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Association of Physician Assistants in Cardiology

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  • 18 Oct 2017 4:04 PM | Anonymous

    Through the end of the month, save 15% on ACC educational products and live courses*—including the New York Cardiovascular Symposium—using promo code YouSave15.

    Just contact the ACC Resource Center at resource@acc.org or (202) 375-6000, ext. 5603, to redeem your discount.

    Nonmember PAs can save $50 when they join the College in October using code Take50. Encourage your colleagues to join and take advantage of all of the benefits of ACC membership!

  • 16 Oct 2017 10:33 AM | Anonymous

    Managing CV Disease Risk in Diabetes

    ACC Heart House Roundtable: June 20th, 2017
    Laura Ross, PA-C - APAC Board of Directors

    The American College of Cardiology invited APAC to participate in this roundtable to join experts from cardiology, endocrinology, and prevention to discuss recent trials with exciting results. We now have several new medications that significantly decrease cardiovascular risk with drugs traditionally used just to treat diabetes.

    Historically, lowering the glucose with diabetic medications has not been enough to decrease cardiovascular risk, and certainly not as much as lipid and blood pressure management.  We have seen that although drugs such as insulin are effective for glucose lowering, the results of the ORIGIN trial failed to demonstrate any CV benefit 2. In fact, many diabetic medications increase the risk of adverse cardiac events such as heart failure (Saxagliptin and rosiglitazone). Metformin has been the only medication until recently that showed evidence of CV benefit seen in the UKPDS study 3, which showed there was a 30% lower risk for macrovascular disease.   We discussed recent studies and new FDA indications that show that there are new opportunities to add medications that not only treat diabetes and are safe for our cardiology patients, but they also have been shown to significantly decrease adverse cardiovascular events. 1

    Sodium-Glucose Cotransporter 2  Inhibitor - Inhibiting SGLT2, which is responsible for 90% of glucose reabsorption, leads to glycosuria and sodium loss.  This promotes diuresis, blood pressure lowering, and weight loss. 

    EMPA-REG OUTCOME  -7,020 patients with diabetes II (HbA1C 7%-10%) and CV disease treated with Empagliflozin (Jardiance) for 3.1 years. Endpoints included CV mortality, nonfatal MI, and nonfatal stroke. Minor difference in HgbA1C, -0.4% with treatement. 4

    • Empagliflozin produced a 38% risk reduction in cardiovascular mortality, 35% decrease in CHF hospitalization, and a 32% risk reduction in all-cause mortality compared with placebo, all of whom were already being treated with statins, angiotensin-converting inhibitors, and aspirin.   Survival curves separated by 3 months and persisted over 3 years. It was investigator reported heart failure.
    • The FDA granted an indication in 2016 for Empagliflozin to reduce the risk for CV death for patients with DM II and CV disease.
    • Other benefits – Improved renal perfusion, reduction in worsening nephropathy,  and increased hemoglobin
    • Possible side effects –Absolute 4.6% increase in genital infections, more often in women. These resolved with a course of antifungal agents, and once treated did not typically come back. No increase in hypoglycemia or ketoacidosis for patients with type II diabetes.  Low risk of hypoglycemia as the effect is proportional to glucose levels, except if using Insulin or Sulfonylureas.
    • Use in primary prevention is currently in trials.

    GLP-1 (glucagon-like peptide-1) receptor agonists   glucose-dependent increase in insulin secretion and inhibition of glucagon secretion. Reduced CV death and/or major adverse CV events, lowers blood pressure and weight, but did not decrease heart failure risks.  

    • This class may have atherothrombotic effects seen 12-18 months later vs. hemodynamic effects seen after a few months with empagliflozin
    • Side effects:  Most common is transient nausea. Low risk of hypoglycemia unless combined with insulin or sulfonylureas.  Excess of retinopathy events, although small number of events.

    LEADER (2) –Liraglutide is a once-daily injectable medication. 9,340 patients with HbA1C of >7.0% (>50 yo with CV disease, or >60 yo with 1 or more CV risk factor) enrolled for 3.8 years.  The primary endpoint of major adverse cardiac events (MACE)was reduced by 13%.  There was a greater benefit for secondary prevention. There was a reduction in new-onset macroalbuminuria, but not on other renal endpoints or CHF. HbgA1C decreased 0.4%.5

    SUSTAIN (3) - Semaglutide is a once-weekly injectable medication. 3,297 patients with  HbA1C >7% followed for 2.1 years.  Treatment reduced the primary endpoint of MACE by 2.3% over 2 years.  CV mortality was not affected, but nonfatal stroke was improved. 6  

    How does this affect my practice as a cardiology PA?

    1.  Cardiology clinicians should consider measuring the hemoglobinA1C in all patients with cardiovascular disease, similar to how our colleagues in endocrinology have checked lipids and blood pressure.
    2. Consider prescribing Empagliflozin to patients with cardiovascular disease and type 2 diabetes who are not on Insulin or sulfonylureas. Safe to add to Metformin. Could also consider sending recommendations to primary care. Monitor for side effects such as genital infections.
    3. Be aware of the diabetes drugs that have been associated with adverse CV outcomes. Sulfonylureas (such as glipizide and increased CV mortality), Thiazolidinediones (such as Rosiglitazone and increased CHF), DPP-4 inhibitors (higher risk for CHF with saxagliptin and alogliptin)1.
    4. Raise awareness for our patients and colleagues! Tthere are new indications for starting medications for diabetes that lower CV risk, and also happen to mildly lower the hemoglobinA1C for patients with type 2 diabetes and established cardiovascular disease.

     

    References:

    1. Sattar, N, Petrie M, Zinman B, et al. Novel Diabetes Drugs and the cardiovascular specialist. J Am Coll Cardiol 2017;69:2646-56.
    2.  ORIGIN Trial Investigators. Basal insulin and cardiovascular and other outcomes in dysglycemia. N Engl J med 2012;367:319-28
    3. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes. Lancet 1998;352:854-65
    4. Zinman B, Wanner C, Lachin JM, et al., EMPA-REG OUTCOME Investigators. N Engl J Med 2015;373:2117-28.
    5. Marso SP, Daniels GH, Brown-Franden K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016;375:311-22.
    6. Marso SP, Bain SC, Consoli A, et al.,SUSTAIN-6. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016; 375:1834-44.
  • 12 Oct 2017 9:47 AM | Anonymous

    APAC is joining in the festivities to celebrate 50 years of the PA Profession! We are so excited to offer 50% off dues for the month of October to honor 50 years of service, dedication, and education.


  • 2 Oct 2017 4:56 PM | Anonymous

    APAC's own Viet Le featured in Cardiovascular Business! Check out the interview below:

    Better utilization of APPs could aid aging cardiology workforce, boost compensation

    Sep 29, 2017 | Daniel Allar

     - Medical team

    Viet Le has talked with other physician assistants (PAs) in cardiology who feel they are little more than “glorified scribes.” Early in his career, he felt confined to that role at times, too.

    Now, he and two nurse practitioners work on cardiovascular research projects at Intermountain Heart Institute in Salt Lake City with three physicians who treat the advanced practice providers (APPs) like colleagues, Le said.

    “Certainly, the comment has always come back, ‘I’m so glad we have you guys, because I could see myself working another 15 years,’” said Le, who teams with two physicians older than 60 and one older than 70. “We offload them and provide that extra concierge care, almost, to our patients because we’re able to do things that (physicians) would love to do, but we have the energy so we do it.”

    Better utilization of APPs may soon become a nationwide necessity. MedAxiom’s annual Cardiovascular Provider Compensation & Production survey revealed 45 percent of American cardiologists are 56 or older and 20 percent are 61 or older.

    The alliance of Le and his physician partners—in which the APPs successfully alleviate much of the workload—could be an important blueprint as aging cardiologists confront physician slowdown and retirement.

    It’s also a mutually beneficial relationship, according to the MedAxiom survey. Of the 27 reporting groups with the highest APP ratios, 18 showed total physician compensation above the median and 12 were above the 75th percentile.

    “The analysis clearly indicates that greater utilization of PAs increases patient access and improves work Relative Value Unit (wRVU) productivity while also increasing physician compensation,” L. Gail Curtis, president and chair of the American Academy of Physician Assistants, said in a statement.

    “It highlights the strong correlation that medical practices with a higher ratio of PAs are among the top revenue producing practices. This shows that PAs contribute to an effective team by handling vital services such as post-op care which in turn allows physicians to see additional patients and/or perform procedures. These results are only possible when a PA is able to practice at the top of their education and experience.”

    Le said Intermountain Heart Institute has a hypertension clinic run mostly by APPs under the supervision of a physician specialist. He can envision clinics in the same mold to treat hyperlipidemia or discharged heart failure patients—a group that requires a disproportionately high number of follow-up visits.

    “These are things that you have the coach, the MD on the team, helping the high-level players on the field,” Le said. “We can do those things and it can be APP-run and that will, I think, make it more efficient.”

    It could also make care more cost-effective, said Joel Sauer, vice president of MedAxiom Consulting and the author of the compensation report. The average full-time equivalent cardiologist earns about $580,000, compared to $98,550 for cardiology APPs.

    And yet there are no standards in cardiovascular medicine on how best to use APPs. There are barriers, Sauer said, such as compensation models that require a physician to see a patient to collect the work RVUs after an APP has done the “heavy lifting.”

    “This doesn’t remove the burden completely from the physician at the end of the day, and we would argue that’s not an efficient way to utilize APPs,” Sauer said. “But it’s expected and we could predict it because of the (compensation) arrangement.”

    Le, co-chair of the physician assistants committee of the American College of Cardiology (ACC), said the ACC is working on guidelines for PAs in general cardiology. Expected to be released next year, the guidelines will cover core competencies, evaluation tools and expectations for PAs. The ACC plans to provide guidelines for cardiovascular subspecialties as well, Le said.

    Sauer said healthcare consultants are also interested in establishing standards for APP use.

    “I would say we definitely have to do a more effective and efficient job at utilizing these resources, because they’re necessary. They help us truly lower the cost of care,” he said.

    Just as importantly, APPs may help bridge the gap between an aging physician workforce and the next generation of cardiologists.

    “We can certainly eke out another decade in those physicians and give time, hopefully, for the new trainees to get out and now work with experienced APPs—bring them into the fold so they now know how to more efficiently use APPs in their teams,” Le said. “Like it or not, the circumstances I think will make for an interesting expansion of APPs’ roles going forward because of this age issue.”

    http://www.cardiovascularbusiness.com/topics/practice-management/better-utilization-apps-could-aid-aging-cardiology-workforce-boost-compensation?utm_source=CVNW&utm_medium=283f9d478f&utm_content=article&utm_campaign=newsletter_referral

  • 15 Sep 2017 3:51 PM | Anonymous

    Our past APAC President Joseph Tommasino, PA-C, MHS, Ph.D is currently running for election to the prestigious AAPA Board of Directors.  Dr. Tommasino has 35 years of experience as a Physician Assistant and is a true advocate for the profession.  He has served as president of two PA organizations during his illustrious career as well as participated for many years in the AAPA’s House of Delegates.  We at APAC strongly endorse Dr. Tommasino for this seat and encourage all of you to cast your vote at this time by clicking here: https://www.aapa.org/about/aapa-governance-leadership/board-of-directors/aapa-general-elections/

    Hurry! The voting period closed on September 19, 2017.  Dr. Tommasino is staunchly dedicated and highly motivated to utilize his seat on the AAPA Board of Directors to promote the PA profession, which benefits the practitioners as well as the patients.

    Wishing you the best of luck Dr. Tommasino from all of your friends at APAC!

    Amy Simone, PA-C

    APAC President

  • 27 Apr 2017 1:22 PM | Anonymous

    Program Proceeds Will Benefit the PA Foundation Student Scholarship Fund

    Johns Creek, GA, Oct. 25, 2016 – The National Commission on Certification of Physician Assistants (NCCPA) has announced a new designation to honor currently and formerly certified Physician Assistants who have proven their dedication to lifelong learning and maintenance of certification and are now retired from practice. The PA-C Emeritus designation will be awarded to those PAs who: 

    • Are at least 60 years old or unable to practice due to permanent disability
    • Are retired from clinical practice
    • Have been NCCPA-certified at least 20 cumulative years as a PA
    • Have no reportable actions in their NCCPA disciplinary history

    According to NCCPA Board Chair Denni Woodmansee, MS, PA-C, “The PA-C Emeritus designation recognizes certified PAs who have a long history of upholding the highest professional standards. It is a title of respect that acknowledges their willingness to complete rigorous recertification requirements throughout their careers as part of their commitment to the patients they served.”

    Through the end of 2017, NCCPA will accept applications from all PAs meeting the requirements above. Beginning in 2018, applications will only be accepted from currently certified PAs, to be awarded when their PA-C certification expires.

    Proceeds from the one-time $50 application fee will be donated to the PA Foundation to expand the NCCPA Endowed Scholarship that funds three annual scholarships to PA students.

    The PA-C Emeritus an honorary title and is not equivalent to PA-C certification; it is intended for those who no longer need to maintain certification.

    For more information or to apply, PAs should visit www.nccpa.net/emeritus .

    About the National Commission on Certification of Physician Assistants: The National Commission on Certification of Physician Assistants (NCCPA) is the only certifying organization for physician assistants (PAs) in the United States. The PA-C credential is awarded by NCCPA to PAs who fulfill certification, certification maintenance and recertification requirements. NCCPA also administers the Certificate of Added Qualifications (CAQ) program for experienced, Certified PAs practicing in seven specialties. For more information, visit www.PAsDoThat.net.


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To enhance the personal and professional growth of its constituent members and all Physician Assistants practicing in the Cardiology specialty through educational opportunities, community involvement, and political representation and advocacy.

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