ACC.22 Update Part 2: Influenza Vaccines, EHR Alerts, PCSK9 Inhibitors

Volume 14, Issue 2

It’s been just under 2 weeks since ACC.22 concluded, and the cardiology community is still abuzz with all the exciting science that was presented. Last week, we dove into 3 exciting new studies looking at agents for hyperkalemia, heart failure, and hyperlipidemia. This week, we continue the coverage of ACC.22 with 3 more exciting new studies.

The PROMPT-HF trial involved 100 providers treating 1310 patients with heart failure with reduced ejection fraction (HFrEF). Providers were randomized to receive or to not receive alerts through the electronic health record. The alert was designed to give providers information on patient characteristics and offer individualized guideline-directed medical therapy (GDMT) recommendations.

“The primary outcome was an increase in the number of GDMT classes prescribed at 30 days postrandomization,” which occurred in 176 out of 685 (26%) patients with EHR alerts vs 117 out of 625 (19%) patients receiving usual care, authors noted. The alert was associated with an increase in GDMT class prescriptions of over 40% [adjusted RR: 1.41 (1.03, 1.93); P=.03]. The number of patients needed to treat with these targeted alerts to achieve the primary outcome was 14.

Use of GDMT remains very poorly utilized in routine clinical practice despite the wide availability of contemporary guidelines. PROMPT-HF is a very exciting study, as this relatively easy-to-implement alert-based system could significantly increase the number of eligible patients who receive life-saving GDMT.

High-intensity statins are the standard of care for patients after acute coronary syndromes (ACS), although a significant number of patients continue to experience recurrent coronary events. In the PACMAN-AMI study, patients with recent ACS were randomized to receive either statins with placebo or statins with PCSK9 inhibitor combination therapy.

This small study did not evaluate clinical outcomes. Rather, it showed the mean change in percent atheroma volume was -2.13% with statins plus alirocumab vs -.92% with statins plus placebo at 52 weeks. In addition, the mean change in maximum lipid core burden index within 4 mm was -79.42 in the alirocumab group compared with -37.60 in the placebo group.

This study is exciting, as it points to a clear signal for atheroma volume regression with combination therapy in patients with recent ACS and percutaneous coronary intervention. These findings pave the way for a larger trial to evaluate clinical endpoints in this high-risk patient group.

Finally, we have the IVVE study, which followed 5000 participants over 3 flu seasons. Findings indicated patients with heart failure who received an annual influenza vaccine had fewer major cardiovascular events during peak influenza season and lower rates of hospitalization and pneumonia year-round.

I wanted to highlight this study because I feel that with all the focus on COVID-19 vaccines for the last 2 years, the importance of the flu shot may have been lost in the background.