Heart Failure: 2017 ACC/AHA Update Q2

Heart Failure: 2017 ACC/AHA Update

According to the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure”  p 17,

“In patients with chronic symptomatic HFrEF ________ who tolerate an ACE inhibitor or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality” (Class I).

“ARNI = angiotensin receptor–neprilysin inhibitor”

a) NYHA class I, II or III
b) NYHA class II or III
c) NYHA class II, III or IV
d) NYHA class IV

click here for answer

(B)


source: http://www.onlinejacc.org/content/early/2017/04/20/j.jacc.2017.04.025?_ga=2.134278641.1865466118.1504974232-2120518496.1502210448

“In patients with chronic symptomatic HFrEF
NYHA class II or III who tolerate an ACE inhibitor
or ARB, replacement by an ARNI is recommended
to further reduce morbidity and mortality (138). “

 

 

Heart Failure: 2017 ACC/AHA Update Q1

According to the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure,”
either “BNP (B-type natriuretic peptide)” or “NT-proBNP (N-terminal pro-B-type natriuretic peptide) … can be used in patient care settings.”

Which of these natriuretic peptides “is a substrate for neprilysin” and therefore increased by ARNI  (angiotensin receptor-neprilysin inhibitor) use?

a) BNP
b) NT-proBNP
c) both
d) neither

“ARNI = angiotensin receptor–neprilysin inhibitor “

click here for answer

(A)  

Source, PDF p 10

http://www.onlinejacc.org/content/early/2017/04/20/j.jacc.2017.04.025?_ga=2.134278641.1865466118.1504974232-2120518496.1502210448

LDL Lowering: 2017 ACC Update on Non-Statin Therapy Q5

According to the 2017 ACC Update on Non-Statin Therapy p 6,

” …  evidence supports the use of an initial fasting lipid panel … followed by a second fasting lipid panel ______ after initiation of statin therapy, … Thereafter, assessments should be performed every _______ as clinically indicated …”

a)  3 weeks ; 6 weeks
b)  4 to 12 weeks ; 3 to 12 months
c)  6 months ; 12 months
d)  6 to 12 months ; 1 to 2 years

click here for answer

(B)

source: http://www.onlinejacc.org/content/early/2017/08/30/j.jacc.2017.07.745?_ga=2.235135105.1865466118.1504974232-2120518496.1502210448
“… second fasting lipid panel 4 to 12 weeks after initiation of statin therapy, to determine a patient’s adherence and confirm anticipated response to therapy. Thereafter, assessments should be performed every 3 to 12 months as clinically indicated to assess adherence and response to therapy …”

 

LDL Lowering: 2017 ACC Update on Non-Statin Therapy

According to the 2017 ACC Update on Non-Statin Therapy p 26,

“Women who are currently on lipidlowering drugs should be advised to discontinue pharmacologic therapy, with the exception of _______, generally at least 1 month and preferably 3 months before attempted
conception, or immediately if the patient is already
pregnant”

a) statins
b) BAS [bile acid sequestrants]
c) PCSK9 inhibitors
d) ezetimibe

click here for answer

(B)

source: http://www.onlinejacc.org/content/early/2017/08/30/j.jacc.2017.07.745?_ga=2.235135105.1865466118.1504974232-2120518496.1502210448

LDL Lowering: 2017 ACC Update to Non-Statin Therapy

According to the 2017 ACC Update on Non-Statin Therapy,

for a patient with “Clinical ASCVD with comorbidities, on statin for secondary prevention” on “maximally tolerated statin intensity” who “has a less-than-anticipated response (<50% reduction in LDL-C and may consider LDL-C </=70 mg/dL or non–HDL-C </=100 mg/dL)” in addition to evaluation of statin “adherence” and other “lifestlye modifications,” which of the following would be considered earliest in the algorithm (PDF p 15):

a) “consider the incorporation of soluble dietary fiber and phytosterols”
b) “consider the addition of ezetimibe”
c) “consider the addition of a PCSK9 inhibitor”
d) “consider the addition of either ezetimibe or a PCSK9 inhibitor”

click here for answer

(A) fiber, phyo-sterols

Source: PDF p 15
http://www.onlinejacc.org/content/early/2017/08/30/j.jacc.2017.07.745?_ga=2.235135105.1865466118.1504974232-2120518496.1502210448

LDL Lowering: 2017 ACC Update to Non-Statin Therapy

According to the 2017 ACC Update on Non-Statin Therapy,

In patients with “Clinical ASCVD with comorbidities, on statin for secondary
prevention” who “have achieved a ______ reduction in LDL-C from baseline
(and may consider LDL-C <70 mg/dL or non–HDL-C <100 mg/dL),
it is reasonable to continue statin therapy …” without change.

a) >/=20%
b) >/=30%
c) >/=40%
d) >/=50%

click here for answer

(D)

source PDF p 15
http://www.onlinejacc.org/content/early/2017/08/30/j.jacc.2017.07.745?_ga=2.235135105.1865466118.1504974232-2120518496.1502210448

LDL Lowering: 2017 ACC Update to Non-Statin Therapy Q1

According to the 2017 ACC Update on Non-Statin Therapy,
1 of the “4 major statin benefit groups” includes:

“… adults ages 40 to 75 years without ASCVD or diabetes,
with LDL-C 70 to 189 mg/dL, and an
estimated 10-year risk for ASCVD of _____
as determined by the Pooled Cohort Equations …”

a) >/=2.5%
b) >/=7.5%
c) >/=10%
d) >/=20%

click here for answer

(B)

Source: PDF page 6
http://www.onlinejacc.org/content/early/2017/08/30/j.jacc.2017.07.745?_ga=2.235135105.1865466118.1504974232-2120518496.1502210448