CLINICAL
NEWS
American College of Cardiology Extended Learning
Classic
2014 AHA/ACC Valvular Heart Disease
Guidelines: The Impact on Clinical Practice
I
n 2014, new guidelines were published for
managing patients with valvular heart disease
(VHD). Why was it time for new
guidelines? Rick Nishimura, MD, writing committee co-chair, offered several
reasons:
• The new document has more data
on natural history of valve disease.
• Since previous versions, better
imaging and quantification are possible.
• Given better outcomes from
interventions and ‘less invasive’
interventions, which contribute to a
lower threshold for their use today,
treatment can be extended to sicker
patients.
As for specifics, one of the most significant additions is the new classification of VHD stages that consider the
degree of valve narrowing or leakage,
the presence of symptoms, the response of the left and/or right ventricle
to the valve lesion, and any change in
heart rhythm.
The guideline also provides a proposed risk assessment tool that should
be applied to all patients considered
for intervention. Acknowledging that
current scoring systems are useful but
limited, the document’s original assessment combines procedure-specific
impediments, major organ system compromise, comorbidities, patient frailty,
and the STS predicted risk of mortality
model. The risk scores—along with the
specific risks and benefits—should be
discussed with the patient in a shared
decision-making process to determine
the best therapy for the individual.
“Due to more knowledge regarding the natural history of untreated
patients with severe VHD and better
outcomes from surgery, we’ve lowered
the threshold for operation to include
more patients with asymptomatic severe valve disease,” said Dr. Nishimura.
“Now, select patients with severe asymptomatic aortic stenosis and severe
asymptomatic mitral regurgitation can
be considered for intervention, depending on certain other factors, such as
operative mortality and in the case of
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CardioSource WorldNews
mitral regurgitation, the ability to achieve a durable
valve repair.”
A FIRST FOR TAVR
The document further addresses, for the first time,
UNRESTRICTED COMMERCIAL AND
MEDICARE PART D FORMULARY
COVERAGE NATIONWIDE
FOR YOUR PATIENTS ON EFFIENT® (PRASUGREL)
NATIONAL COVERAGE FOR EFFIENT*
90 + 88
%
Commercial
†
%
Medicare Part D‡
*Access defined as unrestricted lowest brand co-pay (LBC) or 2nd LBC.
Approximately 73%† of commercial and 80%‡ of
Medicare Part D patients have unrestricted access
to Effient at the LBC amount or better
Source: Managed Markets Insight & Technology (MMIT), LLC as of June 2015, and is subject to change
without notice by a health plan or state. Please contact the plan or state for the most current information
This information is not a guarantee of coverage or payment (partial or full). Actual benefits are determined
by each plan administrator in accordance with its respective policy and procedures
Formulary information in this document does not establish clinical comparability of products and should
not be seen as making any claim regarding efficacy or safety