Disparities in health care disproportionally impact under-resourced and minority communities resulting in excess mortality and morbidity. Decreasing and eliminating these disparities will improve health statistics for all. The American College of Cardiology's (ACC) Health Equity Task Force is demonstrating its commitment to health equity through championing the improvement of patients’ lived experiences, population health, and clinician well-being while reducing health care costs—the Quadruple Aim of Health Equity.  

In this interview, Drs. Richard Chazal and Paul Douglass discuss Achieving Equitable Cardiovascular Care for All: ACC Board of Trustees Health Equity Task Force Action Plan.  

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Medical therapy is critical in preventing the worst complications of peripheral artery disease (PAD), among them heart attack, stroke, bleeding risk, and leg disease, which could lead to acute limb ischemia and amputation. Blood thinning medications (antithrombotic therapy) have shown rapid evolution and broad benefits and novel approved strategies that improve outcomes are available. It is imperative that clinicians select appropriate patients for use and consider the complex situations for management. 

In this interview, Drs. Cindy Grines and Marc Bonaca discuss Antithrombotic Strategies for Patients with Peripheral Artery Disease: JACC Scientific Statement. 

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The goal of the ABYSS (Assessment of Beta-Blocker Interruption 1 Year After an Uncomplicated Myocardial Infarction on Safety and Symptomatic Cardiac Events Requiring Hospitalization) trial was to evaluate beta-blocker interruption compared with beta-blocker continuation after an uncomplicated myocardial infarction (MI). Although the efficacy of beta blockers on decreasing mortality has diminished in the reperfusion era in patients without heart failure, this class of well tolerated drugs  remain useful to decrease the rate of rehospitalization in patients who have suffered MI. 

 In this interview, Drs. Deepak Bhatt and Johanne Silvain discuss the results of ABYSS and beta blocker interruption in patients with prior MI. 

 References: 

1. Silvain J, Cayla G, Ferrari E, et al., for the ABYSS Investigators of the ACTION Study Group. Beta-Blocker Interruption or Continuation After Myocardial Infarction. N Engl J Med 2024;Aug 30:[Epub ahead of print]. 

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It is imperative that clinicians understand the differences in each patient and how effective therapies must be individualized and often combined to treat patients with varying profiles. Efforts to unify heart failure across the ejection fraction and rebrand "heart failure" to "heart success" may be achieved by better understanding patients to prevent progression to stage C or D.  

In this episode, Dr. Jim Januzzi interviews guideline author Dr. Lynne Stevenson on the importance of understanding the optimal evaluation and management of patients with heart failure.  

This podcast is part of the Heart Failure & SGLT2is: The New Pillar in Care grant initiative. 

In this interview, Vidhu Anand, MD, FACC, and Alison L. Bailey, MD, FACC, provide a comprehensive exploration of Low Flow-Low Gradient Aortic Stenosis, shedding light on its definition and exploring treatment approaches for patients with HF. 

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With EMPACT-MI being presented at ACC, the definitive study of an additional agent (empagliflozin) will allow for a great discussion on options for patients who have acute MI and evidence of heart failure. 

In this interview, Schuyler Jones, MD FACC, and Purvi Parwani, MBBS, MPH, FACC discuss Not the Same Old 5 Medications: Contemporary GDMT Algorithm in the Post-MI Patient. 

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High levels of Lp(a) impact approximately 1 in 5 individuals globally, signaling an elevated risk of heart attacks, strokes, and valve disease. How should clinicians navigate this challenge, given the current lack of specific treatment options? 

 In this interview, Raul Santos MD, PhD, and Sun Moon Kim MD, FACC discuss strategies to lowering an elevated Lp(a) based on current evidence and available treatments. 

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Understanding the etiology of left ventricular hypertrophy is increasingly important due to the increasing number of targeted therapies coming online. This discussion provides a high-level approach to differentiating important causes of increased wall thickness. 

 In this interview, Timothy C. Wong, MD, MS, FACC and Sidney C. Smith Jr., MD, MACC discuss pitfalls in the diagnosis of HCM. 

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Incorporating spiritual evaluation into medical science is worth consideration. The presence of edifying emotions can potentially yield positive effects on hypertension treatment outcomes. 

In this interview, Maria Emília Figueiredo Teixeira, MD, PhD and Sidney C. Smith Jr., MD, MACC discuss the primary findings uncovered by the Feel Trial. 

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If there were a pill that could lower blood pressure, lower LDL cholesterol, improve erectile function and lower cardiovascular risk, would you take it? Good, because we already have it, and it comes pre-packaged in plant-based foods. 

In this interview, Robert Ostfeld MD, MSc, FACC and Alison L. Bailey, MD FACC explore the vital link between nutrition and cardiovascular health. 

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Hypertrophic cardiomyopathy (HOCM) often goes unnoticed, yet as awareness grows, patients may find themselves more symptomatic than expected. How do doctors and patients navigate the array of management options, from medications to minimally invasive procedures or open-heart surgery? Discover what options offer the best chance for patients to feel their best, or even achieve a sense of normalcy, with minimal risk and hassle. 

In this interview, Srihari S. Naidu, MD, FACC and Cindy L. Grines, MD, FACC, discuss HOCM: Selecting the Right Meds and Procedures. 

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Premature ventricular contractions (PVCs), commonly experienced as palpitations from occasional skipped heartbeats, are typically benign but can escalate to severe symptoms or heart failure in individuals with a high PVC burden. Understanding the most effective diagnostic tests for quantifying PVCs is crucial for guiding appropriate management strategies. 

In this interview, Jim Cheung MD, FACC and Anthony N. DeMaria MD, MACC discuss PVC burden and its temporal variability. 

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Patients can benefit from better healthcare access and outcomes by services that are enabled by artificial intelligence (AI). The current state of technology is evolving to now allow diagnosis of advanced conditions from simple diagnostic testing, broadening the scope of early diagnosis and treatment.  

What are the safe cards for the deployment of AI in real-world clinical care? In this interview, Drs. DJ Lakkireddy and Rohan Khera discuss Transforming Cardiovascular Care With Artificial Intelligence: From Discovery to Practice: JACC State-of-the-Art Review. 

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Individuals from lower socioeconomic status (SES) backgrounds face heightened risks of morbidity and mortality, particularly in the context of health conditions such as cardiovascular disease. Despite this increased vulnerability, they often face barriers to accessing crucial secondary prevention programs, such as cardiac rehabilitation. How can we bridge this gap and ensure that these vulnerable patients receive the support they urgently need? 

In this interview, Diann Gaalema, PhD and Anthony N. DeMaria, MD, MACC discuss financial incentives to improving cardiac rehab participation. 

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In this interview, Stephen Greene, MD, FACC and Sidney C. Smith Jr., MD, MACC discuss inpatient initiation of HF GDMT. 

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Why should we assess plaque burden beyond luminal narrowing for cardiac prevention?   

In this interview, Andrew Choi, MD, FACC and Clyde W. Yancy, MD, MSc, MACC discuss insights from data and studies involving plaque burden, morphology and flow. 

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The most common congenital heart defect, congenital BAV, affects 1% of the population (2% in men, 0.5% in women), with a male-to-female ratio of 2:1 to 3:1. It's characterized by diverse phenotypic expressions and outcomes, falling into two prognostic groups: 

1. Typical valvulo-aortopathy: Most common, with progressive BAV dysfunction and/or aorta dilatation but long-term survival similar to the general population. 

1. Complex valvulo-aortopathy: Associated with significant concomitant disorders and/or accelerated valvulo-aortopathy, leading to inferior long-term survival. 

BAV is a lifelong clinical condition with a morbidity burden exceeding 80%. Common complications include progression to ≥ moderate AS or AR, native aortic valve surgery, aortic aneurysm, surgery for aortic aneurysm, surgery for coarctation of the aorta, infective endocarditis, and aortic dissection.

In this interview, Hector I. Michelena, MD, FACC and W. Douglas Weaver MD, MACC discuss the history of and complications associated with bicuspid valvuloaortopathy. 

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Discover how detection of coronary artery calcium can greatly enhance risk prediction and risk mitigation, making it a critical tool for clinicians aiming to personalize patient care and prevent future cardiac events. 

In this interview, Michael D. Shapiro, DO, FACC and Roger S. Blumenthal MD, FACC explore CAC scoring and the role of calcium detection in tailoring patient care, personalized risk assessment, and the prevention of future cardiac events. 

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In this interview, Leslie Cho, MD, FACC, and Steven E. Nissen MD, MACC explore the nuances of estrogen and testosterone replacement: who benefits, when to consider it, and how long it should last. 

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Ticagrelor monotherapy following one month of dual antiplatelet therapy (DAPT) outperforms 12-month DAPT (aspirin and ticagrelor) post PCI for reducing clinically meaningful bleeding with no increased thrombotic risk.

In this interview, Gregg W Stone MD, FACC and Anthony N. DeMaria MD, MACC discuss principal results from the Ultimate DAPT Trial.

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Other ACC resources on DAPT and bleeding risk:

1.      One-Month Ticagrelor Monotherapy After PCI in Acute Coronary Syndromes - IVUS-ACS/ULTIMATE-DAPT

2.      Study Suggests Most Patients with Acute Coronary Syndromes Can Safely Stop Aspirin One Month After Percutaneous Coronary Intervention

3.      ACC.24 Presentation Slides | ULTIMATE-DAPT

The Be Active trial demonstrates the efficacy of scalable interventions, incorporating remote monitoring and behavioral economics, in boosting physical activity among high-risk cardiovascular patients. Lasting effects were observed even six months post-intervention. While additional data may be warranted for some stakeholders, these interventions hold promise as integral components of exercise-based prevention strategies for cardiovascular disease. 

In this interview, Alexander Fanaroff, MD, MHS and Glenn A. Hirsch MD, MHS, FACC discuss results from the Be Active RCT. 

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The VICTORION-INIATATE study demonstrated that initiating inclisiran, a highly potent lipid-lowering therapy, upon failure to achieve lipid targets with statins, yielded superior outcomes compared to standard care. This approach facilitated a greater proportion of patients in reaching LDL-C targets recommended by current guidelines. Presently, the conventional management of cholesterol disorders in the US routinely falls short of attaining treatment goals for the majority of patients. 

In this interview, Michael J. Koren, MD, FACC, and C. Noel Bairey Merz, MD, FACC discuss results from the VICTORION-INITIATE randomized trial. 

Heart failure is an increasingly recognized complication in chronic diabetes that may be caused by a number of processes including direct effects of hyperglycemia on the heart muscle. So-called diabetic cardiomyopathy may affect up to 20% of people with chronic diabetes and represents a unique target for treatment. 

 In this interview, James Januzzi, MD, FACC, and Alison L. Bailey, MD FACC discuss the primary results from the ARISE-HF study: Selective Aldose Reductase Inhibitor For Diabetic Cardiomyopathy. 

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Can algorithms improve the management of patients with myocardial injury? Is there a tool to aid diagnosing patients faster and more accurately leading to appropriate treatment sooner to optimize results? This study highlights the challenges and opportunities associated with the integration of artificial intelligence (AI) into health care to improve outcomes. 

In this interview, Drs. Allen Taylor and Derek Chew discuss the findings of the RAPIDxAI trial: re-engineering the clinical approach to suspected cardiac chest pain assessment in the emergency department by expediting evidence to practice using AI. 

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It's becoming increasingly evident that alongside top-notch clinical expertise, the CV specialist of the future must be surrounded by a multi-talented, diverse team to provide optimal patient care. In addition, it is crucial that the clinician and CV organization engage in non-clinical competencies to enhance value for patients, the healthcare system, and society. MedAxiom and ACC collaborate synergistically toward achieving these goals. 

In this interview, Jerry Blackwell MD, MBA, FACC and Joseph E. Marine MD, MBA, FACC, discuss The Future of Cardiology - Value-Based Care, Private Equity and the Practice Landscape. 

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Patients with acute myocardial infarction are at a high risk of heart failure and death. Despite advances in care and reduction in the rate of recurrent myocardial infarctions, the risk for heart failure continues to be unacceptably high. No intervention in 2 decades has been shown to improve this risk. 

 In this interview, Javed Butler, MD, MPH, MBA, and Sun Moon Kim, MD, FACC, discuss the results of the EMPACT-MI trial. 

About half of patients with chronic heart failure have an ejection fraction >40%. Therapy for patients in this group has been challenging until recently; few therapies have been effective in improving clinical outcomes in this population. Recently, data from several clinical trials of SGLT2 inhibitors, mineralocorticoid receptor antagonists (MRA), Angiotensin-receptor neprilysin inhibitors (ARNI), and GLP-1 receptor agonists, however, have offered potential for targeted therapy in this population. Meanwhile, device therapy continues to evolve for this group.  

 In this interview, Clyde W. Yancy, MD, MSc, MACC, and Akshay S. Desai, MD, MPH, discuss How to Manage Heart Failure With Preserved Ejection Fraction: Practical Guidance for Clinicians. 

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Aortic valve disease is often identified too late before clinicans can provide meaningful prevention. 

Identifying aortic valve calcium opens the door for potential prevention of progression: a phenotype researchers could build randomized controlled trials around. 

In this interview, Richard A. Chazal MD, MACC and Michael J. Blaha, MD, MPH discuss Prevalence of Aortic Valve Calcium and the Long-Term Risk of Incident Severe Aortic Stenosis. 

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After a heart attack, it is important to lower cholesterol levels to prevent future heart attacks. Monitoring cholesterol levels on treatment is just as important as monitoring blood pressure levels on treatment to make sure that the medicines are having the desired effect. 

In this interview, C. Noel Bairey Merz, MD, FACC, and Vera Bittner, MD, MSPH, FACC, discuss Low-Density Lipoprotein Cholesterol Testing Following MI Hospitalization Among Medicare Beneficiaries. 

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This episode covers a review on disparities in cardiovascular perioperative health care. The writers propose actionable solutions utilizing multidisciplinary perspectives from cardiology, cardiac surgery, cardiothoracic anesthesiology, critical care, medical ethics, and health disparity experts. 

In this interview, Adam J. Milam, MD, PhD, and Clyde W.Yancy, MD, MSc, MACC, discuss the JACC State-of-the-Art Review: Racial and Ethnic Disparities in Perioperative Health Care Among Patients Undergoing Cardiac Surgery. 

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Cardiac imaging is increasingly used in the workup of coronary artery disease, with growth greatest for CCTA and with falling use of SPECT. Because of the low cost of computed tomography, this growing use of imaging has had only a small impact on cost of provision of diagnostic imaging in this population. 

In this interview, Jonathan R. Weir-McCall, PhD, and Christopher M. Kramer, MD, FACC, discuss From JACC: National Trends in Coronary Artery Disease Imaging: Associations With Health Care Outcomes and Costs. 

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In this interview, José A. Joglar, MD, FACC, and Joseph E. Marine MD, MBA, FACC, discuss the top takeaways from the latest atrial fibrillation (AFib) guideline, which provides new and updated recommendations for preventing and optimally managing AFib. 

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A study provides new data for patients with genetic heart disease (GHD) and exercise recommendations. For decades, those with GHD were excluded from exercise and sports participation. This has led to poor exercise tolerance, increased risk for CAD and poor outcomes in this group related to reduced fitness.  This study helps frame that those with GHD are unique and as a result, require an individualized approach to care. After expert consultation, patients with GHD can often be safe to participate in exercise including competitive sports. This is a first step in the direction of understanding the role of exercise in GHD in the care of patients who wish to exercise. 

In this interview, Katherine Martinez, and Matthew Martinez MD, FACC, discuss From JACC: Return-to-Play for Elite Athletes With Genetic Heart Diseases Predisposing to Sudden Cardiac Death. 

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Continuous cardiac monitoring detects brief, asymptomatic, heart rhythm abnormalities in one-third of older individuals and these symptoms are associated with an increased risk of stroke. 

The ARTESiA trial clearly demonstrates that use of the blood thinner apixaban reduces patient risk of stroke compared to treatment with aspirin, but is associated with an increased risk of bleeding. 

In this interview, Jeff S. Healey, MD, and Thomas F. Deering MD, FACC, discuss AHA Late-Breaker: Apixaban for the Prevention of Stroke in Patients With Subclinical Atrial Fibrillation. 

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The BedMed and BedMed-Frail trials assisted in providing clarity as to the daily timing of prescribed blood pressure medication. The two trials, one conducted in a general primary-care population and the other among nursing-home residents, determined no difference in major cardiovascular events or safety between blood pressure (BP) medication distribution in the evening or morning. 

 In this interview, Drs. Anthony DeMaria and Scott Garrison review the BedMed and BedMed-Frail trials findings which proved the emphasis to patients is taking BP medication when they are least likely to forget, irrelevant of time of day.  

References: 

1. Pigazzani F, Dyar KA, Morant SV, et al. Effect of timed dosing of usual antihypertensives according to patient chronotype on cardiovascular outcomes: the Chronotype sub-study cohort of the Treatment in Morning versus Evening (TIME) study. EClinicalMedicine 2024;72:102633.  

1. Mackenzie IS, Rogers A, Poulter NR, et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022;400:1417-25.  

1. Hermida RC, Crespo JJ, Dominguez-Sardina M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J 2020;41:4565-76.  

1. Hermida RC, Ayala DE, Fernandez JR, et al. Administration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. Chronobiol Int 2013;30:280-314.  

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The 2023 guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. In this interview, Kristin Newby, MD, FACC, and Nanette Kass Wenger MD, MACC, discuss Behind the ACC 2023 Guideline for Chronic CAD: Conversations and Controversies. 

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To improve our understanding of the basic principles in the treatment and management of patients with chronic heart disease, in this interview, Salim S. Virani, MD, PhD, FACC, and Roger S. Blumenthal, MD, FACC, discuss top takeaways from the ACC 2023 Guideline for Chronic CAD. 

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Patients with worsening heart failure are at an extraordinarily high risk for mortality and readmission. Early identification and optimal management of these patients can significantly improve patient outcomes. Several clinical trials in these patients have shown benefit with various therapies. 

In this interview, Javed Butler, MD, MPH, MBA, FACC, and Matthew Martinez, MD, FACC, discuss Management of Worsening Heart Failure with Reduced Ejection Fraction. 

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The SELECT trial extends findings from previous trials, which demonstrated cardiovascular benefit in diabetes mellitus (DM), to those without DM. In this interview, Abraham Lincoff, MD, FACC, and Glenn A. Hirsch MD, MHS, FACC, discuss AHA Late-Breaker: SELECT – Semaglutide and Cardiovascular Outcomes in Patients with Overweight or Obesity Who Do Not Have Diabetes. 

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In this review, authors discuss how multimodality imaging can help to evaluate the left ventricular remodeling response and improve risk stratification in patients with moderate aortic stenosis.  

In this interview, Jeroen J Bax, MD, PhD, FACC, and Matt Cavender, MD, MPH, FACC, discuss JACC review, Managing Patients With Moderate Aortic Stenosis. 

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In this interview, Andrew Kates, MD, FACC, and Alison L. Bailey, MD, FACC, discuss the top takeaways in general cardiology from 2023 including ARAMIS, ORBITA-2, and STOP-CA trials. 

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While we know that statin treatment reduces the risk of stroke, heart attack and heart deaths in people at moderate-to-high risk, or with high cholesterol, in REPRIEVE statins decreased the risk in those at low-to-moderate risk, and with 'normal' cholesterol levels who would not usually be considered candidates for treatment. 

 In this interview, Pamela S. Douglas, MD, MACC, and Roger S. Blumenthal MD, FACC, discuss Pitavastatin to Prevent Cardiovascular Disease in HIV Infection. 

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In this interview, Dhanunjaya “DJ” Lakkireddy, MBBS, FACC, and Alison L. Bailey, MD, FACC discuss the top takeaways from 2023 in cardiac electrophysiology including AF and the latest guidelines and ARTESIA and MONITOR-AF studies.  

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In this interview, Noel Bairey Merz, MD, FACC, and Alison L. Bailey, MD, FACC discuss the top takeaways from 2023 in Preventive Cardiology including the CLEAR-Outcomes, REPRIEVE, and SELECT trials.  

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In this interview, Clyde Yancy MD, MSc, FACC, and Alison L. Bailey MD, FACC, discuss the Top Takeaways from 2023 in Heart Failure. Dr. Yancy discusses trials including STEP-HFpEF, SELCT and DELIVER. 

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The BedMed and BedMed-Frail trials assisted in providing clarity as to the daily timing of prescribed blood pressure medication. The two trials, one conducted in a general primary-care population and the other among nursing-home residents, determined no difference in major cardiovascular events or safety between blood pressure (BP) medication distribution in the evening or morning. 

In this interview, Drs. Anthony DeMaria and Scott Garrison review the BedMed and BedMed-Frail trials findings which proved the emphasis to patients is taking BP medication when they are least likely to forget, irrelevant of time of day.  

References: 

1. Pigazzani F, Dyar KA, Morant SV, et al. Effect of timed dosing of usual antihypertensives according to patient chronotype on cardiovascular outcomes: the Chronotype sub-study cohort of the Treatment in Morning versus Evening (TIME) study. EClinicalMedicine 2024;72:102633.  

1. Mackenzie IS, Rogers A, Poulter NR, et al. Cardiovascular outcomes in adults with hypertension with evening versus morning dosing of usual antihypertensives in the UK (TIME study): a prospective, randomised, open-label, blinded-endpoint clinical trial. Lancet 2022;400:1417-25.  

1. Hermida RC, Crespo JJ, Dominguez-Sardina M, et al. Bedtime hypertension treatment improves cardiovascular risk reduction: the Hygia Chronotherapy Trial. Eur Heart J 2020;41:4565-76.  

1. Hermida RC, Ayala DE, Fernandez JR, et al. Administration-time differences in effects of hypertension medications on ambulatory blood pressure regulation. Chronobiol Int 2013;30:280-314.  

Subscribe on Apple Podcasts | Subscribe on Google Play | Subscribe to ACCEL 

In this interview, Christopher M. Kramer MD, FACC, and Alison L. Bailey MD FACC, discuss the Top Takeaways from 2023 in CV Imaging. Dr. Kramer discusses the PRECISE trial, AI evolution in imaging and more. 

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In this interview, Deepak Bhatt, MD, FACC, and Alison L. Bailey, MD FACC, discuss Top Takeaways from 2023 in Interventional Cardiology. Dr. Bhatt discusses trials including FIRE, MULTISTARS, and TRILUMINATE.  

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ORBITA-2 was designed to test whether stents reduce angina more than a placebo procedure in patients with single or multivessel disease on little or no antianginal medication at 12 weeks of follow up.

In this interview, Christopher Rajkumar, MD, Rasha Al-Lamee, MD, and William E. Boden MD, FACC, discuss AHA Late-Breaker: Percutaneous Coronary Intervention for Stable Angina (ORBITA-2): A Randomized, Placebo-Controlled Trial.

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The goal of the TIGHT K trial was to evaluate if prescribing relaxed control of potassium levels and only giving supplements in the rare event that levels became pathologically low was equally as effective in preventing atrial fibrillation (AFib) after cardiac surgery as tightly controlling levels.  

In this interview, Drs. Steven Nissen and Benjamin O’Brien discuss the TIGHT K trial results which proved that practitioners can safely cease the widespread practice of maintaining high-normal potassium levels after isolated coronary artery bypass grafting surgery. Additional benefits include improved tpatient experience and reduced patient cost. 

References: 

1. O’Brien B, Campbell NG, Allen E, et al; TIGHT K Investigators. Potassium supplementation and prevention of atrial fibrillation after cardiac surgery: the TIGHT K randomized clinical trial. JAMA 2024;332:979-88. 

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