ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research

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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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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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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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 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 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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The goal of the SENIOR RITA trial was to evaluate routine invasive therapy compared with conservative therapy among older patients with non–ST-elevation myocardial infarction. Additionally, the trial assessed whether optimal medical therapy or coronary angiography and stents are beneficial in older adults with heart attacks. 

In this interview, Drs. Nanette Kass Wenger and Vijay Kunadian discuss the SENIOR RITA trial results and the importance of individualizing routine invasive therapy in individuals ≥75 years of age. 

References: 

1. Kunadian V, Mossop H, Shields C, et al., for the British Heart Foundation SENIOR-RITA Trial Team and Investigators. Invasive Treatment Strategy for Older Patients With Myocardial Infarction. N Engl J Med 2024;Sep 1:[Epub ahead of print]. 

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Fasting is a routine part of preparing for a heart procedure. Research found through the SCOFF trial suggests that for certain procedures, removing the need to fast is safer and more comfortable for patients. 

 In this interview, Drs. Roxana Mehran and David Ferreira discuss new evidence from the SCOFF trial and the possibility of reconsidering fasting requirements in clinical guideline. 

 References: 

1. Ferreira D, Hardy J, Meere W, et al. Safety and care of no fasting prior to catheterization laboratory procedures: a non-inferiority randomized control trial protocol (SCOFF trial). Eur Heart J Open 2023;3:oead111. 

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The RESHAPE-HF2 (Randomized Investigation of the MitraClip Device in Heart Failure [HF]: Second Trial in Patients With Clinically Significant Functional Mitral Regurgitation [MR]) trial assessed the safety and efficacy of mitral transcatheter edge-to-edge repair (M-TEER) using MitraClip among symptomatic HF patients with secondary MR. The results of this trial indicate that M-TEER using the MitraClip on a background of maximally tolerated guideline-directed medical therapy (GDMT) was superior to GDMT alone in reducing HF hospitalization and mortality at 2 years in symptomatic HF patients with grade 3-4+ MR. 

 In this interview, Drs. Sidney Smith and Stefan Anker discuss the benefits of RESHAPE-HF2, including reduction in HF hospitalization (particularly among those with a history of HF hospitalization within the past year), significant quality-of-life improvements, and other patient-centered outcomes. 

 References: 

1. Anker SD, Friede T, von Bardeleben RS, et al., for the RESHAPE-HF2 Investigators. Transcatheter Valve Repair in Heart Failure With Moderate to Severe Mitral Regurgitation. N Engl J Med 2024;Aug 31:[Epub ahead of print]. 

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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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