Cardiologist
@UHhospitals
, Harrington Heart & Vascular Institute. Director Advanced HF & Transplant Center. Professor of Medicine
@CWRUSOM
. SoMe Editor
#JACCHF
.
Our patient died in the ICU yesterday. After a final attempt at resuscitation, with family at bedside, we stopped and performed
#ThePause
. It was our first one but all the ICU caregivers instinctively knew what to do. It was electrifying. Recognizing Debbie Klein
@ClevelandClinic
Catastrophic outcome for the Advanced Heart Failure and Transplant Cardiology match in the United States in 2022: this year only n=74 applicants with 79 programs offering n=127 positions; 62% of programs went unfilled, with 44% of positions going unfilled.
It is with immense gratitude that I would like to share that I am being promoted to Professor of Medicine
@CWRUSOM
. Many thanks are in order to my family, mentors, colleagues, collaborators, students, and hospital leadership.
Thank you
@ClevelandClinic
for the friendships, training, and wonderful opportunities. I am so
#grateful
. We have accomplished a tremendous amount over the last 13 years. Today was my last day. I am looking forward to the next chapter of my career.
Borlaug HFpEF pearl: "Hemodynamics were normal at rest, but PCWP increased strikingly with passive leg raise. This indicates even before exercise that HFpEF is present, as the increase in venous return could not be accommodated without excessive increase in filling pressure."
Internal Medicine residency graduates looking to match into cardiology may be interested in our 1-year non-accredited heart failure training program at
@UHhospitals
Harrington Heart & Vascular Institute and
@CWRUSOM
. (1/2)
Shocking images. Here is what continuous-flow LVAD therapy does to the aorta with time: vascular fibrosis and stiffening due to collagen deposition and loss of elastin. Link between CF-LVAD and vascular complications including stroke, bleeding, and renal insufficiency?
The effects of nonphysiological flow generated by continuous-flow LVADs on the aorta remain poorly understood.
A new
#JACC
study shows there is aortic remodeling and fibrosis that correlates with duration of
#LVAD
support.
#CardioTwitter
Just accepted at
#JACCHF
@JACCJournals
a new term:
#EILAH
Many patients with
#HFpEF
have no overt volume overload and normal resting left atrial (LA) pressure. This study sought to characterize patients with normal resting LA pressure (PCWP <15 mm Hg) but
Advanced Heart Failure & Transplant Cardiology: What happened in the 2023 Match?
@TheNRMP
More programs than ever (n=73; n=127 positions offered) want to train advanced HF specialists, but the interest is flat (n=71 positions filled). A small number (n=28) of large fairly
Thrilled to share our publication in
@JACCJournals
: Domain Management Approach to Heart Failure in the Geriatric Patient. "We believe that clinicians who embrace this approach can improve health outcomes for older adults with HF."
#cvgeri
#geriatrics
My group proposed a new specialist: the “HF Internist.” An IM trained physician who does an extra year of HF training (non-accredited HF fellowship). We call for standardization of training curriculum in the US, and consideration for
@HFSA
certification.
#AHFTC
In this RCT comparing variable pacing, RV pacing was associated w significantly improved functional status, QoL, fewer ventricular tachyarrhythmias, compared with BiV pacing. This study supports turning off LV lead pacing in LVAD patients w CRT.
We propose that a "Heart Failure Internist" is an internal medicine physician who completed additional comprehensive HF training. We further propose that by further diversifying the HF clinical workforce with these unique specialists we will be able to provide more and better
Advanced HF and Transplant Cardiology NRMP statistics from the 2021 Match: there will be n=71 HF/Tx fellows in the US in 2021-2022 academic year, with only 57% of positions offered being filled.
I’m starting to think that it is inevitable that AHFTC training will need to be completely re-engineered. I don’t see how we can train people to be good at cardiac transplantation, outpatient HF care, cardiomyopathies, and now critical care. Can’t do it all.
#HFSA2022
🚨HFSA Scientific Statement published today. Here is why you should check it out!
#cognitiveimpairment
#heartfailure
Cognitive Impairment in Heart Failure: A Heart Failure Society of America Scientific Statement
We seek speakers. You are invited. Announcing a first-of-its-kind virtual symposium to explore the future of
#heartfailure
training. We have seen the trends, and we are worried. AHFTC is failing to attract trainees. Save the date: Feb 16, 2023, 7PM CST.
Excited to launch a
@YouTube
channel for our "Heart Failure Grand Rounds"
@HarringtonHVI
@UHhospitals
. These lectures are moderated by Dr. Monique Robinson
@DrMoniqueR
. We are going through the archives and plan to load highly requested lectures in the
Note both the resequencing, and the timing. "How Should We Sequence the Treatments for Heart Failure and a Reduced Ejection Fraction? A Redefinition of Evidence-Based Medicine"
Dr. Fuster explaining that the normal LDL for an adult should be <70, SBP<120mmg and Hgb A1C<5.7%. He plans to study this in a RCT, see design here.
#ACC23
Heart transplant inpatient morning rounds
@UHhospitals
start at 8:30AM, where multi-disciplinary teamwork is key. Lisa (SW), Hayaan (HF fellow), Julie (transplant nurse manager), Eiran (MD), Alexandra (transplant PharmD), Jennifer (transplant dietitian). Proud of this team!
📢 We train
#HFInternists
. Internal medicine residency graduates looking to match into cardiology may be interested in our 1-year non-accredited heart failure training program at
@HarringtonHVI
@UHhospitals
.
Celebrating our heart transplant team
@UHhospitals
. We completed our 13th transplant of the year. It is a tremendous honor to be involved with organ transplantation!! Proud to provide this service to our communities.
Match results for 2024, reported today, suggest again that interest in AHFTC is low. Of n=73 programs participating in the match n=30 were filled and n=43 went unfilled (59% of programs unmatched). Of n=129 available positions, n=73 filled and n=56 (43%) unfilled.
#NRMP
Heart transplant program at Yale grew significantly. They report doing so via strategic hiring and liberalizing their donor acceptance criteria. Median donor age (IQR) 40 (29-48). Thank you for sharing your learnings!
Our heart transplant team
@UHhospitals
completed our 18th transplant of the year. The energy and excitement are palpable!! We are proud to serve; We provide rapid
#access
to those in need. It is a tremendous honor to be involved with organ transplantation.
Three heart transplants completed
@UHhospitals
in three days. It is an honor to be involved with organ transplantation. Welcome to the team Dr. Yasir Abu-Omar
Our team
@UHhospitals
successfully completed a heart transplant this week. Congrats to all members of our team and and surgeons Drs. Baeza and Elgudin. We have a vibrant team and I'm thrilled to be part of it. It is a tremendous honor to be involved in
#organ
#transplantation
.
We all know that quadruple therapy is foundational in HFrEF care, but what should we do when HFrEF fails? Multiple strategies exist. Don’t give up on GDMT!
#ACC24
I've always been bothered by arbitrary cutoffs LVEF by which we make decisions for GDMT. Shown here is "Current HF Classification and the New Proposed Conceptualization of LVEF."
#JACCHF
@MedCrisis
@echotainment
You'll like 4D flow MRI data. Here is intracardiac flow in a healthy volunteer, with all inflow into LA tracked and quantified.
Astounding results from real-world observational study of PA pressure monitoring in heart failure (CardioMEMS Post-Approval Study). Consistent. Most benefit when baseline mPA>35. ACOs take notice.
@CircHF
Sharing document released today by
@HFSA
and
@JCardFail
: "Virtual Visits for Care of Patients with Heart Failure in the Era of COVID-19: A Statement from the Heart Failure Society of America".
Despite the tremendous need we are not attracting enough trainees. It is time for all of us who care about field to confront our failures. If we don't do it now, we will dwindle, scientific knowledge will advance too slowly, and the clinical need will not be met.
I’ve spoken to multiple people this week who refuse
#COVID19
vaccine. High-risk individuals w cardiac disease, heart failure, or post transplant. Mixture of irrational fear, conspiracy theories, political / religious beliefs. Very unsettling to see those at highest risk decline.
Open position
@UHhospitals
: Advanced Heart Failure and Transplant Cardiology Fellowship, July 2023. Fellow will be offered additional leadership training at the Weatherhead School of Management
@caseweatherhead
. Applicants must have completed an ACGME-accredited CVD fellowship.
Live from the wards: Why did this patient get admitted with ADHF? Was it “non-compliance”? Clock drawing makes cognitive impairment visible. Cardiologists need to be aware and assess cognition.
#MiniCog
@ParagGoyalMD
Join the conversation!! Announcing
#HFLeadership
micro talks. Register now for this free virtual symposium on the future of heart failure training. Thursday, February 16, 7-9PM CST.
A 4th COVID vaccine is now recommended for solid organ transplant recipients, to be given 5 months after third shot. The eligibility window is now opening up for most, so it’s time to start advising our patients as such.
AHFTC Program Directors meeting
@HFSA
. Fellowship slots 63.6% filled. About 50% of programs have unfilled positions. We need to do a better job attracting cardiology trainees to our field.
#heartfailure
New Insights in Myocarditis and Inflammatory Cardiomyopathy. Welcome to my old friend and colleague
@WilsonTangMD
Dr. Tang for HHVI Grand Rounds
@UHhospitals
.
Here’s why scale weight can be highly misleading in HF: 50% of patients with ADHF will have a rise in filling pressures without change in weight.
#THT2024
I asked
@pfizer
when to use tafamidis meglumine 80mg once daily (VYNDAQEL) versus tafamidis 61mg once daily (VYNDAMAX) for treatment of
#ATTR
-CM. Here's the informative response I received.
Colleagues
#MedTwitter
, While the dose shown here is certainly higher than what we usually use I want to emphasize that I didn’t share this to scare people away from using diuretics, but rather to highlight the need to battle congestion in heart failure. 1/x
Diagnostic accuracy of point-of-care ultrasonography for left ventricular dysfunction. Review article of
#POCUS
in the
@NEJM
I'm thinking about getting one of these. Any advice about which to pick? I need something that fits in white coat pocket.
An incredible two days
@UHhospitals
with our surgical teams completing two heart transplants and one lung transplant. It is an honor to be involved with organ transplantation.
Michelle
@MKIttlesonMD
brilliantly describing a 2+1 model. Where general cardiology fellows can choose to get a ‘HF certificate’. Those who want to do VAD and transplant can go on to the current 4th year construct.
#AHFTC
Cardiologists don’t often check albuminuria. Understanding spectrum of risk. Potential benefit shown in CKD trials of SGLT2i are large.
#ACC22
@mvaduganathan
JACC: HF video podcast. I interviewed Dr. Olivia Gilbert
@droliviagilbert
about her survey of cardiology trainees on attitudes about careers in AHFTC. "Interest in our field seems to have plateaued."
@JACCJournals
#JACCHF
Full interview on YouTube soon.
SGLT2i is a team sport (cardiologists, endocrinologists, nephrologists)... but who is responsible for starting? ACC "Recent Advances in HFrEF"
@ACCinTouch
#ACCRoundtable
Should US hospitals withdraw from the US News And World Report rankings? “If, like universities, hospitals divorce themselves from ratings, we can refocus on the mission of treating our patients and communities equitably, and not being unduly influenced by
Godspeed
#heartfailure
fellows
@UHhospitals
class of 2020-2021. Sheda, Osama, Hayaan, Chirag, and Lydia. These are the faces of hard work, perseverance, and empathy. We will sincerely miss you. May you succeed in all your pursuits. ❤️
Retirement party for Dr. Mehdi Razavi, 56 years
@ClevelandClinic
, an early contributor to coronary angiography. “We are all here to take care of patients well.”
"The trajectory that we're on is that there won't be enough heart failure expertise in the community to take care of this massive wave of heart failure that's coming."
@EiranGorodeski
@ShelleyWood2
@TCTMD
Our Heart Failure Grand Rounds
@UHhospitals
@CWRUSOM
speaker this week is Dr. Emer Joyce
@heartofthemater
from Dublin, Ireland. "Update in Cardiac Sarcoidosis", Wednesday, April 21, 2021, 12PM EST. We will live-tweet this conference. Please DM me for a zoom link to watch it live.
What is the future of
#heartfailure
training?
Announcing speakers for this free virtual symposium, February 16, 2023, 7-9PM CST. Moderators: Gorodeski, Cowger, Srivastava, Sauer.
Register now!
#HFLeadership