Safety of Beta-Blocker Administration in STEMI Patients With Risk Factors for Cardiogenic Shock.

Beta-blockers are recommended in the first 24 hours after ST-segment elevation myocardial infarction (STEMI) except in those at risk of cardiogenic shock. This retrospective cohort study aimed to assess if early beta-blocker use was associated with cardiogenic shock development in STEMI patients. Cardiogenic shock was assessed in adult patients with STEMI undergoing percutaneous coronary intervention (PCI) with guideline defined risk factors for shock (age above 70 years, systolic blood pressure below 120 mmHg, and heart rate above 120 bpm or below 60 bpm) who did or did not receive a beta-blocker within 24 hours of PCI.

Use of Prophylactic or Therapeutic Anticoagulation in Critically Ill Patients With Pre-existing Atrial Fibrillation.

The optimal anticoagulation regimen for atrial fibrillation (AF) in critically ill patients is challenging as these patients may be at an increased risk for bleeding and clotting despite an absence or presence of anticoagulation. The purpose of this study was to compare bleeding and thrombotic rates in critically-ill adults with pre-existing AF receiving therapeutic anticoagulation versus chemical or mechanical venous thromboembolism prophylaxis. A retrospective, observational study was conducted.

A Practical Guide to Understanding and Treating Peripheral Artery Disease.

Peripheral arterial disease (PAD) is the third leading cause of atherosclerotic morbidity after coronary heart disease and stroke yet is widely underdiagnosed and undertreated. Treatment of risk factors such as diabetes and cigarette smoking can benefit patients with PAD. Patients should have adequate blood pressure and lipid control to decrease clinical manifestations and symptoms of PAD.

A systematic review of therapeutic enoxaparin dosing in obesity.

Enoxaparin is a hydrophilic drug with obesity having little effect on its apparent volume of distribution, therefore patients with obesity receiving standard 1 mg/kg dosing may be at a higher risk of supratherapeutic dosing. Conversely, dose reducing patients with obesity could place already at risk patients at higher risk of a thrombotic event. Data and recommendations are variable for the most appropriate weight-based dose of therapeutic enoxaparin in obese patients, particularly those a weight > 100 kg or a body mass index (BMI) ≥ 40 kg/m.

NAPLEX Preparatory Perceptions from Recent Graduates at One College of Pharmacy.

Objectives: The current study assessed how students prepared for the North American Pharmacist Licensure Examination (NAPLEX), and examined factors associated with first-time pass rates. In addition, updated information on student perceptions of several currently available NAPLEX preparation resources was collected.

Methods: A survey was administered to 2022 graduates from 1 school, which collected data on student demographics, and NAPLEX-related items regarding when the exam was taken and how students prepared, including resources used.

Implementation and Evaluation of a Residency Preparation Program for Fourth-Year Doctor of Pharmacy Students.

Objective: To describe the impact of a formal residency preparation program on student match rates, and to evaluate student-reported advisement activities and perceptions of the residency application process.

Methods: An optional, noncredit-bearing, residency preparation program was implemented in professional year 4 (PY4) of the Doctor of Pharmacy curriculum. The program consisted of 4 residency preparation presentations and/or workshops: curriculum vitae writing, navigating the residency application process and American Society of Health-Systems Pharmacy Midyear Clinical Meeting, letter of intent writing, and interview skills.

Comparison of bleeding and ischemic events with apixaban vs. rivaroxaban in triple antithrombotic therapy regimens.

Objective: To compare the risk of readmissions for major bleeding within one year between apixaban and rivaroxaban as a component of triple antithrombotic therapy.

Methods: This study was a multicenter, retrospective cohort study conducted at two academic medical centers in the Western New York and New York City region between July 1, 2011 and September 25, 2019. Adult patients were included if they were diagnosed with atrial fibrillation or venous thromboembolism and discharged on new triple antithrombotic therapy.

Impact of a pharmacist collaborative drug therapy management protocol on utilization of a discharge prescription program and hospital readmissions.

Purpose: To evaluate the impact of a collaborative drug therapy management (CDTM) agreement allowing a pharmacist to automatically prescribe refills of discharge medications to patients' preferred outpatient pharmacy on utilization of a hospital discharge prescription program and hospital readmission rates.

Methods: This was a single-center, quasi-experimental pre-post intervention study. Patients aged 18 years or older discharged from the cardiology services to home were eligible for inclusion in the study.

Effect of P2Y12 platelet reactivity level on peri- and postoperative outcomes of cardiac surgery patients.

Background: Evidence surrounding P2Y12 platelet reactivity units (PRU) impact on bleeding outcomes in patients undergoing coronary artery bypass is varied. This study sought to assess whether on-pump CABG procedures result in increased bleeding in patients with high compared to low PRUs.

Methods: This retrospective cohort study compared those with a PRU level ≤237 (low PRU group) to >237 (high PRU group).

A Retrospective Review of Cardiogenic Shock Development in Patients With ST-Elevation Myocardial Infarction and Percutaneous Coronary Intervention Receiving Early Beta-Blockers.

Beta-blockers (BBs) have proven to improve morbidity and mortality in patients after an ST elevation myocardial infarction (STEMI). Guidelines suggest initiating a BB within 24 hours, except in those with risk factors for developing cardiogenic shock, although published literature is conflicting regarding the true association of these risk factors with shock. This retrospective cohort study aimed to assess whether the presence of defined risk factors was associated with cardiogenic shock after early BB administration in patients with a STEMI and percutaneous coronary intervention.

Retrospective Study of Appropriate Primary Prevention in Postmenopausal Women Presenting with a Major Adverse Cardiovascular Endpoint (MACE).

Background: Postmenopausal women may be at an increased risk for cardiovascular events. The postmenopausal transition represents a key time for implementation of preventative strategies to reduce the risk of cardiovascular disease. The objective of this study was to evaluate the appropriate use of primary prophylaxis of cardiovascular disease in this population and to determine if an opportunity exists for improvement in primary prevention prescribing.

Neural Net Modeling of Checkpoint Inhibitor Related Myocarditis and Steroid Response.

Background: Serious but rare side effects associated with immunotherapy pose a difficult problem for regulators and practitioners. Immune checkpoint inhibitors (ICIs) have come into widespread use in oncology in recent years and are associated with rare cardiotoxicity, including potentially fatal myocarditis. To date, no comprehensive model of myocarditis progression and outcomes integrating time-series based laboratory and clinical signals has been constructed.

Comparison of Higher-Than-Standard to D-Dimer Driven Thromboprophylaxis in Hospitalized Patients With COVID-19.

Coronavirus disease 2019 is a global health threat often accompanied with coagulopathy. Despite use of thromboprophylaxis in this population, thrombotic event rates are high. This was a multicenter, retrospective cohort study comparing the safety and effectiveness of thromboprophylaxis strategies at 2 institutions in hospitalized patients with coronavirus disease 2019.

Combination Therapy of Ezetimibe and Rosuvastatin for Dyslipidemia: Current Insights.

Cardiovascular disease is one of the leading causes of death around the world with various efforts being made to reduce risk in patients through preventive measures. One major method for prevention has been managing cholesterol, particularly low-density lipoprotein to decrease atherosclerotic plaque burden, potentially decreasing future cardiac complications. Statins have been the gold standard therapy for hypercholesterolemia treatment due to their ease of dosing, limited drug interactions, and favorable safety profile.

Comparison of Bleeding Rates between Oral Anticoagulants in Combination with Dual Antiplatelet Therapy (Triple Therapy) in a Real-World Cohort.

Triple antithrombotic therapy including an anticoagulant, P2Y12 inhibitor, and aspirin increases bleed risk up to 27%. The components of this regimen can vary, which may impact bleed risk. To compare the safety of various triple antithrombotic regimens.

Early Versus Late Administration of P2Y 12 Inhibitors in Non-ST Segment Elevation Myocardial Infarction and Delayed Cardiac Catheterization.

Regardless of early invasive or ischemia-guided approaches to non-ST segment elevation myocardial infarction (NSTEMI) management, P2Y 12 inhibitors remain the backbone in therapy. The ideal timing of administration remains unclear. The purpose of this study was to determine the safety and effectiveness of early versus late administration of P2Y 12 inhibitors in patients presenting with an NSTEMI who go to the catheterization laboratory beyond 24 hours from presentation.

Comparison of Ischemic and Bleeding Events Between Short-Duration Versus Long-Duration Tirofiban Regimens in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention.

Tirofiban has been used historically as a bridge to platelet inhibition with clopidogrel in ST-segment myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) to prevent stent thrombosis. However, ticagrelor and prasugrel reach similar levels of platelet inhibition at 30 minutes to that of clopidogrel at 6 hours, challenging the need for long-duration tirofiban. This 1-year, retrospective cohort study compared ischemic and bleeding outcomes of short-duration versus long-duration tirofiban regimens in patients with STEMI who received ticagrelor or prasugrel at the time of PCI.

Implementation and Assessment of a Heart Failure Virtual Patient Simulation in a Required Pharmacotherapy Course.

To assess second year Doctor of Pharmacy students' academic performance in and perceptions of a heart failure (HF) virtual patient simulation used in a required pharmacotherapy course. A heart failure virtual patient simulation was created to augment heart failure pharmacotherapy course material at the University at Buffalo School of Pharmacy and Pharmaceutical Sciences in the fall of 2019. This was a retrospective, pre-post observational cohort study.

Clinical characteristics, time course, treatment and outcomes of patients with immune checkpoint inhibitor-associated myocarditis.

Background: Immune checkpoint inhibitors (ICI) have emerged as a front-line therapy for a variety of solid tumors. With the widespread use of these agents, immune-associated toxicities are increasingly being recognized, including fatal myocarditis. There are limited data on the outcomes and prognostic utility of biomarkers associated with ICI-associated myocarditis.

Evaluation of metoprolol versus diltiazem for rate control of atrial fibrillation in the emergency department.

Objective: The purpose of this study was to compare the effectiveness and safety of the metoprolol and diltiazem administration in the Emergency Department (ED) for rate control of supraventricular tachycardia.

Methods: This was a retrospective cohort study of adult patients who presented to the ED with ventricular rates ≥120 beats per minute (bpm) and who received bolus doses of either intravenous metoprolol or intravenous diltiazem. The primary outcome was achievement of rate control, defined as heart rate < 110 bpm, at two hours after administration of the last bolus dose of metoprolol or diltiazem.

COVID-19 pandemic: Challenges and solutions from the cardiology pharmacist's perspective.

The recent coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) challenges pharmacists worldwide. Alongside other specialized pharmacists, we re-evaluated daily processes and therapies used to treat COVID-19 patients within our institutions from a cardiovascular perspective and share what we have learned. To develop a collaborative approach for cardiology issues and concerns in the care of confirmed or suspected COVID-19 patients by drawing on the experiences of cardiology pharmacists across the country.

Inpatient Initiation of Sacubitril/Valsartan.

Objective: Discuss the literature and describe strategies to overcome barriers of inpatient initiation of sacubitril/valsartan in patients with heart failure with reduced ejection fraction (HFrEF).

Data Sources: A PubMed, EMBASE, and Google Scholar literature search (January 2014 to June 2020) limited to English language articles was conducted with the following terms: , , , , , , , , and .

Study Selection And Data Extraction: Included articles described inpatient initiation of sacubitril/valsartan or described its impact on BNP, NT-proBNP, diuretic dosing, or cost of care.

A probe for measuring current density during magnetic stimulation.

Time-varying magnetic fields induce currents in conductive media, and when the induced current is large enough in excitable tissue, stimulation occurs. This phenomenon has been applied to the human brain and peripheral nerves for diagnostic evaluation of the neural system. One important aspect that is presently unknown is the current level necessary in tissue for stimulation induced by magnetic fields.

Determination of tissue viability in experimental electrical injuries.

Electrical burns or ischemia (induced by vascular ligation) were produced in the legs of 15 anesthetized dogs to study evolution of tissue changes compared with impedance alterations. After the application of 1-ampere currents at 60 Hz, animals were monitored from 1 to 4 days. Muscle impendance was measured with frequency sweeping to determine tissue destruction.

Fibrillation induced at powerline current levels.

Electrical fibrillation of the human heart results in many unfortunate deaths. Because little information is available on short duration high current fibrillation, current levels below 1 and 50 A were used to induce ventricular fibrillation in hogs. Application times ranged between 16 ms and 3 s.