Bridging the Gaps: A Patient-Centered Approach to Selecting Novel Oral Anticoagulants

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Bridging the Gaps: A Patient-Centered Approach to Selecting Novel Oral Anticoagulants

Eric J. Velazquez, MD, FACP, FACC, FASE, FAHA

Release Date: April 18, 2016
Expiration Date: April 17, 2017

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Activity Description

This 30-minute CME webinar will offer an overview of the 2014 AHA/ACC/HRS evidence-based guidelines, and the safety and efficacy of oral anticoagulants, as well as a case discussion focusing on the management of a patient with atrial fibrillation (AF), from assessing stroke risk, to identifying an optimal treatment strategy with the patient, and modifying therapy if adverse events occur.

In support of improving patient care, Duke University Health System Department of Clinical Education & Professional Development is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME), to provide continuing education for the health care team.

Jointly provided by the Duke University Health System Department of Clinical Education & Professional Development and Spire Learning.

This activity is supported by independent educational grants from Boehringer Ingelheim
Pharmaceuticals, Inc. and Daiichi Sankyo, Inc.

Learning Objectives
At the conclusion of this educational activity, participants should be able to:

Utilize stroke risk stratification outlined in evidence-based guidelines to select optimal oral anticoagulation therapy for AF patients
Calculate net benefit-risk of stroke prevention treatment in AF patients based on the safety and efficacy of oral anticoagulation therapy and individual patient profiles
Identify adverse events in AF patients due to oral anticoagulants and modify stroke prevention therapy in AF patients when appropriate
Employ shared decision making and educational tools to determine personalized stroke prevention regimens in AF patients

Faculty
Eric J. Velazquez, MD, FACP, FACC, FASE, FAHA
(Activity Medical Director)
Professor of Medicine
Chief, Cardiovascular Imaging Section
Director, Cardiac Diagnostic Unit &
Echocardiography Laboratories
Assistant Director, DCRI Clinical Trials
Duke University
Durham, NC

Faculty Biography
Eric J. Velazquez, MD, FACP, FACC, FASE, FAHA, is Professor of Medicine, Chief of the Cardiovascular Imaging Section, and Director of the Cardiac Diagnostic Unit and Echocardiography Laboratories at Duke University Health System in Durham, North Carolina. Dr Velazquez is also the Assistant Director of DCRI Clinical Trials at Duke Clinical Research Institute. He received his medical degree from the Albert Einstein College of Medicine of Yeshiva University in New York, and went on to complete a residency in Internal Medicine and fellowships in clinical cardiology, clinical research, and echocardiography at Duke University Medical Center.

Dr Velazquez’s research interests include the evaluation and management of heart failure, particularly with coronary artery disease, hypertension, valve disease, and cardiovascular imaging. He has led global clinical trial operations for numerous cardiovascular clinical trial programs. Dr Velazquez is the principal investigator for the Surgical Treatment for Ischemic Heart Failure (STICHES) Program funded by the National Heart, Lung, and Blood Institute (NHLBI). He recently completed serving as principal investigator for the NHLBI-funded Global Health Program for Chronic Cardiovascular Diseases in Eldoret, Kenya.

Dr Velazquez has co-authored over 250 peer-reviewed publications, including recent articles in The New England Journal of Medicine, Journal of the American Medical Association, Circulation, and European Heart Journal. He serves as Chair of the American Society of Echocardiography Task Force on International Echocardiography. Dr Velazquez is a reviewer for medical journals including the American Heart Journal, Circulation, and European Heart Journal. He is a Fellow of the American College of Physicians (ACP), American College of Cardiology (ACC), American Society of Echocardiography (ASE), and American Heart Association (AHA). In 2014, Dr Velazquez was inducted into the American Society of Clinical Investigation, an honor society dedicated to the advancement of research, translation of findings into clinical practice, and mentoring future generations of physician-scientists.

Activity Medical Director
The activity content was developed by Eric J. Velazquez, MD, FACP, FACC, FASE, FAHA.

Resolution Of Conflicts Of Interest
Duke University Health System Department of Clinical Education & Professional Development has implemented a process to resolve any potential conflicts of interest for each continuing education activity in order to help ensure content objectivity, independence, fair balance, and the content that is aligned with the interest of the public.

Disclosures
It is the policy of the Duke University Health System Department of Clinical Education & Professional Development to require the disclosure of anyone who is in a position to control the content of an educational activity. All relevant financial relationships with any commercial interests and/or manufacturers must be disclosed to participants at the beginning of each activity.

Staff and Content Validation Reviewer Disclosure
The staff involved with this activity and any content validation reviewers of this activity have reported no relevant financial relationships with commercial interests.

Content Validation Reviewer: Jonathan P. Piccini, MD, MHS
Educational Planning Committee: Byron Turner, M.Ed.

The following speakers and/or planning committee members have indicated that they have relationship(s) with industry to disclose:

Activity Faculty
Eric J. Velazquez, MD, FACP, FACC, FASE, FAHA
Consultant/Advisory Board: Alnylam Pharmaceuticals, Inc; Novartis Pharmaceuticals Corporation
Investigator: Abbott Laboratories; National Heart, Lung, and Blood Institute
Speaker Bureau: AHM Direct; Experts Exchange, LLC; ReachMD

Educational Planning Committee
Spire Learning
Christine Kocienda: Shareholder (Spouse/Partner): Johnson & Johnson; Procter & Gamble

The following planning committee member has indicated they have no relationship(s) with industry to disclose relative to the content of this CME activity:

Educational Planning Committee
Spire Learning
Erin Franceschini, MS: Nothing to disclose with regard to commercial support

Target Audience
Cardiologists, internists, family medicine physicians, primary care physicians, other specialists, nurse practitioners, physician assistants, nurses, and other clinicians in the hospital setting.

Accreditation
This activity has been planned and implemented by the Duke University Health System Department of Clinical Education & Professional Development and Spire Learning for the advancement of patient care. The Duke University Health System Department of Clinical Education & Professional Development is accredited by the American Nurses Credentialing Center (ANCC), the Accreditation Council for Pharmacy Education (ACPE), and the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing education for the health care team.

Duke University Health System Department of Clinical Education & Professional Development designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)^TM. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Method Of Participation

There is no fee for participating and receiving CME credit for this enduring activity, which should take approximately 30 minutes to complete. In order to receive full CME credit, participants must review the CME information, view the online activity and complete the online evaluation with a 70% passing score on the posttest. We cannot award credit unless all steps are completed.

Off-Label Statement

Duke University Health System Department of Clinical Education & Professional Development requires CME faculty (speakers) to disclose to attendees when products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not FDA approved); and any limitations on the information that is presented, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. This information is intended solely for continuing medical education and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent prescribing information. Faculty will be discussing information about pharmaceutical agents that is outside of U.S. Food and Drug Administration approved labeling. The following off-label uses are discussed:

Tranexamic acid for the management of oral anticoagulant bleeding

Levels of Evidence

Level A: Multiple populations evaluated.*
Data derived from multiple randomized clinical trials or meta-analyses.

Level B: Limited populations evaluated.*
Data derived from a single randomized trial or nonrandomized studies.

Level C: Very limited populations evaluated.*
Only consensus opinion of experts, case studies, or standard of care.

*Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use.

Source: Jneid H et al. Circulation. 2012;126:875-910.

Classification Of Recommendation
Class I: Benefit >>> Risk; Procedure/treatment should be performed/administered
Class IIa: Benefit >> Risk; Additional studies with focused objectives needed. It is reasonable to perform procedure/administer treatment
Class IIb: Benefit > Risk; Additional studies with broad objectives needed; additional registry data would be helpful.
Procedure/treatment may be considered
Class III No benefit: Procedure/test not helpful; treatment has no proven benefit
Class III Harm: Procedure/test has excess cost without benefit or harmful; treatment harmful to patient

Source: Jneid H et al. Circulation. 2012;126:875-910.

Disclaimer And Copyright Statement
The content and views presented in this educational activity are those of the presenter and do not necessarily reflect those of the Duke University Health System Department of Clinical Education & Professional Development, Spire Learning, Boehringer Ingelheim Pharmaceuticals, Inc., and Daiichi Sankyo, Inc. This material is prepared based upon a review of multiple sources of information, but it is not exhaustive of the subject matter. The information provided in this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

Copyright 2016 Spire Learning. All rights reserved. No part of this activity may be reproduced or transmitted in any other form or by any means electronic or mechanical without first obtaining written permission from Spire Learning or the Duke University Health System Department of Clinical Education & Professional Development.

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