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Antiplatelet therapy is a mainstay treatment for the prevention of recurrent cardiovascular events in patients with stable coronary artery disease (CAD). Anticoagulation therapy is the cornerstone of therapy for most patients with atrial fibrillation (AF). AF and CAD are frequent comorbid conditions, occurring in 20-30% of patients with stable CAD. Unfortunately, combining antiplatelet and anticoagulation therapy increases the risk of major bleeding over 50% compared to anticoagulation alone. Recent real-world observational data suggest that direct oral anticoagulation (DOACs) therapy can reduce cardiovascular event rates. This begs the question: In patients with stable CAD and AF, is combination therapy necessary or is anticoagulation monotherapy sufficient?  The AFIRE study attempted to address this important clinical question.

Guest Authors: Alina Kukin, PharmD and Zachary R. Noel, PharmD, BCCP

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Heart failure with reduced ejection fraction (HFrEF) is associated with significant morbidity and mortality. Current guidelines recommend a renin-angiotensin inhibitor, beta-blocker, and aldosterone antagonist to reduce morbidity and mortality in these patients. Despite the use of multiple drug classes, 5-year mortality rates hover near 50% in patients with heart failure (HF). Despite the numerous medications available, mortality and the risk of HF hospitalizations remains high. Sodium-glucose cotransporter-2 inhibitors (SGLT2-I) have been shown to reduce HF hospitalizations in patients with diabetes. Could this medication class be useful for HF treatment even in patients without diabetes?

Guest Authors:  John Andraos, PharmD; Alexa Zeiger, PharmD; and Michael S. Kelly, PharmD, BCACP

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Heart failure (HF) affects at least 5.7 million people in the United States alone and requires a strict self-care regimen to avoid hospitalizations. Patients with HF have high readmission rates, high medical costs, and many experience a poor quality of life. But what if patients with HF do not understand or are not capable of carrying out the recommended HF “self-care regimen”? Subjective questionnaires are often used to assess HF symptoms and self-care behaviors but may not accurately depict a patient’s functional capabilities. The FRAIL-HF study attempted to objectively evaluate patients’ ability to perform HF self-care tasks and correlate self-care ability with readmissions rates and one-year mortality.

Guest Authors: Holly Porras, PharmD and Emily Prohaska, PharmD, BCACP, BCGP

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Several guidelines now recommend direct oral anticoagulants (DOACs) as the preferred anticoagulants for patients with non-valvular atrial fibrillation (a-fib). However, the landmark clinical trials focused largely on the primary prevention of stroke.  Moreover, real-world data using DOACs for secondary prevention is lacking. Many have argued that warfarin might be a better choice in these high-risk patients because it requires routine monitoring and increases the patient’s contact with the healthcare system. Does the choice of anticoagulant make a difference in preventing recurrent stroke?

Guest Authors: Blaire White, PharmD; Amber Cizmic, PharmD, BCACP; and Tish Smith, PharmD, BCACP

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Treatment-resistant hypertension, the need for 4 or more medications to achieve goal blood pressure (BP), occurs in nearly 1 in 5 patients.1 But is it truly treatment-resistant? Nonadherence is often regarded as the primary cause in many patients.  But how can we distinguish between other causes of hypertension that should prompt additional diagnostic testing or treatment intensification? A recent study suggests there is a simple solution: watch them take their pills.

Guest Authors: Meagan Brown, PharmD, BCACP and Raven Jackson, PharmD

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Until recently, glucagon-like-peptide-1 (GLP-1) receptor agonists were only available as injectable products. Some clinicians and patients are reluctant to use injectable agents because they require additional patient education and can be intimidating.  If a GLP-1 receptor agonist were available in an oral dose form, it would be welcomed treatment option. But would the cardiovascular safety and benefits of oral GLP-1 receptor agonists be better, similar, or worse than their injectable siblings?

Guest Authors:  Sally Earl, PharmD, BCPS and Megan Supple, PharmD, BCACP

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Patients frequently present to outpatient clinics and community pharmacies with acute exacerbations of chronic obstructive pulmonary disease and clinicians have an important decision to make. Should they prescribe antibiotics? Patients may seek antibiotics as a quick fix to their symptoms, but many AECOPD are not caused by bacterial infection. Prescribing unnecessary antibiotics exposes patients to adverse effects and can increase antimicrobial resistance.  But not prescribing antibiotics could delay recovery if the exacerbation is of bacterial origin … or worse, result in an avoidable hospitalization and death. Could a simple, bedside test empower patients and prescribers to use antimicrobials more selectively?

Guest Author:  Brittany Schmidt, PharmD, BCACP

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The “silent killer” that impacts every ambulatory care practice is medication non-adherence.  Today, medication non-adherence is estimated to cause 125,000 preventable deaths every year and costs all of us $300 billion. It is no surprise that pharmacists have an important roll to play tackling this critical issue. Many pharmacies have now implemented medication synchronization or med sync programs to proactively address medication adherence.  While some have called med sync a “golden ticket,” research is clearly needed.

Guest Authors: Michael Kachmarsky, PharmD, BCACP and Daniel Longyhore, PharmD, MS, BCACP

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Patients who have had acute coronary syndromes (ACS) are more likely to suffer from major depression than the general population with rates of clinically relevant symptoms of depression as high as 45%. Unfortunately, even if patients are routinely screened for depression with a PHQ-2 and PHQ-9 in primary care settings, appropriate treatments are often not initiated. Depression causes psychological stress which activates the sympathetic nervous system which leads to increased cortisol levels, inflammation, and platelet activation that can contribute to atherosclerosis and accelerate plaque formation. Thus, untreated depression may worsen cardiac outcomes.

Guest Authors: Hansita B. Patel, PharmD and Abigail L. Hulsizer, PharmD

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The transgender/gender nonconforming (TGNC) community faces a variety of challenges including access to healthcare, societal stigma, and discrimination. As a profession, pharmacy is well-positioned to reduce and address the barriers to care faced by TGNC individuals and to provide them with positive experiences within the healthcare system. However, formal instruction about this patient population’s social and medical needs is lacking in most pharmacy school curricula.

Guest Authors: Justin Bachman, PharmD and Abby Frye, PharmD, BCACP

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