This activity is supported by educational grants from
 Boehringer Ingelheim and Daiichi Sankyo.

OVERVIEW

Hospitalists are taking leading roles in overseeing and comanaging anticoagulant use in patients, including for those with nonvalvular atrial fibrillation (NVAF) who are at risk for stroke. It is critical for hospitalists to be able to apply treatment plans utilizing appropriate anticoagulant therapy during the patient’s hospital stay as well as at discharge. This requires hospitalists to have the ability to understand and apply current standards of care for appropriate use of the newer anticoagulants for preventing stroke in NVAF patients. This interactive video case module will evaluate the current guidelines and scientific evidence regarding oral anticoagulation for stroke prevention in patients with NVAF. The activity will include thorough discussions on initial management of patients with NVAF, appropriate situations for oral anticoagulation in the presence of NVAF, appropriate choice of oral anticoagulant, reversal of oral anticoagulation, as well as guidelines for oral anticoagulation and stroke prevention in NVAF patients and in special-population NVAF patients.

GOAL

To provide participants with up-to-date information about prevention of stroke using direct oral anticoagulants in patients with NVAF.

TARGET AUDIENCE

Hospitalists, as well as cardiologists, general internists, nurse practitioners, and physicians’ assistants at hospitals who treat patients who are at-risk for or who have NVAF and stroke.

LEARNING OBJECTIVES

After completing the activity, the participant will demonstrate the ability to:

• Describe the pharmacology, pharmacokinetic profiles, and special dosing recommendations for NOACs in NVAF.
• Evaluate clinical guidelines for anticoagulation therapy in NVAF patients at risk for stroke.
• Assess the benefits and risks of anticoagulation therapy in patients with NVAF.
• Choose appropriate anticoagulant therapy in virtual NVAF patient cases.

CME INFORMATION

Accreditation Statement:

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of University of Virginia School of Medicine, ASiM and the Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.

The University of Virginia School of Medicine designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credits.^TM Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Release date: June 2, 2016.                    Expiration date: June 2, 2019.

Estimated time to complete activity: 60 minutes

FACULTY & FACULTY DISCLOSURES

Full Disclosure Policy Affecting CME Activities:

The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.

The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.

All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.

The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliations to disclose.

PARTICIPATING FACULTY

Leonard Feldman, MD, FACP, SFHM (Co-Chair)
Associate Professor of Medicine and Pediatrics
Johns Hopkins University School of Medicine
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative and Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Kurt Pfeifer, MD, FACP (Co-Chair)
Associate Professor of Medicine
General Internal Medicine
Associate Program Director
Internal Medicine Residency
Medical College of Wisconsin
Milwaukee, Wisconsin
Dr Pfeifer reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Rohit Malhotra, MD
Assistant Professor
Department of Medicine, Cardiovascular Medicine
University of Virginia Health System
Charlottesville, Virginia
Dr Malhotra reports receiving grants/research support from Boehringer Ingelheim and serving on a speaker’s bureau, as a faculty member, or peer reviewer for Medtronic.

Andrew E. Darby, MD (Peer Reviewer)
Assistant Professor
Department of Medicine, Cardiovascular Division
University of Virginia Health System
Charlottesville, Virginia
Dr Darby reports having no significant financial or advisory relationships with corporate organizations related to this activity.

The staff at ASiM reports having no significant financial or advisory relationships with corporate organizations related to this activity.

Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices

The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.

Off-Label Product Discussion

All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.

SHM CONFLICT OF INTEREST DISCLOSURE POLICY

In accordance with the ACCME Standards for Commercial Support, SHM requires that individuals in a position to control the content of an educational activity disclose all relevant financial relationships with any commercial interest. SHM resolves all conflicts of interest to ensure independence, objectivity, balance, and scientific rigor in all its educational programs. All relevant financial relationships shall be disclosed to participants prior to the start of the activity.

Furthermore, SHM seeks to verify that all scientific research referred to, reported, or used in a continuing medical education (CME) activity conforms to the generally accepted standards of experimental design, data collection, and analysis. SHM is committed to providing its learners with high-quality CME activities that promote improvements in healthcare and not those of a commercial interest.

DISCLAIMER

The opinions and recommendations expressed by faculty and other experts are based on current scientific evidence and standards of care and their professional expertise. This enduring material is produced for educational purposes only. The University of Virginia School of Medicine implements specific educational planning processes to ensure that content is patient-centric and independent. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use

INSTRUCTIONS

The following is an interactive case-based video module designed to help you gauge your basic knowledge of NVAF in stroke prevention and then direct you to specific areas you may need to focus on. It consists of 3 sections: a nondesignated pretest, the interactive activity, and a CME post-test and evaluation. All 3 sections must be completed to receive CME credit. Participants must receive a post-test score of 70% or higher to pass and will have 3 chances to do so. A certificate of participation will be available online immediately following successful completion of the activity.