CT-first strategy supported for stable angina patients

A study has backed a CT-first strategy for the diagnosis of obstructive coronary artery disease (CAD) in patients with stable chest pain, showing that it is as effective as invasive coronary angiography and leads to fewer procedures and complications.

Published in the NEJM the results of the DISCHARGE (Diagnostic Imaging Strategies for Patients with Stable Chest Pain and Intermediate Risk of Coronary Artery Disease) trial come from 3,523 patients with an intermediate pretest probability of obstructive CAD referred for ICA.

Major adverse cardiovascular events (cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke) occurred in 2.1% of those who had CT as an initial diagnostic imaging strategy for guiding the treatment, and in 3.0% in the ICA group (hazard ratio, 0.70).

Only 22% of the CT-first group had ICA, and major procedure-related complications occurred in 0.5% of the CT group and in 1.9% of the ICA group (hazard ratio, 0.26). Angina relief was similar for both groups, with rates during the final four weeks of follow-up of 8.8% in patients in the CT group and 7.5% of those in the ICA group (odds ratio, 1.17).

The results favoured a non-invasive approach to preliminary evaluation of CAD before possible ICA in selected patients, the study authors said.

Heart disease patients skip medications due to cost, pharmacists say

Rising prescription charges mean that patients with conditions such as heart failure and atrial fibrillation are asking pharmacists which of their prescribed medications could be skipped to save money, the Pharmacy Guild says.

With charges now set at $42.50 per prescription after the maximum co-payment went up again on 1 January 2022, this means scripts are on track to cost patients up to $50 per prescription by the end of the decade, the Guild says.

Citing ABS figures showing that more than 900,000 Australians delayed or didn’t get a script filled in 2019–20 due to cost, the Guild says the PBS medications that are becoming unaffordable include nebivolol for heart failure and DOACs such as rivaroxaban, dabigatran and apixaban for AF.

And research conducted on behalf of the Pharmacy Guild of Australia has found that nearly a third (31%) of middle-income households ($60,000 to $100,000) without a concession card have found it difficult to afford medications on the PBS.

“Pharmacists are worried that there will be more preventable ill-health and even deaths as people are increasingly finding themselves having to choose between buying the medicines they need and other essential items like rent, groceries and petrol,” Guild president Trent Twomey said.

“This is a dangerous trend, as prescribed medications are designed to work together to preserve the health and ultimately save the lives of the patients who need them,” he said.

“As community pharmacists, we are raising the alarm. When medicines become unaffordable, it means that there is no real universal access to the PBS which is the foundation of our health system.”

Russian cardiologists banned by ESC

Due to the invasion of Ukraine, the European Society of Cardiology (ESC) has banned cardiologists based in the Russian Federation or in Belarus from active participation in any ESC event or activity.

The ESC said it condemned the military aggression by Russia and would temporarily suspend the memberships of the Russian Society of Cardiology and the Belarussian Society of Cardiologists in the ESC.

“The ESC very much regrets the effect this may have on individual Russian and Belarussian cardiologists and scientists, but the message to Russian and Belarussian leadership must be distinct and unequivocal,” it said.

Meanwhile the American College of Cardiology also issued a statement of concern about the war, and said it supported all those on the ground in Ukraine, as well as those in neighbouring countries and throughout the world who are helping to provide support and medical care for the ever-growing number of refugees.

The ACC said it has made a donation to the UN Refugee Agency (USA for UNHCR) to provide emergency aid to families in Ukraine.