Ricky Turgeon

Very similar to the ARB story

Yes those are the 2 options to create an indication: (1) compare to placebo when standard of care (SoC) contraindicated or (2) head2head vs SoC for OG indication. 1 "easier" & addresses a potentially bigger gap. I meant that 1 is ethically justifiable vs placebo instead of SoC, whereas 2 is not

Seeing this incl criterion ("cannot tolerate Spiro") a lot with ongoing nsMRAs/ASIs RCTs. Makes ethical sense since can't offer placebo in spiro-eligible pts, but usual problems are hyperK and dec eGFR; does any1 think these drugs will really be better tolerated? Spiro will not be usurped easily

It'd look like many cardiology drug CI/KM curves and would still impress many!

These results are unquestionably cool, but that might be the most egregiously misleading y axis I've ever seen. It feels like they are doing everything they can to obfuscate the absolute risk reduction here. When do we ever report cumulative incidence with raw event # on the y axis?

Use of a DOAC after a procedure undertaken because you couldn't take a DOAC, to prevent a complication from that procedure

🚨 Just published! This guideline provides multi-disciplinary clinical teams with practical recommendations for SGLT2is, MRAs, ARNI and drugs with GLP-1 receptor agonist activity.

Read the guideline here: onlinecjc.ca/article/S082...

#Cardiosky #HeartFailure

What if We Can't Rely on PubMed? - Absolutely Maybe PubMed is incredibly reliable. And a lot depends on it. It’s an ecosystem built around MEDLINE, the steady feed of new publications…

Also check out @hildabast.bsky.social post on PubMed alternatives

absolutelymaybe.plos.org/2025/02/14/w...

Not with the AI piece, but I find the device and its app very clunky

Comparison of Quadruple Therapy Sequencing Strategies for Heart Failure With Reduced Ejection Fraction | Journal of the American Heart Association

Comparison of Quadruple Therapy Sequencing Strategies for Heart Failure With Reduced Ejection Fraction | Journal of the American Heart Association www.ahajournals.org/doi/10.1161/...

And absolute risk reduction

DIGIT-HF + DIG pooled
(DIG: composite of all-cause death & HF hospitalization calculated using IPD since this endpoint was not originally reported in the trial manuscript):

a woman is wearing a santa hat and saying gretchen stop trying to make fetch happen it 's not going to happen ALT: a woman is wearing a santa hat and saying gretchen stop trying to make fetch happen it 's not going to happen

DIGIT-HF trial - more to say on this later, but my initial thoughts can be summarized in a classic gif. www.nejm.org/doi/full/10....

Differences in indications, contraindications, and prescribing patterns for heart failure between specialties: the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry

Differences in indications, contraindications, and prescribing patterns for heart failure between specialties: the VancOuver CoastAL Acute Heart Failure (VOCAL-AHF) registry
www.sciencedirect.com/science/arti...

Evening Blood Pressure Medication Administration and Cardiovascular Events: Systematic Review and Meta-Analysis Controversy persists whether evening administration of antihypertensive medications reduces cardiovascular events. We aimed to synthesize the randomized evidence comparing the risk of cardiovascular e...

Our meta-analysis that I presented at ESC last year now published & available open-access: Evening Blood Pressure Medication Administration and Cardiovascular Events: Systematic Review and Meta-Analysis - Canadian Journal of Cardiology onlinecjc.ca/article/S082...

Educational Strategies for Clinical Supervision of Artificial Intelligence Use | NEJM Many learners are more facile with the use of large language models in medicine than their supervisors are. The authors provide an approach to clinical supervision that can mitigate the perils and ...

🧠 In @nejm.org, Raja-Elie Abdulnour et al. warn: AI in medical training risks deskilling & mis-skilling. They propose DEFT-AI to teach critical thinking & safe human-AI collaboration. Verify, then trust.
📖 doi.org/10.1056/NEJM...
#ResearchEthics #MedicalEducation

Shared decision-making approach to type 2 diabetes management Objective To provide an online interactive decision aid to facilitate shared decision making in the context of medication choices for patients with type 2 diabetes mellitus (T2DM). Sources of informa...

Apropos of nothing today ;)
(One potential / my) Shared decision-making approach to type 2 diabetes management
www.cfp.ca/content/70/5...

Folic acid supplementation prevents phenytoin-induced gingival overgrowth in children - PubMed This study provides Class I evidence that folic acid supplementation, 0.5 mg/day, is associated with prevention of gingival overgrowth in children taking PHT monotherapy.

Does folate supplementation work here like it does for phenytoin in kids? pubmed.ncbi.nlm.nih.gov/21482950/

7/ Next steps include further validation & impact analysis. It could also be used in some clever analyses of RCTs to assess risk-based heterogeneity of treatment effect. Ultimately, this is a tool to inform patients with CAD of their prognosis: decisionaid.ca/cr-decide can be used for this now

Development and Validation of the CR-DECIDE Models to Predict Major Adverse Cardiovascular Events and Health Status in Stable Coronary Artery Disease Guidelines emphasize individualized care in the management of stable coronary artery disease (CAD). We aimed to develop and validate clinical prediction models for major adverse cardiovascular events ...

6/ The full paper describing the development & (internal & external) validation: www.cjcopen.ca/article/S258...
Highlights:
-Good discrimination internally & in ISCHEMIA
-Slight under-prediction of MACE in ISCHEMIA trial, esp in highest-risk group
-Net clinical utility vs treating all as high risk

5/ We developed models with all predictors & "reduced", simpler models with fewer, readily-available variables. Importantly for the health status models, replacing patient-reported QoL with CCS/NYHA class substantially worsened predictions; there's no substitute for eliciting directly from patients!

4/ We developed the MACE model in a BC-based registry (n=24,990) & the health status models in the APPROACH registry in AB (n=13,312)🇨🇦. We considered known predictors of MACE & CAD-related health status, including history, labs, & coronary anatomy

3/ Unlike with primary CV prevention, there are no widely-used risk calculators in patients with existing CAD to guide decision-making. Everyone with CAD is considered "high risk" with various features used to qualitatively de-risk/up-risk patients.

2/ We set out to develop a set of clinical prediction models ("risk calculators") to predict major adverse cardiovascular events (MACE) @3yr & health status @1yr in patients with stable CAD to help facilitate shared decision-making re: revascularization & secondary prevention medications

We made a new decision aid! Introducing CR-DECIDE: decisionaid.ca/cr-decide/
A brief 🧵 on how we developed it & how it can be used 1/7

Development and Validation of the CR-DECIDE Models to Predict Major Adverse Cardiovascular Events and Health Status in Stable Coronary Artery Disease Guidelines emphasize individualized care in the management of stable coronary artery disease (CAD). We aimed to develop and validate clinical prediction models for major adverse cardiovascular events ...

Development and Validation of the CR-DECIDE Models to Predict Major Adverse Cardiovascular Events and Health Status in Stable Coronary Artery Disease - CJC Open www.cjcopen.ca/article/S258...

ICE killed a Canadian man.

ACHIEVE trial - Spironolactone in Hemodialysis stopped early... due to futility 😢

I had some hopes for this one.
#ERA25

The Aldosterone Blockade for Health Improvement Evaluation in End-Stage Renal Disease (ACHIEVE) Trial: Rationale and Clinical Research Protocol - Michael Walsh, David Collister, Martin Gallagher, Patr... Background: The mineralocorticoid aldosterone may contribute to the risk of cardiovascular morbidity and mortality in patients receiving maintenance dialysis. W...

It's been a long journey but today we can share the methods and rationale for the #ACHIEVEtrial (Spiro vs placebo for patients with kidney failure receiving maintenance dialysis) and tomorrow we share the results at #era25
journals.sagepub.com/doi/10.1177/...

Figure of survival curve showing no difference

There you have it: BEDMED published in @jama.com

jamanetwork.com/journals/jam...

h/t @drjmluther.bsky.social

No difference in bedtime versus morning BP meds - as expected

#NephSky #Hypertension
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