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Cardio nurses react to late-breaking clinical news

Saturday March 16, 2013
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The Preventive Cardiovascular Nurses Association was represented at the American College of Cardiology’s annual Scientific Sessions in San Francisco and commented on some of the late-breaking clinical news at the March 9-11 event.

• The HPS2-THRIVE study revealed that the addition of extended-release niacin to patients on statin therapy with well-controlled LDL cholesterol shows no significant reduction in major vascular events.

Researchers examined more than 25,000 patients over four years and found a 4% (non-statistically significant) reduction in major vascular events in patients who added ER niacin to statin therapy. In addition, study data revealed significant adverse affects on these patients, such as increased diabetic issues, infection, skin conditions, GI issues and more.

"For patients with controlled LDL and HDL, adding niacin to statin therapy has more risk than benefit," Lynne Braun, RN, PhD, CNP, CLS, FAHA, FPCNA, FAAN, of Rush University and the Heart & Vascular Institute in Chicago, and a member of the PCNA board of directors, said in a news release.

"However, there are more targeted groups that may benefit from niacin added to statin therapy, such as patients with high Lp(a). Future studies should target such populations to see if the outcome of this trial could be more significant."

• The REMINDER trial revealed that the addition of eplerenone to standard therapy within 24 hours of symptom onset improves the outcomes of patients with acute STEMI but no evidence of heart failure.

"The benefit of eplerenone in the acute phase is very significant," Barbara Fletcher, RN, MN, FAHA, FPCNA, FAAN, of the University of North Florida in Jacksonville, and president-elect on the PCNA board, said in a news release. "The impact in post-acute phase will need further investigation, but could be promising and impact clinical practice by nurses."

• The TACT study revealed results of partnering high-dose vitamins with chelation therapy for a primary endpoint of affecting total mortality, recurrent myocardial infarction, stroke, coronary revascularization and hospitalization for angina.

"The NIH-funded trial did show some benefit of chelation therapy and high-dose vitamins, but some non-adherence was noted," Fletcher said. "This data is of interest, but we must continue to practice evidence-based guideline therapy. Future research with high-dose vitamins and chelation therapy is warranted."

• The TERISA trial revealed data that shows the effectiveness of renolazine in reducing angina frequency and sublingual nitroglycerin use in patients with type 2 diabetes, coronary artery disease and chronic angina.

"This promising data shows beneficial outcomes in type 2 diabetic patients treated with renolazine," Fletcher said. "This is important data and gives nurses another medication to use with their patients with elevated HbA1c and chronic stable angina."

Joint symposium

The PCNA and ACC held their second-annual joint symposium during the conference. Speakers discussed how various health professionals could efficiently work together to provide the most effective care of patients with heart failure.

The session highlighted "the importance of utilizing a team approach in care of patients with a chronic cardiovascular diseases — in this case, heart failure," Fletcher said. "Treatment and management are key for better patient outcomes. This can include devices as well as pharmacological or non-pharmacological management.

"Patients are part of the team and they have a role, too. Now and in the future, home self-care will be vital in improving clinical outcomes."


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