="clearfix privacy-list ">
        <li><label for="private-radio"><input type="radio" id="private-radio" name="privacy" data-value="2" value="2" checked=""><button type="button"><span class="private"></span>Private</button></label></li>
        <li><label for="public-radio"><input type="radio" id="public-radio" name="privacy" data-value="1" value="1"><button type="button"><span class="public"></span>Public</button></label></li>
      </ul>
    </div>
  </div>
  <div class="buttons-footer clearfix"><button type="button" class="button-footer button-cancel">Cancel</button><button type="button" id="create-playlist-button" class="button-footer button-save">Create</button></div>
</form>

<form id="live-stream-share">
  <div class="peers">
    <div class="select-peers css-2b097c-container">
      <div class=" css-yk16xz-control">
        <div class=" css-1hwfws3">
          <div class=" css-1wa3eu0-placeholder">Peer's name</div>
          <div class="css-1g6gooi">
            <div class="" style="display: inline-block;"><input autocapitalize="none" autocomplete="off" autocorrect="off" id="react-select-2-input" spellcheck="false" tabindex="0" type="text" aria-autocomplete="list" value=""
                style="box-sizing: content-box; width: 2px; background: 0px center; border: 0px; font-size: inherit; opacity: 1; outline: 0px; padding: 0px; color: inherit;">
              <div
                style="position: absolute; top: 0px; left: 0px; visibility: hidden; height: 0px; overflow: scroll; white-space: pre; font-size: 16px; font-family: Museo, Arial, sans-serif; font-weight: 400; font-style: normal; letter-spacing: normal; text-transform: none;">
              </div>
            </div>
          </div>
        </div>
        <div class=" css-1wy0on6"><span class=" css-1okebmr-indicatorSeparator"></span>
          <div class=" css-tlfecz-indicatorContainer" aria-hidden="true"><svg height="20" width="20" viewBox="0 0 20 20" aria-hidden="true" focusable="false" class="css-8mmkcg">
              <path
                d="M4.516 7.548c0.436-0.446 1.043-0.481 1.576 0l3.908 3.747 3.908-3.747c0.533-0.481 1.141-0.446 1.574 0 0.436 0.445 0.408 1.197 0 1.615-0.406 0.418-4.695 4.502-4.695 4.502-0.217 0.223-0.502 0.335-0.787 0.335s-0.57-0.112-0.789-0.335c0 0-4.287-4.084-4.695-4.502s-0.436-1.17 0-1.615z">
              </path>
            </svg></div>
        </div>
      </div>
      <div><input name="recipient" type="hidden"></div>
    </div>
  </div>
  <div class="textarea"><textarea class="textarea" name="message" placeholder="Write your message"></textarea></div><button class="share-button" id="share-on-rmd" type="button">Share</button>
</form>

POST

<form class="share-module__form" action="" method="post"><input type="hidden" name="csrfmiddlewaretoken" value="nSuZcyP1Ss4UPqrXPKUX0Me8MyJnIQrEMsyiUroLDy4SmjUHOi5iO8QLtcExeeMr">
  <div class="field field-text"><select multiple="" data-autocomplete-light-function="select2" data-autocomplete-light-url="/messages/appuser-autocomplete/" id="id_recipient" name="recipient" placeholder="Peer's name" data-placeholder="Peer's name"
      tabindex="-1" class="select2-hidden-accessible" aria-hidden="true"></select><span class="select2 select2-container select2-container--default" dir="ltr" style="width: auto;"><span class="selection"><span
          class="select2-selection select2-selection--multiple" role="combobox" aria-haspopup="true" aria-expanded="false" tabindex="-1">
          <ul class="select2-selection__rendered">
            <li class="select2-search select2-search--inline"><input class="select2-search__field" type="search" tabindex="0" autocomplete="off" autocorrect="off" autocapitalize="off" spellcheck="false" role="textbox" aria-autocomplete="list"
                placeholder="Peer's name" style="width: 100px;"></li>
          </ul>
        </span></span><span class="dropdown-wrapper" aria-hidden="true"></span></span></div>
  <div class="field field-textarea"><textarea placeholder="Write your message"></textarea></div><button type="submit" class="btn-share">Share</button>
</form>

Text Content

SYNERGY OF GUIDELINE-DIRECTED MEDICAL THERAPIES IN HEART FAILURE TO OPTIMIZE
PATIENT OUTCOMES

Be part of the knowledge.™
* Log In
* Register

* Facebook
* Twitter
* Linked in
* Instagram

Search
* Public Playlists

* Specialty
* Allergy and Clinical Im…

* Anesthesiology

* Cardiology

* Dermatology

* Emergency Medicine

* Endocrinology

* Gastroenterology and He…

* General Medicine and Pr…

* Genetics

* Infectious Diseases

* Nephrology

* Neurology and Neurosurg…

* Nutrition

* OB/GYN and Women's Heal…

* Oncology - Hematology

* Ophthalmology

* Pathology and Lab Medic…

* Pediatrics

* Psychiatry and Mental H…

* Pulmonary Medicine

* Radiology

* Rare and Orphan Diseases

* Rheumatology

* Sports Medicine

* Surgery

* Urology

See more
* All Programs
* Advances in Women's Hea…

* AudioAbstracts

* CKD/HF

* Clinician's Roundtable

* CME/CE

* COVID-19: On The Frontl…

* Curious Headlines

* DermConsult

* Diabetes Discourse

* Everyday Family Medicine

* Eye on Ocular Health

* GI Insights

* Global Heart Failure Ac…

* Grand Rounds Nation

* Heart Matters

* Lipid Luminations

* NeuroFrontiers

* Partners in Practice

* Primary Care Today

* Project Oncology

* ReachMD Briefs

* Spotlight On

* VacciNation

See more
* Medical News
* Business of Medicine

* COVID-19 Updates

* Global Health

* Health Policy

* Health Technology

* Allergy, Asthma, and Im…

* Cardiology

* Dermatology

* Diabetes & Endocrinology

* Emergency Medicine

* Gastroenterology

* Genetics

* Geriatrics

* Infectious Disease

* Men's Health

* Nephrology

* Neurology

* Nutrition

* OB/GYN & Women's Health

* Oncology

* Ophthalmology

* Pediatrics

* Primary Care

* Psychiatry

* Pulmonary Medicine

* Radiology

* Rheumatology

* Sports Medicine

* Surgery

See more
* Medical Interest
* Business of Medicine

* Careers

* Ethics

* Global Health

* Government and Healthca…

* Government Policy

* Health Disparities

* Healthcare Policy

* Humor

* Medical Research

* Practice Management

* Public Health Policy

* Technology

See more
* CME/CE

CME/CE SERIES

* CKD/HF
* Global Heart Failure Ac…
* NeuroFrontiers CME
* Women’s Health: Beyond …
* ASCVD Learning Center

CME/CE TOPIC AREAS

* Allergy, Asthma, and Im…
* Cardiology
* Dermatology
* Emergency Medicine
* Endocrinology
* Gastroenterology and He…

* General Medicine and Pr…

* Infectious Diseases

* Nephrology

* Neurology

* Nutrition

* Oncology and Hematology

* Ophthalmology

* Pathology and Laborator…

* Pediatrics

* Psychiatry and Mental H…

* Pulmonary Medicine

* Radiology

* Rare and Orphan Diseases

* Rheumatology

* Surgery

* Urology

* Women's Health

FEATURED EDUCATION PART…

* AXIS Medical Education
* Medtelligence
* Omnia Education
* Prova Education
* RMEI

See more
* Industry Features
* Anesthesiology

* Cardiology

* Dermatology

* Emergency Medicine

* Endocrinology

* Gastroenterology and He…

* General Medicine and Pr…

* Infectious Diseases

* Nephrology

* Neurology and Neurosurg…

* OB/GYN and Women's Heal…

* Oncology - Hematology

* Ophthalmology

* Pathology and Lab Medic…

* Pediatrics

* Psychiatry and Mental H…

* Pulmonary Medicine

* Rheumatology

* Surgery

See more
* Meetings
* Live Broadcasts
* My Career

We’re glad to see you’re enjoying ReachMD…
but how about a more personalized experience?

SYNERGY OF GUIDELINE-DIRECTED MEDICAL THERAPIES IN HEART FAILURE TO OPTIMIZE
PATIENT OUTCOMES

0.50 credits
30 minutes
9
LikeLiked
Share
Save
RestartRestart Program
ResumePlay Program
Read full article
Share
Save
9
LikeLiked

TRANSCRIPT

SYNERGY OF GUIDELINE-DIRECTED MEDICAL THERAPIES IN HEART FAILURE TO OPTIMIZE
PATIENT OUTCOMES

* Take Post-Test

TRANSCRIPT

SYNERGY OF GUIDELINE-DIRECTED MEDICAL THERAPIES IN HEART FAILURE TO OPTIMIZE
PATIENT OUTCOMES

* Take Post-Test

TRANSCRIPT

SYNERGY OF GUIDELINE-DIRECTED MEDICAL THERAPIES IN HEART FAILURE TO OPTIMIZE
PATIENT OUTCOMES

Print Download
close

Announcer:
Welcome to CME on ReachMD. This activity, entitled “Synergy of
Guideline-Directed Medical Therapies in Heart Failure to Optimize Patient
Outcomes” is provided by Medtelligence.

Prior to beginning the activity, please be sure to review the faculty and
commercial support disclosure statements as well as the learning objectives.

Dr. Butler:
Renin-angiotensin-aldosterone system inhibition [RAASi] is the foundation of
guideline-directed medical therapy [GDMT] for heart failure patients. However,
due to practice gaps, the benefits of RAASi therapy are not enjoyed by a
significant proportion of the population requiring its use. This is especially
true for patients with comorbid conditions. Hyperkalemia is a common adverse
effect of RAASi therapy that needs to be anticipated and mediated so that the
optimal dosing of necessary medications can occur. Maximizing guideline-directed
medical therapy in the face of hyperkalemia remains a key clinical challenge
that if not handled properly can result in increased morbidity and mortality.

This is CME on ReachMD, and I am Dr. Butler.

Dr. Kosiborod:
I’m Mikhail Kosiborod, cardiologist at Saint Luke’s Mid America Heart Institute
in Kansas City.

Dr. Weir:
And I’m Dr. Matthew Weir, and I work in Baltimore, Maryland.

Dr. Butler:
Today, we are going to go through a case and discuss different treatment
approaches to optimize guideline-directed medical therapy while managing
hyperkalemia. So let’s dive right into it.

This is a patient with CKD, stage 3b, recurrent hyperkalemia, potassium levels
around 5. You cannot increase the diuretic dose because of the creatinine issues
and the fact that the patient is actually optimally decongested.

So, Dr. Kosiborod, let me start with you and ask your approach to the management
of a patient like this when you are trying to optimize the RAASi therapy but
have issues with CKD and hyperkalemia.

Dr. Kosiborod:
Well, thank you, Javed, and of course this is a very common clinical scenario.
We have a patient with heart failure and reduced ejection fraction [HFrEF],
somebody who also has a concomitant chronic kidney disease, which is so common
in our patients with HFrEF, and his borderline potassium levels that, of course,
occur in patients with heart failure and kidney disease, especially advanced
kidney disease.

And to your question, I think the critical important issue here is that you’ve
got to, first and foremost, make sure the patient’s optimized on
guideline-directed medical therapy, which has the 4 pillars of fundamental
disease-modifying treatments in HFrEF. Those include RAAS blockers,
renin-angiotensin system blockers, or ARNI; beta-blockers; MRAs, the
mineralocorticoid receptor antagonists; and SGLT2 inhibitors. And as it happens,
at least several of these classes of medications may further increase potassium
levels as you make sure, the clinicians, that you get patients on GDMT, on those
4 pillars, and you also then make sure, after the patient is receiving all 4
pillars, that they’re also receiving optimal doses. This is exactly the patient
that’s likely to develop further elevations in potassium levels. So, first
thing, make sure patient’s receiving GDMT and optimize GDMT. Second, monitor
potassium levels carefully because this patient’s high risk for developing
hyperkalemia. And third is, if hyperkalemia does develop, then figure out what
can be done to make sure a patient can continue to stay on optimal GDMT, because
we know that’s what has been shown to improve survival and reduce
hospitalizations and, at least with some classes of the medications, also
improve quality of life.

So in the past we, of course, had very limited options of what to do if
potassium levels continue to progressively elevate. It would typically mean
dietary modifications or, unfortunately, what’s frequently done is
down-titration or discontinuation of the classes of medicines that can increase
potassium levels, most notably RAAS blockers, ARNI, or MRAs – or sometimes all
of the above – and that, we know, is not optimal because patients that have that
therapy down-titrated, discontinued, have a higher associated risk of poor
outcomes.

Dr. Butler:
So, yeah, I completely agree with you. I mean, and again, just to put it in
perspective, just a potassium of 5 by itself is not necessarily a reason not to
optimize medical therapy. The question is whenever you try and then the
potassium goes up, and that’s when you are facing this challenge, whether to go
up on the dose and do something else to manage hyperkalemia or cut back on the
doses.

Dr. Weir, what do you think?

Dr. Weir:
Well, this is a major clinical conundrum that we face. And that is mitigating
potassium levels that might possibly interfere with using guideline-based
medical therapy. And what I mean here is being able to utilize appropriate doses
of either ACE, ARB, or ARNI coupled with MRA in an appropriate dose. And let’s
also remember, too, beta-blockers tend to increase serum potassium as well. So
really, 3 of the 4 foundations that Dr. Kosiborod mentioned are drugs that tend
to elevate serum potassium levels. And let’s also agree, too, ramping up
diuretic doses may not be the correct answer, especially if the patient’s
euvolemic, because causing volume depletion activates the very neurohormonal
systems you are trying to dampen with these therapies.

Dr. Butler:
So, Mikhail, let me ask you one more question related to this patient. There is
some emerging data on less risk of hyperkalemia with SLGT2 inhibitors, and that
may actually facilitate other therapies. But what are your perspectives on that?

Dr. Kosiborod:
That’s an excellent point, Javed, and I would say there are actually 2 things to
keep in mind. There are 2 out of 4 guideline-directed therapies, Class 1, and
indicated therapies in HFrEF actually have been shown to potentially mitigate
some of the risk of hyperkalemia to an extent. So the first I’m actually going
to mention sacubitril/valsartan, or ARNI, as compared to an ACE inhibitor in the
PARADIGM-HF trial, was associated with or led to lower risk of significant
hyperkalemia. That does not mean that you have no risk of hyperkalemia with
ARNI; it just means you have less as compared to an ACE inhibitor, and
presumably ARB, even though, of course, in the PARADIGM trial, the comparator
was an ACE inhibitor. And then the second data, more recently emerging as you
just pointed out, and it’s actually coming from a variety of trials, but
probably most notably and clearly demonstrated in the DAPA-HF secondary
analysis, which is in DAPA-HF trial, of dapagliflozin versus placebo in patients
with HFrEF. Patients that were on dapagliflozin concomitantly with MRA had a
significantly lower risk of hyperkalemia, you know, clinically important
hyperkalemia with potassium levels more than 6. So it’s nearly, 50% lower risk
of that significant hyperkalemia with dapagliflozin in conjunction with an MRA
versus a placebo in conjunction with an MRA. So what that means is you can kind
of have 2 for 1. You can really optimize therapy from a heart failure standpoint
by using medications like ARNI and SGLT2 inhibitors while at the same time
potentially mitigating the risk of significant hyperkalemia.

Dr. Butler:
So, great insights, Mikhail.

For those just tuning in, you’re listening in to CME on ReachMD. I am Dr. Javed
Butler, and here with me today are Drs. Matthew Weir and Mikhail Kosiborod. We
are discussing how the synergy of guideline-directed medical therapies can
optimize patients’ outcomes in heart failure.

Matt, let me turn to you. So let’s just, for the sake of discussion, assume that
our patient has type 2 diabetes. And talking about novel therapies, we are
seeing all of these data are coming out with nonsteroidal MRAs and prevention of
renal function deterioration as well as cardiovascular outcomes. Pertinent to
our case, what would you say about therapies with those drugs?

Dr. Weir:
Well, Javed, this is an excellent question. And if you look at really all of the
treatment algorithms for cardiorenal disease, we’re looking at expanding the
opportunities to people even with much lower GFRs. I mean, let’s remember, the
very vast majority of all the heart failure studies with reduced ejection
fraction excluded patients with GFRs below 30.

So I think now that we’re reaching out and trying to expand our capabilities of
therapy even to the lower GFR patients, even those with diabetic kidney disease
and reduced ejection fraction, you know, again, new drugs like finerenone have
proven to be very helpful in this regard, but yet again, still tend to raise
potassium by about 0.2 milliequivalents per liter, which could make some
clinicians and some patients a little bit uncomfortable about that level of
serum potassium. So we’re still going to have to be attentive, focus on
appropriate dietary measures, focus on avoiding nonsteroidal anti-inflammatory
drugs, utilize potassium binders when we need to, so that we can mitigate
chronic hyperkalemia, which is really the major barrier for us using many of
these exciting new disease-modifying therapies.

Dr. Butler:
So very helpful. So Mikhail, let me turn back to you. You know, we have
questioned a lot of things just in the past 5, 6 minutes. We talked about the
importance of therapy. We talked about potential less risk with ARNIs,
facilitation by SGLT2 inhibitor, diet, but let’s touch on one last crucial topic
as well, and that is these novel potassium binders, patiromer and sodium
zirconium cyclosilicate. How will you approach these novel potassium binders in
a person like this?

Dr. Kosiborod:
Right. Well as you pointed out, Javed, the emergence of these novel potassium
binders really gives us a new potential treatment option which we didn’t
previously have because not only are they efficacious in lowering potassium
levels, but also tend to be well tolerated, including chronically, over an
extended period of time, something that we just didn’t have available to us
before with all the therapies, like Kayexalate, really not being a chronic
treatment option because of gastrointestinal tolerability issues. So the
question is how would you use it clinically in a patient like this? So I think
as we mentioned earlier, the first order of business is make sure the patient is
optimized on GDMT. And some of the things that you could potentially capitalize
on are things like potential use of ARNI and SGLT2 inhibitors to mitigate the
risk of hyperkalemia.

But let’s say a patient’s potassium increases anyway, and now you’re dealing
with somebody who had a baseline potassium level of 5, and now the potassium
level is what we would normally say moderately elevated – you know, let’s say
5.7, 5.8. And it’s kind of slowly moving in the wrong direction, and of course,
different clinicians have different levels of tolerability for potassium levels,
and it’s certainly going to make some people nervous, as Matt just mentioned. So
in the past, really the only thing one could do is dietary intervention, that
Matt already said earlier, and then, really, after that it’s down-titration and
discontinuation of renin-angiotensin-aldosterone system inhibitors, including
MRAs, which is really not optimal, because we know that these medications
provide benefit to patients with HFrEF, regardless of the potassium levels. We
know this from clinical trials of those medications, of the MRAs.

So now we have another treatment option. So let’s say you’re faced with a
clinical dilemma, essentially, one additional treatment option that could be
entertained now is using either patiromer or sodium zirconium cyclosilicate to
normalize potassium levels or significantly lower potassium levels as you are
optimizing GDMT, in case potassium levels continue to be elevated or elevate
further, as you’re optimizing GDMT.

Dr. Butler:
So great, great cardiology perspective. Matt, nephrologists see a lot of
hyperkalemia. Can you give us a nephrologist’s perspective on these novel
potassium binders, both for chronic hyperkalemia management as well as
enablement of RAASi therapy?

Dr. Weir:
Sure, I’d be delighted to. I think, you know, the real opportunity, moving
forward, is that we are going to have the same opportunities in chronic kidney
disease now that we’ve had already with heart failure, and that is more than a
renin-angiotensin system blocking drug. We’re going to have SGLT2 inhibitors.
We’re going to have these newer nonsteroidal mineralocorticoid receptor
antagonists. So we will continue to have a balance between mitigating potassium
and using these exciting new therapies, which we know improve clinical outcomes.
And so, clearly, we’re going to need to develop experience with chronic
hyperkalemia management, and I think the cornerstone of that, beyond, obviously,
dietary recommendations and avoiding medicines like nonsteroidals, is to utilize
some of the novel, newer potassium binders, which we know have long-term safety
and efficacy data.

Dr. Butler:
Well, thank you both. This has been an important conversation. Before we wrap
up, maybe I can request both of you to give one take-home message. Dr. Weir, let
me start with you.

Dr. Weir:
Use guideline-based medical therapy and mitigate potassium problems.

Dr. Butler:
Dr. Kosiborod?

Dr. Kosiborod:
I think, probably in closing, what I will say is that there was a very important
recent publication in the journal The Lancet that tried to estimate just how
much of a benefit we can provide to patients with heart failure with reduced
ejection fraction if you use all of the evidence-based fundamental therapies in
HFrEF. And we’re talking about more than 6 years of life that we can give
somebody who has HFrEF and is age 65 years or older. That’s a remarkable gift,
and at least some of these treatments, patients won’t just live longer, but feel
better. But in order to do that, you have to use them, and in order to use them
and use them safely, you know, it first of all, of course, requires a lot of
emphasis in your clinical practice.

Dr. Butler:
Well, I cannot agree more with both of you, but unfortunately, that’s all the
time we have today. So I want to thank our audience for listening in, and thank
you both, to Dr. Weir and Dr. Kosiborod, for joining me and for sharing your
valuable insights and thoughts. It was a great time speaking with you today.

Dr. Weir:
Great pleasure. Thank you.

Dr. Kosiborod:
Thank you.

Announcer:
You have been listening to CME on ReachMD. This activity is provided by
Medtelligence.

To receive your free CME credit, or to download this activity, go to
ReachMD.com/Medtelligence. Thank you for listening.

Close
* Take Post-Test

Share this program on:
Facebook
Twitter
LinkedIn
Email
Choose a format
* Video
* Audio
* Podcast
* Transcript
* Transcript PDF

Take Post-TestSkip straight to the post-test if you have already participated in
this activity

Media formats available:
* Video
* Audio
* Podcast
* Transcript
* Transcript PDF

Formats
9
Save
Share
Take Post-TestSkip straight to the post-test if you have already participated in
this activity
0.50 credits
Completing the pre-test is required to view this content.
TAKE PRE-TEST
Completing the pre-survey is required to view this content.
TAKE PRE-SURVEY
Details
Presenters
Comments

* OVERVIEW

Renin-angiotensin-aldosterone system inhibition (RAASi) is the foundation of
guideline-directed medical therapy (GDMT) for heart failure patients.
However, due to practice gaps, a significant proportion of the population
requiring its use do not experience the benefits of RAASi therapy, which is
especially true for patients with comorbid conditions. Hyperkalemia is a
common adverse effect of RAASi therapy that needs to be anticipated and
mediated so that the optimal dosing of necessary medications can occur.
Maximizing GDMT in the face of hyperkalemia remains a key clinical challenge
that, if not handled properly, can result in increased morbidity and
mortality.

In this activity, Drs. Javed Butler, Mikhail Kosiborod, and Matthew Weir
review a patient case and discuss different treatment approaches to optimize
GDMT while managing hyperkalemia. Tune in to make sure you’re doing all you
can to improve outcomes for your patients with heart failure and comorbid
conditions.

* DISCLOSURE OF CONFLICTS OF INTEREST

In accordance with the ACCME Standards for Integrity and Independence, Global
Learning Collaborative (GLC) requires that individuals in a position to
control the content of an educational activity disclose all relevant
financial relationships with any ineligible company. GLC mitigates all
conflicts of interest to ensure independence, objectivity, balance, and
scientific rigor in all its educational programs.

Host:
Mikhail N. Kosiborod, MD
Professor of Medicine
Saint Luke's Hospital of Kansas City
Kansas City, MO
Research Grant: AstraZeneca, Boehringer Ingelheim
Consulting Fees: Amarin, Amgen, Applied Therapeutics, AstraZeneca, Bayer,
Boehringer Ingelheim, Eli Lilly, Glytec, Janssen, Merck (Diabetes), Novartis,
Novo Nordisk, Sanofi, Vifor Pharma
Other Research Support: AstraZeneca
Honorarium: AstraZeneca, Boehringer Ingelheim, Novo Nordisk

Faculty:
Javed Butler, MD, MBA, MPH
Professor & Chair, Department of Medicine
University of Mississippi Medical Center
Jackson, MS
Consulting Fees: Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer,
Boehringer Ingelheim, Bristol Myers Squibb, CVRx, G3 Pharmaceuticals, Impulse
Dynamics, Innolife, Janssen, LivaNova, Luitpold, Medtronic, Merck, Novartis,
Novo Nordisk, Relypsa, Roche, V-Wave Ltd., Vifor Pharma

Matthew R. Weir, MD
Division Head, Nephrology
University of Maryland
School of Medicine
Baltimore, MD
Consulting Fees: AstraZeneca, Boehringer-Ingelheim, Janssen, Merck, Relypsa,
Vifor Pharma

Reviewers/Content Planners/Authors:

* Sean T. Barrett has nothing to disclose.
* Megan Clem has nothing to disclose.
* Amanda Hilferty has nothing to disclose.
* Brian P. McDonough, MD, FAAFP, has nothing to disclose.
* Mario Trucillo, PhD, MS, has nothing to disclose.

* LEARNING OBJECTIVES

After participating in this educational activity, participants should be
better able to:

* Discuss the rationale for optimizing all recommended foundational
therapies for the management of heart failure (HF)
* Explain the synergistic effect of recommended therapies to improve HF
outcomes
* Describe different approaches to the management of hyperkalemia to enable
continued RAASi use

* TARGET AUDIENCE

This activity is designed to meet the educational needs of nephrologists,
primary care physicians, nurse practitioners, nurses, and all allied
healthcare professionals involved in the diagnosis and treatment of heart
failure and chronic kidney disease.

* ACCREDITATION AND CREDIT DESIGNATION STATEMENTS

In support of improving patient care, Global Learning Collaborative (GLC) is
jointly accredited by the Accreditation Council for Continuing Medical
Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE),
and the American Nurses Credentialing Center (ANCC), to provide continuing
education for the healthcare team.

Global Learning Collaborative (GLC) designates this enduring activity for a
maximum of .25 AMA PRA Category 1 Credits™. Physicians should claim only the
credit commensurate with the extent of their participation in the activity.

Global Learning Collaborative (GLC) designates this activity for 15 minutes
of nursing contact hours. Nurses should claim only the credit commensurate
with the extent of their participation in the activity.

* PROVIDER(S)/EDUCATIONAL PARTNER(S)

Our ultimate goal is to improve the care being delivered to patients, and our
high quality, evidence-based CME initiatives reflect our dedication to the
creation and execution of excellence and are the product of shared research,
knowledge, and clinical practice skills across the healthcare continuum.

* COMMERCIAL SUPPORT

This activity is supported by an independent educational grant from Vifor
Pharma.

* DISCLAIMER

The views and opinions expressed in this educational activity are those of
the faculty and do not necessarily represent the views of GLC and
Medtelligence. This presentation is not intended to define an exclusive
course of patient management; the participant should use his/her clinical
judgment, knowledge, experience, and diagnostic skills in applying or
adopting for professional use any of the information provided herein. Any
procedures, medications, or other courses of diagnosis or treatment discussed
or suggested in this activity should not be used by clinicians without
evaluation of their patients’ conditions and possible contraindications or
dangers in use, review of any applicable manufacturer’s product information,
and comparison with recommendations of other authorities. Links to other
sites may be provided as additional sources of information. Once you elect to
link to a site outside of Medtelligence you are subject to the terms and
conditions of use, including copyright and licensing restriction, of that
site.

Reproduction Prohibited
Reproduction of this material is not permitted without written permission
from the copyright owner.

* SYSTEM REQUIREMENTS

Our site requires a computer, tablet, or mobile device and a connection to
the Internet. For best results, a high-speed Internet connection is
recommended (DSL/Cable/Fibre). We also recommend using the latest version of
your favorite browser to ensure compliance with W3C standards, such as
Chrome, Safari, Firefox, or Microsoft Edge.

* PUBLICATION DATES

Release Date: 12/15/2021

Expiration Date: 12/15/2022

Presenters
Mikhail Kosiborod, MD
Javed Butler, MD, MBA, MPH
Matthew R. Weir, MD

FACEBOOK COMMENTS

Recommended
Details
Presenters
Comments

RECOMMENDED

NOW PLAYING

CME/CE

Synergy of Guideline-Directed Medical Therapies in Heart Failure to Optimize
Patient Outcomes

UP NEXT

* OVERVIEW

* DISCLOSURE OF CONFLICTS OF INTEREST

Matthew R. Weir, MD
Division Head, Nephrology
University of Maryland
School of Medicine
Baltimore, MD
Consulting Fees: AstraZeneca, Boehringer-Ingelheim, Janssen, Merck, Relypsa,
Vifor Pharma

Reviewers/Content Planners/Authors:

* LEARNING OBJECTIVES

After participating in this educational activity, participants should be
better able to:

* TARGET AUDIENCE

* ACCREDITATION AND CREDIT DESIGNATION STATEMENTS

* PROVIDER(S)/EDUCATIONAL PARTNER(S)

* COMMERCIAL SUPPORT

This activity is supported by an independent educational grant from Vifor
Pharma.

* DISCLAIMER

Reproduction Prohibited
Reproduction of this material is not permitted without written permission
from the copyright owner.

* SYSTEM REQUIREMENTS

* PUBLICATION DATES

Release Date: 12/15/2021

Expiration Date: 12/15/2022

Presenters
Mikhail Kosiborod, MD
Javed Butler, MD, MBA, MPH
Matthew R. Weir, MD

FACEBOOK COMMENTS

* Terms
* Privacy
* Mobile
* Newsroom
* Contact
* About
* FAQs
* Cookies

* Facebook
* Twitter
* Linked in
* Instagram

TITLE

close
Video Player is loading.
Play Video
Loaded: 1.78%

00:00
Previous
Current Time 0:00
/
Duration 14:58
FullscreenNextMinimizeRewind 10 secsPlayForward 10 secs
Mute

Restart

The Clinical Playbook: Team-based Integration of ADCs in Metastatic NSCLC

This is a modal window.

Beginning of dialog window. Escape will cancel and close the window.

TextColorWhiteBlackRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentBackgroundColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyOpaqueSemi-TransparentTransparentWindowColorBlackWhiteRedGreenBlueYellowMagentaCyanTransparencyTransparentSemi-TransparentOpaque
Font Size50%75%100%125%150%175%200%300%400%Text Edge
StyleNoneRaisedDepressedUniformDropshadowFont FamilyProportional
Sans-SerifMonospace Sans-SerifProportional SerifMonospace SerifCasualScriptSmall
Caps
Reset restore all settings to the default valuesDone
Close Modal Dialog

End of dialog window.

Close
Video Player is loading.
Advertisement

NEXT RECOMMENDED

PREVIOUS CHAPTER

NEXT RECOMMENDED IN 5

REPLAY PLAY NEXT
SKIP INTRO

* XDiscussion
* Player

ON AIRReachMD Radio

The Clinical Playbook: Team-based Integration of ADCs in Metastatic NSCLC

Save video to...

Watch Later

Create New PlaylistCancel

Create New Playlist

* Private
* Public

CancelCreate

SHARE ON REACHMD

Peer's name

Video Player is loading.
Play Video
Play
Mute

Current Time 0:00
/
Duration -:-
Loaded: 0%

Stream Type LIVE
Seek to live, currently playing liveLIVE
Remaining Time --:-
Playback Rate

1x
Chapters
* Chapters

Descriptions
* descriptions off, selected

Captions
* captions settings, opens captions settings dialog
* captions off, selected

Audio Track

Picture-in-PictureFullscreen

This is a modal window.

Beginning of dialog window. Escape will cancel and close the window.

End of dialog window.

SHARE ON REACHMD

Close
*

Share
ReachMD Radio

Schedule19 Sep 2022
PrevNext

SEGMENT CHAPTERS

PLAYLIST:

RECOMMENDED

NOW PLAYING

CME/CE

Synergy of Guideline-Directed Medical Therapies in Heart Failure to Optimize
Patient Outcomes

UP NEXT

CME/CE

The Role of Potassium Binders in Optimal HF Management: Discussing the DIAMOND
Study

Coming Together: Improving Global Care of Heart Failure

Addressing Unmet Needs in HER2-Low Breast Cancer Care

CME/CE

Expert Answers to Common Questions for Who’s at Risk? Preventing and Managing
Tumor Lysis Syndrome and Neutropenia in CLL

The COVID-19 Pandemic & Dangerous Delays in Cancer Screenings

CME/CE

Optimizing Treatment Selection and Side Effect Management in BRAF-Mutant
Melanoma

Getting to Know Gastroesophageal Reflux Disease

CME/CE

Opioid Epidemic and Rising Maternal HCV Rates: What You Need to Know.

You are now leaving ReachMD.com and going to a site run by another organization.

Press cancel to remain on ReachMD. Press the link below or the continue button
to keep going.

ContinueCancel
Webpack App

ABOUT YOUR PRIVACY

We process your data to deliver content or advertisements and measure the
delivery of such content or advertisements to extract insights about our
website. We share this information with our partners on the basis of consent and
legitimate interest. You may exercise your right to consent or object to a
legitimate interest, based on a specific purpose below or at a partner level in
the link under each purpose. These choices will be signaled to our vendors
participating in the Transparency and Consent Framework.
Allow All

MANAGE CONSENT PREFERENCES

STRICTLY NECESSARY COOKIES

Always Active
Strictly Necessary Cookies

These cookies are necessary for the website to function and cannot be switched
off in our systems. They are usually only set in response to actions made by you
which amount to a request for services, such as setting your privacy
preferences, logging in or filling in forms. You can set your browser to block
or alert you about these cookies, but some parts of the site will not then work.
These cookies do not store any personally identifiable information.

PERFORMANCE COOKIES

Performance Cookies

These cookies allow us to count visits and traffic sources so we can measure and
improve the performance of our site. They help us to know which pages are the
most and least popular and see how visitors move around the site. All
information these cookies collect is aggregated and therefore anonymous. If you
do not allow these cookies we will not know when you have visited our site, and
will not be able to monitor its performance.

FUNCTIONAL COOKIES

Functional Cookies

These cookies enable the website to provide enhanced functionality and
personalisation. They may be set by us or by third party providers whose
services we have added to our pages. If you do not allow these cookies then some
or all of these services may not function properly.

TARGETING COOKIES

Targeting Cookies

These cookies may be set through our site by our advertising partners. They may
be used by those companies to build a profile of your interests and show you
relevant adverts on other sites. They do not store directly personal
information, but are based on uniquely identifying your browser and internet
device. If you do not allow these cookies, you will experience less targeted
advertising.

STORE AND/OR ACCESS INFORMATION ON A DEVICE

Store and/or access information on a device

Cookies, device identifiers, or other information can be stored or accessed on
your device for the purposes presented to you.

List of IAB Vendors‎ | View Full Legal Text Opens in a new Tab

PERSONALISED ADS AND CONTENT, AD AND CONTENT MEASUREMENT, AUDIENCE INSIGHTS AND
PRODUCT DEVELOPMENT

Personalised ads and content, ad and content measurement, audience insights and
product development

* SELECT BASIC ADS

Required Cookies

Ads can be shown to you based on the content you’re viewing, the app you’re
using, your approximate location, or your device type.