June 19, 2025 • 16 mins
In this episode of The First Fill, we will focus on the 2025 ACC/AHA Clinical Practice Guidelines for the management of acute coronary syndromes (ACS). You'll hear how pharmacists can take an active role in implementing evidence-based care by optimizing dual antiplatelet therapy, supporting stepwise lipid management, and reinforcing secondary prevention strategies such as cardiac rehab and lifestyle modification.
Each month, APhA will release two podcast episodes offering a fresh dose of education highlights, practice pearls, and insights to inform your pharmacy practice and advance patient care. Listen to new episodes at your convenience! Both members and nonmembers can log into their APhA pharmacist.com Learning Library account to successfully complete a short assessment at the end of each month to earn 0.5 hours of CE credits (.05 CEU).
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Disclaimer: The content is intended for informational purposes only and should not be considered or taken as medical advice. The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of any entities they represent or its employees.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:04):
Welcome to the first film.
I’m Yara Al-Shaer, ExecutiveFellow in Education at APhA.
In today’s episode, we’re divinginto the 2025 ACC/AHA/ACEP/NAEMSP/SCAI
Guideline
for the Management of AcuteCoronary Syndromes or ACS
and exploring the pharmacist’sexpanding role
(00:26):
in implementing evidence-basedcardiovascular care.
From optimizing dual antiplatelet therapy
to ensuring access to lipid-loweringagents and cardiac rehab, pharmacists
are uniquely positioned to close care gapsand improve long-term outcomes in ACS.
Before we dive in, I’d like to introducemy guests today, Katie Meyer
(00:47):
and Neha Dhavalikar, Katie and Neha why don’t you introduce yourselves?
Well hello there Yara,Thanks so much for having me.
My name is Katie Meyer, and I serveas the senior director of content
creationat APhA, excited to be part of this.
Yeah.
Hi, Yara. Thank you for the introduction.
My name is Nihar Dhavalikar,I am the safety net health equity
(01:09):
fellow with Novo Script Centraland the American Pharmacists Association.
Thank you both for being here.
So let's dive in.
Katie, let's start with DAPT.
When a patient is discharged after ACS,what do pharmacists
need to know to provide the bestrecommendation possible about DAPT?
Sure. Yeah. Of course.
So DAPT is still the go to after ACSand guidelines
(01:32):
still recommend aspirinplus a P2Y12 inhibitor.
Appropriate dosing of oral antiplatelet
agent is essential for optimizing outcomes
and minimizing risk,and they should be initiated
in patients with ACS as soon as possible.
Aspirin remains foundational,starting with a loading dose of 162
(01:53):
to 325mg, preferably non-enteric
coated and chewed for rapid onset,
followed by a daily maintenancedose of 75 to 100mg.
In addition to receiving aspirin,patients with ACS should be treated
with a loading dose of an oral P2Y12inhibitor, followed by daily dose dosing.
(02:14):
For clopidogrel, a
loading dose of
300 to 600mg is used for non elevation.
ACS or STEMI without fibrinolysis
followed by 75 mg daily; however,
in STEMI with fibrinolytic therapy,a 300 mg loading
dose is recommendedif the patient is ≤75 years,
(02:36):
while older adults should begin with 75 mgwithout a loading dose.
Prasugrel is reserved for patientsundergoing PCI and not receiving
fibrinolytics; the loading dose is 60 mg,followed by 10 mg daily if the patient
weighs greater than or equal to 60 kgand is under 75 years.
(02:57):
For lower-weight or older patients, 5mg daily is advised,
though caution is warranteddue to increased bleeding risk.
Ticagrelor, another preferred agentfor DAPT, is initiated
with a 180 mg loading dose,then continued at 90 mg twice daily.
There are several considerations to keepin mind when selecting a P2Y12 inhibitor
(03:21):
These depend on the clinical settingand patient specific factors
such as age, weight, kidney function,or believed risk.
Certain agents may be preferred overothers.
As pharmacists, we play a critical rolein confirming correct doses,
adjusting therapy, counselingpatients on adherence and side effects,
and ensuringthat the best agent is selected
(03:42):
based on each individual patient'scircumstance.
We can also be alert for medicationsthat might increase bleeding, like NSAIDs
or a SSRIs and talk to the teamif adjustments are needed.
And lastly, we can
make sure patients actually understandwhy they're on to antiplatelet,
what signs of bleeding to look out for,and what to do if they miss a dose.
(04:03):
And don't forget those 3 to 6 monthcheck ins.
Some patients might need to shortenor extend up, and pharmacists
can help bring this to the table.
Thank you Katie.
That was very valuable.And now what about duration?
How to help personalizeDAPT beyond just 12 month for everyone?
Yeah.
So that's where the 2025 guidelines addvalue.
(04:26):
It shifts from that priormentality of 12 months
for everyone to individualized durations.
Now we're looking at toolslike the Academic Research Consortium
High Bleeding Risk, or ARC-HBR to guide
clinical decisionmaking based on bleeding risk.
The ARC-HBR is a clinical risktool developed to help health
(04:48):
care providers identify patients at highbleeding risk during or after
per cutaneous coronary intervention,
especially when considering dapt duration
and patient is considered high bleedingrisk if they meet at least one
major criterion or two minor criteria
as described by the ARC-HBR tool.
(05:09):
Major criteriainclude conditions strongly associated
with serious bleeding complications,such as the use of long term oral
anticoagulation,so warfarin or doacs Severe end stage
chronic kidney disease with a EGFRof less than 30 males per minute.
Recent major bleeding,so especially gastrointestinal
(05:30):
or intercranial within the pastsix months.
Hemoglobin levelsbelow 11 and platelet count before
below 100,000 or Active cancer.
Minor criteria.
Criteria reflect more moderatebut still clinically relevant
bleeding risks and include agegreater than or equal to 75 years.
(05:51):
Moderate chronic kidney disease.
Long term use of NSAIDs or steroids.
Prior strokebeyond 12 months and mild anemia.
These
criteria help assess bleedingrisk, which informs
decisions about the durationand intensity of DAPT therapy.
Following ACS and PCI.
(06:13):
While ARC-HBR doesn't directlydictate therapy
duration, it informed guidelinerecommended decisions.
Pharmacists play a critical rolein using this tool
to identify and documentbleeding risk during medication review
and transitions of care,as well as educating high risk patients
on the importance of adherence,recognizing signs of bleeding,
(06:35):
and ensuring appropriatefollow up and monitor monitoring
is conducted. In.
A. Nihar.
The 2025 Access guidelinestake a stronger stance
on LDL targets and stepwiselipid lowering.
can you walk us throughhow the new recommendations
(06:56):
guide therapy selectionfor different patient scenarios,
and how pharmacists can supportthese decisions in practice?
Sure.
So this is actually the firstcomprehensive guideline released for ACS
as a whole.
Previous guidelines were publishedseparately for STEMI and NSTEMI
with the last updatesdating back to 2013 and 2014.
(07:19):
These new guidelinesincorporate insights from the 2023
Chronic Coronary SyndromesManagement recommendations.
So it is fair to say that a unified,updated framework has been long overdue.
One of the key takeaways from
this guideline is a strongerfocus on treat to target LDL strategies.
High intensity statins are stillthe foundation, like atorvastatin
(07:41):
40 to 80mg or rosuvastatin20 to 40mg daily.
But the guideline nowgives clear thresholds on
when to add nonstop and agents like ezetimibe,
PCSK9inhibitors, Inclisiran, or bempedoic acid.
If Ldl-c remains above goal.
When looking at adding non-statintherapies to a maximally tolerated
(08:04):
statin regimenezetimibe is often our first go to.
And in combinationit lowers LDL by 15 to 25%.
If more LDL lowering is needed.
Pcsk9 inhibitors like alirocumab or
evolocumab can lower LDL by around 60%
in. Inclisiran is a newer agent
(08:25):
inhibitor taken every six months,
and lowers LDL by about 50%.
And finally, there's bempodoic acid,which lowers LDL
by about 20% and can be usefulin statin intolerant patients.
The guidelines also provide flexibilityin how to approach different
clinical scenarios, such as patientswho are statin naive, statin intolerant,
(08:48):
or already on a maximally toleratedstatin dose but not yet LDL-c.
Goal.
So let me walk you through a patient caseto illustrate all of this.
So let's say patient X is admitted
with a myocardial infarctionand receives a stent placement.
As Katie mentioned earlier,they are started on DAPT
(09:10):
And the next step is optimizingtheir lipid lowering therapy.
If patientX has not previously been on a statin,
they should be initiatedon a high intensity statin
such as atorvastatin 40 to 80mg oncedaily, or rosuvastatin 20 to 40mg once
daily.
Now, let us say the patienthas already been taking atorvastatin 80mg.
(09:31):
And this is now a secondarycoronary event.
And despite therapy,their LDL-c remains elevated,
say between 85 to 90mg/dL.
Based on recent labs,
in this
case, the guidelines recommendadding a non-statin agent,
such as ezetimibe, PCSK9inhibitors, inclisiran, or bempedoic acid.
(09:53):
This approach also appliesif the patient's LDL-c levels
remain between 55 to 69mg/dL despite
being on maximally tolerated therapy,or if they are statin intolerant.
Which is defined as intoleranceto at least two different
statins, including one at the lowest
available dose.
(10:14):
Following any initiationor adjustment of lipid lowering therapy.
Post ACS,a fasting lipid panel is recommended
within 4 to 8 weeks to assesstreatment response.
Post ACS,the ultimate targeted threshold for LDL-c
is less than 50mg/dL.
Given that the risk of major adversecardiovascular events,
(10:37):
also known as MACE is highest inthe early months post ACS, early follow up
visits are essential to monitor progressand make timely adjustments
in therapy to help patientsreach their LDL-c targets.
finally, Neha for secondary prevention.
What are some ways pharmacists can step inafter initial hospital discharge?
(10:59):
Absolutely.
So this is a very robust topic.
But according to the new guidelines,aggressive LDL-c lowering
is a key component of secondarycardiovascular disease prevention.
For context, every 1mmol/L
which is approximately 39mg/dL reduction
in LDL-c is associated with approximatelya 22% relative reduction
(11:23):
in cardiovascular eventsover a period of 4 to 5 years.
This highlights a critical opportunity forpharmacists to intervene post-Discharge.
One of the most impactful wayswe can contribute
is by monitoring and optimizingstatin therapy, and that includes
reviewing discharge prescriptionsfor appropriate statin intensity.
Identifying any gaps in therapyor inappropriate dosing.
(11:47):
Communicating with providers to align withguideline recommended statin regimens.
Especially for patientsrecovering from an ACS event.
This role is particularly importantduring transitions of care,
as an ACS is often a life altering event.
Pharmacists are well positionedto step in and address
(12:07):
common misconceptions and stigmasurrounding statin use,
and providing education and counselingat this vulnerable time can help patients
understand the lifesaving benefitsof statins in secondary prevention.
The guidelines also recommend thatif a patient experiences
adverse event effectsfrom a statin, clinicians should consider
(12:28):
challenging the same or different statinat follow up visit,
or even switchingto another class of lipid lowering agents.
Statin re challengingshould be individualized for each patient
and may involve adjusting the regimen,
for example, taking it every other dayinstead of once daily,
switching to a different statinand lowering the dose,
(12:48):
or gradually titratingto the maximum tolerated dose,
or reintroducing the statinafter a drug holiday to assess tolerance.
This approach is importantgiven the substantial long term
cardiovascular benefits of statin therapy,and pharmacists
play a vital role in this process,especially because patients
often self discontinue statinswithout notifying their care team.
(13:11):
Acting as a liaison between patientsand providers.
Pharmacistscan help ensure that lipid lowering
therapy is not only initiated,but also sustained over time.
Additionally,pharmacists can make a big impact
by helping ensure that patientswith comorbidities like type two diabetes
or heartfailure are started on an SGLT2 inhibitor
(13:31):
or GLP1 receptor agonist,because beyond glucose control,
these medications have provencardiovascular benefits that can reduce
the risk of future events in patientswith ASCVD.
In addition to medication management,the guidelines recommend
that patients be referred to cardiacrehabilitation prior to discharge.
(13:52):
And this rehab is not just about exercise.
It offers structured support for lifestylechanges,
medicationadherence, and psychosocial health.
Pharmacists can reinforcethe value of rehab during early follow up
and help ensure patientsfollow through with their enrollment.
Core components of cardiac rehabilitationinclude patient assessment,
(14:13):
counseling on nutrition and physicalactivity, management of weight,
blood pressure, lipidsand diabetes, and psychosocial help.
Tobacco cessationand supervised exercise training.
Many of
these areas can be revisitedand reinforced during pharmacy
visits, particularly for patientsactively engaged in rehab
(14:33):
or prescribe medicationsconsistent with secondary prevention.
Evidence shows that patients in cardiac
rehabilitationtend to have better outcomes.
And finally,I want to highlight the role of vaccines
after an acute coronary syndrome.
The guidelines recommenda yearly influenza vaccine for patients
without contraindications,and that is because influenza infections
(14:55):
have been shown to triggerplaque instability
and increasethe risk of another cardiac event.
So vaccine administration is important
to reduce risk of deathand MACE in these patients.
Pharmacists should take the leadin ensuring
their post ACSpatients are getting their flu shots.
And while there is not enoughrandomized trial data to support
(15:16):
routine use of other vaccinesat the time of ACS hospitalizations,
patients should still follow regular CDCrecommended
immunization schedulesunless contraindicated.
Thank you both.
Katie and Neha for such a practical,engaging discussion on the 2025 ACC/AHA
guidelinesand how pharmacists can make a difference
(15:37):
in the care of patientsrecovering from ACS.
To wrap up today's episode.
Pharmacists play a critical rolein optimizing DAPT post-ACS
by confirming appropriate drug selection,dose,
therapy duration,and supporting patient education.
The 2025 guidelines emphasize
individualized antiplatelet durationusing tools like the ARC-HBR
(16:00):
to assess bleeding risk, somethingpharmacists can actively contribute
to during med reviewsand discharge planning.
When LDL levels remain above
goal, pharmacists can supportstepwise lipid lowering therapy
using statins and non-statinagent based on the clinical context.
And finally, for secondaryprevention, pharmacists ensure continuity,
(16:21):
reinforcing rehab enrollment,lifestyle counseling, and lab follow up.
All right, folks,that's all the time we have for today.
Look out for part
two of this month’s First Fill Podcastthat will be released next Thursday.
And don't forget to collect CE credits
through the learning libraryat pharmacists.com.
We'd love your feedback on this episode,and we'll see you next time on the first
Fill Take care!
Welcome to the first film.
I’m Yara Al-Shaer, ExecutiveFellow in Education at APhA.
In today’s episode, we’re divinginto the 2025 ACC/AHA/ACEP/NAEMSP/SCAI
Guideline
for the Management of AcuteCoronary Syndromes or ACS
and exploring the pharmacist’sexpanding role
(00:26):
in implementing evidence-basedcardiovascular care.
From optimizing dual antiplatelet therapy
to ensuring access to lipid-loweringagents and cardiac rehab, pharmacists
are uniquely positioned to close care gapsand improve long-term outcomes in ACS.
Before we dive in, I’d like to introducemy guests today, Katie Meyer
(00:47):
and Neha Dhavalikar, Katie and Neha why don’t you introduce yourselves?
Well hello there Yara,Thanks so much for having me.
My name is Katie Meyer, and I serveas the senior director of content
creationat APhA, excited to be part of this.
Yeah.
Hi, Yara. Thank you for the introduction.
My name is Nihar Dhavalikar,I am the safety net health equity
(01:09):
fellow with Novo Script Centraland the American Pharmacists Association.
Thank you both for being here.
So let's dive in.
Katie, let's start with DAPT.
When a patient is discharged after ACS,what do pharmacists
need to know to provide the bestrecommendation possible about DAPT?
Sure. Yeah. Of course.
So DAPT is still the go to after ACSand guidelines
(01:32):
still recommend aspirinplus a P2Y12 inhibitor.
Appropriate dosing of oral antiplatelet
agent is essential for optimizing outcomes
and minimizing risk,and they should be initiated
in patients with ACS as soon as possible.
Aspirin remains foundational,starting with a loading dose of 162
(01:53):
to 325mg, preferably non-enteric
coated and chewed for rapid onset,
followed by a daily maintenancedose of 75 to 100mg.
In addition to receiving aspirin,patients with ACS should be treated
with a loading dose of an oral P2Y12inhibitor, followed by daily dose dosing.
(02:14):
For clopidogrel, a
loading dose of
300 to 600mg is used for non elevation.
ACS or STEMI without fibrinolysis
followed by 75 mg daily; however,
in STEMI with fibrinolytic therapy,a 300 mg loading
dose is recommendedif the patient is ≤75 years,
(02:36):
while older adults should begin with 75 mgwithout a loading dose.
Prasugrel is reserved for patientsundergoing PCI and not receiving
fibrinolytics; the loading dose is 60 mg,followed by 10 mg daily if the patient
weighs greater than or equal to 60 kgand is under 75 years.
(02:57):
For lower-weight or older patients, 5mg daily is advised,
though caution is warranteddue to increased bleeding risk.
Ticagrelor, another preferred agentfor DAPT, is initiated
with a 180 mg loading dose,then continued at 90 mg twice daily.
There are several considerations to keepin mind when selecting a P2Y12 inhibitor
(03:21):
These depend on the clinical settingand patient specific factors
such as age, weight, kidney function,or believed risk.
Certain agents may be preferred overothers.
As pharmacists, we play a critical rolein confirming correct doses,
adjusting therapy, counselingpatients on adherence and side effects,
and ensuringthat the best agent is selected
(03:42):
based on each individual patient'scircumstance.
We can also be alert for medicationsthat might increase bleeding, like NSAIDs
or a SSRIs and talk to the teamif adjustments are needed.
And lastly, we can
make sure patients actually understandwhy they're on to antiplatelet,
what signs of bleeding to look out for,and what to do if they miss a dose.
(04:03):
And don't forget those 3 to 6 monthcheck ins.
Some patients might need to shortenor extend up, and pharmacists
can help bring this to the table.
Thank you Katie.
That was very valuable.And now what about duration?
How to help personalizeDAPT beyond just 12 month for everyone?
Yeah.
So that's where the 2025 guidelines addvalue.
(04:26):
It shifts from that priormentality of 12 months
for everyone to individualized durations.
Now we're looking at toolslike the Academic Research Consortium
High Bleeding Risk, or ARC-HBR to guide
clinical decisionmaking based on bleeding risk.
The ARC-HBR is a clinical risktool developed to help health
(04:48):
care providers identify patients at highbleeding risk during or after
per cutaneous coronary intervention,
especially when considering dapt duration
and patient is considered high bleedingrisk if they meet at least one
major criterion or two minor criteria
as described by the ARC-HBR tool.
(05:09):
Major criteriainclude conditions strongly associated
with serious bleeding complications,such as the use of long term oral
anticoagulation,so warfarin or doacs Severe end stage
chronic kidney disease with a EGFRof less than 30 males per minute.
Recent major bleeding,so especially gastrointestinal
(05:30):
or intercranial within the pastsix months.
Hemoglobin levelsbelow 11 and platelet count before
below 100,000 or Active cancer.
Minor criteria.
Criteria reflect more moderatebut still clinically relevant
bleeding risks and include agegreater than or equal to 75 years.
(05:51):
Moderate chronic kidney disease.
Long term use of NSAIDs or steroids.
Prior strokebeyond 12 months and mild anemia.
These
criteria help assess bleedingrisk, which informs
decisions about the durationand intensity of DAPT therapy.
Following ACS and PCI.
(06:13):
While ARC-HBR doesn't directlydictate therapy
duration, it informed guidelinerecommended decisions.
Pharmacists play a critical rolein using this tool
to identify and documentbleeding risk during medication review
and transitions of care,as well as educating high risk patients
on the importance of adherence,recognizing signs of bleeding,
(06:35):
and ensuring appropriatefollow up and monitor monitoring
is conducted. In.
A. Nihar.
The 2025 Access guidelinestake a stronger stance
on LDL targets and stepwiselipid lowering.
can you walk us throughhow the new recommendations
(06:56):
guide therapy selectionfor different patient scenarios,
and how pharmacists can supportthese decisions in practice?
Sure.
So this is actually the firstcomprehensive guideline released for ACS
as a whole.
Previous guidelines were publishedseparately for STEMI and NSTEMI
with the last updatesdating back to 2013 and 2014.
(07:19):
These new guidelinesincorporate insights from the 2023
Chronic Coronary SyndromesManagement recommendations.
So it is fair to say that a unified,updated framework has been long overdue.
One of the key takeaways from
this guideline is a strongerfocus on treat to target LDL strategies.
High intensity statins are stillthe foundation, like atorvastatin
(07:41):
40 to 80mg or rosuvastatin20 to 40mg daily.
But the guideline nowgives clear thresholds on
when to add nonstop and agents like ezetimibe,
PCSK9inhibitors, Inclisiran, or bempedoic acid.
If Ldl-c remains above goal.
When looking at adding non-statintherapies to a maximally tolerated
(08:04):
statin regimenezetimibe is often our first go to.
And in combinationit lowers LDL by 15 to 25%.
If more LDL lowering is needed.
Pcsk9 inhibitors like alirocumab or
evolocumab can lower LDL by around 60%
in. Inclisiran is a newer agent
(08:25):
inhibitor taken every six months,
and lowers LDL by about 50%.
And finally, there's bempodoic acid,which lowers LDL
by about 20% and can be usefulin statin intolerant patients.
The guidelines also provide flexibilityin how to approach different
clinical scenarios, such as patientswho are statin naive, statin intolerant,
(08:48):
or already on a maximally toleratedstatin dose but not yet LDL-c.
Goal.
So let me walk you through a patient caseto illustrate all of this.
So let's say patient X is admitted
with a myocardial infarctionand receives a stent placement.
As Katie mentioned earlier,they are started on DAPT
(09:10):
And the next step is optimizingtheir lipid lowering therapy.
If patientX has not previously been on a statin,
they should be initiatedon a high intensity statin
such as atorvastatin 40 to 80mg oncedaily, or rosuvastatin 20 to 40mg once
daily.
Now, let us say the patienthas already been taking atorvastatin 80mg.
(09:31):
And this is now a secondarycoronary event.
And despite therapy,their LDL-c remains elevated,
say between 85 to 90mg/dL.
Based on recent labs,
in this
case, the guidelines recommendadding a non-statin agent,
such as ezetimibe, PCSK9inhibitors, inclisiran, or bempedoic acid.
(09:53):
This approach also appliesif the patient's LDL-c levels
remain between 55 to 69mg/dL despite
being on maximally tolerated therapy,or if they are statin intolerant.
Which is defined as intoleranceto at least two different
statins, including one at the lowest
available dose.
(10:14):
Following any initiationor adjustment of lipid lowering therapy.
Post ACS,a fasting lipid panel is recommended
within 4 to 8 weeks to assesstreatment response.
Post ACS,the ultimate targeted threshold for LDL-c
is less than 50mg/dL.
Given that the risk of major adversecardiovascular events,
(10:37):
also known as MACE is highest inthe early months post ACS, early follow up
visits are essential to monitor progressand make timely adjustments
in therapy to help patientsreach their LDL-c targets.
finally, Neha for secondary prevention.
What are some ways pharmacists can step inafter initial hospital discharge?
(10:59):
Absolutely.
So this is a very robust topic.
But according to the new guidelines,aggressive LDL-c lowering
is a key component of secondarycardiovascular disease prevention.
For context, every 1mmol/L
which is approximately 39mg/dL reduction
in LDL-c is associated with approximatelya 22% relative reduction
(11:23):
in cardiovascular eventsover a period of 4 to 5 years.
This highlights a critical opportunity forpharmacists to intervene post-Discharge.
One of the most impactful wayswe can contribute
is by monitoring and optimizingstatin therapy, and that includes
reviewing discharge prescriptionsfor appropriate statin intensity.
Identifying any gaps in therapyor inappropriate dosing.
(11:47):
Communicating with providers to align withguideline recommended statin regimens.
Especially for patientsrecovering from an ACS event.
This role is particularly importantduring transitions of care,
as an ACS is often a life altering event.
Pharmacists are well positionedto step in and address
(12:07):
common misconceptions and stigmasurrounding statin use,
and providing education and counselingat this vulnerable time can help patients
understand the lifesaving benefitsof statins in secondary prevention.
The guidelines also recommend thatif a patient experiences
adverse event effectsfrom a statin, clinicians should consider
(12:28):
challenging the same or different statinat follow up visit,
or even switchingto another class of lipid lowering agents.
Statin re challengingshould be individualized for each patient
and may involve adjusting the regimen,
for example, taking it every other dayinstead of once daily,
switching to a different statinand lowering the dose,
(12:48):
or gradually titratingto the maximum tolerated dose,
or reintroducing the statinafter a drug holiday to assess tolerance.
This approach is importantgiven the substantial long term
cardiovascular benefits of statin therapy,and pharmacists
play a vital role in this process,especially because patients
often self discontinue statinswithout notifying their care team.
(13:11):
Acting as a liaison between patientsand providers.
Pharmacistscan help ensure that lipid lowering
therapy is not only initiated,but also sustained over time.
Additionally,pharmacists can make a big impact
by helping ensure that patientswith comorbidities like type two diabetes
or heartfailure are started on an SGLT2 inhibitor
(13:31):
or GLP1 receptor agonist,because beyond glucose control,
these medications have provencardiovascular benefits that can reduce
the risk of future events in patientswith ASCVD.
In addition to medication management,the guidelines recommend
that patients be referred to cardiacrehabilitation prior to discharge.
(13:52):
And this rehab is not just about exercise.
It offers structured support for lifestylechanges,
medicationadherence, and psychosocial health.
Pharmacists can reinforcethe value of rehab during early follow up
and help ensure patientsfollow through with their enrollment.
Core components of cardiac rehabilitationinclude patient assessment,
(14:13):
counseling on nutrition and physicalactivity, management of weight,
blood pressure, lipidsand diabetes, and psychosocial help.
Tobacco cessationand supervised exercise training.
Many of
these areas can be revisitedand reinforced during pharmacy
visits, particularly for patientsactively engaged in rehab
(14:33):
or prescribe medicationsconsistent with secondary prevention.
Evidence shows that patients in cardiac
rehabilitationtend to have better outcomes.
And finally,I want to highlight the role of vaccines
after an acute coronary syndrome.
The guidelines recommenda yearly influenza vaccine for patients
without contraindications,and that is because influenza infections
(14:55):
have been shown to triggerplaque instability
and increasethe risk of another cardiac event.
So vaccine administration is important
to reduce risk of deathand MACE in these patients.
Pharmacists should take the leadin ensuring
their post ACSpatients are getting their flu shots.
And while there is not enoughrandomized trial data to support
(15:16):
routine use of other vaccinesat the time of ACS hospitalizations,
patients should still follow regular CDCrecommended
immunization schedulesunless contraindicated.
Thank you both.
Katie and Neha for such a practical,engaging discussion on the 2025 ACC/AHA
guidelinesand how pharmacists can make a difference
(15:37):
in the care of patientsrecovering from ACS.
To wrap up today's episode.
Pharmacists play a critical rolein optimizing DAPT post-ACS
by confirming appropriate drug selection,dose,
therapy duration,and supporting patient education.
The 2025 guidelines emphasize
individualized antiplatelet durationusing tools like the ARC-HBR
(16:00):
to assess bleeding risk, somethingpharmacists can actively contribute
to during med reviewsand discharge planning.
When LDL levels remain above
goal, pharmacists can supportstepwise lipid lowering therapy
using statins and non-statinagent based on the clinical context.
And finally, for secondaryprevention, pharmacists ensure continuity,
(16:21):
reinforcing rehab enrollment,lifestyle counseling, and lab follow up.
All right, folks,that's all the time we have for today.
Look out for part
two of this month’s First Fill Podcastthat will be released next Thursday.
And don't forget to collect CE credits
through the learning libraryat pharmacists.com.
We'd love your feedback on this episode,and we'll see you next time on the first
Fill Take care!
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If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
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The official podcast of comedian Joe Rogan.
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The latest news in 4 minutes updated every hour, every day.