General Primary Care&nbsp;&nbsp;&nbsp;

Is there a role for routine stress testing in intermediate-high risk CAD patients with a significantly elevated coronary calcium score who are otherwise asymptomatic?

How do you consider and approach transition to hospice in a patient with HFrEF who does not appear to tolerate GDMT?

What should the LDL target be in patients with prediabetes and high lipoprotein (a) with family history of coronary artery disease?

6 Answers available

What class(es) of antihypertensives should be considered next for refractory hypertension in a patient compliant with high doses of Entresto, chlorthalidone, amlodipine, clonidine, and spironolactone if they previously did not have any improvement on beta blocker or hydralazine and work-up for secondary causes were unremarkable?

At what point should we consider referral for renal denervation therapy?

How do you approach the management of extremely low LDL levels in older adult patients receiving statin therapy for primary prevention of cardiovascular disease?

What is your approach to initiating spironolactone in patients with end stage kidney disease and heart failure?

5 Answers available

Do you take any special considerations when working up a pregnant patient for secondary causes of hypertension?

How do you counsel patients with metabolic syndrome who decline statin therapy and have low coronary calcium scores regarding their long-term CVD risk?

How many days prior to surgery do you recommend stopping SGLT2 inhibitors and when is it safe to resume therapy?

Do you counsel patients to take antihypertensives at specific times of day to maximize efficacy or minimize side effects?

For patients over 70 with elevated ASCVD risk but no prior cardiovascular events, do you ever recommend continuing or initiating low-dose aspirin?

Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication

What is your systolic blood pressure target for patients over 80 with frailty and multiple comorbidities?

What are your thoughts on the results of the ALONE-AF trial and the safety profile of discontinuing anticoagulation post-ablation, provided there is no atrial arrhythmia recurrence?

If it's reasonable to stop anticoagulation, how frequently should patients be monitored for AFib/atrial arrhythmia recurrence?

How do you use NT-proBNP in patients with chronic kidney disease or end-stage kidney disease, given that these conditions can affect NT-proBNP levels?

Do you recommend initiating treatment with an SGLT2 inhibitor or semaglutide first for a patient with obesity and heart failure with preserved ejection fraction?

Would you initiate both medications at the same time?

Should presence of coronary artery calcifications on CT/CTA be considered as presence of vascular disease on CHA2DS2-VASc score?

When would you consider long-term cardiac monitoring to look for atrial fibrillation in patients with mitral stenosis given their baseline elevated risk for atrial fibrillation and thrombosis?

How should we approach the recommendation of intermittent fasting for weight loss in patients with pre-existing cardiovascular conditions, given the observed association of increased CV mortality with eating durations of less than 8 hrs?

Chen & Zhong, AHA/ASA Journals 2024

What are some practical ways to incorporate cardiac POCUS in the primary care setting?

For example, do you find it most useful for outpatient disease assessment/management, consideration of further imaging or specialist referral, or tria...

What is your risk/benefit analysis when deciding on the appropriateness and timing for discontinuation of systemic anticoagulation in patients who underwent ablation for paroxysmal atrial fibrillation with CHADS2VASc score >2?

Should we be more cautious with the use of GLP 1 R agonist therapy in patients with Type 1 diabetes mellitus and obesity given the increased risk of cardiovascular disease with high body weight variability?

Prattichizzo et al., PMID 39468384