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Branco A, Fatima R, Liblik K, Jackson R, Payne D, El-Diasty M. Euglycemic DKA Associated with SGLT2 Inhibitors after Cardiac Surgery, Review of Current Literature. J Cardiothorac Vasc Anesth 2022; 36:3877-3886. [DOI: 10.1053/j.jvca.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/01/2022] [Accepted: 06/10/2022] [Indexed: 11/11/2022]
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Barmanray RD, Kyi M, Fourlanos S. Optimising diabetes in hospital: the integral role of an inpatient diabetes team. Intern Med J 2022; 52:339-340. [DOI: 10.1111/imj.15648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Rahul D. Barmanray
- Department of Diabetes and Endocrinology The Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
| | - Mervyn Kyi
- Department of Diabetes and Endocrinology The Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
| | - Spiros Fourlanos
- Department of Diabetes and Endocrinology The Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
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Nguy J, Hitchen SA, Lan NSR, Dwivedi G, Larbalestier R, Yeap BB, Fegan PG. Barriers to prescribing proprotein convertase subtilisin-kexin type 9 inhibitors after coronary revascularisation. Intern Med J 2022. [PMID: 35112773 DOI: 10.1111/imj.15700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Guidelines advocate for intensive lipid-lowering in patients with atherosclerotic cardiovascular disease (ASCVD). In May 2020, evolocumab, a proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitor, became government subsidised in Australia for patients with ASCVD requiring further low-density lipoprotein cholesterol (LDL-C) lowering. AIM To identify barriers to prescribing PCSK9 inhibitors in hospitalised patients with ASCVD. METHODS A retrospective three-month, single-site, observational analysis was conducted in consecutive patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) surgery. Lipid-lowering therapy prescriptions, including PSCK9 inhibitors, were assessed using electronic medical records, compared against the Australian Pharmaceutical Benefits eligibility criteria, and barriers to PCSK9 inhibitor use identified. RESULTS Of 331 patients, 244 (73.7%) underwent PCI and 87 (26.3%) underwent CABG surgery. A lipid profile during or within 8 weeks of admission was measured for 202 (82.8%) patients undergoing PCI and 59 (67.8%) undergoing CABG surgery. In patients taking high-intensity statins on admission (n=109), LDL-C ≥1.4, ≥1.8 and >2.6mmol/L were seen in 64 (58.7%), 44 (40.4%) and 19 (17.4%) respectively. High-intensity statin prescribing at discharge was high (>80%); however, ezetimibe was initiated in zero patients with LDL-C ≥1.4mmol/L. There was variable advice given by clinicians for LDL-C targets. No patients met criteria for subsidised PSCK9 inhibitor therapy, largely due to lack of qualifying lipid levels following combined statin and ezetimibe therapy. CONCLUSION Prescribing of non-statin LDL-C-lowering therapies remains low in patients with ASCVD. Under-prescribing of ezetimibe and suboptimal lipid testing rates are barriers to accessing subsidised PCSK9i therapy using current Australian eligibility criteria. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jenny Nguy
- Fiona Stanley Hospital, Department of Pharmacy, Perth, Western Australia, Australia.,Fiona Stanley Hospital, Department of Endocrinology and Diabetes, Perth, Western Australia, Australia
| | - Sarah A Hitchen
- Fiona Stanley Hospital, Department of Pharmacy, Perth, Western Australia, Australia.,Fiona Stanley Hospital, Department of Endocrinology and Diabetes, Perth, Western Australia, Australia
| | - Nick S R Lan
- Fiona Stanley Hospital, Department of Endocrinology and Diabetes, Perth, Western Australia, Australia.,Fiona Stanley Hospital, Department of Cardiology, Perth, Western Australia, Australia.,The University of Western Australia, Internal Medicine, Medical School, Perth, Western Australia, Australia
| | - Girish Dwivedi
- Fiona Stanley Hospital, Department of Cardiology, Perth, Western Australia, Australia.,The University of Western Australia, Internal Medicine, Medical School, Perth, Western Australia, Australia.,Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Robert Larbalestier
- Fiona Stanley Hospital, Department of Cardiothoracic Surgery, Perth, Western Australia, Australia
| | - Bu B Yeap
- Fiona Stanley Hospital, Department of Endocrinology and Diabetes, Perth, Western Australia, Australia.,The University of Western Australia, Internal Medicine, Medical School, Perth, Western Australia, Australia
| | - P Gerry Fegan
- Fiona Stanley Hospital, Department of Endocrinology and Diabetes, Perth, Western Australia, Australia.,Curtin University, Medical School, Perth, Western Australia, Australia
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Lan NSR, Ali US, Larbalestier R, Dwivedi G, Bell DA. An opportunity to improve secondary prevention with icosapent ethyl in patients who have undergone coronary artery bypass graft surgery. Cardiovasc Revasc Med 2021:S1553-8389(21)00826-5. [PMID: 34974987 DOI: 10.1016/j.carrev.2021.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Icosapent ethyl reduces cardiovascular events in high-risk patients with hypertriglyceridaemia on statin therapy. However, it is not widely available and the potential application following coronary artery bypass graft (CABG) surgery is not well-established. We aimed to determine the real-world percentage of CABG surgery patients who may be eligible for the therapy. METHODS A retrospective analysis was performed between February 2015 and August 2020 in an Australian hospital. Patients were included if a lipid profile was performed at least three weeks following CABG surgery. Data was extracted from electronic medical records. Eligibility for icosapent ethyl was defined according to inclusion criteria from the REDUCE-IT trial. RESULTS Of 484 patients with follow-up lipid profiles, 21 (4.3%) were not eligible for icosapent ethyl based on age and 39 (8.1%) were not prescribed statin therapy or were prescribed a fibrate. After applying triglyceride and low-density lipoprotein cholesterol level criteria, 124 (25.6%) patients were potentially eligible for icosapent ethyl therapy. Of those eligible, high-intensity statin therapy were prescribed in 108 (87.1%). DISCUSSION A substantial percentage of CABG surgery patients may be eligible for icosapent ethyl and could potentially benefit from its cardiovascular protection. Further research should evaluate the additional cardiovascular benefits of icosapent ethyl in this very high-risk group of patients who are already treated with high-intensity statins.
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Hitchen SA, Lan NSR, Rankin JM, Larbalestier R, Yeap BB, Fegan PG. Real-world barriers and safety of initiating sodium-glucose co-transporter 2 inhibitor treatment immediately following an acute cardiac event in people with diabetes. J Diabetes Complications 2021; 35:108057. [PMID: 34610888 DOI: 10.1016/j.jdiacomp.2021.108057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/01/2021] [Accepted: 09/25/2021] [Indexed: 11/24/2022]
Abstract
In this real-world study, the main barriers for not initiating SGLT2 inhibitor therapy early after an acute cardiac event are prescribing criteria around glycated haemoglobin and renal function. Initiation of SGLT2 inhibitors near to, or at, hospital discharge following the cardiac event was not associated with 30-day diabetic ketoacidosis readmissions.
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Affiliation(s)
- Sarah A Hitchen
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia; Department of Pharmacy, Fiona Stanley Hospital, Western Australia, Australia.
| | - Nick S R Lan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia; Medical School, The University of Western Australia, Western Australia, Australia; Department of Cardiology, Fiona Stanley Hospital, Western Australia, Australia
| | - James M Rankin
- Department of Cardiology, Fiona Stanley Hospital, Western Australia, Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Western Australia, Australia
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia; Medical School, The University of Western Australia, Western Australia, Australia
| | - P Gerry Fegan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Western Australia, Australia; Medical School, Curtin University, Western Australia, Australia
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