The ASCVD Risk Estimator is OUT and PREVENT is IN! Join us on this episode of 'What's the Proof?' where hosts Bobby Scott and Sandy Robertson explore the American Heart Association's revolutionary PREVENT calculator. This new tool not only replaces outdated risk calculators but also introduces the comprehensive Cardiovascular-Kidney-Metabolic (CKM) Syndrome framework, aimed at transforming the approach to cardiovascular disease prevention. Delve into how this innovative calculator incorporates a broader range of health determinants to assess cardiovascular risk more accurately and inclusively. We'll break down how to use the PREVENT calculator, discuss its impact on clinical practice, and illustrate its application with a case example. This episode is essential for clinicians striving to enhance their understanding of cardiovascular risk assessment and eager to apply these insights into their everyday clinical decision-making.

Episode Highlights:

• Introduction to PREVENT: Discover how the American Heart Association's new PREVENT calculator is set to replace the Pooled Cohort Equations for assessing cardiovascular risk - 03:32
• History of Risk Assessment Tools: Dive into the evolution of cardiovascular disease risk assessment tools from the Framingham score to the latest PREVENT calculator - 04:25
• Understanding Cardiovascular-Kidney-Metabolic (CKM) Syndrome: Explore how the AHA's new disease framework integrates heart, kidney, and metabolic health into a unified risk assessment and management approach - 07:42
• Case Example Discussion: Follow a detailed walkthrough of a case illustrating how the PREVENT calculator and CKM staging can guide clinical decisions - 11:20
• Comprehensive Risk Assessment with PREVENT: Explore the features of the PREVENT calculator, which assesses cardiovascular, heart failure, and composite CVD risks using not just traditional health factors like blood pressure and cholesterol, but also innovative elements such as the urine albumin-creatinine ratio and the social deprivation index based on patient's zip code - 14:29
• Future Directions and Clinical Implementation: Discuss the potential changes in clinical guidelines and practices with the integration of the PREVENT tool in cardiovascular disease prevention strategies - 19:22

Episode Links:

• PREVENT Online Calculator
• AHA Scientific Statement
• Development/Validation Study

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Comments/Questions/Suggestions? Email us at whatstheproofpodcast@gmail.com or find us on X @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP, DABFM; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN, DABFM
• Production & Cover Art: Bobby Scott, MD, FAAFP, DABFM
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

"One drug, three doses, one test.” In this episode of 'What's the Proof?', we are joined by our guest, Dr. Bobby Levy, who will be discussing the application of buprenorphine-naloxone in the treatment of opioid use disorder. Discover how personal experiences led Dr. Levy to become a passionate advocate for integrating opioid use disorder treatment into primary care. Gain insights into the robust evidence supporting the use of buprenorphine, its practical dosing and initiation, and Dr. Levy's compelling counterpoints to common criticisms. This episode offers a unique perspective for any physician keen on confronting the opioid epidemic. Listen in and find out how you can make a life-saving impact in your community.

Episode Outline:

• Opening remarks - 00:35
• Introducing Dr. Levy and his journey to OBOT - 02:31
• The role of Primary Care Providers in OBOT - 09:42
• Evidence supporting buprenorphine-naloxone - 12:46
• Debunking the myth of "trading one addiction for another" - 20:52
• Harm reduction model - 22:48
• Potential challenges and downsides - 24:48
• Dosing and initiation - 28:00
• Key takeaways from interview - 33:26
• Host reflections and closing - 35:46

Episode Links:

• Questions for Dr. Levy - robert.levy@atriumhealth.org
• NEJM RCT - https://pubmed.ncbi.nlm.nih.gov/12954743/
• Efficacy of Bup in primary care - https://pubmed.ncbi.nlm.nih.gov/19553061/
• Cochrane Review - https://pubmed.ncbi.nlm.nih.gov/15266465/
• BMJ Cohort Study on mortality - https://pubmed.ncbi.nlm.nih.gov/32234712/
• All-cause mortality benefit- https://pubmed.ncbi.nlm.nih.gov/34076676/

If you liked the episode, please follow us and tell your colleagues and friends!

Comments/Questions/Suggestions? Email us at whatstheproofpodcast@gmail.com or find us on X @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
• Production & Cover Art: Bobby Scott, MD, FAAFP
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay

Are you checking eosinophil counts on your COPD patients? If not, it's time to start! Do you know which class of COPD medications have demonstrated a mortality benefit in RCTs? If not, you don't want to miss this one!

In the premiere episode of Season Two, Bobby and Sandy review updates from the 2023 Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. We'll talk about some of the major changes, including the new and improved initial therapy diagram. We delve into key learnings from the IMPACT and ETHOS trials, and discuss why the LABA+ICS regimens recommended in previous guidelines are now discouraged.

Episode Outline:

• Introduction - 01:35
• The new and improved 2x2 therapy initiation table - 03:40
• Recommended initial treatment - 05:58
• Use of eosinophils to guide therapy - 09:12
• Factors to consider when adding ICS - 16:33
• Adjusting therapy in follow up - 18:20
• Studies showing mortality benefit with triple therapy - 22:05
• Potential downsides of triple therapy - 25:56
• Wrap up/key takeaways - 28:23

Key Takeaways:

• LABA+ICS is out, triple therapy is in! In patients with frequent COPD exacerbations, consider triple therapy (especially if they have eosinophils>300) but beware if history of repeated pneumonia, history of mycobacterial infection, or eos <100.
• Triple therapy is the only pharmacological intervention for COPD with an associated mortality benefit
• ABCD is gone, it’s now ABE. Be sure that you are doing a formal symptom assessment like the mMRC or CAT!
• More patients are getting LAMA/LABA combination at start than previous guidelines. Now for all group B and E patients

Episode Links:

• 2023 GOLD Pocket Guide https://goldcopd.org/wp-content/uploads/2023/03/POCKET-GUIDE-GOLD-2023-ver-1.2-17Feb2023_WMV.pdf
• IMPACT Trial (2018) https://pubmed.ncbi.nlm.nih.gov/29668352/
• ETHOS Trial (2020) https://pubmed.ncbi.nlm.nih.gov/32579807/

If you liked the episode, please leave a positive review and subscribe! Tell your colleagues and friends!

Comments/Questions/Suggestions? Email us at whatstheproofpodcast@gmail.com or find us on Twitter @theproofpodcast!

Credits:

• Hosts: Bobby Scott, MD, FAAFP; Sandy Robertson, PharmD; Dawn Caviness, MD, BSN
• Production & Cover Art: Bobby Scott, MD, FAAFP
• Music: Twisterium, MondayHopes, Muzaproduction, and SergeQuadrado from Pixabay