AHA Journals, Author Interviews, Heart Disease, Surgical Research / 30.10.2020
Reversal of Heart Failure Using Left Ventricular Assist Devices
MedicalResearch.com Interview with:
[caption id="attachment_55798" align="alignleft" width="160"] Dr. Drakos[/caption]
Stavros G. Drakos, MD, PhD, FACC
Professor of Cardiology
Univ. of Utah Healthcare & Medical School and the Salt Lake VA Medical Center.
Dr. Drakos is Medical Director of the University's Cardiac Mechanical Support/Artificial Heart Program
Co-Director Heart Failure & Transplant and Director of Research for the Division of Cardiology
MedicalResearch.com: What is the background for this study?
Response: Heart transplantation and LVADs are first line therapies for advanced chronic heart failure. There were some earlier anecdotal observations and single center small studies from several programs in the US and overseas that left ventricular assist devices (LVADs) significantly reduce the strain on failing hearts and in some cases, using LVADs for limited periods of time has allowed hearts to “rest” and remodel their damaged structures. As a result of these repairs, described as “reverse remodeling,” heart function can improve to the point that the LVAD can be removed.
The new study sought to broaden the reach of the research with a multicenter trial involving physicians and scientists at the University of Utah Health, the University of Louisville, University of Pennsylvania, the Albert Einstein College of Medicine/Montefiore Medical Center, the Cleveland Clinic, and the University of Nebraska Medical Center.
Dr. Drakos[/caption]
Stavros G. Drakos, MD, PhD, FACC
Professor of Cardiology
Univ. of Utah Healthcare & Medical School and the Salt Lake VA Medical Center.
Dr. Drakos is Medical Director of the University's Cardiac Mechanical Support/Artificial Heart Program
Co-Director Heart Failure & Transplant and Director of Research for the Division of Cardiology
MedicalResearch.com: What is the background for this study?
Response: Heart transplantation and LVADs are first line therapies for advanced chronic heart failure. There were some earlier anecdotal observations and single center small studies from several programs in the US and overseas that left ventricular assist devices (LVADs) significantly reduce the strain on failing hearts and in some cases, using LVADs for limited periods of time has allowed hearts to “rest” and remodel their damaged structures. As a result of these repairs, described as “reverse remodeling,” heart function can improve to the point that the LVAD can be removed.
The new study sought to broaden the reach of the research with a multicenter trial involving physicians and scientists at the University of Utah Health, the University of Louisville, University of Pennsylvania, the Albert Einstein College of Medicine/Montefiore Medical Center, the Cleveland Clinic, and the University of Nebraska Medical Center. 
Dr. Maslin[/caption]
Dr. Douglas Maslin, MPhil, MB BCHir
Dermatologist and Pharmacologist
Addenbrooke's Hospital
Cambridge, UK
MedicalResearch.com: What is the background for this study?
Response: I’d like to answer this question in three parts:
Dr. Batool-Anwar[/caption]
Salma Batool-Anwar, MBBS, MPH
Instructor, Harvard Medical School
Pulmonary and Critical Care, Sleep Medicine
Brigham and Women's Faulkner Hospital
MedicalResearch.com: What is the background for this study?
Response: A well functioning sleep-wake cycle is vital to our health and prevention of chronic diseases.
During previous disaters sleep disturbances have been reported.
When Massachusetts governor declared a state of emergency in March’20, we hypothesized that sleep duration would be adversely affected by covid-19 related lockdown and stress.
The study was approved by the institutional review board and information was collected retrospectively using the electronic medical records. 
Mr. Olin[/caption]
Steve Olin
Chief Product Officer
Rally Health, Inc., part of the Optum business of UnitedHealth Grou
MedicalResearch.com: Can you please elaborate on Rally Health’s mission?
Mr. Olin: Our founding mission 10 years ago and still to this day is to put health in the hands of the individual. As a digital health company, we live this mission through our focus in three key areas:
1) Providing digital-first access to care by giving individuals easy-to-use digital tools and support to navigate their health care and take full advantage of their health benefits;
2) Engaging people in their daily health by creating experiences that people enjoy and that inspire them to perform healthy actions, and by giving them access to resources that help them achieve their health goals;
3) Saving people time and money by providing digital tools that help them understand health care costs and guide them to lower-cost, high-quality care options.
Dr. Bayes-Genis[/caption]
Antoni Bayes-Genis, MD, PhD, FESC, FHFA
Head, Heart Institute. Hospital Universitari Germans Trias i Pujol
Full Professor, Autonomous University Barcelona
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Omega-3 fatty acids are incorporated into the phospholipids of cellular membranes, including cardiac contractile cells, and have a wide range of demonstrated physiological effects. Several potential mechanisms have been investigated, including antiarrhythmic, anti-inflammatory, and endothelial.
Omega-3 fatty acids lower heart rate and improve heart rate variability, both associated with lower sudden cardiac death risk, one of the complications that may occur after a myocardial infarction.
Increased omega-3 fatty acids also enhance arterial elasticity by increasing endothelium-derived vasodilators, which is associated with blood pressure–lowering effects.
They also have a cardioprotective effect on platelet-monocyte aggregation, and lower triglyceride levels.
Dr. Mahncke[/caption]
MedicalResearch.com: What is heart failure?
Response: Heart failure – sometimes called congestive heart failure or congestive cardiac failure – is when the heart cannot pump sufficient blood flow to maintain the body’s needs. Common symptoms include excessive tiredness, shortness of breath and swelling particularly in legs. It’s treated with a combination of lifestyle changes, drugs, and devices. An estimated 6.5 million Americans are diagnosed with heart failure, with 960,000 new cases each year, leading some to describe it as reaching epidemic proportions. In older adults, it’s the most common cause of hospital readmissions within 30 days of discharge and among the most costly areas of Medicare expenditures.
Dr. Bragg[/caption]
Marie Bragg, PhD
Assistant Professor, Department of Population Health on Health Choice
NYU College of Global Public Health
MedicalResearch.com: What is the background for this study?
Response: We know from previous research that children who see food advertisements eat significantly more calories than children who see non-food advertisements. Those studies led the World Health Organization and National Academy of Medicine to issue reports declaring that exposure to food advertising is a major driver of childhood obesity.
What we don’t know is how frequently unhealthy food and beverage brands are appearing in YouTube videos posted by Kid Influencers. Kid influences are children whose parents film videos of the child playing with toys, unwrapping presents, eating food, or engaging in other family-friendly activities. The parents then post the videos to YouTube for other children and parents to view for entertainment. 
Dr. Mazzeffi[/caption]
Michael Mazzeffi MD MPH MSc
Associate Professor of Anesthesiology
Division Chief Anesthesiology Critical Care Medicine
Medical Director Rapid Response Team
MedicalResearch.com: What is the background for this study?
Response: We have known for some time that COVID19 is characterized by hypercoagulability or excess blood clotting. In fact, the incidence of blood clots in the lungs (pulmonary emboli) is as high 20% and is two to three times more common in COVID19 than in severe influenza. Further, autopsies of patients who died from COVID19 have shown that endothelial cells (cells that line the blood vessels) are damaged and that "micro clots" form in multiple organs. Together, these findings strongly suggest that excess blood clotting and endothelial cell dysfunction are defining features of severe COVID19.
For several months, my colleagues and I have been interested in whether aspirin might improve outcomes in patients with severe COVID19. In prior observational research studies, aspirin was found to be protective in patients with severe lung injury. The general idea is that aspirin reduces platelet aggregates in the lung and this improves outcome. Unfortunately, in a prior randomized controlled study (LIPS-A) aspirin was not shown to reduce the incidence of acute respiratory distress syndrome. Nevertheless, COVID19 has unique features that make aspirin more likely to be effective. Mainly COVID19 is associated with hypercoagulability to a greater degree than in other viral illnesses. 
Dr. Love you to the moon and back![/caption]
Susan Lu PhD
Gerald Lyles Rising Star Associate Professor of Management
Krannert School of Management
Purdue University
MedicalResearch.com: What is the background for this study?
Response: We started this project in 2016. Overcrowding in emergency rooms (ERs) is a common yet nagging problem. It not only is costly for hospitals but also compromises care quality and patient experience. Hence, finding effective ways to improve ER care delivery is of great importance. Meanwhile, the advancement of healthcare technologies including electronic medical records, online doctor ratings and 4G mobile network motivates us to think about the impact of telemedicine on ER operations in the near future. 
Christos V. Chalitsios[/caption]
Christos Chalitsios B.Sc, M.Sc PhD student
Funded by British Medical Association (BMA)
School of Medicine
Division of Respiratory Medicine
University of Nottingham
City Hospital,Nottingham
MedicalResearch.com: What is the background for this study?
Response: Inhaled (ICS) and oral (OCS) corticosteroids play a crucial role in the control of airway inflammation in asthma. Given that the use of ICS in asthma is likely to increase with the recent change in GINA guidance recommending combined long-acting-β2-agonists with ICS at step 1 and the upward trend in prescribing of OCS, we sought to clarify the link between steroids, osteoporosis and FF in patients with asthma, stratifying the risk by dose, number of courses and type of steroids. The prevalence of patients receiving at least one bisphosphonate was also calculated.
Dr. Etkin[/caption]
Amit Etkin, MD, PhD
Department of Psychiatry and Behavioral Sciences
Wu Tsai Neurosciences Institute, Stanford Universitu
Stanford, CA
MedicalResearch.com: What is the mission of Cohen Veterans Bioscience - CVB?
Response: Cohen Veterans Bioscience (CVB) is a non-profit 501(c)(3) research biotech dedicated to fast-tracking the development of diagnostic tests and personalized therapeutics for the millions of Veterans and civilians who suffer the devastating effects of trauma-related and other brain disorders.
MedicalResearch.com: How can patients with PTSD or MDD benefit from this information?
Response: With the discovery of this new brain imaging biomarker, patients who suffer from PTSD or MDD may be guided towards the most effective treatment without waiting months and months to find a treatment that may work for them.
MedicalResearch.com: What is the background for this study?
Response: This study, which was supported with a grant from Cohen Veterans Bioscience, grants from the National Institute of Mental Health (NIMH and other supporters, derives from our work over the past few years which has pointed to the critical importance of understanding how patients with a variety of psychiatric disorders differ biologically. The shortcomings of our current diagnostic system have become very clear over the past 1-2 decades, but the availability of tools for transcending these limitations on the back of objective biological tests has not kept pace with the need for those tools.
In prior work, we have used a variety of methods, including different types of brain imaging, to identify brain signals that underpin key biological differences within and across traditional psychiatric diagnoses. We have also developed specialized AI tools for decoding complex patterns of brain activity in order to understand and quantify biological heterogeneity in individual patients. These developments have then, in turn, converged with the completion of a number of large brain imaging-coupled clinical trials, which have provided a scale of these types of data not previously available in the field.
Dr. Leaf[/caption]
David E. Leaf, MD, MMSc, FASN
Assistant Professor of Medicine, Harvard Medical School
Director of Clinical and Translational Research in Acute Kidney Injury
Division of Renal Medicine, Brigham and Women's Hospital
MedicalResearch.com: What is the background for this study?
Response: The data for this study were derived from a multicenter cohort study of over 4,000 critically ill patients with COVID-19 admitted to ICUs at 68 sites across the US, as part of the Study of the Treatment and Outcomes in Critically Ill Patients with COVID-19 (STOP-COVID). STOP-COVID was initiated by David E. Leaf, MD, MMSc and Shruti Gupta, MD, MPH, from the Division of Renal Medicine at Brigham and Women’s Hospital and Harvard Medical School. It was initiated in March, 2020 as an unfunded, grassroots network, and now includes over 400 collaborators from 68 sites across the US.
Using this data, we used a ‘target trial emulation’ approach to examine whether early administration of the monoclonal antibody, tocilizumab, reduces mortality in critically ill patients with COVID-19. Target trial emulation, a novel method of analyzing observational data, is the idea of simulating a randomized control trial to reduce bias. 
Dr. Meyers[/caption]
Craig Meyers, PhD
Department of Microbiology and Immunology
Pennsylvania State College of Medicine
Hershey, PA
MedicalResearch.com: What is the background for this study?
Response: As nasal and oral cavities are major points of entry and transmission for human coronaviruses our team of physicians and scientists (Craig Meyers, Janice Milici, Samina Alam, David Quillen, David Goldenberg and Rena Kass of Penn State College of Medicine and Richard Robison of Brigham Young University) were interested in testing common over-the-counter oral antiseptics and mouthwashes for their efficacy to inactivate infectious human coronavirus, which is structurally similar to SARS-CoV-2, the virus that causes COVID-19. While we wait for a vaccine for COVID-19 to be developed, methods to reduce transmission are needed. We chose products that are readily available and often already part of people’s daily routines.
Dr. Kriner[/caption]
Douglas L. Kriner, PhD
The Clinton Rossiter Professor in American Institutions
Department of Government
Cornell University
MedicalResearch.com: What is the background for this study?
Response: When a safe and effective vaccine for COVID-19 reaches the market, the world will not change overnight. Rather, government and public health individuals will have to develop a comprehensive plan to distribute the vaccine and to convince potentially wary Americans to take it.
Our study examined the influence of both specific vaccine characteristics and the politics surrounding it on public willingness to vaccinate. Both matter in important ways. For example, efficacy is unsurprisingly a major driver of public opinion; Americans are more willing to take a vaccine that is more efficacious.
Dr. Al Rafai[/caption]
Mahmoud Al Rifai MD MPH
Section of Cardiology, Department of Medicine
Baylor College of Medicine Houston
[caption id="attachment_55680" align="alignleft" width="150"]
Dr. Virani[/caption]
Salim S. Virani, MD, PhD
Section of Cardiology
Michael E. DeBakey Veterans Affairs Medical Center
Section of Cardiology, Department of Medicine
Baylor College of Medicine Houston
MedicalResearch.com: What is the background for this study?
Response: E-cigarettes typically cost more than combustible cigarettes and there is more variability in cost due to a wide variety of flavors, e-cigarette liquid, and vaping device that are available in the market. Therefore, use of e-cigarettes may vary depending on income with potentially higher use among higher income individuals.
Dr. KantersA[/caption]
Response: A watershed moment for the fight against HIV was the antiretroviral treatment (ART) scale-up that made HIV treatments available around the world. While HIV activism led to its initiation, two key ingredients to the ART scale-up were the advent of a once-daily single-pill HIV treatment and the creation of the World Health Organization (WHO) clinical guidelines for treatment and prevention of HIV. The HIV treatment in question combines three drugs in a single pill and centers around a drug called efavirenz.
The WHO guidelines use a public health framework, which is to say that it uses a treatment algorithm that is both equitable and simple enough to allow some task-shifting to less specialized workers. As such, the guidelines suggest a single preferred treatment for people initiating HIV treatment. While resource rich countries can use a personalized medicine approach, many settings where HIV is endemic cannot.
In 2015, our review found strong evidence that a newer HIV drug, called dolutegravir, was better than efavirenz in respect to efficacy, tolerability and safety; however, there was not enough evidence to support its use in key populations, such as people with HIV-tuberculosis co-infections and pregnant women. For this and other reasons, the WHO could not recommend its use as the preferred treatment at initiation.
Since then, we have continued to dynamically assess the evidence to determine the best treatment to have as the preferred ART for first-time HIV treatment. This is the culmination of 6 years of work and its findings have helped the WHO change its recommended preferred first-line therapy from an efavirenz-based ART to a dolutegravir-based ART. 
Dr. Profeta[/caption]
Paola Profeta, PhD
Professor of Public Economics, Department of Social and Political Sciences
Bocconi University
Director, Msc Politics and Policy Analysis, Bocconi University
Coordinator, Dondena Gender Initiative, Dondena Research Center
President, European Public Choice Society
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We interview more than 20000 men and women in 8 OECD countries in two periods during the lockdown.
Using two waves from 8 OECD countries, we find that women are more likely to perceive the pandemic as a very serious health problem, to agree with restraining measures and to comply with public health rules, such as using facemasks. This gender differences are less strong for married individuals and for individuals who have been directly exposed to COVID, for instance by knowing someone who was infected.