Sunsets & Heartbeats: Therapy De-Escalation in COPD and Post-Operative Atrial Fibrillation


Kieran Quinn is back with Daniel Marinescu, fellow in Respirology at the University of Toronto.  Together they cover the SUNSET trial on long-term triple therapy de-escalation in patients with chronic obstructive pulmonary disease (COPD) and the risk of thromboembolism associated with post-operative atrial fibrillation.

The new Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines on COPD outline that patients without exacerbations should not receive inhaled corticosteroids (ICS).  The benefit of ICS is in preventing exacerbations; however, the risks of ICS include increased risk of pneumonia and other infections.  Dan summarizes a randomized-controlled trial on the safety of de-prescribing inhaled corticosteroids in patients with COPD on triple therapy without frequent exacerbations.

The incidence of post-operative atrial fibrillation after noncardiac surgery is around 0.3 to 4%, much less common than after cardiac surgery.  Kieran covers a retrospective matched cohort study on the risk of thromboembolism in patients that developed non-valvular atrial fibrillation post-operatively after noncardiac surgery compared to those who developed atrial fibrillation during a hospitalization event.

Finally, the Good Stuff segment.  Dan shares a creative piece that compares losing empathy to losing power steering in an old car and the need to refuel.  Kieran discusses a piece on shifting our focus on therapies that extend life to those that improve overall quality of life.

Like what you hear?  Rate us on iTunes!  Chat with us on Twitter at @roundstable and tweet at Kieran Quinn @kieranlquinn and at Daniel Marinescu @marinescudc.

Interested in helping us evaluate our podcast episodes? We’re currently recruiting a panel of residents to serve as regular reviewers for the show. If you’re interested, email wkwong@qmed.ca.

The Papers

1. SUNSET: https://www.atsjournals.org/doi/abs/10.1164/rccm.201803-0405OC

2. Post-op Atrial Fibrillation: http://www.onlinejacc.org/content/72/17/2027

Good Stuff

1. Empathy: https://www.nejm.org/doi/full/10.1056/NEJMp1808397

2. Dying Healthy: http://annals.org/aim/article-abstract/2703441/dying-healthy-public-health-priorities-fixed-population-life-expectancies

Music Credits

The Rounds Table Theme Music by Brendan Quinn, Creative Director and Composer, Vapor RMW

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