While the American Heart Association (AHA) 2020 Scientific Sessions took place in a dramatically different format this year — becoming fully virtual for the first time — one aspect remained the same: Brigham investigators were once again at the forefront of major cardiovascular trials, presenting findings with the potential to transform cardiovascular care.
The two studies highlighted below represent only a sample of the cutting-edge research Brigham experts in the field presented at the conference.
Remote, Personalized Care Program Improves Health
Long before the COVID-19 pandemic catapulted virtual care into the mainstream, Brigham cardiologist Benjamin Scirica, MD, MPH, and his colleagues saw an opportunity to help patients at high risk for cardiovascular disease better manage their blood pressure and cholesterol at home.
They started a program that relies on a team of navigators and pharmacists to help deliver personalized care remotely, using standardized treatment algorithms and digital solutions such as home blood pressure cuffs to adjust medications based on how a patient was doing.
Patients in the LDL cholesterol program saw an average decrease of 42 percent in their LDL cholesterol level (52mg/dl). Among the high blood pressure group, patients experienced an average decrease of 14 mmHg for systolic blood pressure and 6 mmHg for diastolic.
Navigators served as the face of the program. They communicated directly with patients, providing treatment recommendations and education until treatment goals were met. Pharmacists initiated and adjusted prescriptions for individuals based on clinical algorithms. The program was supervised by specialists, and primary care physicians were updated on all treatment changes.
“Our program demonstrates that we can remotely improve cardiovascular health through cholesterol and blood pressure control faster, more efficiently and with greater personalization than standard practice,” said Scirica, who presented the trial’s results on Nov. 17 with simultaneous publication in the journal Circulation. “And we see this as a transferable program — one that could be adopted in other health care settings. It could be applied to a broad range of clinical scenarios across our system and across the world, especially in places where health care resources may be scarce.”
Promising News for Patients with Diabetes and Kidney Disease or Heart Failure
Evidence supporting a new class of diabetes drugs known as sodium/glucose cotransporter 2 (SGLT2) inhibitors has been mounting. Now, two large clinical trials conducted by investigators at the Brigham add new information about the benefits for patients with diabetes and chronic kidney disease, as well as those with worsening heart failure.
In these paired trials — known by their acronyms SCORED and SOLOIST — teams of investigators led by Brigham cardiologist Deepak L. Bhatt, MD, MPH, evaluated sotagliflozin, a drug that helps the body eliminate blood sugar via urine and the digestive tract. Results of each trial were published in The New England Journal of Medicine and presented by Bhatt simultaneously at the AHA Scientific Sessions on Nov. 16.
In the SCORED trial, the drug reduced cardiovascular deaths, hospitalizations for heart failure and urgent visits for heart failure by 26 percent in patients with diabetes and chronic kidney disease. It also reduced heart attacks and strokes by 32 percent and 34 percent, respectively, among this group of patients. It is also the first trial of an SGLT2 inhibitor to show a beneficial effect on stroke.
In the SOLOIST trial, which looked at patients with different types of heart failure, sotagliflozin was linked to a 33 percent drop in cardiovascular deaths, hospitalizations for heart failure and urgent visits for heart failure. It is the first large randomized trial to show SGLT2 inhibitors are safe and effective for patients hospitalized with acute heart failure.
“It is now clear that most patients with type 2 diabetes and either kidney disease or heart failure should be on an SGLT2 inhibitor,” said Bhatt, executive director of Interventional Cardiovascular Programs at the Brigham.