Esmerelda Visit 1: An elderly Mexican-American female presenting with hypertension

Title:	Esmerelda Visit 1: An elderly Mexican-American female presenting with hypertension
Topic:	Cardiology
Relevant Terms:	Coronary Heart Disease, Dyslipidemia, Hypertension
Primary Audience:	Cardiologists; Cardiac Care Associates (Nurses, Nurse Practitioners, Physician Assistants)
Launch Date:	08-Mar-10
Credits:	0.5 AMA PRA Category 1 Credit™ 0.5 ANCC contact hour
Expiration Date:	The accreditation for this activity has expired.

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Learning Objectives

Upon completion of the activity, participants should be able to:

Apply appropriate cardiovascular disease risk assessment tools to their patients
Increase the number of at-risk patients screened for dyslipidemia, including men, women and diabetics
Recognize and identify at least two lipid targets for each level of risk
Intensify therapy for patients who do not meet their lipid targets
Implement strategies to improve adherence to lipid-lowering treatments among their patients

Faculty

James A. de Lemos, MD
Assistant Professor of Internal Medicine and Cardiology
Donald W. Reynolds Cardiovascular Clinical Research Center
University of Texas Southwestern Medical Center
Dallas, Texas

Michael A. Blazing, MD
Assistant Professor of Medicine
Division of Cardiology
Duke University Medical Center
Durham, North Carolina

Robert P. Giugliano, MD, MS, FACC
Associate Physician
Cardiovascular Division
Brigham and Women's Hospital
Associate Professor of Medicine
Harvard Medical School
Boston, Massachusetts

Robert P. Giugliano, MD, MS, FACC

Dr. Giugliano is currently an Associate Physician in the Cardiovascular Division at the Brigham and Women's Hospital and Associate Professor of Medicine at Harvard Medical School. He graduated Summa Cum Laude and Phi Beta Kappa (Jr. year) majoring in Mathematics at Dartmouth College in 1985, and received his medical degree at Harvard Medical School in 1989. Dr. Giugliano completed his internship, residency, and chief residency in Los Angeles at Cedars-Sinai Medical Center, an affiliate hospital of UCLA, from 1989-93, and then returned to Boston as a cardiology fellow at the Massachusetts General Hospital (1993-6).

In 1996, Dr. Giugliano joined the Brigham and Women's Hospital as a Research Fellow in Medicine working with the Thrombolysis in Myocardial Infarction (TIMI) Study Group under the direction of Eugene Braunwald, and completed a Masters of Science in epidemiology at the Harvard School of Public Health. In 1997, he joined the faculty in the Cardiovascular Division of the Brigham and Women's Hospital and has served as the principal investigator for 9 multicenter clinical trials as part of the TIMI Study Group, where he is now a Senior Investigator.

His areas of research interests include novel antithrombotic and fibrinolytic agents for acute coronary syndromes (ACS), lipid-lowering therapies, and the assessment of outcomes in patients with ACS. He has authored over 100 articles, 25 editorials/book chapters, and given over hundreds of lectures nationally and internationally. Dr. Giugliano is the principal TIMI investigator for the EARLY ACS trial investigator early use of eptifibatide [IntegrelinTM] in high-risk nSTE-ACS. He is also a co-investigator and member of the Operations Committee for the IMPROVE-IT trial comparing VytorinTM to Simvastatin in 18,000 patients post ACS, and for the ENGAGE-AF TIMI 48 Trial of a novel oral factor Xa inhibitor (edoxaban) in 16,500 patients with atrial fibrillation.

Dr. Giugliano was the principal investigator at BWH for a number of additional trials including the AVANTE-GARDE-TIMI 43, PROVE IT-TIMI 22, A2Z, and TIMI 11b studies, and has served on numerous Data Safety Monitoring Boards, clinical endpoint committees, and Holter/ECG Core Laboratories. Dr Giugliano also continues to participate in research projects with the Massachusetts General Hospital Unstable Angina/Myocardial Infarction Research Group directed by Dr. Christopher O'Donnell and the MGH Coronary Clinical Trials Group under the direction of Dr. Ik-Kyung Jang. Dr. Giugliano is an active participant in the clinical activities in the Cardiovascular Medicine Division attending in the Levine Cardiac Intensive Care Unit, telemetry unit, and consult services, and seeing patients in a busy growing outpatient practice.

Dr. Giugliano lives in Westwood, MA with his wife and four children. His other interests include music, baseball, hockey, running, mathematics, and gardening.

Lynne T. Braun, PhD, CNP, FAHA, FAAN
Professor, Department of Adult Health Nursing
Nurse Practitioner, Preventive Cardiology Center and the Heart Center for Women
Rush Heart and Vascular Institute
Rush University Medical Center
Chicago, Illinois

In this activity, you will have the opportunity, with input from leading clinical experts, to work-up and manage a virtual patient with hypertension and a strong family history of cardiometabolic disease, Esmerelda, a Mexican-American elderly female who presents today for her first visit. During this initial virtual visit, you will be able to assess your current knowledge, prioritize work up options, review peer-to-peer evidence-based debate on specific management issues that relate to this visit, and plan your course of action for future visits with Esmerelda.

TARGET AUDIENCE
This activity is designed for a primary audience of Cardiologists and Cardiac Care Associates (including Nurses, Nurse Practitioners, Physician Assistants), and a secondary audience of other health professionals, such as Endocrinologists and primary care physicians (PCPs), who treat patients with cardiovascular disease and may benefit from this activity.

PURPOSE 
The purpose of this CME/CE activity is to assist healthcare providers in improving their understanding of cardiovascular medicine in practice. This CME/CE activity does not provide extensive training or offer certification in cardiovascular fields. The information provided in this CME/CE activity is for continuing education purposes only and is not meant to substitute for the independent clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient's medical condition.

ACCF LEARNER BILL OF RIGHTS 
As an ACCF participant you have the right to expect:

•    Content that promotes improvements in quality in healthcare
•    Content that is valid, reliable and accurate
•    Contributions based on the best scientific evidence available
•    Balanced presentations, free of commercial bias
•    Disclosure of relationships with industry
•    Disclosure of off label usage

DISCLOSURE POLICY STATEMENTS

UNAPPROVED USE DISCLOSURE
Faculty may discuss information about pharmaceutical agents and/or medical devices/products that is outside of U.S. Food and Drug Administration approved labeling. This information is intended solely for continuing medical education and is not intended to promote off-label use of these medications. If you have questions, contact the medical affairs department of the manufacturer for the most recent information.   

James A. de Lemos, MD reports receiving consulting fees/honoraria from Astra Zeneca, Tethys, Johnson and Johnson, Roche Diagnostics, Biosite, and Pfizer. He is on the scientific advisory board for Bristol Myers Squibb, and is on the speaker's bureau for Merck/Schering, BMS/Sanofi-Aventis and Pfizer. Dr. de Lemos receives grant/research support from Roche and Biosite.
Michael A. Blazing, MD reports being a consultant to and has received grants from Merck/Schering-Plough.

Robert P. Giugliano, MD, MS, FACC reports receiving consulting fees/honoraria from Daiichi-Sankyo, Regeneron, HeartScape, Schering-Plough, and Merck. He is on the speakers bureau for Sanofi Aventis, Bristol Myers Squibb, Pfizer. Dr. Giugliano receives grant/research support from Daiichi-Sankyo, Novartis, Merck, and Schering-Plough.

Lynne T. Braun, PhD, CNP, FAHA, FAAN has nothing to disclose.

Editorial Support: Steven Haimowitz, MD, Kate Evans, ELS, and Anya Romanowski, MS, RD, CDN have nothing to disclose.

ACCF's DISCLOSURE/CONFLICT OF INTEREST POLICY
As a provider accredited by the Accreditation Council for Continuing Medical Education (ACCME) and the American Nurses Credentialing Center (ANCC), the American College of Cardiology Foundation (ACCF) must ensure balance, independence, objectivity and scientific rigor in all of their directly sponsored or jointly sponsored educational activities. Provider(s) and faculty participating in a sponsored activity are required to disclose to the audience any significant financial interests or other relationships he/she or a member of their immediate family may have (1) with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity. ACCF is committed to providing its learners with high-quality activities and materials that promote improvements and quality in health care and not a specific proprietary business or commercial interest. The intent of this disclosure is not to prevent participation in sponsored educational activities by persons with a financial or other relationship, but rather to provide learners with information on which they can make their own determination whether financial interests or relationships may influence the credited activity. ACCF assesses conflict of interest (COI) with its faculty, planners, managers, staff and other individuals who are in a position to control the content of CME/CE-credited activities. All relevant potential conflicts of interest that are identified are thoroughly vetted through a process that includes course directors and appropriate peer review by education committee chairs/members, for fair balance, scientific objectivity and validity, and patient care and safety recommendations.

ACCF also requires that all faculty disclose their intent to discuss any unlabeled/unapproved uses of drugs and/or devices during their presentation.

ACCREDITATION STATEMENT
The American College of Cardiology Foundation (ACCF) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American College of Cardiology Foundation (ACCF) is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation.

While offering CME/CE credits, this activity is not intended to provide extensive training or certification in the field.

SUCCESSFUL COMPLETION
Recognizing that learning can be achieved when participants identify their individual need(s), credit can be awarded following the review of the case and completion of the posttest and evaluation.

CREDIT DESIGNATION
The ACCF designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

The ACCF designates this activity for a maximum of 0.5 ANCC contact hours. Attendees should only claim credits commensurate with the extent of their participation in the activity.

TO OBTAIN CME/CE CREDITS

Read the learning objectives and faculty disclosures.
Participate in the activity.
Complete the post-test and activity evaluation.
Physicians claiming CME, and Nurses and Nurse Practitioners claiming CE, who successfully complete the post-test and evaluation will receive CME/CE credit.
All other participants who successfully complete the post-test and evaluation will receive a certificate of participation.

COURSE VIEWING REQUIREMENTS
Learning Media — online asynchronous learning activity

Internet Explorer (v6 or greater), or Firefox

MAC
Safari

Release Date: March 8, 2010
Expiration Date: March 7, 2011

ACKNOWLEDGEMENT
This activity is supported by educational grants from AstraZeneca, GlaxoSmithKline, and Merck/Schering-Plough Pharmaceuticals.

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