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‘Mammogram of the heart’: Inside coronary artery calcium scores
LOS ANGELES – according to a cardiologist who urged that endocrinologists embrace the tests when appropriate and use them to inform treatment decisions.
In the big picture, “you might want to think of this as the mammogram of the heart,” said Matthew J. Budoff, MD, professor of medicine at the University of California, Los Angeles, in a presentation at the annual scientific & clinical congress of the American Association of Clinical Endocrinologists.
“If we find a lot of plaque, we act on it,” Dr. Budoff said. “If we don’t, we reassure [patients] and test them down the road.”
According to Dr. Budoff, research confirms that the tests correlate with plaque progression and atherosclerotic burden and offer important insight into treatment decisions for diabetes. “Not all people with diabetes have atherosclerosis, and not all deserve the same therapy,” he said.
In other words, not every patient with diabetes needs to be on the same regimen, such as a statin.
Dr. Budoff pointed to recent research that revealed coronary artery calcium (CAC) scores of zero Agatston units are signs of excellent cardiac health in terms of clogged arteries – regardless of whether a patient is diabetic or not.
“Even patients with a score of zero in the setting of diabetes do very well,” said Dr. Budoff, who normally wouldn’t recommend a statin for those patients even though they have diabetes. “If you see a person without coronary calcium, their cardiovascular death rate is really, really low. Maybe you don’t have to be as aggressive with atherosclerosis. You can wait 5 years after a score of zero and reassess the risk.”
And this advice holds up regardless of the gender, age, or ethnicity of a patient.
However, Dr. Budoff cautioned against waiting too long for another assessment. “I don’t think we want to wait 10 years. A lot of things change over a decade: Our blood pressure and LDL cholesterol go up, our triglycerides and [hemoglobin] A1Cs go up – our risk factors progress with age. I’d encourage you to not wait more than 5 years to retest [a patient] to see what’s going on.”
What if a CAC score is higher than zero? A score of more than 100 is a danger signal, Dr. Budoff said. “No matter how you look at the data, a patient with a high score has higher risk of cardiovascular death or dying in general.” This is especially true among women with diabetes for reasons that are not clear.
What to do if a patient’s score is over 100? “Get them on a baby aspirin and on a statin,” he said.
CAC scores lower than 100 are less worrisome in older people and more worrisome in younger people. An age-adjusted score of 5 in a 45-year-old woman, for example, is a cause for concern because any atherosclerosis is a problem at that age.
“If they have some plaque in their coronaries at age 40 or 45, it will grow over time,” he added.
Dr. Budoff offered other insights into CAC and diabetes.
First, based on CAC scores, asymptomatic, middle-aged patients with type 1 diabetes don’t seem to be at higher risk of coronary artery disease than the general population. About 70% of 1,205 patients followed for an average of 11 years had a CAC score of zero, according to findings from a study led by Dr. Budoff (JACC Cardiovasc Imaging. 2019 Mar 8. doi: 10.1016/j.jcmg.2019.01.014).
However, positive scores translate to more risk, and “the higher the score, the higher the risk,” he emphasized.
Second, CAC screening by itself can be a motivator for lifestyle changes in people with diabetes. A randomized, controlled trial reported in 2011 found that patients who were told about their scores improved on several health measures, including blood pressure, cholesterol levels, and weight (J Am Coll Cardiol. 2011 Apr 12;57[15]:1622-32).
“They were [more] willing to take their medicines. They lost weight, and they were better at diet and exercise,” Dr. Budoff said. “Showing them a calcium score and what it means was a big motivation.”
The study also found major reductions in medication and procedure cost among patients who got the CAC results. About half of them had a CAC score of zero, he said, and that means “we’re not going to run them on a treadmill or put them on a statin.”
Dr. Budoff reported receiving grant funding from GE Healthcare.
LOS ANGELES – according to a cardiologist who urged that endocrinologists embrace the tests when appropriate and use them to inform treatment decisions.
In the big picture, “you might want to think of this as the mammogram of the heart,” said Matthew J. Budoff, MD, professor of medicine at the University of California, Los Angeles, in a presentation at the annual scientific & clinical congress of the American Association of Clinical Endocrinologists.
“If we find a lot of plaque, we act on it,” Dr. Budoff said. “If we don’t, we reassure [patients] and test them down the road.”
According to Dr. Budoff, research confirms that the tests correlate with plaque progression and atherosclerotic burden and offer important insight into treatment decisions for diabetes. “Not all people with diabetes have atherosclerosis, and not all deserve the same therapy,” he said.
In other words, not every patient with diabetes needs to be on the same regimen, such as a statin.
Dr. Budoff pointed to recent research that revealed coronary artery calcium (CAC) scores of zero Agatston units are signs of excellent cardiac health in terms of clogged arteries – regardless of whether a patient is diabetic or not.
“Even patients with a score of zero in the setting of diabetes do very well,” said Dr. Budoff, who normally wouldn’t recommend a statin for those patients even though they have diabetes. “If you see a person without coronary calcium, their cardiovascular death rate is really, really low. Maybe you don’t have to be as aggressive with atherosclerosis. You can wait 5 years after a score of zero and reassess the risk.”
And this advice holds up regardless of the gender, age, or ethnicity of a patient.
However, Dr. Budoff cautioned against waiting too long for another assessment. “I don’t think we want to wait 10 years. A lot of things change over a decade: Our blood pressure and LDL cholesterol go up, our triglycerides and [hemoglobin] A1Cs go up – our risk factors progress with age. I’d encourage you to not wait more than 5 years to retest [a patient] to see what’s going on.”
What if a CAC score is higher than zero? A score of more than 100 is a danger signal, Dr. Budoff said. “No matter how you look at the data, a patient with a high score has higher risk of cardiovascular death or dying in general.” This is especially true among women with diabetes for reasons that are not clear.
What to do if a patient’s score is over 100? “Get them on a baby aspirin and on a statin,” he said.
CAC scores lower than 100 are less worrisome in older people and more worrisome in younger people. An age-adjusted score of 5 in a 45-year-old woman, for example, is a cause for concern because any atherosclerosis is a problem at that age.
“If they have some plaque in their coronaries at age 40 or 45, it will grow over time,” he added.
Dr. Budoff offered other insights into CAC and diabetes.
First, based on CAC scores, asymptomatic, middle-aged patients with type 1 diabetes don’t seem to be at higher risk of coronary artery disease than the general population. About 70% of 1,205 patients followed for an average of 11 years had a CAC score of zero, according to findings from a study led by Dr. Budoff (JACC Cardiovasc Imaging. 2019 Mar 8. doi: 10.1016/j.jcmg.2019.01.014).
However, positive scores translate to more risk, and “the higher the score, the higher the risk,” he emphasized.
Second, CAC screening by itself can be a motivator for lifestyle changes in people with diabetes. A randomized, controlled trial reported in 2011 found that patients who were told about their scores improved on several health measures, including blood pressure, cholesterol levels, and weight (J Am Coll Cardiol. 2011 Apr 12;57[15]:1622-32).
“They were [more] willing to take their medicines. They lost weight, and they were better at diet and exercise,” Dr. Budoff said. “Showing them a calcium score and what it means was a big motivation.”
The study also found major reductions in medication and procedure cost among patients who got the CAC results. About half of them had a CAC score of zero, he said, and that means “we’re not going to run them on a treadmill or put them on a statin.”
Dr. Budoff reported receiving grant funding from GE Healthcare.
LOS ANGELES – according to a cardiologist who urged that endocrinologists embrace the tests when appropriate and use them to inform treatment decisions.
In the big picture, “you might want to think of this as the mammogram of the heart,” said Matthew J. Budoff, MD, professor of medicine at the University of California, Los Angeles, in a presentation at the annual scientific & clinical congress of the American Association of Clinical Endocrinologists.
“If we find a lot of plaque, we act on it,” Dr. Budoff said. “If we don’t, we reassure [patients] and test them down the road.”
According to Dr. Budoff, research confirms that the tests correlate with plaque progression and atherosclerotic burden and offer important insight into treatment decisions for diabetes. “Not all people with diabetes have atherosclerosis, and not all deserve the same therapy,” he said.
In other words, not every patient with diabetes needs to be on the same regimen, such as a statin.
Dr. Budoff pointed to recent research that revealed coronary artery calcium (CAC) scores of zero Agatston units are signs of excellent cardiac health in terms of clogged arteries – regardless of whether a patient is diabetic or not.
“Even patients with a score of zero in the setting of diabetes do very well,” said Dr. Budoff, who normally wouldn’t recommend a statin for those patients even though they have diabetes. “If you see a person without coronary calcium, their cardiovascular death rate is really, really low. Maybe you don’t have to be as aggressive with atherosclerosis. You can wait 5 years after a score of zero and reassess the risk.”
And this advice holds up regardless of the gender, age, or ethnicity of a patient.
However, Dr. Budoff cautioned against waiting too long for another assessment. “I don’t think we want to wait 10 years. A lot of things change over a decade: Our blood pressure and LDL cholesterol go up, our triglycerides and [hemoglobin] A1Cs go up – our risk factors progress with age. I’d encourage you to not wait more than 5 years to retest [a patient] to see what’s going on.”
What if a CAC score is higher than zero? A score of more than 100 is a danger signal, Dr. Budoff said. “No matter how you look at the data, a patient with a high score has higher risk of cardiovascular death or dying in general.” This is especially true among women with diabetes for reasons that are not clear.
What to do if a patient’s score is over 100? “Get them on a baby aspirin and on a statin,” he said.
CAC scores lower than 100 are less worrisome in older people and more worrisome in younger people. An age-adjusted score of 5 in a 45-year-old woman, for example, is a cause for concern because any atherosclerosis is a problem at that age.
“If they have some plaque in their coronaries at age 40 or 45, it will grow over time,” he added.
Dr. Budoff offered other insights into CAC and diabetes.
First, based on CAC scores, asymptomatic, middle-aged patients with type 1 diabetes don’t seem to be at higher risk of coronary artery disease than the general population. About 70% of 1,205 patients followed for an average of 11 years had a CAC score of zero, according to findings from a study led by Dr. Budoff (JACC Cardiovasc Imaging. 2019 Mar 8. doi: 10.1016/j.jcmg.2019.01.014).
However, positive scores translate to more risk, and “the higher the score, the higher the risk,” he emphasized.
Second, CAC screening by itself can be a motivator for lifestyle changes in people with diabetes. A randomized, controlled trial reported in 2011 found that patients who were told about their scores improved on several health measures, including blood pressure, cholesterol levels, and weight (J Am Coll Cardiol. 2011 Apr 12;57[15]:1622-32).
“They were [more] willing to take their medicines. They lost weight, and they were better at diet and exercise,” Dr. Budoff said. “Showing them a calcium score and what it means was a big motivation.”
The study also found major reductions in medication and procedure cost among patients who got the CAC results. About half of them had a CAC score of zero, he said, and that means “we’re not going to run them on a treadmill or put them on a statin.”
Dr. Budoff reported receiving grant funding from GE Healthcare.
REPORTING FROM AACE 2019
Is pro soccer a risk factor for ALS?
according to Italian researchers who reviewed trading cards of about 25,000 male professional soccer players who played in Italy. The researchers then scanned news reports to find which of those players developed the rare neurologic disease. Players who developed ALS were a much younger age at diagnosis when compared with the general population, according to the researchers, who will present their findings at the annual meeting of the American Academy of Neurology.
While the findings might implicate professional-level soccer in the development of ALS, there could be other factors at work, said lead author Ettore Beghi, MD, of the Mario Negri Institute for Pharmacological Research, Milan. “Repeated traumatic events, heavy physical exercise, and substance use could also be factors in the increased ALS risk among soccer players,” Dr. Beghi said in a news release. “In addition, genetics may play a role.”
The ALS-related deaths of several Italian pro soccer players sparked suggestions that the disease and the sport could be somehow linked, according to Dr. Beghi and colleagues. To determine whether professional soccer players are at increased ALS risk, they reviewed the archives of the country’s major soccer card publisher from the years 1959 to 2000, recording the name, date, and place of birth; field position; and team history for the tens of thousands of players they identified.
News reports revealed that 33 players in that cohort developed ALS, compared with 17.6 cases that would be expected based on Italian general population estimates, according to Dr. Beghi and colleagues.
The number of cases per 100,000 person-years was 1.9 for all the soccer players, and 4.7 for those who were younger than 45 years at diagnosis, researchers said. In general, soccer players were younger at diagnosis, with a median age of ALS onset of 43.3 years, versus 62.5 years in the general population, they added.
These findings cannot be applied to those who play soccer below the professional level, since only professional athletes were studied, Dr. Beghi said. Moreover, the results should not be construed to suggest that people avoid playing soccer, he said, adding that the researchers had few specific details on the players’ ALS diagnoses.
Patients with ALS more often report head injuries, compared with the general population, while links between exercise and ALS have been found in some studies, but not others, according to the researchers.
“Clinical and experimental observations suggest an association between ALS and use of nonsteroidal anti-inflammatory agents and dietary supplements, including branched chain amino acids,” researchers added in the abstract for their report.
The study by Dr. Beghi and colleagues was supported by the Mario Negri Institute in Milan.
Source: Beghi E et al. AAN 2019, Abstract S1.001.
according to Italian researchers who reviewed trading cards of about 25,000 male professional soccer players who played in Italy. The researchers then scanned news reports to find which of those players developed the rare neurologic disease. Players who developed ALS were a much younger age at diagnosis when compared with the general population, according to the researchers, who will present their findings at the annual meeting of the American Academy of Neurology.
While the findings might implicate professional-level soccer in the development of ALS, there could be other factors at work, said lead author Ettore Beghi, MD, of the Mario Negri Institute for Pharmacological Research, Milan. “Repeated traumatic events, heavy physical exercise, and substance use could also be factors in the increased ALS risk among soccer players,” Dr. Beghi said in a news release. “In addition, genetics may play a role.”
The ALS-related deaths of several Italian pro soccer players sparked suggestions that the disease and the sport could be somehow linked, according to Dr. Beghi and colleagues. To determine whether professional soccer players are at increased ALS risk, they reviewed the archives of the country’s major soccer card publisher from the years 1959 to 2000, recording the name, date, and place of birth; field position; and team history for the tens of thousands of players they identified.
News reports revealed that 33 players in that cohort developed ALS, compared with 17.6 cases that would be expected based on Italian general population estimates, according to Dr. Beghi and colleagues.
The number of cases per 100,000 person-years was 1.9 for all the soccer players, and 4.7 for those who were younger than 45 years at diagnosis, researchers said. In general, soccer players were younger at diagnosis, with a median age of ALS onset of 43.3 years, versus 62.5 years in the general population, they added.
These findings cannot be applied to those who play soccer below the professional level, since only professional athletes were studied, Dr. Beghi said. Moreover, the results should not be construed to suggest that people avoid playing soccer, he said, adding that the researchers had few specific details on the players’ ALS diagnoses.
Patients with ALS more often report head injuries, compared with the general population, while links between exercise and ALS have been found in some studies, but not others, according to the researchers.
“Clinical and experimental observations suggest an association between ALS and use of nonsteroidal anti-inflammatory agents and dietary supplements, including branched chain amino acids,” researchers added in the abstract for their report.
The study by Dr. Beghi and colleagues was supported by the Mario Negri Institute in Milan.
Source: Beghi E et al. AAN 2019, Abstract S1.001.
according to Italian researchers who reviewed trading cards of about 25,000 male professional soccer players who played in Italy. The researchers then scanned news reports to find which of those players developed the rare neurologic disease. Players who developed ALS were a much younger age at diagnosis when compared with the general population, according to the researchers, who will present their findings at the annual meeting of the American Academy of Neurology.
While the findings might implicate professional-level soccer in the development of ALS, there could be other factors at work, said lead author Ettore Beghi, MD, of the Mario Negri Institute for Pharmacological Research, Milan. “Repeated traumatic events, heavy physical exercise, and substance use could also be factors in the increased ALS risk among soccer players,” Dr. Beghi said in a news release. “In addition, genetics may play a role.”
The ALS-related deaths of several Italian pro soccer players sparked suggestions that the disease and the sport could be somehow linked, according to Dr. Beghi and colleagues. To determine whether professional soccer players are at increased ALS risk, they reviewed the archives of the country’s major soccer card publisher from the years 1959 to 2000, recording the name, date, and place of birth; field position; and team history for the tens of thousands of players they identified.
News reports revealed that 33 players in that cohort developed ALS, compared with 17.6 cases that would be expected based on Italian general population estimates, according to Dr. Beghi and colleagues.
The number of cases per 100,000 person-years was 1.9 for all the soccer players, and 4.7 for those who were younger than 45 years at diagnosis, researchers said. In general, soccer players were younger at diagnosis, with a median age of ALS onset of 43.3 years, versus 62.5 years in the general population, they added.
These findings cannot be applied to those who play soccer below the professional level, since only professional athletes were studied, Dr. Beghi said. Moreover, the results should not be construed to suggest that people avoid playing soccer, he said, adding that the researchers had few specific details on the players’ ALS diagnoses.
Patients with ALS more often report head injuries, compared with the general population, while links between exercise and ALS have been found in some studies, but not others, according to the researchers.
“Clinical and experimental observations suggest an association between ALS and use of nonsteroidal anti-inflammatory agents and dietary supplements, including branched chain amino acids,” researchers added in the abstract for their report.
The study by Dr. Beghi and colleagues was supported by the Mario Negri Institute in Milan.
Source: Beghi E et al. AAN 2019, Abstract S1.001.
FROM AAN 2019
Noninvasive FFRCT called ADVANCE in chest pain assessment
NEW ORLEANS – Fractional flow reserve derived noninvasively from coronary CT angiography showed clinical merit as a practical tool for evaluation of chest pain at 1 year of follow-up in the ADVANCE registry, Manesh R. Patel, MD, reported at the annual meeting of the American College of Cardiology.
In ADVANCE, a fractional flow reserve value greater than 0.80 derived from CT angiography, or FFRCT, was associated with a significantly lower rate of cardiovascular death or MI at 1 year than in patients with an FFRCT of 0.80 or lower, according to Dr. Patel, professor of medicine and chief of the division of cardiology at Duke University, Durham, N.C.
“The lower rates of revascularization and clinical events in patients with FFRCT who were managed conservatively provide reassurance regarding this clinical strategy if you were to put it into your practice,” he observed.
ADVANCE is in an international, real-world, prospective registry of more than 5,000 patients in Europe, Japan, and North America. All had clinically suspected ischemic coronary artery disease (CAD). They also had at least 30% atherosclerosis documented on coronary CT angiography as a trigger for noninvasive assessment of FFR calculated from computational fluid dynamics. The idea behind FFRCT is that by combining the anatomic information provided by CT angiography with the physiological, functional data from FFR, the result is a better guide to need for revascularization of true obstructive CAD than with conventional invasive coronary angiography alone. Indeed, FFRCT could eventually prove to be a cost-effective gatekeeper to the cardiac catheterization laboratory by cutting down on high rates of invasive coronary angiography for nonactionable CAD.
That point was suggested by the previously reported 90-day outcomes of the ADVANCE registry, the cardiologist explained. Participating physicians first classified patients and made a revascularization/no-revascularization management plan on the basis of the core laboratory CT angiography results alone. But when they received the FFRCT results, they reclassified patients and changed the management plan in 67% of cases. That’s because the prevalence of nonobstructive CAD was 44% in patients with an FFRCT greater than 0.80 in all coronary arteries, compared with just 14% in those with an FFRCT of 0.80 or less. As a result, 72% of patients with an FFRCT of 0.80 or less underwent revascularization, while the vast majority of patients with an FFRCT greater than 0.80 were initially managed conservatively (Eur Heart J. 2018 Nov 1;39[41]:3701-11).
The 1-year outcomes from ADVANCE as presented by Dr. Patel showed low rates of major adverse cardiovascular events overall. Of note, the composite endpoint of cardiovascular death or MI occurred significantly more often in patients with an FFRCT of 0.80 or less, by a margin of 0.8% versus 0.2%, for a 320% increased relative risk. The patients with a FFRCT greater than 0.80 continued to have a much lower revascularization rate from 90 days through 1 year: 5.8% versus 38.4% in the lower-FFRCT group. And 93% of patients placed on medical therapy alone after receiving their FFRCT results remained on medical therapy without revascularization or a major adverse cardiovascular event at 1 year.
Discussant Matthew J. Budoff, MD, commented that it’s time to move beyond observational studies and conduct randomized trials of an FFRCT-based screening strategy in patients with clinical suspicion of obstructive CAD.
“We want to understand the enormous advantages of having FFR-like data before we take patients to the cath lab. And I do think that adding physiology to the anatomy is going to be the approach that we’re going to be predominantly using in the future,” said Dr. Budoff, professor of medicine at the University of California, Los Angeles.
Dr. Patel noted that the ongoing, randomized, 2,100-patient PRECISE study is directed at determining in a more definitive way the clinical and cost-effectiveness of an FFRCT strategy.
The ADVANCE registry is funded by HeartFlow. Dr. Patel reported receiving research grants from that company and several others, as well as the National Institutes of Health. He serves on advisory boards for Bayer, Janssen, and Amgen.
Simultaneous with Dr. Patel’s presentation at ACC 2019, the 1-year ADVANCE registry results were published online (JACC Cardiovasc Imag. 2019 Mar 17. doi: 10.1016/j.jcmg.2019.03.003).
NEW ORLEANS – Fractional flow reserve derived noninvasively from coronary CT angiography showed clinical merit as a practical tool for evaluation of chest pain at 1 year of follow-up in the ADVANCE registry, Manesh R. Patel, MD, reported at the annual meeting of the American College of Cardiology.
In ADVANCE, a fractional flow reserve value greater than 0.80 derived from CT angiography, or FFRCT, was associated with a significantly lower rate of cardiovascular death or MI at 1 year than in patients with an FFRCT of 0.80 or lower, according to Dr. Patel, professor of medicine and chief of the division of cardiology at Duke University, Durham, N.C.
“The lower rates of revascularization and clinical events in patients with FFRCT who were managed conservatively provide reassurance regarding this clinical strategy if you were to put it into your practice,” he observed.
ADVANCE is in an international, real-world, prospective registry of more than 5,000 patients in Europe, Japan, and North America. All had clinically suspected ischemic coronary artery disease (CAD). They also had at least 30% atherosclerosis documented on coronary CT angiography as a trigger for noninvasive assessment of FFR calculated from computational fluid dynamics. The idea behind FFRCT is that by combining the anatomic information provided by CT angiography with the physiological, functional data from FFR, the result is a better guide to need for revascularization of true obstructive CAD than with conventional invasive coronary angiography alone. Indeed, FFRCT could eventually prove to be a cost-effective gatekeeper to the cardiac catheterization laboratory by cutting down on high rates of invasive coronary angiography for nonactionable CAD.
That point was suggested by the previously reported 90-day outcomes of the ADVANCE registry, the cardiologist explained. Participating physicians first classified patients and made a revascularization/no-revascularization management plan on the basis of the core laboratory CT angiography results alone. But when they received the FFRCT results, they reclassified patients and changed the management plan in 67% of cases. That’s because the prevalence of nonobstructive CAD was 44% in patients with an FFRCT greater than 0.80 in all coronary arteries, compared with just 14% in those with an FFRCT of 0.80 or less. As a result, 72% of patients with an FFRCT of 0.80 or less underwent revascularization, while the vast majority of patients with an FFRCT greater than 0.80 were initially managed conservatively (Eur Heart J. 2018 Nov 1;39[41]:3701-11).
The 1-year outcomes from ADVANCE as presented by Dr. Patel showed low rates of major adverse cardiovascular events overall. Of note, the composite endpoint of cardiovascular death or MI occurred significantly more often in patients with an FFRCT of 0.80 or less, by a margin of 0.8% versus 0.2%, for a 320% increased relative risk. The patients with a FFRCT greater than 0.80 continued to have a much lower revascularization rate from 90 days through 1 year: 5.8% versus 38.4% in the lower-FFRCT group. And 93% of patients placed on medical therapy alone after receiving their FFRCT results remained on medical therapy without revascularization or a major adverse cardiovascular event at 1 year.
Discussant Matthew J. Budoff, MD, commented that it’s time to move beyond observational studies and conduct randomized trials of an FFRCT-based screening strategy in patients with clinical suspicion of obstructive CAD.
“We want to understand the enormous advantages of having FFR-like data before we take patients to the cath lab. And I do think that adding physiology to the anatomy is going to be the approach that we’re going to be predominantly using in the future,” said Dr. Budoff, professor of medicine at the University of California, Los Angeles.
Dr. Patel noted that the ongoing, randomized, 2,100-patient PRECISE study is directed at determining in a more definitive way the clinical and cost-effectiveness of an FFRCT strategy.
The ADVANCE registry is funded by HeartFlow. Dr. Patel reported receiving research grants from that company and several others, as well as the National Institutes of Health. He serves on advisory boards for Bayer, Janssen, and Amgen.
Simultaneous with Dr. Patel’s presentation at ACC 2019, the 1-year ADVANCE registry results were published online (JACC Cardiovasc Imag. 2019 Mar 17. doi: 10.1016/j.jcmg.2019.03.003).
NEW ORLEANS – Fractional flow reserve derived noninvasively from coronary CT angiography showed clinical merit as a practical tool for evaluation of chest pain at 1 year of follow-up in the ADVANCE registry, Manesh R. Patel, MD, reported at the annual meeting of the American College of Cardiology.
In ADVANCE, a fractional flow reserve value greater than 0.80 derived from CT angiography, or FFRCT, was associated with a significantly lower rate of cardiovascular death or MI at 1 year than in patients with an FFRCT of 0.80 or lower, according to Dr. Patel, professor of medicine and chief of the division of cardiology at Duke University, Durham, N.C.
“The lower rates of revascularization and clinical events in patients with FFRCT who were managed conservatively provide reassurance regarding this clinical strategy if you were to put it into your practice,” he observed.
ADVANCE is in an international, real-world, prospective registry of more than 5,000 patients in Europe, Japan, and North America. All had clinically suspected ischemic coronary artery disease (CAD). They also had at least 30% atherosclerosis documented on coronary CT angiography as a trigger for noninvasive assessment of FFR calculated from computational fluid dynamics. The idea behind FFRCT is that by combining the anatomic information provided by CT angiography with the physiological, functional data from FFR, the result is a better guide to need for revascularization of true obstructive CAD than with conventional invasive coronary angiography alone. Indeed, FFRCT could eventually prove to be a cost-effective gatekeeper to the cardiac catheterization laboratory by cutting down on high rates of invasive coronary angiography for nonactionable CAD.
That point was suggested by the previously reported 90-day outcomes of the ADVANCE registry, the cardiologist explained. Participating physicians first classified patients and made a revascularization/no-revascularization management plan on the basis of the core laboratory CT angiography results alone. But when they received the FFRCT results, they reclassified patients and changed the management plan in 67% of cases. That’s because the prevalence of nonobstructive CAD was 44% in patients with an FFRCT greater than 0.80 in all coronary arteries, compared with just 14% in those with an FFRCT of 0.80 or less. As a result, 72% of patients with an FFRCT of 0.80 or less underwent revascularization, while the vast majority of patients with an FFRCT greater than 0.80 were initially managed conservatively (Eur Heart J. 2018 Nov 1;39[41]:3701-11).
The 1-year outcomes from ADVANCE as presented by Dr. Patel showed low rates of major adverse cardiovascular events overall. Of note, the composite endpoint of cardiovascular death or MI occurred significantly more often in patients with an FFRCT of 0.80 or less, by a margin of 0.8% versus 0.2%, for a 320% increased relative risk. The patients with a FFRCT greater than 0.80 continued to have a much lower revascularization rate from 90 days through 1 year: 5.8% versus 38.4% in the lower-FFRCT group. And 93% of patients placed on medical therapy alone after receiving their FFRCT results remained on medical therapy without revascularization or a major adverse cardiovascular event at 1 year.
Discussant Matthew J. Budoff, MD, commented that it’s time to move beyond observational studies and conduct randomized trials of an FFRCT-based screening strategy in patients with clinical suspicion of obstructive CAD.
“We want to understand the enormous advantages of having FFR-like data before we take patients to the cath lab. And I do think that adding physiology to the anatomy is going to be the approach that we’re going to be predominantly using in the future,” said Dr. Budoff, professor of medicine at the University of California, Los Angeles.
Dr. Patel noted that the ongoing, randomized, 2,100-patient PRECISE study is directed at determining in a more definitive way the clinical and cost-effectiveness of an FFRCT strategy.
The ADVANCE registry is funded by HeartFlow. Dr. Patel reported receiving research grants from that company and several others, as well as the National Institutes of Health. He serves on advisory boards for Bayer, Janssen, and Amgen.
Simultaneous with Dr. Patel’s presentation at ACC 2019, the 1-year ADVANCE registry results were published online (JACC Cardiovasc Imag. 2019 Mar 17. doi: 10.1016/j.jcmg.2019.03.003).
REPORTING FROM ACC 19
Utilizing mentorship to achieve equity in leadership
Academic medicine and the health care industry
Achieving equity in leadership in academic medicine and the health care industry doesn’t have to be a pipe dream. There are clear, actionable steps that will lead us there.
The benefits of diversity are numerous and well documented. Diversity brings competitive advantage to organizations and strength to teams. With academic health centers (AHCs) facing continual stressors while at the same time being significant financial contributors to – and anchors in – their communities, ensuring their high performance is critical to society as a whole. To grow, thrive, and be ethical examples to their communities, health centers need the strongest and most innovative leaders who are reflective of the communities that they serve. This means more diversity in leadership positions.
When we look at the facts of the gender makeup of academic medicine and the health care industry, we can clearly see inequity – only 22% of medical school full professors, 18% of medical school department chairs, and 17% of medical school deans are women. Note that it has taken 50 years to get from 0 women deans to the 25 women deans who are now in this role. Only 28% of full and associate professors and 21% of department chairs are nonwhite. In the health care industry, only 13% of CEOs are women. The pace toward equity has been excruciatingly slow, and it’s not only women and underrepresented minorities who lose, but also the AHCs and their communities.
So how do we reach equity? Mentorship is a key pathway to this goal. In a session at Hospital Medicine 2019 (HM19), “What Mentorship Has Meant To Me (And What It Can Do For You): High Impact Stories from Leaders in Hospital Medicine,” fellow panelists and I outlined how mentorship can positively affect your career, define the qualities of effective mentors and mentees, describe the difference between mentorship and sponsorship, and explained how to navigate common pitfalls in mentor-mentee relationships.
We spoke about the responsibility the mentee has in the relationship and the need to “manage up,” a term borrowed from the corporate world, where the mentee takes responsibility for his or her part in the relationship and takes a leadership role in the relationship. The mentee must be an “active participant” in the relationship for the relationship to be successful. We hope that attendees at the session took some key points back to their institutions to open dialogue on strategies to achieve equity through building mentoring relationships.
When I look back on my time in residency and fellowship, I recognize that I was surrounded by people who offered guidance and advice. But once I became a faculty member, that guidance was less apparent, and I struggled in the first few years. It wasn’t until I attended a conference on peer mentoring that I recognized that I didn’t just need a didactic mentor, but that I needed a portfolio of mentors and that I had to take the initiative to actively engage mentorship. So I did, and its effects on my career have been powerful and numerous.
The evidence is there that mentorship can play a major role in advancing careers. Now it is up to the leadership of academic and nonacademic health centers to take the initiative and establish formalized programs in their institutions. We all benefit when we have diversity in leadership – so let’s get there together.
Dr. Spector is executive director, Executive Leadership in Academic Medicine, associate dean of faculty development, Drexel University, Philadelphia.
Academic medicine and the health care industry
Academic medicine and the health care industry
Achieving equity in leadership in academic medicine and the health care industry doesn’t have to be a pipe dream. There are clear, actionable steps that will lead us there.
The benefits of diversity are numerous and well documented. Diversity brings competitive advantage to organizations and strength to teams. With academic health centers (AHCs) facing continual stressors while at the same time being significant financial contributors to – and anchors in – their communities, ensuring their high performance is critical to society as a whole. To grow, thrive, and be ethical examples to their communities, health centers need the strongest and most innovative leaders who are reflective of the communities that they serve. This means more diversity in leadership positions.
When we look at the facts of the gender makeup of academic medicine and the health care industry, we can clearly see inequity – only 22% of medical school full professors, 18% of medical school department chairs, and 17% of medical school deans are women. Note that it has taken 50 years to get from 0 women deans to the 25 women deans who are now in this role. Only 28% of full and associate professors and 21% of department chairs are nonwhite. In the health care industry, only 13% of CEOs are women. The pace toward equity has been excruciatingly slow, and it’s not only women and underrepresented minorities who lose, but also the AHCs and their communities.
So how do we reach equity? Mentorship is a key pathway to this goal. In a session at Hospital Medicine 2019 (HM19), “What Mentorship Has Meant To Me (And What It Can Do For You): High Impact Stories from Leaders in Hospital Medicine,” fellow panelists and I outlined how mentorship can positively affect your career, define the qualities of effective mentors and mentees, describe the difference between mentorship and sponsorship, and explained how to navigate common pitfalls in mentor-mentee relationships.
We spoke about the responsibility the mentee has in the relationship and the need to “manage up,” a term borrowed from the corporate world, where the mentee takes responsibility for his or her part in the relationship and takes a leadership role in the relationship. The mentee must be an “active participant” in the relationship for the relationship to be successful. We hope that attendees at the session took some key points back to their institutions to open dialogue on strategies to achieve equity through building mentoring relationships.
When I look back on my time in residency and fellowship, I recognize that I was surrounded by people who offered guidance and advice. But once I became a faculty member, that guidance was less apparent, and I struggled in the first few years. It wasn’t until I attended a conference on peer mentoring that I recognized that I didn’t just need a didactic mentor, but that I needed a portfolio of mentors and that I had to take the initiative to actively engage mentorship. So I did, and its effects on my career have been powerful and numerous.
The evidence is there that mentorship can play a major role in advancing careers. Now it is up to the leadership of academic and nonacademic health centers to take the initiative and establish formalized programs in their institutions. We all benefit when we have diversity in leadership – so let’s get there together.
Dr. Spector is executive director, Executive Leadership in Academic Medicine, associate dean of faculty development, Drexel University, Philadelphia.
Achieving equity in leadership in academic medicine and the health care industry doesn’t have to be a pipe dream. There are clear, actionable steps that will lead us there.
The benefits of diversity are numerous and well documented. Diversity brings competitive advantage to organizations and strength to teams. With academic health centers (AHCs) facing continual stressors while at the same time being significant financial contributors to – and anchors in – their communities, ensuring their high performance is critical to society as a whole. To grow, thrive, and be ethical examples to their communities, health centers need the strongest and most innovative leaders who are reflective of the communities that they serve. This means more diversity in leadership positions.
When we look at the facts of the gender makeup of academic medicine and the health care industry, we can clearly see inequity – only 22% of medical school full professors, 18% of medical school department chairs, and 17% of medical school deans are women. Note that it has taken 50 years to get from 0 women deans to the 25 women deans who are now in this role. Only 28% of full and associate professors and 21% of department chairs are nonwhite. In the health care industry, only 13% of CEOs are women. The pace toward equity has been excruciatingly slow, and it’s not only women and underrepresented minorities who lose, but also the AHCs and their communities.
So how do we reach equity? Mentorship is a key pathway to this goal. In a session at Hospital Medicine 2019 (HM19), “What Mentorship Has Meant To Me (And What It Can Do For You): High Impact Stories from Leaders in Hospital Medicine,” fellow panelists and I outlined how mentorship can positively affect your career, define the qualities of effective mentors and mentees, describe the difference between mentorship and sponsorship, and explained how to navigate common pitfalls in mentor-mentee relationships.
We spoke about the responsibility the mentee has in the relationship and the need to “manage up,” a term borrowed from the corporate world, where the mentee takes responsibility for his or her part in the relationship and takes a leadership role in the relationship. The mentee must be an “active participant” in the relationship for the relationship to be successful. We hope that attendees at the session took some key points back to their institutions to open dialogue on strategies to achieve equity through building mentoring relationships.
When I look back on my time in residency and fellowship, I recognize that I was surrounded by people who offered guidance and advice. But once I became a faculty member, that guidance was less apparent, and I struggled in the first few years. It wasn’t until I attended a conference on peer mentoring that I recognized that I didn’t just need a didactic mentor, but that I needed a portfolio of mentors and that I had to take the initiative to actively engage mentorship. So I did, and its effects on my career have been powerful and numerous.
The evidence is there that mentorship can play a major role in advancing careers. Now it is up to the leadership of academic and nonacademic health centers to take the initiative and establish formalized programs in their institutions. We all benefit when we have diversity in leadership – so let’s get there together.
Dr. Spector is executive director, Executive Leadership in Academic Medicine, associate dean of faculty development, Drexel University, Philadelphia.
Cardiac PET/CT can guide CAD therapy
NEW ORLEANS – A PET/CT-derived myocardial ischemic burden in excess of 10% defines a subset of patients with symptomatic CAD who derive significantly greater benefit from an invasive management strategy than a noninvasive one, Kent G. Meredith, MD, reported at the annual meeting of the American College of Cardiology.
Conversely, patients with an ischemia burden of 10% or less have a lower major adverse event rate if they undergo noninvasive treatment.
“We see that cardiac PET/CT-derived ischemic burden provides a convenient and useful tool for predicting clinical outcomes of invasive and noninvasive treatment strategies,”said Dr. Meredith, a cardiologist at Intermountain Medical Center in Murray, Utah.
He presented a retrospective single-center study of 5,528 consecutive patients with symptomatic CAD referred for PET/CT at Intermountain. As a condition for study inclusion, they needed to survive for at least 90 days after imaging, have no elevation of troponin, and have no prior history of CAD.
This was a study of real-world clinical practice featuring standardized institutional protocols. Dr. Meredith explained that the 10% ischemic burden threshold used by cardiologists at Intermountain to help determine an individual’s optimal treatment strategy is based upon “a very important study” in which investigators at Cedars-Sinai Medical Center in Los Angeles showed 16 years ago, in nearly 11,000 consecutive patients, that revascularization had a survival benefit over medical therapy alone at an ischemic burden in excess of 10% as measured by stress myocardial perfusion single photon emission CT (Circulation. 2003 Jun 17;107[23]:2900-7).
Dr. Meredith and his coinvestigators carried out their study to make sure this ischemic burden cutoff is still valid today in view of the considerable changes in imaging technology and optimal medical therapy in the intervening years.
Among the study population, 203 patients had a PET/CT-derived ischemic burden greater than 10% using a well-established scoring system (J Nucl Cardiol. 2006 Nov;13[6]:e157-71), while 5,325 had a lesser ischemic burden. Fifty-six percent of patients with an ischemic burden above the 10% threshold underwent coronary revascularization, 26% had coronary angiography without revascularization, and 18% were managed by optimal medical therapy alone.
The group with an ischemic burden of 10% or less was managed very differently: One percent had revascularization, 3% had angiography without revascularization, and 96% were managed medically.
The higher a patient’s baseline ischemic burden, the higher the major adverse cardiovascular event (MACE) rate during 1-4 years of follow-up. The composite MACE rate, comprising death, hospitalization for acute MI, or late revascularization after 90 days, was 3.9% in patients with an ischemic burden of 10% of less, compared with 8.9% in those above the 10% threshold.
In a multivariate analysis adjusted for demographics, hyperlipidemia, heart failure, and diabetes, patients with an ischemic burden greater than 10% had a 4.6-fold greater risk of MACE if managed medically than if they underwent revascularization. And among those with an ischemic burden of 10% or less, the adjusted risk of MACE was increased 2.8-fold if they received revascularization instead of medical management.
Dr. Meredith reported having no financial conflicts regarding his study, conducted free of commercial sponsorship.
NEW ORLEANS – A PET/CT-derived myocardial ischemic burden in excess of 10% defines a subset of patients with symptomatic CAD who derive significantly greater benefit from an invasive management strategy than a noninvasive one, Kent G. Meredith, MD, reported at the annual meeting of the American College of Cardiology.
Conversely, patients with an ischemia burden of 10% or less have a lower major adverse event rate if they undergo noninvasive treatment.
“We see that cardiac PET/CT-derived ischemic burden provides a convenient and useful tool for predicting clinical outcomes of invasive and noninvasive treatment strategies,”said Dr. Meredith, a cardiologist at Intermountain Medical Center in Murray, Utah.
He presented a retrospective single-center study of 5,528 consecutive patients with symptomatic CAD referred for PET/CT at Intermountain. As a condition for study inclusion, they needed to survive for at least 90 days after imaging, have no elevation of troponin, and have no prior history of CAD.
This was a study of real-world clinical practice featuring standardized institutional protocols. Dr. Meredith explained that the 10% ischemic burden threshold used by cardiologists at Intermountain to help determine an individual’s optimal treatment strategy is based upon “a very important study” in which investigators at Cedars-Sinai Medical Center in Los Angeles showed 16 years ago, in nearly 11,000 consecutive patients, that revascularization had a survival benefit over medical therapy alone at an ischemic burden in excess of 10% as measured by stress myocardial perfusion single photon emission CT (Circulation. 2003 Jun 17;107[23]:2900-7).
Dr. Meredith and his coinvestigators carried out their study to make sure this ischemic burden cutoff is still valid today in view of the considerable changes in imaging technology and optimal medical therapy in the intervening years.
Among the study population, 203 patients had a PET/CT-derived ischemic burden greater than 10% using a well-established scoring system (J Nucl Cardiol. 2006 Nov;13[6]:e157-71), while 5,325 had a lesser ischemic burden. Fifty-six percent of patients with an ischemic burden above the 10% threshold underwent coronary revascularization, 26% had coronary angiography without revascularization, and 18% were managed by optimal medical therapy alone.
The group with an ischemic burden of 10% or less was managed very differently: One percent had revascularization, 3% had angiography without revascularization, and 96% were managed medically.
The higher a patient’s baseline ischemic burden, the higher the major adverse cardiovascular event (MACE) rate during 1-4 years of follow-up. The composite MACE rate, comprising death, hospitalization for acute MI, or late revascularization after 90 days, was 3.9% in patients with an ischemic burden of 10% of less, compared with 8.9% in those above the 10% threshold.
In a multivariate analysis adjusted for demographics, hyperlipidemia, heart failure, and diabetes, patients with an ischemic burden greater than 10% had a 4.6-fold greater risk of MACE if managed medically than if they underwent revascularization. And among those with an ischemic burden of 10% or less, the adjusted risk of MACE was increased 2.8-fold if they received revascularization instead of medical management.
Dr. Meredith reported having no financial conflicts regarding his study, conducted free of commercial sponsorship.
NEW ORLEANS – A PET/CT-derived myocardial ischemic burden in excess of 10% defines a subset of patients with symptomatic CAD who derive significantly greater benefit from an invasive management strategy than a noninvasive one, Kent G. Meredith, MD, reported at the annual meeting of the American College of Cardiology.
Conversely, patients with an ischemia burden of 10% or less have a lower major adverse event rate if they undergo noninvasive treatment.
“We see that cardiac PET/CT-derived ischemic burden provides a convenient and useful tool for predicting clinical outcomes of invasive and noninvasive treatment strategies,”said Dr. Meredith, a cardiologist at Intermountain Medical Center in Murray, Utah.
He presented a retrospective single-center study of 5,528 consecutive patients with symptomatic CAD referred for PET/CT at Intermountain. As a condition for study inclusion, they needed to survive for at least 90 days after imaging, have no elevation of troponin, and have no prior history of CAD.
This was a study of real-world clinical practice featuring standardized institutional protocols. Dr. Meredith explained that the 10% ischemic burden threshold used by cardiologists at Intermountain to help determine an individual’s optimal treatment strategy is based upon “a very important study” in which investigators at Cedars-Sinai Medical Center in Los Angeles showed 16 years ago, in nearly 11,000 consecutive patients, that revascularization had a survival benefit over medical therapy alone at an ischemic burden in excess of 10% as measured by stress myocardial perfusion single photon emission CT (Circulation. 2003 Jun 17;107[23]:2900-7).
Dr. Meredith and his coinvestigators carried out their study to make sure this ischemic burden cutoff is still valid today in view of the considerable changes in imaging technology and optimal medical therapy in the intervening years.
Among the study population, 203 patients had a PET/CT-derived ischemic burden greater than 10% using a well-established scoring system (J Nucl Cardiol. 2006 Nov;13[6]:e157-71), while 5,325 had a lesser ischemic burden. Fifty-six percent of patients with an ischemic burden above the 10% threshold underwent coronary revascularization, 26% had coronary angiography without revascularization, and 18% were managed by optimal medical therapy alone.
The group with an ischemic burden of 10% or less was managed very differently: One percent had revascularization, 3% had angiography without revascularization, and 96% were managed medically.
The higher a patient’s baseline ischemic burden, the higher the major adverse cardiovascular event (MACE) rate during 1-4 years of follow-up. The composite MACE rate, comprising death, hospitalization for acute MI, or late revascularization after 90 days, was 3.9% in patients with an ischemic burden of 10% of less, compared with 8.9% in those above the 10% threshold.
In a multivariate analysis adjusted for demographics, hyperlipidemia, heart failure, and diabetes, patients with an ischemic burden greater than 10% had a 4.6-fold greater risk of MACE if managed medically than if they underwent revascularization. And among those with an ischemic burden of 10% or less, the adjusted risk of MACE was increased 2.8-fold if they received revascularization instead of medical management.
Dr. Meredith reported having no financial conflicts regarding his study, conducted free of commercial sponsorship.
REPORTING FROM ACC 19
Top AGA Community patient cases
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Biologic blood levels for pediatric IBD patient
An 11-year-old was experiencing right lower quadrant pain, a low-grade fever, painful red nodules in his legs, joint pain, moderate anemia, a peri-anal abscess and high fecal calprotectin. An MRI revealed signs of lower small bowel disease and moderate narrowing of the ileum. He was treated and showing no symptoms at about 20 weeks. The community discussed if the patient would benefit from adding adalimumab blood levels to his maintenance.
2. False positives in new DNA-based colon cancer tests
A discussion around some noninvasive colon cancer tests, such as Cologuard and liquid biopsy tests like Epi proColon, revealed community frustrations with false positives and dealing with an increased number of anxious patients awaiting colonoscopies.
3. Olmesartan-induced enteropathy
A female patient switched blood pressure medications and developed diarrhea, abdominal discomfort, and weight loss. She tested positive for celiac-type enteropathy and was placed on a gluten-free diet, with symptoms resolving a couple weeks later. She switched back to her original medication, and her GI had questions for the community regarding potential for a long-term condition, as well as celiac serology follow-up.
4. Inactive UC
A 49-year-old woman with a history of pancolitis hasn’t required therapy for over 10 years. Recent biopsies showed architectural distortion and atrophy consistent with inactive colitis, without any active colitis in the rectum, but the descending colon presented a polyp mucosa with chronic colitis, erosion, and regenerative hyperplasia. Given her history, the physician solicited advice on therapy and rescoping consistency going forward.
More clinical cases and discussions are at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Biologic blood levels for pediatric IBD patient
An 11-year-old was experiencing right lower quadrant pain, a low-grade fever, painful red nodules in his legs, joint pain, moderate anemia, a peri-anal abscess and high fecal calprotectin. An MRI revealed signs of lower small bowel disease and moderate narrowing of the ileum. He was treated and showing no symptoms at about 20 weeks. The community discussed if the patient would benefit from adding adalimumab blood levels to his maintenance.
2. False positives in new DNA-based colon cancer tests
A discussion around some noninvasive colon cancer tests, such as Cologuard and liquid biopsy tests like Epi proColon, revealed community frustrations with false positives and dealing with an increased number of anxious patients awaiting colonoscopies.
3. Olmesartan-induced enteropathy
A female patient switched blood pressure medications and developed diarrhea, abdominal discomfort, and weight loss. She tested positive for celiac-type enteropathy and was placed on a gluten-free diet, with symptoms resolving a couple weeks later. She switched back to her original medication, and her GI had questions for the community regarding potential for a long-term condition, as well as celiac serology follow-up.
4. Inactive UC
A 49-year-old woman with a history of pancolitis hasn’t required therapy for over 10 years. Recent biopsies showed architectural distortion and atrophy consistent with inactive colitis, without any active colitis in the rectum, but the descending colon presented a polyp mucosa with chronic colitis, erosion, and regenerative hyperplasia. Given her history, the physician solicited advice on therapy and rescoping consistency going forward.
More clinical cases and discussions are at https://community.gastro.org/discussions.
Physicians with difficult patient scenarios regularly bring their questions to the AGA Community to seek advice from colleagues about therapy and disease management options, best practices, and diagnoses.
In case you missed it, here are the most popular clinical discussions shared in the forum recently:
1. Biologic blood levels for pediatric IBD patient
An 11-year-old was experiencing right lower quadrant pain, a low-grade fever, painful red nodules in his legs, joint pain, moderate anemia, a peri-anal abscess and high fecal calprotectin. An MRI revealed signs of lower small bowel disease and moderate narrowing of the ileum. He was treated and showing no symptoms at about 20 weeks. The community discussed if the patient would benefit from adding adalimumab blood levels to his maintenance.
2. False positives in new DNA-based colon cancer tests
A discussion around some noninvasive colon cancer tests, such as Cologuard and liquid biopsy tests like Epi proColon, revealed community frustrations with false positives and dealing with an increased number of anxious patients awaiting colonoscopies.
3. Olmesartan-induced enteropathy
A female patient switched blood pressure medications and developed diarrhea, abdominal discomfort, and weight loss. She tested positive for celiac-type enteropathy and was placed on a gluten-free diet, with symptoms resolving a couple weeks later. She switched back to her original medication, and her GI had questions for the community regarding potential for a long-term condition, as well as celiac serology follow-up.
4. Inactive UC
A 49-year-old woman with a history of pancolitis hasn’t required therapy for over 10 years. Recent biopsies showed architectural distortion and atrophy consistent with inactive colitis, without any active colitis in the rectum, but the descending colon presented a polyp mucosa with chronic colitis, erosion, and regenerative hyperplasia. Given her history, the physician solicited advice on therapy and rescoping consistency going forward.
More clinical cases and discussions are at https://community.gastro.org/discussions.
Screening colonoscopy coinsurance fix legislation introduced
Medicare beneficiaries who have a screening colonoscopy and have polyps found and removed, find themselves on the hook for the coinsurance since the screening is now classified as a therapeutic procedure. AGA has been working for years with Congress to change this since removal of polyps is integral to the screening. Screenings save lives and Congress must enact legislation to fix this “surprise bill” that beneficiaries face.
Sens. Sherrod Brown, D-OH, Roger Wicker, R-MS, Ben Cardin, D-MD, and Susan Collins, R-ME, and Reps. Donald Payne Jr., D-NJ, Rodney Davis, R-IL, Donald McEachin, D-VA, and David McKinley, R-WV, have introduced the Removing Barriers to Colorectal Cancer Screening Act. This bipartisan, bicameral legislation would waive the Medicare coinsurance for a screening colonoscopy that becomes therapeutic. Fixing this barrier will ensure that seniors will have access to lifesaving screenings and we will continue to make progress in fighting colorectal cancer.
AGA continues to advocate that Congress support and pass the Removing Barriers to Colorectal Cancer Screening Act and we need your help. Please take a moment to ask your legislator to support this important legislation by going to www.gastro.org/take-action.
Colorectal cancer remains the second leading cancer killer in the U.S. despite the evidence that screening can save lives. The Affordable Care Act made great strides in ensuring that all Americans have access and coverage of lifesaving colorectal cancer screenings without cost sharing and clarified that private insurers could not impose cost sharing on screening colonoscopies that become therapeutic since “removal of polyps is integral” to the screening. We believe that same policy should be applied to our nation’s seniors and the Centers for Medicare and Medicaid should use their authority to make this change.
AGA is committed to ensuring that patients have access to quality lifesaving screenings. Unfortunately, this current Medicare policy has caused enormous confusion among patients and providers and we continue to provide information and education to practices on how this policy impacts their patients. Fixing this problem will alleviate this confusion and ensure that Medicare patients are incentivized to have preventive screenings.
Medicare beneficiaries who have a screening colonoscopy and have polyps found and removed, find themselves on the hook for the coinsurance since the screening is now classified as a therapeutic procedure. AGA has been working for years with Congress to change this since removal of polyps is integral to the screening. Screenings save lives and Congress must enact legislation to fix this “surprise bill” that beneficiaries face.
Sens. Sherrod Brown, D-OH, Roger Wicker, R-MS, Ben Cardin, D-MD, and Susan Collins, R-ME, and Reps. Donald Payne Jr., D-NJ, Rodney Davis, R-IL, Donald McEachin, D-VA, and David McKinley, R-WV, have introduced the Removing Barriers to Colorectal Cancer Screening Act. This bipartisan, bicameral legislation would waive the Medicare coinsurance for a screening colonoscopy that becomes therapeutic. Fixing this barrier will ensure that seniors will have access to lifesaving screenings and we will continue to make progress in fighting colorectal cancer.
AGA continues to advocate that Congress support and pass the Removing Barriers to Colorectal Cancer Screening Act and we need your help. Please take a moment to ask your legislator to support this important legislation by going to www.gastro.org/take-action.
Colorectal cancer remains the second leading cancer killer in the U.S. despite the evidence that screening can save lives. The Affordable Care Act made great strides in ensuring that all Americans have access and coverage of lifesaving colorectal cancer screenings without cost sharing and clarified that private insurers could not impose cost sharing on screening colonoscopies that become therapeutic since “removal of polyps is integral” to the screening. We believe that same policy should be applied to our nation’s seniors and the Centers for Medicare and Medicaid should use their authority to make this change.
AGA is committed to ensuring that patients have access to quality lifesaving screenings. Unfortunately, this current Medicare policy has caused enormous confusion among patients and providers and we continue to provide information and education to practices on how this policy impacts their patients. Fixing this problem will alleviate this confusion and ensure that Medicare patients are incentivized to have preventive screenings.
Medicare beneficiaries who have a screening colonoscopy and have polyps found and removed, find themselves on the hook for the coinsurance since the screening is now classified as a therapeutic procedure. AGA has been working for years with Congress to change this since removal of polyps is integral to the screening. Screenings save lives and Congress must enact legislation to fix this “surprise bill” that beneficiaries face.
Sens. Sherrod Brown, D-OH, Roger Wicker, R-MS, Ben Cardin, D-MD, and Susan Collins, R-ME, and Reps. Donald Payne Jr., D-NJ, Rodney Davis, R-IL, Donald McEachin, D-VA, and David McKinley, R-WV, have introduced the Removing Barriers to Colorectal Cancer Screening Act. This bipartisan, bicameral legislation would waive the Medicare coinsurance for a screening colonoscopy that becomes therapeutic. Fixing this barrier will ensure that seniors will have access to lifesaving screenings and we will continue to make progress in fighting colorectal cancer.
AGA continues to advocate that Congress support and pass the Removing Barriers to Colorectal Cancer Screening Act and we need your help. Please take a moment to ask your legislator to support this important legislation by going to www.gastro.org/take-action.
Colorectal cancer remains the second leading cancer killer in the U.S. despite the evidence that screening can save lives. The Affordable Care Act made great strides in ensuring that all Americans have access and coverage of lifesaving colorectal cancer screenings without cost sharing and clarified that private insurers could not impose cost sharing on screening colonoscopies that become therapeutic since “removal of polyps is integral” to the screening. We believe that same policy should be applied to our nation’s seniors and the Centers for Medicare and Medicaid should use their authority to make this change.
AGA is committed to ensuring that patients have access to quality lifesaving screenings. Unfortunately, this current Medicare policy has caused enormous confusion among patients and providers and we continue to provide information and education to practices on how this policy impacts their patients. Fixing this problem will alleviate this confusion and ensure that Medicare patients are incentivized to have preventive screenings.
‘Put your own oxygen mask on first’
Takeaways from the leadership conference stress the importance of self-care, emotional intelligence, and remaining optimistic.
“Leadership 101: put your own oxygen mask on first @DarwinConwell #AGAleads #AGAForward @AmerGastroAssn”— Dr Michelle T. Long (@DrMTLong)
The inaugural Leadership Development Conference combined participants from three AGA programs for a weekend of networking, mentorship, and mapping out goals and initiatives.
Attendees included the 2020 class of AGA Future Leaders and mentors, Women’s Leadership Conference participants, and mentors and scholars of the new AGA FORWARD Program, an NIH-funded initiative that supports underrepresented minority physicians and scientists.
“Got to meet one of my tweeps heroes today! She’s even more awesome in real life!! #AGALeads #WomenInMedicine #WomenInGI @drfolamay @AmerGastroAssn” — Dr Aline Charabaty (@DCharabaty)
“Dr. Boland (Lynch syndrome) discussing career success in an ever changing scientific environment #AGALeads #AGAForward” — Eric J. Vargas M.D. (@EricJVargasMD)
“7 AGA Presidents, moderated by Dr. Anandasabapathy on Pathways to Leadership and Overcoming Challenges of the Era Presidential Panel @AmerGastroAssn Leadership conference program @SeragHashem @BCMDeptMedicine @KanwalFasiha @Aketwaroo @richashukla84” — Ruben Hernaez (@ruben_hernaez)
The event coincided with International Women’s Day, giving Women’s Leadership Conference attendees the chance to celebrate their journeys and grow into leadership roles with other #WomenInGI.
“#AGALeads #womenleadershipconference #womeninGI #InternationWomensDay with some amazing ladies in GI!! @AmerGastroAssn @AlisonGoldinMD @ibddocmaria @joanwchen” — ReezwanaCMD (@reezwanc)
“#AGAleads #WomeninGI women negotiating in a group are perceived favorably – Ellen Zimmerman, MD”
— Fazia Mir-Shaffi,MD (@Faiziya) March 9, 2019
“What I learned at @AmerGastroAssn #womeninGI Leadership course (after waiting a bit to see what stuck w me)
1. If you say yes to a request, you’re saying yes to doing it well.
2. Knowing your limitations will serve you better than being great at everything” — Laura Targownik (@UofM_GI_Head)
Aline Charabaty Pishvaian, MD, shared some takeaways in the AGA Community forum (community.gastro.org) about challenges women in GI face — a breakout discussion from the Women’s Leadership Conference.
View more insight and takeaways from participants on Twitter using #AGALeads.
Takeaways from the leadership conference stress the importance of self-care, emotional intelligence, and remaining optimistic.
Takeaways from the leadership conference stress the importance of self-care, emotional intelligence, and remaining optimistic.
“Leadership 101: put your own oxygen mask on first @DarwinConwell #AGAleads #AGAForward @AmerGastroAssn”— Dr Michelle T. Long (@DrMTLong)
The inaugural Leadership Development Conference combined participants from three AGA programs for a weekend of networking, mentorship, and mapping out goals and initiatives.
Attendees included the 2020 class of AGA Future Leaders and mentors, Women’s Leadership Conference participants, and mentors and scholars of the new AGA FORWARD Program, an NIH-funded initiative that supports underrepresented minority physicians and scientists.
“Got to meet one of my tweeps heroes today! She’s even more awesome in real life!! #AGALeads #WomenInMedicine #WomenInGI @drfolamay @AmerGastroAssn” — Dr Aline Charabaty (@DCharabaty)
“Dr. Boland (Lynch syndrome) discussing career success in an ever changing scientific environment #AGALeads #AGAForward” — Eric J. Vargas M.D. (@EricJVargasMD)
“7 AGA Presidents, moderated by Dr. Anandasabapathy on Pathways to Leadership and Overcoming Challenges of the Era Presidential Panel @AmerGastroAssn Leadership conference program @SeragHashem @BCMDeptMedicine @KanwalFasiha @Aketwaroo @richashukla84” — Ruben Hernaez (@ruben_hernaez)
The event coincided with International Women’s Day, giving Women’s Leadership Conference attendees the chance to celebrate their journeys and grow into leadership roles with other #WomenInGI.
“#AGALeads #womenleadershipconference #womeninGI #InternationWomensDay with some amazing ladies in GI!! @AmerGastroAssn @AlisonGoldinMD @ibddocmaria @joanwchen” — ReezwanaCMD (@reezwanc)
“#AGAleads #WomeninGI women negotiating in a group are perceived favorably – Ellen Zimmerman, MD”
— Fazia Mir-Shaffi,MD (@Faiziya) March 9, 2019
“What I learned at @AmerGastroAssn #womeninGI Leadership course (after waiting a bit to see what stuck w me)
1. If you say yes to a request, you’re saying yes to doing it well.
2. Knowing your limitations will serve you better than being great at everything” — Laura Targownik (@UofM_GI_Head)
Aline Charabaty Pishvaian, MD, shared some takeaways in the AGA Community forum (community.gastro.org) about challenges women in GI face — a breakout discussion from the Women’s Leadership Conference.
View more insight and takeaways from participants on Twitter using #AGALeads.
“Leadership 101: put your own oxygen mask on first @DarwinConwell #AGAleads #AGAForward @AmerGastroAssn”— Dr Michelle T. Long (@DrMTLong)
The inaugural Leadership Development Conference combined participants from three AGA programs for a weekend of networking, mentorship, and mapping out goals and initiatives.
Attendees included the 2020 class of AGA Future Leaders and mentors, Women’s Leadership Conference participants, and mentors and scholars of the new AGA FORWARD Program, an NIH-funded initiative that supports underrepresented minority physicians and scientists.
“Got to meet one of my tweeps heroes today! She’s even more awesome in real life!! #AGALeads #WomenInMedicine #WomenInGI @drfolamay @AmerGastroAssn” — Dr Aline Charabaty (@DCharabaty)
“Dr. Boland (Lynch syndrome) discussing career success in an ever changing scientific environment #AGALeads #AGAForward” — Eric J. Vargas M.D. (@EricJVargasMD)
“7 AGA Presidents, moderated by Dr. Anandasabapathy on Pathways to Leadership and Overcoming Challenges of the Era Presidential Panel @AmerGastroAssn Leadership conference program @SeragHashem @BCMDeptMedicine @KanwalFasiha @Aketwaroo @richashukla84” — Ruben Hernaez (@ruben_hernaez)
The event coincided with International Women’s Day, giving Women’s Leadership Conference attendees the chance to celebrate their journeys and grow into leadership roles with other #WomenInGI.
“#AGALeads #womenleadershipconference #womeninGI #InternationWomensDay with some amazing ladies in GI!! @AmerGastroAssn @AlisonGoldinMD @ibddocmaria @joanwchen” — ReezwanaCMD (@reezwanc)
“#AGAleads #WomeninGI women negotiating in a group are perceived favorably – Ellen Zimmerman, MD”
— Fazia Mir-Shaffi,MD (@Faiziya) March 9, 2019
“What I learned at @AmerGastroAssn #womeninGI Leadership course (after waiting a bit to see what stuck w me)
1. If you say yes to a request, you’re saying yes to doing it well.
2. Knowing your limitations will serve you better than being great at everything” — Laura Targownik (@UofM_GI_Head)
Aline Charabaty Pishvaian, MD, shared some takeaways in the AGA Community forum (community.gastro.org) about challenges women in GI face — a breakout discussion from the Women’s Leadership Conference.
View more insight and takeaways from participants on Twitter using #AGALeads.
Does BMI affect outcomes after ischemic stroke?
according to research that will be presented at the annual meeting of the American Academy of Neurology.
“One possible explanation is that people who are overweight or obese may have a nutritional reserve that may help them survive during prolonged illness,” said Zuolu Liu, MD, of the University of California, Los Angeles, in a press release. “More research is needed to investigate the relationship between BMI and stroke.”
The obesity paradox was first noted when studies suggested that being overweight improved survival in patients with kidney disease or heart disease. Investigators previously examined whether the obesity paradox is observed in stroke, but their studies were underpowered and produced ambiguous results.
Dr. Liu and colleagues sought to evaluate the relationship between BMI and 90-day outcomes of acute ischemic stroke. They examined data for all participants in the FAST-MAG trial, which studied whether prehospital treatment with magnesium improved disability outcomes of acute ischemic stroke. Dr. Liu and colleagues focused on the outcomes of death, disability or death (that is, modified Rankin Scale score of 2-6), and low stroke-related quality of life (that is, Stroke Impact Scale score less than 70). They analyzed potential relationships with BMI univariately and in multivariate models that adjusted for 12 prognostic variables, such as high blood pressure, high cholesterol, and smoking.
Dr. Liu’s group included 1,033 participants in its study. The population’s mean age was 71 years, and 45.1% of the population was female. Mean National Institutes of Health Stroke Scale (NIHSS) score was 10.6, and mean BMI was 27.5 kg/m2.
The investigators found an inverse association between the risk of death and BMI. Adjusted odds ratios for mortality were 1.67 for underweight participants, 0.85 for overweight participants, 0.54 for obese participants, and 0.38 for severely obese participants, compared with participants of normal weight. Similarly, the risk of disability had a U-shaped relationship with BMI. Odds ratios for disability or death were 1.19 for underweight participants, 0.78 for overweight participants, 0.72 for obese participants, and 0.96 for severely obese participants, compared with participants of normal weight. This relationship was attenuated after adjustment for other prognostic factors, however. Dr. Liu’s group did not find a significant association between BMI and low stroke-related quality of life.
The study was limited by the fact that all participants were from Southern California, which potentially reduced the generalizability of the results. The racial and ethnic composition of the study population, however, is similar to that of the national population, said the researchers.
No study sponsor was reported.
SOURCE: Liu Z et al. AAN 2019, Abstract P3.3-01.
according to research that will be presented at the annual meeting of the American Academy of Neurology.
“One possible explanation is that people who are overweight or obese may have a nutritional reserve that may help them survive during prolonged illness,” said Zuolu Liu, MD, of the University of California, Los Angeles, in a press release. “More research is needed to investigate the relationship between BMI and stroke.”
The obesity paradox was first noted when studies suggested that being overweight improved survival in patients with kidney disease or heart disease. Investigators previously examined whether the obesity paradox is observed in stroke, but their studies were underpowered and produced ambiguous results.
Dr. Liu and colleagues sought to evaluate the relationship between BMI and 90-day outcomes of acute ischemic stroke. They examined data for all participants in the FAST-MAG trial, which studied whether prehospital treatment with magnesium improved disability outcomes of acute ischemic stroke. Dr. Liu and colleagues focused on the outcomes of death, disability or death (that is, modified Rankin Scale score of 2-6), and low stroke-related quality of life (that is, Stroke Impact Scale score less than 70). They analyzed potential relationships with BMI univariately and in multivariate models that adjusted for 12 prognostic variables, such as high blood pressure, high cholesterol, and smoking.
Dr. Liu’s group included 1,033 participants in its study. The population’s mean age was 71 years, and 45.1% of the population was female. Mean National Institutes of Health Stroke Scale (NIHSS) score was 10.6, and mean BMI was 27.5 kg/m2.
The investigators found an inverse association between the risk of death and BMI. Adjusted odds ratios for mortality were 1.67 for underweight participants, 0.85 for overweight participants, 0.54 for obese participants, and 0.38 for severely obese participants, compared with participants of normal weight. Similarly, the risk of disability had a U-shaped relationship with BMI. Odds ratios for disability or death were 1.19 for underweight participants, 0.78 for overweight participants, 0.72 for obese participants, and 0.96 for severely obese participants, compared with participants of normal weight. This relationship was attenuated after adjustment for other prognostic factors, however. Dr. Liu’s group did not find a significant association between BMI and low stroke-related quality of life.
The study was limited by the fact that all participants were from Southern California, which potentially reduced the generalizability of the results. The racial and ethnic composition of the study population, however, is similar to that of the national population, said the researchers.
No study sponsor was reported.
SOURCE: Liu Z et al. AAN 2019, Abstract P3.3-01.
according to research that will be presented at the annual meeting of the American Academy of Neurology.
“One possible explanation is that people who are overweight or obese may have a nutritional reserve that may help them survive during prolonged illness,” said Zuolu Liu, MD, of the University of California, Los Angeles, in a press release. “More research is needed to investigate the relationship between BMI and stroke.”
The obesity paradox was first noted when studies suggested that being overweight improved survival in patients with kidney disease or heart disease. Investigators previously examined whether the obesity paradox is observed in stroke, but their studies were underpowered and produced ambiguous results.
Dr. Liu and colleagues sought to evaluate the relationship between BMI and 90-day outcomes of acute ischemic stroke. They examined data for all participants in the FAST-MAG trial, which studied whether prehospital treatment with magnesium improved disability outcomes of acute ischemic stroke. Dr. Liu and colleagues focused on the outcomes of death, disability or death (that is, modified Rankin Scale score of 2-6), and low stroke-related quality of life (that is, Stroke Impact Scale score less than 70). They analyzed potential relationships with BMI univariately and in multivariate models that adjusted for 12 prognostic variables, such as high blood pressure, high cholesterol, and smoking.
Dr. Liu’s group included 1,033 participants in its study. The population’s mean age was 71 years, and 45.1% of the population was female. Mean National Institutes of Health Stroke Scale (NIHSS) score was 10.6, and mean BMI was 27.5 kg/m2.
The investigators found an inverse association between the risk of death and BMI. Adjusted odds ratios for mortality were 1.67 for underweight participants, 0.85 for overweight participants, 0.54 for obese participants, and 0.38 for severely obese participants, compared with participants of normal weight. Similarly, the risk of disability had a U-shaped relationship with BMI. Odds ratios for disability or death were 1.19 for underweight participants, 0.78 for overweight participants, 0.72 for obese participants, and 0.96 for severely obese participants, compared with participants of normal weight. This relationship was attenuated after adjustment for other prognostic factors, however. Dr. Liu’s group did not find a significant association between BMI and low stroke-related quality of life.
The study was limited by the fact that all participants were from Southern California, which potentially reduced the generalizability of the results. The racial and ethnic composition of the study population, however, is similar to that of the national population, said the researchers.
No study sponsor was reported.
SOURCE: Liu Z et al. AAN 2019, Abstract P3.3-01.
FROM AAN 2019
AGA president advocates for increased access to care for digestive disease patients
AGA President David Lieberman, MD, AGAF, was on Capitol Hill advocating for legislation to ensure that digestive disease patients have timely access to lifesaving treatments and touted the importance of increasing access to colorectal cancer screenings. Specifically, Dr. Lieberman sought support for H.R. 1570/S. 668, the Removing Barriers to Colorectal Cancer Screening Act, legislation that would fix the current Medicare screening colonoscopy coinsurance problem. Currently, when a Medicare beneficiary has a screening colonoscopy that turns therapeutic, the procedure is no longer considered a screening and the patient is on the hook for the “surprise” bill. This bipartisan, bicameral legislation would fix this problem for beneficiaries.
Dr. Lieberman also participated in a congressional briefing sponsored by AGA, ACG, and ASGE on the importance of colorectal cancer (CRC) screening and spoke of the geographic, ethnic, and socioeconomic barriers to CRC screening and how it impacts the rates of screening. Rep. James P. McGovern, D-MA, chair of the House Rules Committee, also spoke about the importance of CRC screenings and the number of lives that can be saved with screening. He also stressed that we have made strides in screening because of the research that is funded through the NIH which Congress needs to continue to support.
Protection for patients who are subject to step-therapy protocols was another area that Dr. Lieberman emphasized during his meetings with congressional staff. Step therapy is a utilization management tool where insurers force patients to fail one or more therapies before they will cover the initial therapy recommended by their physician. This policy is more and more common especially for patients with inflammatory bowel disease (IBD) who rely on biologics for treatment. Dr. Lieberman stressed that forcing a patient to fail a medication that they know will be ineffective is in violation of the Hippocratic oath. Restoring the Patient’s Voice Act, legislation soon to be reintroduced by Reps. Raul Ruiz, D-CA, and Brad Wenstrup, R-OH, would provide an expeditated appeals process and provide some common sense exceptions for patients when subjected to step therapy.
Dr. Lieberman stressed the importance of funding the NIH and requested Congress increase their budget by $2 billion in fiscal year 2020. Dr. Lieberman described the NIH as our country’s crown jewel since it invests in biomedical research that will ultimately find cures for countless conditions, increase our country’s economic competitiveness, and spur industries and invests in our country’s best and brightest scientists. We are hopeful that Congress will reject the Trump Administration’s recommendation of a 12% cut for NIH and instead continue to provide the necessary increases the agency needs to remain competitive.
AGA President David Lieberman, MD, AGAF, was on Capitol Hill advocating for legislation to ensure that digestive disease patients have timely access to lifesaving treatments and touted the importance of increasing access to colorectal cancer screenings. Specifically, Dr. Lieberman sought support for H.R. 1570/S. 668, the Removing Barriers to Colorectal Cancer Screening Act, legislation that would fix the current Medicare screening colonoscopy coinsurance problem. Currently, when a Medicare beneficiary has a screening colonoscopy that turns therapeutic, the procedure is no longer considered a screening and the patient is on the hook for the “surprise” bill. This bipartisan, bicameral legislation would fix this problem for beneficiaries.
Dr. Lieberman also participated in a congressional briefing sponsored by AGA, ACG, and ASGE on the importance of colorectal cancer (CRC) screening and spoke of the geographic, ethnic, and socioeconomic barriers to CRC screening and how it impacts the rates of screening. Rep. James P. McGovern, D-MA, chair of the House Rules Committee, also spoke about the importance of CRC screenings and the number of lives that can be saved with screening. He also stressed that we have made strides in screening because of the research that is funded through the NIH which Congress needs to continue to support.
Protection for patients who are subject to step-therapy protocols was another area that Dr. Lieberman emphasized during his meetings with congressional staff. Step therapy is a utilization management tool where insurers force patients to fail one or more therapies before they will cover the initial therapy recommended by their physician. This policy is more and more common especially for patients with inflammatory bowel disease (IBD) who rely on biologics for treatment. Dr. Lieberman stressed that forcing a patient to fail a medication that they know will be ineffective is in violation of the Hippocratic oath. Restoring the Patient’s Voice Act, legislation soon to be reintroduced by Reps. Raul Ruiz, D-CA, and Brad Wenstrup, R-OH, would provide an expeditated appeals process and provide some common sense exceptions for patients when subjected to step therapy.
Dr. Lieberman stressed the importance of funding the NIH and requested Congress increase their budget by $2 billion in fiscal year 2020. Dr. Lieberman described the NIH as our country’s crown jewel since it invests in biomedical research that will ultimately find cures for countless conditions, increase our country’s economic competitiveness, and spur industries and invests in our country’s best and brightest scientists. We are hopeful that Congress will reject the Trump Administration’s recommendation of a 12% cut for NIH and instead continue to provide the necessary increases the agency needs to remain competitive.
AGA President David Lieberman, MD, AGAF, was on Capitol Hill advocating for legislation to ensure that digestive disease patients have timely access to lifesaving treatments and touted the importance of increasing access to colorectal cancer screenings. Specifically, Dr. Lieberman sought support for H.R. 1570/S. 668, the Removing Barriers to Colorectal Cancer Screening Act, legislation that would fix the current Medicare screening colonoscopy coinsurance problem. Currently, when a Medicare beneficiary has a screening colonoscopy that turns therapeutic, the procedure is no longer considered a screening and the patient is on the hook for the “surprise” bill. This bipartisan, bicameral legislation would fix this problem for beneficiaries.
Dr. Lieberman also participated in a congressional briefing sponsored by AGA, ACG, and ASGE on the importance of colorectal cancer (CRC) screening and spoke of the geographic, ethnic, and socioeconomic barriers to CRC screening and how it impacts the rates of screening. Rep. James P. McGovern, D-MA, chair of the House Rules Committee, also spoke about the importance of CRC screenings and the number of lives that can be saved with screening. He also stressed that we have made strides in screening because of the research that is funded through the NIH which Congress needs to continue to support.
Protection for patients who are subject to step-therapy protocols was another area that Dr. Lieberman emphasized during his meetings with congressional staff. Step therapy is a utilization management tool where insurers force patients to fail one or more therapies before they will cover the initial therapy recommended by their physician. This policy is more and more common especially for patients with inflammatory bowel disease (IBD) who rely on biologics for treatment. Dr. Lieberman stressed that forcing a patient to fail a medication that they know will be ineffective is in violation of the Hippocratic oath. Restoring the Patient’s Voice Act, legislation soon to be reintroduced by Reps. Raul Ruiz, D-CA, and Brad Wenstrup, R-OH, would provide an expeditated appeals process and provide some common sense exceptions for patients when subjected to step therapy.
Dr. Lieberman stressed the importance of funding the NIH and requested Congress increase their budget by $2 billion in fiscal year 2020. Dr. Lieberman described the NIH as our country’s crown jewel since it invests in biomedical research that will ultimately find cures for countless conditions, increase our country’s economic competitiveness, and spur industries and invests in our country’s best and brightest scientists. We are hopeful that Congress will reject the Trump Administration’s recommendation of a 12% cut for NIH and instead continue to provide the necessary increases the agency needs to remain competitive.