Evaluation of Apixaban Use in Patients With Advanced Kidney Disease.

Current guidelines and literature suggest apixaban may be used in patients with severe kidney disease and atrial fibrillation (AF) for stroke and systemic embolism risk reduction (SSE) or patients with acute venous thromboembolism (VTE). Limited data is available for long-term safety and efficacy outcomes in this patient population. Evaluate the use of apixaban for AF or VTE in patients with advanced kidney disease.

Assessing the utility of pre-course assessment and voluntary pre-work in two required integrated pharmacotherapy courses.

Background And Purpose: Self-assessment and self-learning are essential skills for student pharmacists. Data demonstrating the association between these skills in pharmacy courses are limited. The aim of this study was to evaluate the impact of providing pre-course review and administering a pre-course assessment on performance in two required integrated pharmacotherapy (IP) courses - IP: Pulmonology and IP: Cardiology.

A Call to Action for a Programmatic Approach to Addressing Health Disparities and Cultural Competency in Pharmacy Education.

Pharmacy has recognized the importance of education in health disparities and cultural competency (HDCC) for two decades. More recently, there has been emphasis on incorporating equity, diversity, and inclusion (EDI) in pharmacy programs. While many institutions identify a need to incorporate a programmatic approach to HDCC education to meet the growing needs of a diverse population, pharmacy curricula continue to lack a holistic, programmatic approach.

The role of inflammation in the pathogenesis and treatment of arrhythmias.

The pathogenesis of arrhythmias is complex and multifactorial. The role of inflammation in the pathogenesis of both atrial and ventricular arrhythmias (VA) has been explored. However, developing successful pharmacotherapy regimens based on those pathways has proven more of a challenge.

Utilization of EKOS in Patients With Pulmonary Embolism.

Current guidelines recommend utilization of catheter-directed thrombolysis systems for management of patients with submassive pulmonary embolism (PE) who have relative contraindications to systemic thrombolysis. Evidence from previous trials have demonstrated the short-term efficacy and safety of one of these systems, the EkoSonic Endovascular System (EKOS). The objective of this study was to evaluate the long-term efficacy and safety of EKOS in submassive PE.

Key Points for Pharmacists From the ACC Expert Consensus Decision Pathway for Patients Hospitalized With Heart Failure.

Heart failure (HF) is a complex condition, and its clinical course often includes periods of decompensation that represent a deterioration in clinical status. During these periods, patients may experience worsening HF symptoms requiring hospitalization. Heart failure that necessitates hospitalization increases the risk of mortality and rehospitalization.

Inclusion of Health Disparities, Cultural Competence, and Health Literacy Content in US and Canadian Pharmacy Curriculums.

To determine how US and Canadian pharmacy schools include content related to health disparities and cultural competence and health literacy in curriculum as well as to review assessment practices. A cross-sectional survey was distributed to 143 accredited and candidate-status pharmacy programs in the United States and 10 in Canada in three phases. Statistical analysis was performed to assess inter-institutional variability and relationships between institutional characteristics and survey results.

Evaluation of the safety and tolerability of spironolactone in patients with heart failure and chronic kidney disease.

Background: Spironolactone reduces morbidity and mortality in patients with heart failure (HF) with reduced ejection fraction (EF) and decreases hospitalizations in HF with preserved EF. To minimize the risk of hyperkalemia, patients must have an estimated glomerular filtration rate (eGFR) > 30 mL/min/1.73 m and potassium < 5.

Predictors of Student Failure or Poor Performance on Advanced Pharmacy Practice Experiences.

To determine factors predictive of student failure or poor performance on advanced pharmacy practice experiences (APPEs) at a single pharmacy program. This retrospective cohort evaluated students entering the Doctor of Pharmacy (PharmD) program from 2012-2014 at St. Louis College of Pharmacy.

Flecainide is well-tolerated and effective in patient with atrial fibrillation at 12 months: a retrospective study.

Introduction: Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived.

Methods: This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site.

Assessment of a multi-institution integration of cultural competency activities.

Introduction: To meet educational standards and provide effective patient care, student pharmacists must be well-prepared to interact with a diverse patient population. Thus, the objective was to assess the effectiveness of four different active learning strategies in enhancing the cultural competency (CC) of student pharmacists at multiple institutions.

Methods: Across two years, eight colleges/schools of pharmacy integrated two sets of CC activities with different student cohorts (first-third professional year) that were designed to address different aspects of CC.

Evaluating the safety and tolerability of inpatient sacubitril/valsartan initiation in a community hospital.

: Sacubitril/valsartan has been incorporated into guidelines based on the results of the PARADIGM-HF trial, which demonstrated reduced mortality in stable patients with heart failure with reduced ejection fraction (HFEF). Sacubitril/valsartan is recommended in addition to other HF therapies in place of an angiotensin-converting-enzyme inhibitor or angiotensin-receptor-blocker. : To evaluate the safety and tolerability of sacubitril/valsartan initiation in a community hospital.

Evaluation of the Safety and Effectiveness of Direct-Acting Oral Anticoagulants in Patients with Atrial Fibrillation and Coexisting Valvular Heart Disease.

Background: Current guidelines recommend direct-acting oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF) and valvular heart disease (VHD) without a mechanical valve or moderate to severe mitral stenosis. However, real-world data to support the safety and efficacy of DOACs in this patient population are lacking.

Objective: Our objective was to assess the safety and effectiveness of DOACs in patients with AF and VHD.

Evaluation of the effect of prior antiarrhythmic drug use on the success of atrial fibrillation catheter ablation.

What Is Known And Objective: Current guidelines recommend catheter ablation (CA) for atrial fibrillation (AF) refractory to at least one antiarrhythmic drug (AAD), but do not specify an adequate number of AADs to be trialed prior to considering ablation. The objective of this study was to evaluate the effect of CA success based on the number of AADs failed in patients with paroxysmal or persistent AF.

Methods: This retrospective cohort study evaluated patients with paroxysmal or persistent AF who underwent an initial CA at a community hospital.

A rare case of a gabapentin-induced cardiomyopathy.

What Is Known And Objective: Gabapentin, a γ-aminobutyric acid derivative, is used for the treatment of partial onset seizures, postherpetic neuralgia, diabetic neuropathy and a host of other neurological disorders.

Case Description: A 44-year-old woman with spinal stenosis was prescribed gabapentin for pain. Two months after initiating therapy, she was diagnosed with a new-onset non-ischaemic cardiomyopathy with an ejection fraction of 36% measured on a transthoracic echocardiogram.

Evaluation of the impact of body mass index on warfarin requirements in hospitalized patients.

Background: Despite well established empiric dose adjustments for drug and disease-state interactions, the impact of body mass index (BM) on warfarin remains unclear. The objective of this study is to evaluate warfarin requirements in hospitalized patients, stratified by BMI.

Methods: This retrospective review included two cohorts of patients: cohort A (patients admitted with a therapeutic international normalized ratio (INR)) and cohort B (newly initiated on warfarin during hospitalization).

Evaluation of Apixaban for the Treatment of Nonvalvular Atrial Fibrillation With Regard to Dosing and Safety in a Community Hospital.

Apixaban, a direct factor Xa inhibitor, is approved by the US Food and Drug Administration (FDA) for prevention of stroke and systemic embolism in nonvalvular atrial fibrillation. Apixaban's compelling safety and efficacy data, combined with minimal laboratory monitoring, make it an attractive anticoagulant. To characterize and evaluate the dosing and safety of apixaban for the treatment of nonvalvular atrial fibrillation at a community hospital.

Comparative risk impact of edoxaban in the management of stroke and venous thromboembolism.

Edoxaban, a factor Xa inhibitor, was approved by the United States Food and Drug Administration in 2015 for stroke prevention in nonvalvular atrial fibrillation and treatment of venous thromboembolism. It is the fourth target-specific oral anticoagulant to be approved. Edoxaban is noninferior for efficacy compared to warfarin for both approved indications.

Extended-Duration Venous Thromboembolism Prophylaxis in Hospitalized Acutely Ill Medical Patients: A Review of the Evidence.

To evaluate the risks and benefits of extended-duration thromboprophylaxis (EDT) beyond hospitalization in acutely ill medical patients. PubMed was searched from inception (1946) through February 2015 for the search terms venous thrombosis/prevention and control, venous thromboembolism/prevention and control, anticoagulants, and aspirin. Relevant clinical trials evaluating pharmacologic strategies for EDT were screened for inclusion.

Edoxaban, a Novel Oral Factor Xa Inhibitor.

Objective: To evaluate the current literature and potential clinical role of edoxaban (Savaysa) for stroke prevention in nonvalvular atrial fibrillation (NVAF) and treatment of deep-vein thrombosis and pulmonary embolism.

Data Sources: A PubMed and Cochrane Central Register of Controlled trials search was conducted in February 2015 using the search terms edoxaban (ordu-176b) and atrial fibrillation, deep vein thrombosis, pulmonary embolism, or venous thromboembolism. Bibliographies of all retrieved articles were reviewed.

Evaluation of dabigatran for appropriateness of use and bleeding events in a community hospital setting.

Background: Warfarin has been the predominant anticoagulant for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation (NVAF). Its disadvantages are well-known and include a narrow therapeutic index, drug interactions, and the need for frequent monitoring. Dabigatran etexilate, a direct thrombin inhibitor, presents less complexity in prescribing and has emerged as an alternate therapy to warfarin.