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1. Win Ratio with Multiple Thresholds for Composite Endpoints

Author

Mou, Yunhan, Kyriakides, Tassos, Hummel, Scott, Li, Fan, and Huang, Yuan

Subjects
Statistics - Methodology
Abstract

Composite endpoints consisting of both terminal and non-terminal events, such as death and hospitalization, are frequently used as primary endpoints in cardiovascular clinical trials. The Win Ratio method (WR) proposed by Pocock et al. (2012)1 employs a hierarchical structure to combine fatal and non-fatal events by giving death information an absolute priority, which adversely affects power if the treatment effect is mainly on the non-fatal outcomes. We hereby propose the Win Ratio with Multiple Thresholds (WR-MT) that releases the strict hierarchical structure of the standard WR by adding stages with non-zero thresholds. A weighted adaptive approach is developed to determine the thresholds in WR-MT. This method preserves the good statistical properties of the standard WR and has a greater capacity to detect treatment effects on non-fatal events. We show that WR-MT has an overall more favorable performance than WR in our simulation that addresses the influence of follow-up time, the association between events, and the treatment effect levels, as well as a case study based on the Digitalis Investigation Group clinical trial data.

Published
2024

2. Effects of a Novel Contextual Just-In-Time Mobile App Intervention (LowSalt4Life) on Sodium Intake in Adults With Hypertension: Pilot Randomized Controlled Trial

Author

Dorsch, Michael P, Cornellier, Maria L, Poggi, Armella D, Bilgen, Feriha, Chen, Peiyu, Wu, Cindy, An, Lawrence C, and Hummel, Scott L

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundHigh dietary sodium intake is a significant public health problem in the United States. High sodium consumption is associated with high blood pressure and high risk of cardiovascular disease. ObjectiveThe aim of this study was to evaluate the effect of a just-in-time adaptive mobile app intervention, namely, LowSalt4Life, on reducing sodium intake in adults with hypertension. MethodsIn this study, 50 participants aged ≥18 years who were under treatment for hypertension were randomized (1:1, stratified by gender) into 2 groups, namely, the App group (LowSalt4Life intervention) and the No App group (usual dietary advice) in a single-center, prospective, open-label randomized controlled trial for 8 weeks. The primary endpoint was the change in the 24-hour urinary sodium excretion estimated from spot urine by using the Kawasaki equation, which was analyzed using unpaired two-sided t tests. Secondary outcomes included the change in the sodium intake measured by the food frequency questionnaire (FFQ), the 24-hour urinary sodium excretion, blood pressure levels, and the self-reported confidence in following a low-sodium diet. ResultsFrom baseline to week 8, there was a significant reduction in the Kawasaki-estimated 24-hour urinary sodium excretion calculated from spot urine in the App group compared to that in the No App group (–462 [SD 1220] mg vs 381 [SD 1460] mg, respectively; P=.03). The change in the 24-hour urinary sodium excretion was –637 (SD 1524) mg in the App group and –322 (SD 1485) mg in the No App group (P=.47). The changes in the estimated sodium intake as measured by 24-hour dietary recall and by FFQ in the App group were –1537 (SD 2693) mg and –1553 (SD 1764) mg while those in the No App group were –233 (SD 2150) mg and –515 (SD 1081) mg, respectively (P=.07 and P=.01, respectively). The systolic blood pressure change from baseline to week 8 in the App group was –7.5 mmHg while that in the No App group was –0.7 mmHg (P=.12), but the self-confidence in following a low-sodium diet was not significantly different between the 2 groups. ConclusionsThis study shows that a contextual just-in-time mobile app intervention resulted in a greater reduction in the dietary sodium intake in adults with hypertension than that in the control group over a 8-week period, as measured by the estimated 24-hour urinary sodium excretion from spot urine and FFQ. The intervention group did not show a significant difference from the control group in the self-confidence in following a low sodium diet and in the 24-hour urinary sodium excretion or dietary intake of sodium as measured by the 24-hour dietary recall. A larger clinical trial is warranted to further elucidate the effects of the LowSalt4Life intervention on sodium intake and blood pressure levels in adults with hypertension. Trial RegistrationClinicalTrials.gov NCT03099343; https://clinicaltrials.gov/ct2/show/NCT03099343 International Registered Report Identifier (IRRID)RR2-10.2196/11282

Published
2020
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5. Physician Perspectives on the Use of Beta Blockers in Heart Failure With Preserved Ejection Fraction.

Author

Musse, Mahad, Lau, Jennifer, Yum, Brian, Pinheiro, Laura, Curtis, Hannah, Anderson, Timothy, Steinman, Michael, Meyer, Markus, Dorsch, Michael, Hummel, Scott, and Goyal, Parag

Subjects
Humans, Heart Failure, Stroke Volume, Adrenergic beta-Antagonists, Cardiologists, Drug Prescriptions
Abstract

β-blockers are commonly used in heart failure with preserved ejection fraction (HFpEF), even in the absence of a compelling indication and despite the potential to cause harm. Identifying reasons for β-blocker prescription in HFpEF could permit the development of strategies to reduce unnecessary use and potentially improve medication prescribing patterns in this vulnerable population. We administered an online survey regarding β-blocker prescribing behavior to physicians trained in internal medicine or geriatrics (noncardiology physicians) and to cardiologists at 2 large academic medical centers. The survey assessed the reasons for β-blocker initiation, agreement regarding initiation and/or continuation of β-blockers by another clinician, and deprescribing behavior. The response rate was 28.2% (n = 231). Among respondents, 68.2% reported initiating β-blockers in patients with HFpEF. The most common reason for initiating a β-blocker was for treatment of an atrial arrhythmia. Notably, 23.7% of physicians reported initiating a β-blocker without an evidence-based indication. When a β-blocker was considered not necessary, 40.1% of physicians reported they were rarely or never willing to deprescribe. The most common reason for not deprescribing a β-blocker when the physician felt that a β-blocker was unnecessary was the concern about interfering with another physicians treatment plan (76.6%). In conclusion, a significant proportion of noncardiology physicians and cardiologists report prescribing β-blockers to patients with HFpEF, even when evidence-based indications are absent, and rarely deprescribe β-blockers in these scenarios.

Published
2023

6. Dietary Inflammatory Score and Incident Heart Failure in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Author

Park, Christine M., Balkan, Lauren, Ringel, Joanna B., Shikany, James, Dr, Bostick, Robin, Judd, Suzanne E., Jonas, Chanel, Arora, Pankaj, Brown, Todd M., Durant, Raegan, Hummel, Scott, Jackson, Elizabeth A., Sterling, Madeline R., Demmer, Ryan, Yuzefpolskaya, Melana, Levitan, Emily B, Safford, Monika M., and Goyal, Parag

Published
2025
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8. Long term safety and outcomes after atrial shunting for heart failure with preserved or mildly reduced ejection fraction: 5-year and 3-year follow-up in the REDUCE LAP-HF I and II trials

Author

Litwin, Sheldon E., Komtebedde, Jan, Borlaug, Barry A., Kaye, David M., Hasenfuβ, Gerd, Kawash, Rami, Hoendermis, Elke, Hummel, Scott L., Cikes, Maja, Gustafsson, Finn, Chung, Eugene S., Mohan, Rajeev C., Sverdlov, Aaron L., Swarup, Vijendra, Winkler, Sebastian, Hayward, Christopher S., Bergmann, Martin W., Bugger, Heiko, McKenzie, Scott, Nair, Ajith, Rieth, Andreas, Burkhoff, Daniel, Cutlip, Donald E., Solomon, Scott D., van Veldhuisen, Dirk J., Leon, Martin B., and Shah, Sanjiv J.

Published
2024
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9. Medication Complexity Among Older Adults with HF: How Can We Assess Better?

Author

Kwak, Min, Goyal, Parag, Kim, Dae, Hummel, Scott, Dhoble, Abhijeet, Deshmukh, Ashish, Aparasu, Rajender, Holmes, Holly, and Cheng, Monica

Subjects
Humans, Aged, Quality of Life, Medication Adherence, Heart Failure, Drug-Related Side Effects and Adverse Reactions
Abstract

Medical management of heart failure (HF) has evolved and has achieved significant survival benefits, resulting in highly complex medication regimens. Complex medication regimens create challenges for older adults, including nonadherence and increased adverse drug events, especially associated with cognitive impairment, physical limitations, or lack of social support. However, the association between medication complexity and patients health outcomes among older adults with HF is unclear. The purpose of this review is to address how the complexity of HF medications has been assessed in the literature and what clinical outcomes are associated with medication regimen complexity in HF. Further, we aimed to explore how older adults were represented in those studies. The Medication Regimen Complexity Index was the most commonly used tool for assessment of medication regimen complexity. Rehospitalization was most frequently assessed as the clinical outcome, and other studies used medication adherence, quality of life, healthcare utilization, healthcare cost, or side effect. However, the studies showed inconsistent results in the association between the medication regimen complexity and clinical outcomes. We also identified an extremely small number of studies that focused on older adults. Notably, current medication regimen complexity tools did not consider a complicated clinical condition of an older adult with multimorbidity, therapeutic competition, drug interactions, or altered tolerance to the usual dose strength of the medications. Furthermore, the outcomes that studies assessed were rarely comprehensive or patient centered. More studies are required to fill the knowledge gap identifying more comprehensive and accurate medication regimen complexity tools and more patient-centered outcome assessment.

Published
2022

11. Endovascular ablation of the right greater splanchnic nerve in heart failure with preserved ejection fraction: early results of the REBALANCE‐HF trial roll‐in cohort

Author

Fudim, Marat, Fail, Peter S, Litwin, Sheldon E, Shaburishvili, Tamaz, Goyal, Parag, Hummel, Scott L, Borlaug, Barry A, Mohan, Rajeev C, Patel, Ravi B, Mitter, Sumeet S, Klein, Liviu, Rocha‐Singh, Krishna, Patel, Manesh R, Reddy, Vivek Y, Burkhoff, Daniel, and Shah, Sanjiv J

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Clinical Research, Clinical Trials and Supportive Activities, Patient Safety, Prevention, Heart Disease, Cardiovascular, Aged, Female, Heart Failure, Humans, Male, Pulmonary Wedge Pressure, Splanchnic Nerves, Stroke Volume, Ventricular Function, Left, Heart failure with preserved ejection fraction, Splanchnic nerve ablation, Therapeutics, Clinical trial, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Abstract

AimsIn heart failure (HF) with preserved ejection fraction (HFpEF), excessive redistribution of blood volume into the central circulation leads to elevations of intracardiac pressures with exercise limitations. Splanchnic ablation for volume management (SAVM) has been proposed as a therapeutic intervention. Here we present preliminary safety and efficacy data from the initial roll-in cohort of the REBALANCE-HF trial.Methods and resultsThe open-label (roll-in) arm of REBALANCE-HF will enrol up to 30 patients, followed by the randomized, sham-controlled portion of the trial (up to 80 additional patients). Patients with HF, left ventricular ejection fraction (LVEF) ≥50%, and invasive peak exercise pulmonary capillary wedge pressure (PCWP) ≥25 mmHg underwent SAVM. Baseline and follow-up assessments included resting and exercise PCWP, New York Heart Association (NYHA) class, Kansas City Cardiomyopathy Questionnaire (KCCQ), 6-min walk test, and N-terminal pro-B-type natriuretic peptide (NT-proBNP). Efficacy and safety were assessed at 1 and 3 months. Here we report on the first 18 patients with HFpEF that have been enrolled into the roll-in, open-label arm of the study across nine centres; 14 (78%) female; 16 (89%) in NYHA class III; and median (interquartile range) age 75.2 (68.4-81) years, LVEF 61.0 (56.0-63.2)%, and average (standard deviation) 20 W exercise PCWP 36.4 (±8.6) mmHg. All 18 patients were successfully treated. Three non-serious moderate device/procedure-related adverse events were reported. At 1-month, the mean PCWP at 20 W exercise decreased from 36.4 (±8.6) to 28.9 (±7.8) mmHg (p

Published
2022

12. Age- and Sex-Related Differences in Patients With Wild-Type Transthyretin Amyloidosis: Insights From THAOS

Author

Emdin, Michele, Hanna, Mazen, Azevedo, Olga, Lino Cirami, Calogero, Gonzalez Costello, Jose, Slosky, David, Moelgaard, Henning, Nativi Nicolau, Jose, Hummel, Scott, Jeon, Eun-Seok, Fine, Nowell, Murali, Srinivas, Miller, Edward, Shah, Sanjiv, Witteles, Ronald, Waddington-Cruz, Marcia, Lenihan, Daniel, Sekijima, Yoshiki, Van Cleemput, Johan, Correia, Edileide de Barros, Cariou, Eve, Quan, Dianna, Freimer, Miriam, Steidley, David, Hüsing-Kabar, Anna, Plante-Bordeneuve, Violaine, Nienhuis, Hans, Wixner, Jonas, Ralph, Jeffrey, Ventura, Hector, Zivkovic, Sasa, Delgado, Diego, Fernandéz Torrón, Roberto, Gottlieb, Stephen, Cotts, William, Tallaj, Jose, Brunkhorst, Robert, Polydefkis, Michael, Mueller, Christopher, Tschoepe, Carsten, Gonzalez Moreno, Juan, Sarswat, Nitasha, Luo, Jin, Tauras, James, Warner, Alberta, Mora-Ayestaran, Nerea, Dispenzieri, Angela, Kristen, Arnt V., Maurer, Mathew S., Diemberger, Igor, Drachman, Brian M., Grogan, Martha, Gupta, Pritam, Glass, Oliver, Amass, Leslie, and Garcia-Pavia, Pablo

Published
2024
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13. Endovascular Ablation of the Right Greater Splanchnic Nerve in Heart Failure With Preserved Ejection Fraction: Rationale, Design and Lead-in Phase Results of the REBALANCE-HF Trial

Author

Fudim, Marat, Litwin, Sheldon E., Borlaug, Barry A., Mohan, Rajeev C., Price, Matthew J., Fail, Peter, Zirakashvili, Teona, Shaburishvili, Tamaz, Goyal, Parag, Hummel, Scott L., Patel, Ravi B., Reddy, Vivek Y., Burkhoff, Daniel, Patel, Manesh R., Somo, Sami I., and Shah, Sanjiv J.

Published
2024
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16. Exercise Intolerance in Older Adults With Heart Failure With Preserved Ejection Fraction JACC State-of-the-Art Review

Author

Pandey, Ambarish, Shah, Sanjiv J, Butler, Javed, Kellogg, Dean L, Lewis, Gregory D, Forman, Daniel E, Mentz, Robert J, Borlaug, Barry A, Simon, Marc A, Chirinos, Julio A, Fielding, Roger A, Volpi, Elena, Molina, Anthony JA, Haykowsky, Mark J, Sam, Flora, Goodpaster, Bret H, Bertoni, Alain G, Justice, Jamie N, White, James P, Ding, Jingzhone, Hummel, Scott L, LeBrasseur, Nathan K, Taffet, George E, Pipinos, Iraklis I, and Kitzman, Dalane

Subjects
Aging, Heart Disease, Cardiovascular, Animals, Exercise Tolerance, Heart Failure, Diastolic, Humans, exercise intolerance, heart failure with preserved ejection fraction, senescence, skeletal muscle, aging, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology
Abstract

Exercise intolerance (EI) is the primary manifestation of chronic heart failure with preserved ejection fraction (HFpEF), the most common form of heart failure among older individuals. The recent recognition that HFpEF is likely a systemic, multiorgan disorder that shares characteristics with other common, difficult-to-treat, aging-related disorders suggests that novel insights may be gained from combining knowledge and concepts from aging and cardiovascular disease disciplines. This state-of-the-art review is based on the outcomes of a National Institute of Aging-sponsored working group meeting on aging and EI in HFpEF. We discuss aging-related and extracardiac contributors to EI in HFpEF and provide the rationale for a transdisciplinary, "gero-centric" approach to advance our understanding of EI in HFpEF and identify promising new therapeutic targets. We also provide a framework for prioritizing future research, including developing a uniform, comprehensive approach to phenotypic characterization of HFpEF, elucidating key geroscience targets for treatment, and conducting proof-of-concept trials to modify these targets.

Published
2021

19. Life’s Essential 8: Optimizing Health in Older Adults

Author

Kumar, Manish, Orkaby, Ariela, Tighe, Caitlan, Villareal, Dennis T., Billingsley, Hayley, Nanna, Michael G., Kwak, Min Ji, Rohant, Namit, Patel, Shreya, Goyal, Parag, Hummel, Scott, Al-Malouf, Christina, Kolimas, Amie, Krishnaswami, Ashok, Rich, Michael W., Kirkpatrick, James, Damluji, Abdulla A., Kuchel, George A., Forman, Daniel E., and Alexander, Karen P.

Published
2023
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26. Endovascular Ablation of the Greater Splanchnic Nerve in Heart Failure With Preserved Ejection Fraction: The REBALANCE-HF Randomized Clinical Trial.

Author

Fudim, Marat, Borlaug, Barry A., Mohan, Rajeev C., Price, Matthew J., Fail, Peter, Goyal, Parag, Hummel, Scott L., Zirakashvili, Teona, Shaburishvili, Tamaz, Patel, Ravi B., Reddy, Vivek Y., Nielsen, Christopher D., Chetcuti, Stanley J., Sukul, Devraj, Gulati, Rajiv, Kim, Luke, Benzuly, Keith, Mitter, Sumeet S., Klein, Liviu, and Uriel, Nir

Published
2024
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27. Atrial shunt device for heart failure with preserved and mildly reduced ejection fraction (REDUCE LAP-HF II): a randomised, multicentre, blinded, sham-controlled trial

Author

Akar, Joseph, Ando, Jiro, Anzai, Toshihisa, Asakura, Masanori, Bailey, Steven, Basuray, Anupam, Bauer, Fabrice, Bergmann, Martin, Blair, John, Cavendish, Jeffrey, Chung, Eugene, Cikes, Maja, Dauber, Ira, Donal, Erwan, Eicher, Jean-Christophe, Fail, Peter, Flaherty, James, Freixa, Xavier, Gafoor, Sameer, Gertz, Zachary, Gordon, Robert, Guazzi, Marco, Guerrero-Miranda, Cesar, Gupta, Deepak, Gustafsson, Finn, Hadadi, Cyrus, Hakemi, Emad, Handoko, Louis, Hass, Moritz, Hausleiter, Jorg, Hayward, Christopher, Hickey, Gavin, Hummel, Scott, Hussain, Imad, Isnard, Richard, Izumi, Chisato, Jondeau, Guillaume, Juneman, Elizabeth, Kinugawa, Koichiro, Kipperman, Robert, Krakowiak, Bartek, Krim, Selim, Larned, Joshua, Lewis, Gregory, Lipsic, Erik, Magalski, Anthony, Mazimba, Sula, Mazurek, Jeremy, McGrady, Michele, Mckenzie, Scott, Mehta, Shamir, Mignone, John, Morsli, Hakim, Nair, Ajith, Noel, Thomas, Orford, James, Parikh, Kishan, Patterson, Tiffany, Penicka, Martin, Petrie, Mark, Pieske, Burkert, Post, Martijn, Raake, Philip, Romero, Alicia, Ryan, John, Saito, Yoshihiko, Sakamoto, Takafumi, Sakata, Yasushi, Samara, Michael, Satya, Kumar, Sindone, Andrew, Starling, Randall, Trochu, Jean-Noël, Upadhya, Bharathi, van der Heyden, Jan, van Empel, Vanessa, Varma, Amit, Vest, Amanda, Wengenmayer, Tobias, Westenfeld, Ralf, Westermann, Dirk, Yamamoto, Kazuhiro, Zirlik, Andreas, Shah, Sanjiv J, Borlaug, Barry A, Chung, Eugene S, Cutlip, Donald E, Debonnaire, Philippe, Fail, Peter S, Gao, Qi, Hasenfuß, Gerd, Kahwash, Rami, Kaye, David M, Litwin, Sheldon E, Lurz, Philipp, Massaro, Joseph M, Mohan, Rajeev C, Ricciardi, Mark J, Solomon, Scott D, Sverdlov, Aaron L, Swarup, Vijendra, van Veldhuisen, Dirk J, Winkler, Sebastian, and Leon, Martin B

Published
2022
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29. Temporal Trends of Wild-Type Transthyretin Amyloid Cardiomyopathy in the Transthyretin Amyloidosis Outcomes Survey

Author

Barroso, Fabio Adrian, Van Cleemput, Johan, Fine, Nowell, Schmidt, Hartmut, Gess, Burkhard, Moelgaard, Henning, Planté-Bordeneuve, Violaine, Adams, David, Inamo, Jocelyn, Vita, Giuseppe, Cirami, Calogero Lino, Luigetti, Marco, Emdin, Michele, Sekijima, Yoshiki, Yamashita, Taro, Jeon, Eun-Seok, Gonzalez Duarte Briseno, Maria Alejandra, Nienhuis, Hans, Azevedo, Olga, Campistol Plana, Josep Maria, Moreno, Juan Gonzalez, Costello, Jose Gonzalez, Wixner, Jonas, Parman, Yesim, Shah, Sanjiv, Quan, Dianna, Marburger, Tessa, Polydefkis, Michael, Gottlieb, Stephen, Ralph, Jeffrey, Sarswat, Nitasha, Luo, Jin, Murali, Srinivas, Cotts, William, Drachman, Brian, Steidley, David, Hummel, Scott, Slosky, David, Ventura, Hector, Jacoby, Daniel, Hoffman, James, Tauras, James, Zivkovic, Sasa, Tallaj, Jose, Lenihan, Daniel, Mueller, Christopher, Nativi-Nicolau, Jose, Siu, Alfonso, Dispenzieri, Angela, Maurer, Mathew S., Rapezzi, Claudio, Kristen, Arnt V., Garcia-Pavia, Pablo, LoRusso, Samantha, Waddington-Cruz, Márcia, Lairez, Olivier, Witteles, Ronald, Chapman, Doug, Amass, Leslie, and Grogan, Martha

Published
2021
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30. Sex-Related Risk of Cardiac Involvement in Hereditary Transthyretin Amyloidosis: Insights From THAOS

Author

van Cleemput, Johan, Waddington-Cruz, Marcia, Schmidt, Hartmut, Dillmann, Klaus-Ulrich, Mølgaard, Henning, Moreno, Juan Gonzalez, Costello, Jose Gonzalez, Beamud, Francisco Munoz, Davila, Lucia Galan, Adams, David, Inamo, Jocelyn, Lairez, Olivier, Vita, Giuseppe, Merlini, Giampaolo, Cirami, Calogero Lino, Luigetti, Marco, Emdin, Michele, Sekijima, Yoshiki, Jeon, Eun-Seok, Oh, Jeeyoung, Gonzalez Duarte Briseno, Maria Alejandra, Nienhuis, Hans, Coelho, Teresa, Conceicao, Isabel, Azevedo, Olga, Badelita, Sorina, Press, Rayomand, Parman, Yesim, Shah, Sanjiv, Quan, Dianna, Marburger, Tessa, Polydefkis, Michael, Witteles, Ronald, Gottlieb, Stephen, Sarswat, Nitasha, Drachman, Brian, Steidley, David, Hummel, Scott, Slosky, David, Jacoby, Daniel, Nativi-Nicolau, Jose, Tauras, James, Zivkovic, Sasa, Tallaj, Jose, Lenihan, Daniel, Caponetti, Angelo Giuseppe, Rapezzi, Claudio, Gagliardi, Christian, Milandri, Agnese, Dispenzieri, Angela, Kristen, Arnt V., Wixner, Jonas, Maurer, Mathew S., Garcia-Pavia, Pablo, Tournev, Ivailo, Planté-Bordeneuve, Violaine, Chapman, Douglass, and Amass, Leslie

Published
2021
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31. Pragmatic Design of Randomized Clinical Trials for Heart Failure: Rationale and Design of the TRANSFORM-HF Trial

Author

Adams, Kirkwood, Long, Tammy, Bhatt, Kunal, Walker, Brandon, DeWald, Tracy, Biever, Kim, Axsom, Kelly, Acosta, Ariana, Murthy, Sandhya, Camilo, Angeline, Rich, Jonathan D., Martinez, Leslie, Testani, Jeffrey M., Tainsh, Jennifer, Smith, Bryan, Bennett, Amy, Vader, Justin, Stilinovic, Stephanie, McCulloch, Michael, Musso, Iris, Skopicki, Hal, Caikauskaite, Indre, Psotka, Mitchell A., Freiler, Allen, Heroux, Alain, Kartje, Carol, Lala-Trindade, Anuradha, Julien, Lovelyne, Stevens, Gerin, Leppla, Keriann, Tang, Wilson, Fonk, Teresa, Lev, Yair, Fizgerald, Kathleen, William, Preethi, Stroster, John, Eberly, Arthur, III, Workman, Celeste, Gottlieb, Stephen, Bowers-Lash, Mary, Haught, Walter Herbert, Abath, Cynthia, Grafton, Gillian, Neaton, Kelsey, Larned, Joshua, Ortiz, Mara-Li, Tejwani, Lokesh, Villalta, Tara, Mody, Freny, Strugatsky, Svetlana, Krim, Selim, Washington, Katasha, Robinson, Monique, Norton, Nadine, Smart, Frank, Worsham, Emily, Fang, James, Goldstein, Joe, Dunlap, Stephanie, Starnes, Nancy, Adler, Alexander, Theodorof, Virginia, Bell, Adrian, Kondramashin, Aleksey, Banerjee, Dipanjan, Yee, Michael, Ruiz-Duque, Ernesto, Larew, Cynthia, Mizyed, Ahmad, Sawaya, Kara, Friedman, Dennis, Rele, Shilpa, Rommel, John, Burkhart, Janet, Arhinful, Justice, Atkinson, Sam, Goyal, Parag, Samdani, Nidha, Hall, Michael, Watson, Connie, Hummel, Scott, Wells, Joanna, Shetty, Sanjay, White, Jackie, Haas, Donald, Marchand, Colleen, Vilaro, Juan, Osman, Alfaroug, Alexy, Tamas, Dicken, Julie, Guglin, Maya, Willig, Meghan, Ferguson, Andrew, Peabody, Mark, Herre, John, McMichael, Brittany, Clark, John, Britton, Nancy, Ambrosy, Andrew P., Tan, Thida, Heitner, John, Meykler, Marcella, Meadows, Judith, Halliday, Janet, Greene, Stephen J., Velazquez, Eric J., Anstrom, Kevin J., Eisenstein, Eric L., Sapp, Shelly, Morgan, Shelby, Harding, Tina, Sachdev, Vandana, Ketema, Fassil, Kim, Dong-Yun, Desvigne-Nickens, Patrice, Pitt, Bertram, and Mentz, Robert J.

Published
2021
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34. Differences in the approach to guideline‐directed medical therapy in patients with heart failure with reduced ejection fraction: A survey of cardiologists, internists, and pharmacists.

Author

Alhashimi, Lana, Cordwin, David J., Guidi, Jessica, Hummel, Scott L., Koelling, Todd M., and Dorsch, Michael P.

Subjects
MINERALOCORTICOID receptors, PHARMACISTS, INTERNISTS, INAPPROPRIATE prescribing (Medicine), HEART failure patients
Abstract

Introduction: Guideline‐directed medical therapy (GDMT) has significantly improved outcomes in patients with heart failure with reduced ejection fraction. However, GDMT prescribing remains suboptimal. The purpose of this study was to survey cardiologists, internists, and pharmacists on their approach to GDMT prescribing. Methods: A survey containing 20 clinical vignettes of patients with heart failure with reduced ejection fraction was answered by 127 cardiologists, 68 internists, and 89 pharmacists. Each vignette presented options for adjusting GDMT. Responses were dichotomized to the answer of interest. A mixed‐effect model was used to calculate the odds of changing GDMT between pharmacists and physicians. Results: Pharmacists were more likely to make changes to GDMT compared with internists (92.1 vs. 82%; odds ratio [OR] 3.02 [1.50–6.06]; p = 0.002). In medically naïve patients, pharmacists were more likely to initiate beta‐blockers than internists (45.4 vs. 32.0%; OR 2.19 [1.00–4.79], p = 0.049). Pharmacists were more likely than both internists and cardiologists to initiate mineralocorticoid receptor antagonists (34.4 vs. 11.5%; OR 4.95 [2.41–10.18]; p < 0.001 and 34.4 vs. 13.9%; OR 3.95 [2.16–7.21]; p < 0.001). Pharmacists were more likely than both internists and cardiologists to titrate beta‐blockers (30.9 vs. 16.4%; OR 3.15 [1.92–5.19]; p < 0.001 and 30.9 vs. 22.0%; OR 1.88 [0.18–2.87]; p = 0.0030). Pharmacists were more likely than internists to titrate angiotensin receptor‐neprilysin inhibitors (61.8 vs. 34.1%; OR 3.54 [1.50–8.39]; p = 0.004). Conclusions: The survey results show pharmacists were more likely to make any adjustments to GDMT than internists and cardiologists. Pharmacists prefer adding spironolactone and titrating beta‐blockers compared with cardiologists and internists. Compared with only internists, pharmacists were more likely to initiate beta‐blockers and titrate the dose of angiotensin receptor‐neprilysin inhibitor. [ABSTRACT FROM AUTHOR]

Published
2024
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41. Atrial Shunt Device Effects on Cardiac Structure and Function in Heart Failure With Preserved Ejection Fraction

Author

Patel, Ravi B., primary, Silvestry, Frank E., additional, Komtebedde, Jan, additional, Solomon, Scott D., additional, Hasenfuß, Gerd, additional, Litwin, Sheldon E., additional, Borlaug, Barry A., additional, Price, Matthew J., additional, Kawash, Rami, additional, Hummel, Scott L., additional, Cutlip, Donald E., additional, Leon, Martin B., additional, van Veldhuisen, Dirk J., additional, Rieth, Andreas J., additional, McKenzie, Scott, additional, Bugger, Heiko, additional, Mazurek, Jeremy A., additional, Kapadia, Samir R., additional, Vanderheyden, Marc, additional, Ky, Bonnie, additional, and Shah, Sanjiv J., additional

Published
2024
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43. Cardiovascular physiology in the older adults

Author

Dai, Xuming, Hummel, Scott L, Salazar, Jorge B, Taffet, George E, Zieman, Susan, and Schwartz, Janice B

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Aging, Cardiovascular disease, Left ventricular, Cardiorespiratory Medicine and Haematology, Cardiovascular System & Hematology, Cardiovascular medicine and haematology
Published
2015

47. Endovascular Ablation Of The Right Greater Splanchnic Nerve In Heart Failure With Preserved Ejection Fraction: Primary Results Of The REBALANCE-HF Randomized Trial

Author

Shah, Sanjiv, primary, Litwin, Sheldon, additional, Zirakashvili, Teona, additional, Shaburishvili, Tamaz, additional, Goyal, Parag, additional, Hummel, Scott, additional, Mohan, Rajeev, additional, Price, Matthew J., additional, Patel, Ravi, additional, Reddy, Vivek, additional, Burkhoff, Daniel, additional, Somo, Sami, additional, Patel, Manesh, additional, Borlaug, Barry, additional, and Fudim, Marat, additional

Published
2024
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