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Less is More, Some More

Paul Simmons, MD and Neda Frayha, MD
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Less is more! We were thrilled to learn about the JAMA Internal Medicine series highlighting which primary care services we can scale back on or do away with completely. In this month’s Primary Care RAP introduction, Neda and Paul continue breaking down some of these recommendations and how they’ll put them into practice. 

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Sarah N. -

To clarify, for CAD/Dyslipidemia, it is my understanding that the use of a non-statin agent may NOT be indicated for primary prevention, but may be recommended for secondary prevention or those patients at highest risk when LDL is not at goal (< 70). https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.119.044282

Kimberly B. -

I am thinking of a patient of mine who has been on dual anti-platelet therapy since a CABG 2 years ago. He is asymptomatic. Walks 4 miles a day. His cardiologist said he needs to be on the dual anti-platelet therapy forever. Is he different from the people in your study because of his CABG? Or should I reach back to his cardiologist and question whether I can stop one of his anti-platelet meds? Thank you for your episode!

Neda F., MD -

Hi Kimberly. Everything I've found points to the ACC/AHA guidelines that recommend 1 year of DAPT for CAD patients status post CABG. See page 1259 of this document: https://www.jtcvs.org/article/S0022-5223(16)30861-3/pdf

It seems totally reasonable to call the cardiologist and ask if this could be an option for your patient, and if not, why not. Good luck! - Neda

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Hippo Primary Care Written Summary April 2021 248 KB - PDF

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