Aging, Author Interviews, Heart Disease, Lancet, Social Issues / 26.11.2017 Interview with: Prof Kazem Rahimi FRCP The George Institute for Global Health Oxford Martin School University of Oxford, Oxford What is the background for this study? Response: We decided to investigate this topic because disease incidence data is very important for public health bodies; for example, for the allocation of healthcare resources or for the design and assessment of disease prevention measures. When we reviewed the literature, we found that estimates of heart failure incidence, temporal trends, and association by patient features were scarce. Studies often referred to restricted populations (such as relatively small cohorts that may or may not be representative of the general population), or limited data sources (for example, only including patients hospitalized for their heart failure and not considering those diagnosed by clinicians outside of hospitals). Few studies reported comparable, age-standardized rates, with the result that the rates reported varied considerably across the literature. (more…)
Author Interviews, Heart Disease, Nutrition / 14.11.2017 Interview with: “Fresh Food” by Sonny Side Up! is licensed under CC BY 2.0   Dr. Kyla M Lara Icahn School of Medicine at Mount Sinai What is the background for this study? What are the main findings? Response: This was the first study to evaluate whether dietary patterns of black and white adults living in the United States were associated with developing heart failure. We’re hearing a lot in the news about specific diets like low-fat, high protein, low carb, and other diets that decrease cardiovascular risk. We would love it, as physicians, if we could prescribe a specific diet to limit cardiovascular risk in our patients. I’m really excited about our study because instead of examining patterns of what we already know are healthy, we looked at foods people were regularly consuming in the United States and developed dietary patterns from this. This study is similar to other work we have done with stroke and heart attack. We used data from the NIH funded REGARDS study, also known as the Reasons for Geographic and Racial Differences in Stroke. More than 30,000 white and African-American adults were recruited from 2003-2007. From this group, we studied over 18,000 adults who successfully completed a dietary assessment called the Food Frequency Questionnaire. This was a really great group to study because people who live in this particular geographic area of the Southeastern United States, also known as the stroke belt, suffer from a higher risk of death from stroke. It’s extremely important for us to better understand the major risk factors that contribute to this and also cardiovascular disease. We used statistical techniques to derive 5 dietary patterns based on the types of foods participants tended to eat. • Convenience - Mexican and Chinese food, mixed dishes (both meat and bean) • Sweets - added fats, bread, chocolate, desserts, sweet breakfast foods • Southern - added fats, fried food, organ and processed meat, fatty milk • Alcohol/Salads - beer, wine, liquor, green leafy vegetables, salad dressings, nuts and seeds, coffee • Plant Based- fruit, vegetables, fruit juice, cereal, fish, poultry Each participant received a score for each pattern that reflected how closely their diet resembled that dietary pattern. This approach reflects the real world and how people eat. Over the 3135 days (8.6 years) of median follow up, 594 participants were hospitalized for incident HF. Greatest adherence to the plant-based dietary pattern during the study period was associated with a 28% risk reduction of developing heart failure. (more…)
Author Interviews, Geriatrics, Heart Disease, JACC, UCLA / 14.11.2017 Interview with: Kevin S. Shah, M.D. Cardiology Fellow, University of California, Los Angeles Ronald Reagan UCLA Medical Center What is the background for this study? What are the main findings? Response: Heart failure (HF) is a chronic condition and progressive disease which is associated with a high-risk of hospitalization and death. One of the principle ways in which heart function is estimated is the use of ultrasound to calculate the ejection fraction of the heart, an estimate of the heart’s pump function. The ejection fraction can help predict how long patients will live and affects decision-making with regards to what medications may help their condition. A total of 39,982 patients from 254 hospitals who were admitted for Heart failure between 2005 and 2009 were included. They were followed over time to see if they were admitted to the hospital again or if they died during this period. We compared three subgroups within this large group of patients based on their estimated ejection fraction. Across subgroups, the 5-year risk of hospitalization and death was high when compared with the U.S. population. Furthermore, the survival for patients with a diagnosis of heart failure who have been hospitalized once for this condition have a similarly poor 5-year risk of death and re-hospitalization, regardless of their estimated ejection fraction. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA / 13.11.2017 Interview with: Ankur Gupta, MD, PhD Division of Cardiovascular Medicine Brigham and Women’s Hospital Heart & Vascular Center and Harvard Medical School, Boston, Massachusetts What is the background for this study? What are the main findings? Response: The Hospital Readmissions Reduction Program (HRRP), established under the Affordable Care Act, aimed to reduce readmissions from various medical conditions including heart failure - the leading cause of readmissions among Medicare beneficiaries. The program financially penalizes hospitals with high readmission rates. However, there have been concerns of unintended consequences especially on mortality due to this program. Using American Heart Association's Get With The Guidelines-Heart Failure (GWTG-HF) data linked to Medicare data, we found that the policy of reducing readmissions after heart failure hospitalizations was associated with reduction in 30-day and 1-year readmissions yet an increase in 30-day and 1-year mortality. (more…)
Author Interviews, Heart Disease, NEJM, UCLA / 05.11.2017 Interview with: Bruno Péault PhD Professor and Chair, Vascular Regeneration Center For Cardiovascular Science MRC Centre for Regenerative Medicine Scientific Director, BHF Laboratories The University of Edinburgh and Professor, David Geffen School of Medicine at UCLA Orthopaedic Hospital Research Center University of California at Los Angeles Los Angeles, CA 90095-7358 What is the background for this study? Response: Kidney, lung, liver, muscle, heart are among the many organs which can be severely affected by fibrosis, a natural scarring process whereby healthy tissues are replaced by a fibrous non-functional substitute. For instance, the billions of cardiac muscle cells that die after a heart infarct, consequently to blood supply interruption, are replaced by a fibrotic scar that cannot contract, reducing the capacity of the heart to pump blood, and leading often to heart failure. There is currently no efficient treatment of fibrotic scars, the basic cellular component of which is the myofibroblast, a cell of unremarkable appearance and unclear origin. The transforming growth factor β (TGFβ) molecule triggers fibrosis development after being activated, via the extra-cellular matrix, by αv integrins, which are adhesion molecules present at the surface of the target cells. To gain further insight into the cells that drive fibrosis in the heart and skeletal muscle, and explore ways to control this deleterious process, mice were used in which cells expressing the β receptor for PDGF (platelet derived growth factor) have been genetically tagged with a green fluorescent protein, a system previously used by Prof. Neil Henderson to trace fibrosis in the diseased liver (cells naturally expressing PDGFRβ are, in their vast majority, perivascular cells surrounding small blood vessels, as well as some interstitial fibroblasts). Skeletal muscle was injured by a small incision or with a targeted injection of cardiotoxin, a snake venom compound that locally kills myofibers, while the heart was damaged by prolonged infusion of angiotensin II. In both settings, progression of fibrosis was followed over time and contribution of green fluorescent cells – i.e. those expressing PDGFRβ – was assessed. (more…)
Author Interviews, Columbia, Heart Disease, Orthopedics / 28.09.2017 Interview with: Dr. Mathew Maurer, Medical Director The Hypertrophic Cardiomyopathy Center NewYork-Presbyterian/Columbia University Medical Center. What is the background for this study? Response: Transthryretin cardiac amyloidosis (TTR-CA) is an underdiagnosed type of cardiomyopathy in which TTR (transthyretin, also known as prealbumin), a protein that forms amyloid fibrils, deposits in the heart. The deposits cause thickening of the ventricular wall and diastolic as well as systolic dysfunction. It is usually discovered around age 75 and presents more commonly in men than in women. With advances in non-invasive diagnostic modalities and growing awareness, TTR-CA is being diagnosed increasingly more frequently. Additionally, there are several emerging treatments that are under active investigation. Most of these therapies prevent disease progression and don’t address the amyloid already deposited in the heart. Accordingly, it is imperative that we diagnose TTR-CA before patients develop significant amyloid heart disease. However, this presents a great challenge since there are few known clinical predictors that might alert even the most astute physician that a patient is at such risk. With identification of predictors that may appropriately raise the index of clinical suspicion, clinicians may begin to pick up more subtle (and perhaps not yet clinically significant) forms of TTR-CA and initiate treatment before significant damage occurs. The few known clinical predictors of TTR-CA include bilateral carpal tunnel syndrome and lumbar spinal stenosis, and numerous studies found TTR on biopsies and autopsies of other musculoskeletal sites, particularly in hip and knee joints. (Just last week, and also discussed here on, biceps tendon rupture was also shown to occur more frequently in TTR-CA!) We suspected that patients who ultimately develop TTR-CA may first develop clinically significant hip and knee disease, enough to even warrant a hip (THA) or knee (TKA) replacement. (more…)
Author Interviews, Brigham & Women's - Harvard, Heart Disease, JAMA, Orthopedics / 22.09.2017 Interview with: Avinainder Singh, M.B.B.S. Research Fellow Cardiovascular Medicine Brigham & Women's Hospital Harvard Medical School Boston, MA What is the background for this study? Response: Amyloidosis due to aberrant folding of proteins. These misfolded proteins can deposit in various parts of the body and lead to organ dysfunction. The two most common types of amyloidosis affecting the heart include transthyretin and light chain amyloidosis. Transthyretin is a protein produced by the liver which supports the transport of thyroxine and retinol. Wild-type transthyretin amyloidosis (ATTRwt, previously known as senile amyloidosis) occurs due to deposition of misfolded fibrils derived from transthyretin and primarily affects elderly men. Once considered a rare disease, it is now reported to be responsible for nearly 13% of heart failure with preserved ejected fraction and increased wall thickness. Rupture of the biceps tendon is a rare occurrence in the general population (<1 per 1000). We noticed a ruptured biceps tendon in several patients with wild-type transthyretin amyloidosis and performed this study to further evaluate this finding in a group of patients with wild-type transthyretin amyloidosis and in a control group of age-matched patients with non-amyloid heart failure. (more…)
Author Interviews, Boehringer Ingelheim, Heart Disease, JAMA / 18.07.2017 Interview with: Javed Butler, MD, PhD Chief of the Cardiology Division Dr. Vincent Yang, Simons Chair in Internal Medicine Stony Brook University What is the background for this study? What are the main findings? Response: Persistent congestion is associated with worse outcomes in acute heart failure (AHF). Mineralocorticoid receptor antagonists at high doses may relieve congestion, overcome diuretic resistance, and mitigate the effects of adverse neurohormonal activation in AHF. We therefore studies high dose spironolactone in patients with AHF. Unfortunately all of our primary and secondary endpoints were not different between spironolactone and placebo arms. (more…)
Author Interviews, Duke, Heart Disease / 15.06.2017 Interview with: Daniel J. Friedman, MD Duke University Hospital Duke Clinical Research Institute Durham, NC What is the background for this study? What are the main findings? Response: Although primary prevention ICDs have saved countless lives among patients with heart failure and a reduced ejection fraction, the use of primary prevention ICDs in patients with more advanced heart failure [defined by New York Heart Association Class (NYHA)] is controversial. Specifically, there are conflicting data from the pivotal primary prevention ICD trials regarding whether primary prevention ICDs reduce all-cause mortality among patients with a severely reduced ejection fraction (≤35%) and NYHA III heart failure. We performed a patient level meta-analysis using data from 4 pivotal primary prevention ICD trials (MADIT-I, MADIT-II, SCD-HeFT, and DEFINITE) to assess whether primary prevention ICD efficacy varied by NYHA class (II vs. III). Overall, the ICD reduced all-cause mortality among the overall population of patients (NYHA II and III). We subsequently assessed ICD efficacy after stratification by NYHA class. Among NYHA II patients, the ICD significantly reduced all-cause mortality by reducing sudden cardiac death. Although NYHA III patients randomized to an ICD experienced a significantly lower rate of sudden cardiac death, this did not translate into a reduction in all-cause mortality, due to competing causes of non-sudden death (which an ICD cannot treat). Based on relatively wide confidence intervals associated with the estimate for ICD effect in NYHA III patients, there appears to be substantial heterogeneity in outcomes among these patients. This suggests that many NYHA III patients can benefit from a primary prevention ICD, but further study is necessary to determine which NYHA III patients are poised to benefit. (more…)
Author Interviews, Heart Disease, JACC / 20.05.2017 Interview with: Kristie Harris, M.S. Doctoral Candidate, Department of Psychology Psychology Trainee, OSUWMC Department of Psychiatry Columbus, OH 43210 What is the background for this study? Response: In patients with chronic diseases such as heart failure, treatment strategies and medical management often rely on clinician’s assessment of symptoms and impairments in functional status. The six-minute walk test (6MWT) is a validated and commonly-used measure for assessing functional status in this patient population and has the advantage of being self-paced and easily administered. However, its clinical utility may be limited because it is time consuming, not suitable for patients with comorbidities that interfere with walking, and requires a long continuous hallway course. In this this study we report the development of an alternative measure of objective functional status, the sixty-foot walk test (60ftWT). For this task, patients are simply asked to walk four laps of 15 feet and the total time taken to walk the 60ft is recorded in seconds. (more…)
Author Interviews, Global Health, Heart Disease / 03.05.2017 Interview with: Hisham Dokainish, M.D., FRCPC, FASE, FACC Associate Professor of Medicine, McMaster University Principal Investigator, Population Health Research Insitute Director of Heart Failure Services, Director of Medical Diagnostic Units & Echocardiography, Hamilton Health Sciences Hamilton, ON, Canada What is the background for this study? Response: Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions of the world, particularly from low and middle income countries. What are the main findings? Response: We enrolled 5823 patients within 1 year (with 98% follow-up). Overall mortality was 16·5%: highest in Africa (34%) and India (23%), intermediate in southeast Asia (15%), and lowest in China (7%), South America (9%), and the Middle East (9%). These large regional differences in mortality persisted after multivariable adjustment for demographic, clinical, medication and socioeconomic variables. About half of the mortality risk was explained by multivariable modeling with these variables; however, the remainder was unexplained. (more…)
Author Interviews / 10.04.2017 Interview with: Amrut V. Ambardekar, MD Medical Director Cardiac Transplant Program Division of Cardiology, Section of Advanced Heart Failure-Transplant Cardiology University of Colorado What is the background for this study? What are the main findings? Response: As left ventricular assist device (LVAD) technology has improved, the appropriate timing for implant of these devices (essential a form of an artificial heart pump) in patients with advanced heart failure is unknown. The goal of the MedaMACS study was to describe the prognosis of a group of patients with advanced heart failure who currently do not require intravenous therapies, and determine how they compare to a similar group of patients who received a LVAD. The main finding from this study is that the “sickest” group of patients with advanced heart failure on oral medical therapy (known as INTERMACS profile 4 patients) have very poor outcomes with a strong trend for improvement in survival with LVAD therapy. The other take home message is that among all of the patients enrolled in the study on medical therapy, only approximately half were alive after an average of 12 months of follow up without needing a heart transplant or LVAD placement. (more…)
Author Interviews, Heart Disease, JACC, Sleep Disorders / 24.03.2017 Interview with: Christopher M. O’Connor, MD FACC  CEO and Executive Director, Inova Heart & Vascular Institute IHVI Administration Falls Church, Virginia 22042 What is the background for this study? What are the main findings? Response: Sleep apnea is a very common comorbidity of patients with heart failure (both reduced ejection fraction and preserved ejection fraction). Early evidence from observational and small studies suggested that treating sleep apnea with adaptive servo-ventilation (ASV) therapy may improve patient outcomes. There is minimal clinical evidence about identifying and treating sleep apnea in those who’ve been hospitalized with acute decompensated heart failure. The CAT-HF study was designed to help address this, with the primary endpoint being cardiovascular outcomes measured as a Global Rank Score that included survival free from cardiovascular hospitalization and change in functional capacity as measured by the six-minute walk distance. It was also planned to expand on the SERVE-HF study that was investigating the use of ASV therapy to treat central sleep apnea (CSA) in chronic stable heart failure patients with reduced ejection fraction patients (HFrEF). (more…)
Author Interviews, Heart Disease, Karolinski Institute, Outcomes & Safety / 25.02.2017 Interview with: Lars H. Lund, MD Phd, Assoc. Prof., FESC Department of Medicine, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital Sweden What is the background for this study? What are the main findings? Response: Registries are accepted for quality reporting but it is actually unknown whether in heart failure they directly improve outcomes. Here, enrollment in SwedeHF was strongly associated with reduced mortality. (more…)
Author Interviews, Biomarkers, Heart Disease, JACC / 04.01.2017 Interview with: Prof. Michele Emdin, MD, PhD, FESC Associate Professor of Cardiovascular Medicine Director, Cardiology & Cardiovascular Medicine Division Fondazione Toscana Gabriele Monasterio per la Ricerca Medica e di Sanità Pubblica CNR-Regione Toscana with the collaboration of Dr. Alberto Aimo, MD Institute of Life Sciences Scuola Superiore Sant'Anna - Sant'Anna School of Advanced Studies Pisa, Italy What is the background for these meta-analyses? Response: Soluble suppression of tumorigenicity 2 (sST2) is a novel and promising biomarker of heart failure (HF). It has been extensively studied in both stable chronic (CHF) and acute HF (AHF), demonstrating substantial potential as a predictor of prognosis in both settings (Dieplinger et al., 2015). An International Consensus Panel (Januzzi et al., 2015) and latest American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines (Yancy et al., 2013) support the use of sST2 assay for risk stratification in both CHF and AHF patients. By contrast, European Society of Cardiology guidelines do not provide specific recommendations on sST2 (Ponikowski et al., 2016). Because of ambiguity due to discordant conclusions and to the absence of a thorough revision of the literature and of rigorous meta-analyses of published studies up-to-date, we felt it worthwhile to carefully examine and meta-analyze evidence supporting measurement of sST2, in order to assess the prognostic role of this biomarker in CHF and AHF. Most of the groups originally publishing on the topic all over the world and representing the Gotha of clinical research on cardiovascular biomarker, accepted to directly contribute allowing the main Authors to achieve novel information by a guided statistical reappraisal, The final results furnish clinically significant support to the use of sST2 as a risk stratification tool either in the acute or in the chronic heart failure setting. (more…)
Author Interviews, Emory, Exercise - Fitness, Geriatrics, Heart Disease, Lifestyle & Health / 18.11.2016 Interview with: Vasiliki Georgiopoulou MD MPH PhD Assistant Professor of Medicine (Cardiology) Emory University School of Medicine What is the background for this study? What are the main findings? Response: Although existing evidence suggests that more exercise capacity is associated with lower risk of CV disease and death, we don’t know whether more exercise capacity would lead to lower risk for heart failure also. This would be especially important for older adults, who are the group with the highest risk to develop heart failure. We used the data of a cohort study to test this association. The exercise capacity was evaluated by a walking test that is easy to perform – the long-distance corridor walk test. We observed that older adults who were able to complete the test had the lowest risk to develop heart failure and the lowest mortality rates, when compared with those who were not able to complete the test and those who could not do the test for medical reasons. We also observed that changes in exercise capacity 4 years later did not predict subsequent heart failure or mortality – perhaps because less fit older patients had already developed heart failure or had died. (more…)
Author Interviews, Cost of Health Care, Heart Disease, JAMA, Pharmacology / 16.11.2016 Interview with: Paul J. Hauptman, MD Professor Internal Medicine, Division of Cardiology Health Management & Policy, School of Public Health What is the background for this study? What are the main findings? Response: We decided to evaluate the cost of generic heart failure medications after an uninsured patient of ours reported that he could not fill a prescription for digoxin because of the cost for a one month's supply: $100. We called the pharmacy in question and confirmed the pricing. At that point we decided to explore this issue more closely. We called 200 retail pharmacies in the bi-state, St. Louis metropolitan area, 175 of which provided us with drug prices for three generic heart failure medications: digoxin, carvedilol and lisinopril. We found significant variability in the cash price for these medications. Combined prices for the three drugs ranged from $12-$400 for 30 day supply and $30-$1,100 for 90 day supply. The variability was completely random, not a function of pharmacy type, zip code, median annual income, region or state. In fact, pricing even varied among different retail stores of the same pharmacy chain. (more…)
AHA Journals, Author Interviews, Heart Disease, Occupational Health / 12.10.2016 Interview with: Rasmus Rørth MD From Department of Cardiology Rigshospitalet University of Copenhagen, Denmark What is the background for this study? Response: Heart failure is considered to be one of the most common, costly, disabling and deadly medical conditions and is thus a major health care problem. The ability to maintain a full-time job addresses a vital indirect consequence and cost of heart failure, beyond the usual clinical parameters such as mortality and hospitalization. Ability to work is more than just another measure of performance status. As well as its financial importance, employment is crucial for self-esteem and quality of life in patients with chronic illness. Obtaining information on labour force inclusion should, therefore, shed light on an unstudied consequence of heart failure and provide a novel perspective on the impact of heart failure on the lives of those who, perhaps, have most to lose from this condition. (more…)
Author Interviews, Heart Disease, Hospital Readmissions, JACC, NYU, Race/Ethnic Diversity / 12.07.2016 Interview with: Matthew Durstenfeld MD Department of Medicine Saul Blecker, MD, MHS Department of Population Health and Department of Medicine New York University School of Medicine NYU Langone Medical Center New York, New York What is the background for this study? What are the main findings? Response: Racial and ethnic disparities continue to be a problem in cardiovascular disease outcomes. In heart failure, minority patients have more readmissions despite lower mortality after hospitalization for heart failure. Some authors have attributed these racial differences to differences in access to care, although this has never been proven. Our study examined patients hospitalized within the municipal hospital system in New York City to see whether racial and ethnic disparities in readmissions and mortality were present among a diverse population with similar access to care. We found that black and Asian patients had lower one-year mortality than white patients; concurrently black and Hispanic patients had higher rates of readmission. These disparities persisted even after accounting for demographic and clinical differences among racial and ethnic groups. (more…)
Author Interviews, Brigham & Women's - Harvard, Cost of Health Care, Heart Disease, JAMA, Pharmacology / 22.06.2016 Interview with: Thomas Andrew Gaziano, MD, MSc Department of Cardiology Assistant Professor Harvard Medical School What is the background for this study? Response: Heart failure (HF) is the leading cause of admissions to hospitals in the United States and the associated costs run between $24-47 billion annually. Targeting neurohormonal pathways that aggravate the disease has the potential to reduce admissions. Enalapril, an angiotensin converting enzyme-inhibitor (ACEI), is more commonly prescribed to treat HF than Sacubitril/Valsartan, an angiotensin-receptor/neprilysin inhibitor (ARNI). The latter was shown to reduce cardiovascular death and hospitalizations due to heart failure in a multi-country, randomized clinical (PARADIGM-HF), compared to Enalapril. In order to assess the cost-effectiveness of Sacubitril/Valsartan, compared to Enalapril, in the United States, we created a model population with population characteristics equivalent to the population in the PARADIGM-HF trial. Using a 2-state Markov model we simulated HF death and hospitalizations for patients with a left ventricular ejection fraction (LVEF) of 40% or less. (more…)
Author Interviews, Cognitive Issues, Heart Disease, JAMA / 22.04.2016 Interview with: Thomas H. Marwick, MBBS, PhD, MPH Baker IDI Heart and Diabetes Institute Melbourne, Australia What is the background for this study? What are the main findings? Dr. Marwick: Readmission for heart failure (HF) remains common and the risk of this remains hard to predict. It's possible that existing risk scores don't cover all important patient features. We confirmed that cognitive impairment was an unmeasured contributor and incorporated this measurement in a prediction model. The resulting model was the most reliable reported to date and could be used to identify patients who need the closest follow up to avoid readmission. (more…)
Author Interviews, Heart Disease, Hospital Readmissions / 15.12.2015 Interview with: Javed Butler MD MPH Chief, Division of Cardiology Stony Brook University Health Sciences Center SUNY at Stony Brook, NY Medical Research: What is the background for this study? What are the main findings? Dr. Butler: There is a lot of emphasis on reducing the risk of readmission after heart failure hospitalization. The main focus is on early readmissions as the risk for readmission is highest earlier post discharge. In this study, we described the fact that certainly there is some increased risk post discharge, the majority of the risk is actually dependent on the patient and disease characteristics at the time of discharge as opposed to true reduction in risk over time, which is partially related to differential attrition of high risk patients earlier post discharge. (more…)
Author Interviews, Heart Disease, JAMA, UT Southwestern / 25.11.2015

Ambarish Interview with: Ambarish Pandey M.D. Division of Cardiology University of Texas Southwestern Medical Center Dallas, TX Medical Research: What is the background for this study? What are the main findings? Dr. Pandey: Pulmonary artery (PA) catheters have been used for invasive bedside hemodynamic monitoring for past four decades. The ESCAPE trial, published in October 2005, demonstrated that use of  Pulmonary Artery catheter was not associated with a significant improvement in clinical outcomes of patients with heart failure. Accordingly, the current ACC/AHA guidelines discourage the routine use of PA catheter for routine management of acute heart failure in absence of cardiogenic shock or respiratory failure (Class III). Despite the significant evolution of available evidence base and guideline recommendations regarding use of  Pulmonary Artery catheters, national patterns of PA catheter utilization in hospitalized heart failure patients remain unknown. In this study, we observed that use of PA catheter among patients with heart failure decline significantly in the Pre-ESCAPE era (2001 – 2006) followed by a consistent increase in its use in the Post-ESCAPE era (2007-2012). We also observed that the increase in use of  Pulmonary Artery catheters is most significant among heart failure patients without underlying cardiogenic shock or respiratory failure. (more…)
Author Interviews, Duke, Heart Disease, Pharmacology / 10.11.2015 Interview with: Lauren Cooper, MD Fellow in Cardiovascular Diseases Duke University Medical Center Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Cooper: Heart failure guidelines recommend routine monitoring of serum potassium and renal function in patients treated with a mineralocorticoid receptor antagonist (MRA). Specific monitoring recommendations include: within 2-3 days of initiation of the drug, again at 7 days, monthly for at least 3 months, then every 3 months thereafter. However, no large studies had evaluated compliance with these safety recommendations in routine clinical practice. Using Medicare claims data from 2011, we evaluated monitoring of serum creatinine and potassium levels among patients with heart failure initiated on an MRA. After MRA initiation, rates of guideline-recommended laboratory monitoring of creatinine and potassium were low. Of 10,443 Medicare beneficiaries included in this study, 91.6% received pre-initiation testing; however, only 13.3% received appropriate testing in the first 10 days after drug initiation and 29.9% received appropriate testing in the first 3 months. Only 7.2% of patients received guideline-recommended laboratory monitoring both before and after MRA initiation. Chronic kidney disease was associated with a greater likelihood of appropriate testing (relative risk, 1.83; 95% CI, 1.58-2.13), as was concomitant diuretic use (relative risk, 1.78; 95% CI, 1.44-2.21). (more…)
Author Interviews, Heart Disease, JACC / 20.10.2015

Jerry D. Estep, MD, FACC, FASE Associate Professor of Clinical Cardiology Houston Methodist Institute of Academic Medicine Section Head of Heart Transplant & Mechanical Circulatory Support, Division of Heart Failure Medical Director, Heart Transplant & LVAD Program Methodist DeBakey Heart & Vascular Center Houston Interview with: Jerry D. Estep, MD, FACC, FASE Associate Professor of Clinical Cardiology Houston Methodist Institute of Academic Medicine Section Head of Heart Transplant & Mechanical Circulatory Support, Division of Heart Failure Medical Director, Heart Transplant & LVAD Program Methodist DeBakey Heart & Vascular Center Houston Methodist   Medical Research: What is the background for this study? What are the main findings? Dr. Estep: Data for left ventricular assist devices (LVADs) in non-inotrope-dependent advanced heart failure (HF) patients are limited. The risk-benefit tradeoff of LVADs versus optimal medical management (OMM) in this patient cohort is not well understood.  ROADMAP is the first prospective, nonrandomized, observational study comparing LVAD support to OMM in advanced, ambulatory HF patients who are not dependent on intravenous inotropic support, and meet the FDA-approved indications for LVAD destination therapy.  The main  5 findings from the ROADMAP Study include the following: 1) LVAD patients were more severely ill, with more INTERMACS profile 4 compared to OMM patients (65% LVAD vs. 34% OMM, p < 0.001); 2) more LVAD patients met the primary endpoint of survival on original therapy with improvement in 6 minute walk distance of at least 75 meters at 12 months (39% LVAD vs. 21% OMM; [OR: 2.4 [95% CI: 1.2 to 4.8]; p = 0.012) with differences in the primary endpoint primarily due to the use of delayed LVADs in the OMM group; 3) on the basis of as-treated (event free) analysis, 12-month survival (freedom from death, urgent transplant, or delayed LVAD) was greater for LVAD versus OMM (80 ± 4% vs. 63 ± 5%, p = 0.022); 4) adverse events (AEs) were higher in LVAD patients, at 1.89 events/patient-year (eppy), primarily driven by bleeding (1.22 eppy), than with OMM, at 0.83 eppy, primarily driven by worsening HF (0.68 eppy);  and 5) health-related quality of life and depression improved from baseline more significantly with LVADs than with OMM (Δvisual analog score [VAS]: 29 ± 25 vs. 10 ± 22, p < 0.001 and ΔPHQ9: -5 ± 7 vs. -1 ± 5, p < 0.001). (more…)
Author Interviews, Blood Pressure - Hypertension, Duke, Heart Disease, JACC / 24.06.2015

Satoru Kishi, MD Division of Cardiology Johns Hopkins University Baltimore, Interview with: Satoru Kishi, MD Division of Cardiology Johns Hopkins University Baltimore, Maryland MedicalResearch: What is the background for this study? What are the main findings? Dr. Kishi: Blood pressure (BP) at the higher end of the population distribution may represent a chronic exposure that produces chronic injury to the cardiovascular system. Cumulative BP exposure from young adulthood to middle age may adversely influence myocardial function and predispose individuals to heart failure (HF) and other cardiovascular disease (CVD) later in life. The 2005 guidelines for the diagnosis and treatment of HF from the American College of Cardiology and American Heart Association highlight the importance of early recognition of subclinical cardiac disease and the importance of non-invasive tests in the clinical evaluation of heart failure. Our main objective was to investigate how cumulative exposure to high blood pressure from young to middle adulthood influence LV function. In the Coronary Artery Risk Development in Young Adults (CARDIA) study, multiple repeated measures of BP and other cardiovascular risk factors was recorded over a 25 year time span, starting during early adulthood (ages 18-30). (more…)
Author Interviews, Electronic Records, Emergency Care, Heart Disease, JACC / 07.05.2015

Justin A. Ezekowitz, MBBCh MScAssociate Professor, University of Alberta Co-Director, Canadian VIGOUR Centre Director, Heart Function Clinic Cardiologist, Mazankowski Alberta Heart Interview with: Justin A. Ezekowitz, MBBCh MSc Associate Professor, University of Alberta Co-Director, Canadian VIGOUR Centre Director, Heart Function Clinic Cardiologist, Mazankowski Alberta Heart Institute Medical Research: What is the background for this study? Dr. Ezekowitz: Heart Failure is a prevalent health issue that carries high morbidity and mortality. Most epidemiologic research derives information from hospital discharge abstracts, but emergency department visits are another source of information. Many have assumed this code is accurate in the emergency department but uncertainty remains. In our study, we assessed patients at their presentation to Emergency Department, which is usually the first medical contact for acutely ill patients with heart failure. The objective of our study was to compare administrative codes for acute heart failure (I50.x) in the emergency department against a gold standard of clinician adjudication. Medical Research: What are the main findings? Dr. Ezekowitz: Emergency department administrative data is highly correlated with a clinician adjudicated diagnosis. The positive predictive value of acute heart failure as the main diagnosis was 93.3% when compared to clinician adjudication, supported by standardized scoring systems and elevated BNP. (more…)
AHA Journals, Author Interviews, Depression, Duke, Heart Disease, Race/Ethnic Diversity / 24.04.2015

 Dr. Robert J. Mentz MD Assistant Professor of Medicine Director, Duke University Cooperative Cardiovascular Society Advanced Heart Failure and Cardiac Transplantation Duke University Medical Center Duke Clinical Research Interview with: Dr. Robert J. Mentz MD Assistant Professor of Medicine Director, Duke University Cooperative Cardiovascular Society Advanced Heart Failure and Cardiac Transplantation Duke University Medical Center Duke Clinical Research Institute Medical Research: What is the background for this study? What are the main findings? Dr. Mentz: Previous studies have shown that depression is associated with worse outcomes in heart failure patients; however, most of these prior studies were conducted in primarily white patient populations. The impact of depressive symptoms on outcomes specifically in blacks with heart failure has not been well studied. We used data from the HF-ACTION trial of exercise training in heart failure patients, which collected data on depressive symptoms via the Beck Depression Inventory (BDI-II), to assess the association between depressive symptoms and outcomes in black patients as compared with white patients. We found that in blacks with heart failure, baseline symptoms of depression and worsening of symptoms over time were both associated with increased all-cause mortality/hospitalization. (more…)
AHA Journals, Author Interviews, Brigham & Women's - Harvard, Heart Disease, Nutrition / 05.03.2015

Luc Djousse, MD, ScD, FAHA Associate Professor of Medicine, Harvard Medical School Editor-in-Chief, Current Nutrition Reports Director of Research, Division of Aging Brigham and Women's Hospital Boston, MA Interview with: Luc Djousse, MD, ScD, FAHA Associate Professor of Medicine, Harvard Medical School Editor-in-Chief, Current Nutrition Reports Director of Research, Division of Aging Brigham and Women's Hospital Boston, MA 02120 MedicalResearch: What is the background for this study? What are the main findings? Dr. Djousse: While some studies have reported a higher risk of coronary heart disease, diabetes, or high blood pressure with frequent consumption of fried foods, other investigators did not confirm those results. To date, only few studies have evaluated whether frequent consumption of fried foods can raise the risk of developing heart failure. Frying foods not only increases the energy density of foods, but also increase the amount of trans fats. Trans fats can lead to development of heart disease and diabetes and consumption of energy-dense foods in large quantity can lead to weight gain and resulting cardiovascular consequences. We followed about 15000 US male physicians who were free of heart failure for an average of 10 years and found that frequent consumption of fried foods was related to a higher risk of developing heart failure. For example, people that consumed fried foods daily or more were twice more likely to develop heart failure than individuals who consumed fried foods less than once per week. (more…)