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The Hospital Quality Foundation, CMEsolutions and CE Symmetry are pleased to bring you another
accredited Continuing Education activity.


Stroke Prevention in Atrial Fibrillation and Safety of Novel Anticoagulants  
Therapeutic Advances in Long-Term Oral Anticoagulation
 
We are excited to bring you this content in a unique educational format known as the “Flipped Classroom”. This CE activity contains two Sections.

Section 1: The didactic component, is contained in a High Definition video lecture (URL below) and is led by two experts in the field of anticoagulation. Dr. Charles V. Pollack and Dr. Jessica Mega offer a robust review of the current issues in Stroke Prevention in Atrial Fibrillation and the management issues associated with the Novel Oral Anticoagulants.  

Section 2: Upon completion of Section 1, participants will be invited to join a KOL-led webinar. During the webinar, you will have the opportunity to put the concepts presented in Section 1 into practical application through a case-based learning model moderated by either Dr. Pollack or Dr. Mega. You also will have the opportunity to present a case of your own and to discuss this with the faculty moderator and other webinar participants.
NOTE: We will only conduct 2 webinars as part of the continuing education activity. Credit for Section 1 will be available until September 1, 2015.

 
Release Date: September 1, 2014
Expiration Date: September 12015
Accreditation Statement
This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint providership of CMEsolutions, the Hospital Quality Foundation and CE Symmetry. The CMEsolutions is accredited by the ACCME to provide continuing medical education for physicians.
 
Credit Designation

Section 1 (Video Content)

The CMEsolutions designates this enduring material for a maximum of AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
 
ACPE_Logo.jpgThe CMEsolutions is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 1.00 contact hours (0.100 CEUs). ACPE Program Number: 0274-9999-14-022-H04-P 

Section 2 (Webinar Participation)
The CMEsolutions designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 
 
ACPE_Logo.jpgThe CMEsolutions is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 0.50 contact hours (0.050 CEUs). ACPE Program Number: 0274-9999-14-023-H04-P 

 
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Faculty
Charles V. Pollack, MD– Program Chairman
Chairman, Department of Emergency Medicine
Pennsylvania Hospital
Professor, Perelman School of Medicine
University of Pennsylvania
Philadelphia, PA

 
Jessica L Mega, MD, MPH, FACC, FAHA
Cardiologist, Brigham and Women's Hospital
Associate Professor, Harvard Medical School
Director, TIMI Study Group Genetic’s Program
Boston, MA

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Disclosure of Conflicts of Interest
The CMEsolutions requires instructors, planners, managers, and other individuals and their spouses/life partners who are in a position to control the content of this activity to disclose any real or apparent conflicts of interest they may have as related to the content of this activity. All identified conflicts of interest are vetted thoroughly by CMEsolutions for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations.

The faculty reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this activity:
Faculty Disclosures
        Faculty
Research Support Speaker's
Bureau
Consultant Share
Holder
Charles V. Pollack Luitpold x Astra Zeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi-Sankyo, Janssen, Luitpold, Pfizer x
Jessica L. Mega Astra Zeneca, Bayer Healthcare, Bristol-Myers Squibb, Daiichi-Sankyo, Sanofi -Aventis, Accumetrics, NIH/NHLBI x Boehringer Ingelheim, Janssen, American Genomics, WebMD  

 

The planning committee members reported the following financial relationships or relationships to products or devices they or their spouse/life partner have with commercial interests related to the content of this activity.
John DeHart: Nothing to disclose
Shirlene DeHart: Nothing to disclose 
Susan O’Brien, MS, RPh: Nothing to disclose
Robert E. Batte: Nothing to disclose

Statement of Need

Nonvalvular atrial fibrillation (NVAF) is the most common clinically relevant heart rhythm abnormality and increases the risk of stroke and systemic emboli. The prevalence of NVAF is 4% for patients under 60 years of age and 9% for those over 80 years of age. As the population ages over the next four decades, the incidence of NVAF is expected to increase 2.5-fold. Patients with atrial fibrillation are at up to five fold-increased risk of developing a stroke. This puts an enormous burden on patients with poor functional outcome, morbidity, mortality and subsequent financial impact resulting from stroke-related complications. Although there are multiple strategies to mitigate this risk, quite often it is limited to antithrombotic medications. The VKA warfarin was the only antithrombotic agent available in the US for stroke prevention in atrial fibrillation (SPAF) until the early 21st century, when an oral direct thrombin inhibitor (DTI), ximelagatran, was introduced. However, due to suspected hepatotoxicity, ximelagatran was withdrawn from clinical use prior to approval. Dabigatran, also a direct thrombin inhibitor, then entered the market demonstrating a better safety profile.  Subsequently, three oral Factor Xa inhibitors, rivaroxaban, apixiban, and edoxaban, have demonstrated safety and efficacy (compared to warfarin) for SPAF.  

Although clinicians have for years been excited about the prospect of an alternative to warfarin and its well-characterized limitations, they have been relatively slow to embrace the NOACs. There appears to be significant knowledge gaps about the appropriate use of these new drugs including how to monitor their efficacy, and concern over the ability to reverse their effects emergently if necessary.  Often lost in the discussion regarding the lack of an antidote for these medications is the short half-life of the NOACs compared to that of warfarin. This short half-life affords the NOACs a margin of safety over and above their safety demonstrated (especially for apixaban) in clinical trials, as well as that of VKA. There are also pervasive misconceptions about the role of vitamin K as an “antidote” for warfarin-related bleeding. Our program addresses these gaps specifically and comprehensively.
 

Program Goal

The goal of this program is to provide the most current information and evidence on use of NOAC’s in
AF patients, with specific emphasis on management techniques and therapeutic options that most significantly reduce the risk of thromboembolism.
Learning Objectives
Following completion of the didactic component of Stroke Prevention in Atrial Fibrillation and Safety of Novel Anticoagulants: Therapeutic Advances in Long-Term Oral Anticoagulation, the participant should be better able to:
  1. Discuss the risk/benefit balance for ongoing anticoagulation therapy for Stroke Prevention in Atrial Fibrillation (SPAF)
  2. Differentiate among the currently available OAC agents, including warfarin, and identify the potential role each plays in SPAF
  3. Describe a testing strategy appropriate to specific OACs that identifies the extent of anticoagulation in an AFIB patient 
  4. Discuss the evidence-based data available on optimal management of acute bleeding complications in patients taking OAC agents
  5. Outline an evaluation and treatment algorithm for bleeding concerns and SPAF in patients taking OAC agents
Intended Audience
The intended audience for this educational activity includes:
  • Primary Care Providers
  • Hospitalists
  • Emergency Care Providers
  • Cardiologists
  • Physician Assistants
  • Nurse Practitioners
  • Pharmacists

Course Format
 
On-demand video followed by an interactive, case-based webinar.

 
Estimated Time for Completion

Section One: 1 hour for viewing the video content and completion of the Program Evaluation and Request for Credit. 

Section Two: 0.5 hours for participation in a webinar session and completion of the Program Evaluation and Request for Credit.
 


 Method of Participation
To receive CME credit participants should read the Accreditation Information, view the video content and then complete an Evaluation Form for this Section of the CE activity. After completion of the webinar, all participants must complete a very brief Evaluation and Request for Credit form. CE Certificates will be sent via e-mail within 2 weeks of the completion of the form except for Pharmacists. If you are requesting ACPE credit, your information will be provided to the NABP and you will download your certificate from the NABP site.

Once the Program Evaluation and Request for Credit Form for Section 1 has been submitted, participants may receive an invitation to participate in a KOL-led interactive, case-based webinar. After participating in one of the two webinars, 
all participants must complete a second Program Evaluation and Request for Credit form. CE Certificates will be sent via e-mail within 2 weeks of the completion of the form except for Pharmacists. If you are requesting ACPE credit, your information will be provided to the NABP and you will download your certificate from the NABP site. 

The Program Evaluation and Request for Credit form for Section 1 is now a PDF only form and can be downloaded at:
Section 1 PDF Form

The Program Evaluation and Request for Credit form for Section 2 is located at:
tinyurl.com/SPAF-EVAL2
 
Fees
There are no fees for participating in or receiving credit for this activity.
 

Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. CMEsolutions, The Hospital Quality Foundation and CE Symmetry do not recommend the use of any agent outside of the labeled indications.  

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of any organization. Please refer to the official prescribing information for each product for additional information regarding approved indications, contraindications and warnings.
 
Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or courses of diagnosis or treatment discussed should not be used
by clinicians without evaluation of patient conditions, contraindications, applicable manufacturer's product information, and the recommendations of other authorities.

 
Accreditor Contact Information
For information about the accreditation of this program, please contact CMEsolutions at (520) 544-2938 or sdehart@cmesolutions.org.
 
Commercial Support Information
This accredited educational activity is supported by an Educational Grant from Boehringer Ingelheim Pharmaceuticals Inc.
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