Overview of the PRN

The Cardiology Practice and Research Network (PRN) consists of students, residents, fellows, clinical pharmacists, and other practitioners with an interest in cardiovascular disorders. As the fourth-largest ACCP PRN, the Cardiology PRN has 1152 members, including 190 students, 62 residents, and 9 cardiology fellow members. The PRN's mission is to advance the pharmacotherapy of cardiovascular disorders through promoting excellence in education, research, and clinical practice and enhancing its members' knowledge, skills, and productivity. The PRN's objectives are to provide a means for communication and networking among members; provide quality educational programming at national meetings; use the Internet to facilitate access to information, expertise, and professional opportunities available through the PRN; and provide opportunities for collaborative research.

The Cardiology PRN has many opportunities for professional growth through service on eight committees: Membership, Budget/Finance, Research/Scholarship, Resident/Student, Programming, Nominations, Communications/Social Media, and International. Each committee has defined responsibilities to advance cardiology pharmacy practice, with new charges developed each year.

The Cardiology PRN constantly looks for ways to reach members through various platforms. The e-mail list is quite active, with frequent questions that generate discussion regarding patient scenarios and clinical controversies. In addition, the PRN is active on social media platforms, including Twitter (@accpcardprn) and Facebook (www.facebook.com/accpcardprn).

Opportunities and Resources

The Cardiology PRN has many resident, fellow, and student members and supports the active involvement of trainees. One of the PRN's most popular initiatives is the online journal club, which allows residents to engage the entire PRN each month in critiquing recent, high-profile articles pertaining to cardiovascular pharmacotherapy. Case conferences are also conducted periodically throughout the year to give members an opportunity to learn about interesting and challenging patient scenarios with input from experts from across the country. In addition, the PRN implemented a Professional Development Series to reach students and residents and help facilitate professional growth with topics such as achieving career-life balance, applying for residency, and performing peer reviews. The PRN also hosts collaborative webinars with other PRNs each year to highlight therapeutic topics of interest and best practices.

To further facilitate professional growth and networking, the Cardiology PRN provides two $500 travel awards for residents, students, and fellows to attend the ACCP Annual Meeting. The PRN also engages student, resident, and fellow members in networking opportunities and recognition during its business meeting. Other initiatives that may be of particular interest for PRN residents, students, and fellows are participation in a step competition, the development of an annual newsletter, and a writing challenge (a competitive opportunity to collaborate with seasoned members to develop a manuscript).

The Cardiology PRN also has unique opportunities for members in training to promote professional growth throughout the year. Through the PRN's mentoring program, learners are matched with seasoned practitioners having similar professional interests. The mentors serve as a resource for learners and advise them in many areas, such as professional development, scholarship, and career opportunities, as they matriculate through their training programs.

Clinical Update – Pulmonary Arterial Hypertension

Pulmonary arterial hypertension (PAH) leads to progressive increases in pulmonary vascular resistance (PVR), right heart failure, and death, if left untreated. Recently, the 6th World Symposium on Pulmonary Hypertension guidelines were published. These provide important updates in the classification and treatment of patients with PAH. PAH requires hemodynamic assessment and is defined by a mean pulmonary artery pressure of greater than 20 mm Hg with normal left-sided filling pressures and a PVR of 3 Wood units or greater. Most patients with PAH require targeted pharmacotherapy on the basis of multiparametric risk stratification. Fourteen unique pharmacotherapeutic options are FDA approved for PAH. The latest clinical guidelines also provide an updated clinical classification and evidence-based treatment algorithms. A notable change is the focus on initial upfront oral combination therapy for most patients with PAH. For patients who did not attain a low-risk status during follow-up, treatment escalation through sequential combination therapy (including prostacyclins) is paramount.

Table 1. Updated Hemodynamic Definitions^a-c

^aInformation from: Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J 2019;53:1801913.

^bCoons JC. Updates from the 6th World Symposium on Pulmonary Hypertension. Slide presentation at: Pulmonary PRN Focus Session at the ACCP Annual Meeting; October 2019; New York, NY. Reprinted with permission from the American College of Clinical Pharmacy.

^cIn the absence of other causes of precapillary PH, such as PH caused by lung diseases, chronic thromboembolic PH (CTEPH), or other rare diseases.

Box 1. Updated Clinical Classification^a,b

^aInformation from: Galiè N, Channick RN, Frantz RP, et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J 2019;53:1801889.

^bCoons JC. Updates from the 6th World Symposium on Pulmonary Hypertension. Slide presentation at: Pulmonary PRN Focus Session at the ACCP Annual Meeting; October 2019; New York, NY. Reprinted with permission from the American College of Clinical Pharmacy.

CCB = calcium channel blockers; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction.

Table 2. Treatment Guidelines – Initial Combination Therapy for PAH^a,b

1. Information from: Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension: the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J 2016;37:67-119.

^bCoons JC. Pulmonary arterial hypertension. In: 2019 Cardiology Pharmacy Preparatory Review and Recertification Course. Lenexa, KS: American College of Clinical Pharmacy. Reprinted with permission from the American College of Clinical Pharmacy.

ERA = endothelin receptor antagonist; IV = intravenous; PDE5i = phosphodiesterase type 5 inhibitor; SC = subcutaneous; WHO FC = World Health Organization Functional Class.

Box 2. Sequential Therapy^a

^aInformation from: Galiè N, Channick RN, Frantz RP, et al. Risk stratification and medical therapy of pulmonary arterial hypertension. Eur Respir J 2019;53:1801889; Ghofrani HA, Galiè N, Grimminger F, et al. Riociguat for the treatment of pulmonary arterial hypertension. N Engl J Med 2013;369:330-40; Pulido T, Adzerikho I, Channick RN, et al. Macitentan and morbidity and mortality in pulmonary arterial hypertension. N Engl J Med 2013;369:809-18; Sitbon O, Channick R, Chin KM, et al. Selexipag for the treatment of pulmonary arterial hypertension. N Engl J Med 2015;373:2522-33.

ERA = endothelin receptor antagonist; PDE5i = phosphodiesterase type 5 inhibitor.

Submitted by:
James C. Coons, Pharm.D., FCCP, FACC, BCCP
Associate Professor, University of Pittsburgh School of Pharmacy
Department of Pharmacy and Therapeutics;
Clinical Pharmacist, Cardiology, UPMC Presbyterian Hospital