To D/C OR NOT TO D/C: Managing Hyperkalemia in the HF Patient on an ACE/ARB and/or MRA-Optimizing Patient Benefit & Risks
An online educational activity based on a CME/CE Satellite Symposium presented at the 20h Annual Meeting of the Heart Failure Society of America in Orlando, FL.
Target Audience This activity has been designed to meet the educational needs of healthcare professionals with an interest in cardiovascular medicine, including cardiologists, cardiac surgeons, internists, geriatricians, scientists, cardiac rehabilitation specialists, nurses, pharmacists and allied personnel.
Date of Release: December 1, 2016 Program End Date: November 30, 2017
Program Objectives: Upon completion of this activity, participants will be able to:
Discuss the development of hyperkalemia in patients with heart failure who are utilizing angiotensinconverting- enzyme inhibitors, angiotensin receptor blockers (ARBs), or mineralocorticoid receptor antagonists
Assess the clinical trial data on current and emerging pharmacotherapies for the treatment of hyperkalemia in patients with heart failure
Integrate new therapies into the guideline-directed management of heart failure patients with acute or chronic hyperkalemia
Accreditation Statement Physician: The Heart Failure Society of America is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Heart Failure Society of America designates this online activity for a maximum of 1.00 AMA PRA Category 1 Credits™.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Nurse: AKH Inc., Advancing Knowledge in Healthcare is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. This activity is awarded 1.00 Contact Hours.
Pharmacy: AKH, Inc., Advancing Knowledge in Healthcare is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. AKH, Inc., Advancing
Knowledge in Healthcare approves this knowledge-based activity for 1.00 contact hour(s) (0.1 CEUs). UAN 0077-9999-16-096-H04-P. Initial Release Date: December 1, 2016
This online activity is jointly-provided by the Heart Failure Society of American and AKH Inc., Advancing Knowledge in Healthcare.
Course Content - To D/C OR NOT TO D/C: Managing Hyperkalemia in the HF Patient on an ACE/ARB and/or MRA-Optimizing Patient Benefit & Risks
Introduction and Program Overview JoAnn Lindenfeld, MD
Overview of New Medications and the Pathophysiology of Hyperkalemia Javed Butler, MD, MPH, MBA
CASE 1: A Patient with Hyperkalemia JoAnn Lindenfeld, MD
CASE 2: A Patient on MRA Therapy with an Acute Hyperkalemia Episode Ileana Pina, MD, MPH
Panel Discussion, Q&A All Faculty
Heart failure (HF) patients are at increased risk for developing hyperkalemia, particularly when there is coexisting renal insufficiency or renal failure.1 For many of these patients, elevated serum potassium may be related to renal perfusion changes or occur as a result of renal involvement associated with a concurrent disease such as diabetes. It has also been shown that several categories of medications used in the long-term management of HF reduce the kidney’s ability to eliminate elevated potassium levels and increase the risk of developing hyperkalemia.2 Management of hyperkalemia in heart failure patients can be challenging. Among the options are dietary avoidance of high-potassium foods, medication changes, and treatment of hyperkalemia based on the rate of change and severity of potassium elevation along with electrocardiographic (ECG) changes. In 2015, the US Food and Drug Administration approved patiromer a high capacity, oral potassium binder. This medication is a non-absorbed potassium-binding polymer and a calcium-sorbitol counterion.3,4 Also in development is sodium zirconium cyclosilicate (ZS-9). This medication is an insoluble, non-absorbed compound with a structure that was designed to preferentially trap potassium ions. This unique potassium selectivity enables a high in-vitro binding capacity for potassium ions even in the presence of other competing ions.5
This symposium will discuss the development of hyperkalemia in HF patients who are utilizing angiotensinconverting- enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs) or mineralocorticoid receptor antagonists (MRAs), the emerging pharmacotherapies for the treatment of hyperkalemia, and to integrate these treatments into the guideline-directed management of HF patients with acute or chronic hyperkalemia.
References: 1. Eliacik E, Yildirim T, Sahin U, et al. Potassium abnormalities in current clinical practice: frequency, causes, severity and management. Med Princ Pract. 2015; 24(3):271-275.
2. Fröhlich H, Nelges C, Täger T, et al. Long-term changes of renal function in relation to ace inhibitor/angiotensin receptor blocker dosing in patients with heart failure and chronic kidney disease. Am Heart J. 2016 Aug; 178:28-36.
3. Weir MR, Bakris GL, Bushinsky DA, et al. Patiromer in Patients with Kidney Disease and Hyperkalemia Receiving RAAS Inhibitors. N Engl J Med. 2015 Jan 15; 372(3):211-221.
4. Drugs.com. Veltassa Approval. Available: https://www.drugs.com/history/veltassa.html. Accessed: August 10, 2016.
5. Kosiborod M, Rasmussen HS, Lavin P, et al. Effect of sodium zirconium cyclosilicate on potassium lowering for 28 daysamong outpatients with hyperkalemia: the HARMONIZE randomized clinical trial. JAMA. 2014 Dec 3; 312(21):2223-2233.
Disclosures It is the policy of HFSA and AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The faculty must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by HFSA and AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Faculty Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other faculty for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.. All potential conflicts have been resolved in accordance with ACCME guidelines for commercial support and content validation.
Speaker Disclosures: Joann Lindenfeld, MD disclosed the following relevant financial relationships: Consultant/Advisory Board: Abbott, CVRx, Novartis, RElypsa, RESMED, St Jude, VWAVE Contracted Research: Novartis
Ileana l. Piña, MD, MPH discloses no relevant financial relationships.
Javed Butler, MD, MPH, MBA has disclosed the following relevant financial relationships: Consultant/advisory Board: Amgen, Bayer, Boehringer Ingelhaim, Cardiocell, Janssen, Merck, Novartis, Relypsa, Stealth Peptide, Trevena, Z-Pharma
HFSA & AKH Planner / Reviewer Disclosures: John Burnett, Jr., MD, has disclosed no relevant financial relationships.
Mona Fiuzat, PharmD, has disclosed no relevant financial relationships.
Gregg Fonarow, MD, has disclosed the following relevant financial relationships: Research Grants: National Institutes of Health (NIH). Consultant/Advisory Board: Amgen Inc.; Janssen Pharmaceuticals, Inc.; Medtronic; and Novartis Pharmaceuticals Corporation; St. Jude; and ZS Pharma
Kenneth Margulies, MD, has disclosed the following relevant financial relationships: Research Grants: CardioCell, LLC; Merk; Sharp and Dohme; and St. Lukes Hospital (Kansas City) Consultant/Advisory Board: GlaxoSmithKline;
Merk; Janssen Pharmaceuticals, Inc.; and Sharp and Dohme.
Debra Moser, DNSc, RN, has disclosed no relevant financial relationships.
Marc Semigran, MD, has disclosed the following relevant financial relationships: Research Grants: CVRx. Inc.; St. Jude Medical; and Novartis Pharmaceuticals Corporation. Consultant/Advisory Board: Amgen Inc.; and Broadview.
David Whellan, MD, has disclosed no relevant financial relationships.
Margaret V. Clark, MSc, NPS, CRM. RRT-NPS, CMPP — AKH Medical Writer Nothing to disclose
Dorothy Caputo, Ma, BSN, RN — AKH Lead Nurse Planner Nothing to disclose
Dorothy a. Duffy, B.S. Pharmacy — AKH Pharmacy Reviewer Nothing to disclose
Steve Eckert — AKH President & CEO, Planner/Reviewer —Nothing to disclose
Disclosure of Unlabeled Use and Investigational Product This educational activity will include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. HFSA and AKH Inc. specifically disclaims responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant's misunderstanding of the content.
Commercial Support Support for this enduring activity was provide through an independent educational grants from Relypsa, Inc. and ZsPharma, Inc.
Method of Participation and CME/CE Certificate The information provided in this CME/CE activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.
To receive CME/CE credit for this product, the participant must:
Read the CME/CE Information including target audience, learning objectives, and faculty disclosures.
Complete the pre-test.
View the presentations.
Complete the post-test and evaluation by choosing the best answer to each question. You must score 80% or higher on the post-test. You will have the opportunity to re-take questions missed until the 80% score is achieved.
After successfully completing the post-test and evaluation, your CME/CE certificate will be generated and immediately available for print.
To fully understand and translate learning, AKH suggests the following methods of active learning for this activity:
Develop a matrix to classify the at risk patients and appropriate treatment therapy
List situations where the different treatment options may be advantageous
Explore the bibliography and note references to review at a later date.
For Pharmacists: Upon receipt of the completed activity evaluation form, transcript information will be available at www.mycpemonitor.net within 4 weeks.
Participants who attended the live activity are not eligible to receive credit for this enduring activity. There is no fee to participate in this activity.
Medium or Combination of Media Used
This enduring activity is available in these format offerings:
Online access via the HFSA Website under Online Education
Downloadable MP3 files
Mobile version for most mobile devices
Provider Contact Information Heart Failure Society of America 6707 Democracy Blvd., Suite 925 Bethesda, MD 20817 Website: www.hfsa.org Email:email@example.com
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MD, MPH, FHFSA,
Professor and Chairman of the Department of Medicine,
University of Mississippi Medical Center
Professor of Medicine Director, Advanced Heart Failure and Transplant,
Vanderbilt Heart & Lung Institute
Professor of Medicine and Epidemiology/Population Health,
Albert Einstein College of Medicine
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