323 - CHFS SPOTLIGHT: WHAT TO DO WHEN PATIENTS FALL OUTSIDE OF CLINICAL TRIALS' INCLUSION CRITERIA?

Chair(s)

• 

  Margot Davis, MD, MSc, FRCPC (she/her/hers)

  Clinical Assistant Professor, University of British Columbia
  University of British Columbia
  University of British Columbia

Co-Chair(s)

• 

  Justin Ezekowitz, MBBCh MSc

  Professor of Medicine, Division of Cardiology, University of Alberta
  UNIVERSITY OF ALBERTA
  University of Alberta

Presenter(s)

• 

  Haya Aziz, MD, FRCPC

  Fellow, Advanced Heart Failure and Transplant Cardiology
  CHFS
  Duke University
• 

  Michael Diamant, MSc, MD, FRCPC (he/him/his)

  Clinical Assistant Professor, University of British Columbia
  CHFS
  University of British Columbia
• 

  Stephen Fremes, MD, FRCSC (he/him/his)

  Professor, Department of Surgery, University of Toronto
  University of Toronto
  Sunnybrook HSC, University of Toronto
• 

  Lisa Mielniczuk, MD, FRCPC

  Consultant, Division of Circulatory Failure, Department of Cardiovascular Medicine, Mayo Clinic
  Professor, Mayo Clinic College of Medicine
  University of Ottawa Heart Institute/The Ottawa Hospital-Department of Medicine

Planning Committee Member(s)

• 

  Aws Almufleh, MBBS, MPH, FRCPC, FASE, FACC

  Physician Lead of HF Clinic
  CHFS and CSE
  Queen's University
• 

  Haya Aziz, MD, FRCPC

  Fellow, Advanced Heart Failure and Transplant Cardiology
  CHFS
  Duke University
• 

  Michael Diamant, MSc, MD, FRCPC (he/him/his)

  Clinical Assistant Professor, University of British Columbia
  CHFS
  University of British Columbia

Workshop Description: Despite efforts to increase diversity in clinical research, some patient populations remain underrepresented in most contemporary clinical trials. Trial populations may therefore not be representative of all patients cared for in the real-world clinical setting, making it challenging to translate trial findings to day-to-day patient care.

The purpose of this workshop is to provide clinicians with a practical approach to the management of patients who are often excluded from most landmark clinical trials. The workshop will accomplish this by shedding light on a particularly understudied group at increased risk for significant morbidity and mortality: patients with heart failure with reduced ejection fraction (HFrEF) and co-existing chronic kidney disease (CKD).

Through a case-based presentation of a patient with newly diagnosed HFrEF, the audience will have the opportunity to reflect on their own clinical practice and follow the entire patient’s trajectory from the in-hospital diagnosis to the implementation of GDMT in the face of comorbidities such as progressive renal impairment and frequently encountered side-effects, to advanced HF therapy considerations across the spectrum of renal dysfunction.

Furthermore, in view of recent trial results, the workshop will discuss the role of coronary artery disease revascularization in patients with left ventricular dysfunction. This will be accomplished through a dynamic debate bridging the worlds of cardiac surgery and cardiology with experts in both fields. The debate will tackle important questions such as: What is the optimal timing of revascularization vs GDMT in the patient with HFrEF and multivessel coronary artery disease? What is the preferred method of revascularization? How do comorbidities such as advanced kidney disease impact the potential benefit from revascularization?

This is a highly interactive patient-centered workshop with speakers from diverse backgrounds including a trainee, early and senior career members with a wide range of experiences from community to academic clinical settings. Through its multidisciplinary nature, the workshop will equip audience members of all backgrounds with practical approaches for managing complex, high risk HF patients who have been largely underrepresented in cardiovascular clinical trials.

Interactive and Engagement Activities Description: We will incorporate ARS-based live polling between the presenters and audience to allow members to reflect on the patient case and consider their management strategies. A portion of the workshop will be in debate format addressing the topic of revascularization in HFrEF and multivessel disease. We have chosen this format given that clinical decisions in this context are often nuanced and the debate format will allow the audience to appreciate different perspectives from experts in the field as they tackle this important topic. Finally, our dedicated Q&A period will allow the audience to interact directly with panel members.

Presentations:

• 10:40 AM – 10:45 AM PT

  HYPERKALEMIA-RELATED HEART FAILURE THERAPY DISCONTINUATION AND ITS ASSOCIATION WITH ADVERSE OUTCOMES IN PATIENTS WITH HEART FAILURE: A POPULATION-BASED STUDY
  

  Presenter: Aanchel Gupta, MD (she/her/hers) – University Of Alberta