Gregg Fonarow MD @gcfmd Twitter profile

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Gregg Fonarow MD

@gcfmd

2 years

Top 5 strategies to ⬇️ ☠️ and re-🏨 in HFrEF 1. In-🏨 ARNI+BB+MRA+SGLT2i 2. In-🏨 ARNI+BB+MRA+SGLT2i 3. In-🏨 ARNI+BB+MRA+SGLT2i 4. In-🏨 ARNI+BB+MRA+SGLT2i 5. In-🏨 ARNI+BB+MRA+SGLT2i

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Gregg Fonarow MD

@gcfmd

3 years

HFrEF Within 30-60 days of Rx ✅ARNI ⤵️CV☠️HF🏨 42% ✅BB ⤵️☠️25% ✅MRA ⤵️CV☠️HF🏨 37% ✅SGLT2i ⤵️☠️HF🏨urgent visit 58% Unnecessary delays in Rx result in significant harms @SJGreene_md @JavedButler1 @robmentz @DLBHATTMD @MKIttlesonMD @jesse8850 #AHA21

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Gregg Fonarow MD

@gcfmd

2 years

2022 ACC/AHA HF Guidelines are out ARNI+BB+MRA+SGLT2i all Class I for HFrEF From @jaccjournals @paheidenreich @BiykemB @NMHheartdoc @ACCinTouch @American_Heart @HFSA

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Gregg Fonarow MD

@gcfmd

10 months

Compared to ACEI+BB, treatment with disease-modifying quadruple ARNI+BB+MRA+SGLTi in eligible patients with HFrEF ➡️ additional years of overall survival 55 yo: 6.3 years 65 yo: 4.4 years 70 yo: 3.9 years 75 yo: 3.1 years 80 yo: 1.4 years Not days, weeks, or months… Years!

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Gregg Fonarow MD

@gcfmd

5 years

New quadruple Rx for HFrEF: ARNI, BB, MRA, SGLT2i. Cumulative risk reduction in all-cause mortality, 74% relative, 26% absolute, NNT 4 in just 2 years. Plus ⬆️ health status, ⬇️ worsening, and ⬇️ hospitalizations. @HFSA @AAHFN @NMHheartdoc @JavedButler1 @JJheart_doc @rcstarling

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Gregg Fonarow MD

@gcfmd

9 months

HF Won’t Wait! Delay ARNI ➡️ 42% ⬆️ risk CV☠️/HF🏨 Delay BB ➡️ 25% ⬆️ risk ☠️ Delay MRA ➡️ 37% ⬆️ risk CV☠️/HF🏨 Delay SGLTi ➡️ 58% ⬆️ risk CV☠️/HF🏨/ER Unnecessary delays in any one or more of foundational GDMT ➡️ preventable ☠️/🏨 Urgency and intensity needed

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Gregg Fonarow MD

@gcfmd

11 months

HFrEF ↘️↘️↘️median survival 12-18 years GDMT ↗️↗️↗️ median survival: ✅ ARNI 2-3 yrs (1-2 yrs vs ACEI or ARB) ✅ BB 3-4 yrs ✅ MRA 2-3 yrs ✅ SGLTi 1-2 yrs Clinical benefits non-overlapping, incremental, additive Quadruple >>>triple>>>double Fast >>>>slow Simultaneously 🏆

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Gregg Fonarow MD

@gcfmd

1 year

HFrEF ↘️↘️↘️median survival 12-18 years GDMT ↗️↗️↗️ median survival: ✅ ARNI 2-3 yrs (1-2 yrs vs ACEI or ARB) ✅ BB 3-4 yrs ✅ MRA 2-3 yrs ✅ SGL2i 1-2 yrs Clinical benefits non-overlapping, incremental, additive Quadruple >>>triple>>>double Fast >>>>slow Simultaneously!

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Gregg Fonarow MD

@gcfmd

1 year

GDMT for HFrEF ✅ Quadruple, rather than double/triple ✅ Simultaneously, rather than sequentially ✅ Today, rather than someday ✅ Urgently, rather than lackadaisically ✅ Expeditiously, rather than delayed ✅ Now, rather than later ✅ Systematically rather than haphazardly

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Gregg Fonarow MD

@gcfmd

4 years

Comparative efficacy of HFrEF medications for relative risk reduction in all-cause mortality as function of baseline risk by trial ARNI+BB+MRA+SGLT2i superior magnitude of benefit @paheidenreich @MKIttlesonMD @NMHheartdoc @JavedButler1 @mvaduganathan @_adevore @HFSA @DLBHATTMD

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Gregg Fonarow MD

@gcfmd

2 years

Still the Top 5 strategies to ⬇️ ☠️ and re-🏨 in HFrEF 1. In-🏨 ARNI+BB+MRA+SGLT2i 2. In-🏨 ARNI+BB+MRA+SGLT2i 3. In-🏨 ARNI+BB+MRA+SGLT2i 4. In-🏨 ARNI+BB+MRA+SGLT2i 5. In-🏨 ARNI+BB+MRA+SGLT2i

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Gregg Fonarow MD

@gcfmd

5 months

🏨 with HFrEF Only one at a time Go slow Defer to outpatient Be cautious What is the worst that can happen? Delay ARNI ➡️ 42% ⬆️ risk CV☠️/HF🏨 Delay BB ➡️ 25% ⬆️ risk ☠️ Delay MRA ➡️ 37% ⬆️ risk CV☠️/HF🏨 Delay SGLTi ➡️ 58% ⬆️ risk CV☠️/HF🏨/ER Urgency needed!

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Gregg Fonarow MD

@gcfmd

1 year

A review of current evidence regarding the epidemiology, pathophysiology, presentation, diagnosis and treatment of HFpEF Heart Failure With Preserved Ejection Fraction via @JAMA_current part of @JAMANetwork

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Gregg Fonarow MD

@gcfmd

3 years

Today, the FDA approved dapagliflozin to reduce the risk of kidney function decline, kidney failure, CV death and hospitalization for HF in adults with CKD who are at risk of disease progression. FDA Approves Treatment for Chronic Kidney Disease

FDA Approves Treatment for Chronic Kidney Disease

Today, the FDA approved a treatment to reduce the risk of kidney function decline, kidney failure, cardiovascular death and hospitalization for heart failure in

www.fda.gov

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Gregg Fonarow MD

@gcfmd

1 year

HFrEF ↘️ median survival 12-18 years GDMT ↗️ median survival: ✅ ARNI 2-3 yrs (1-2 yrs vs ACEI or ARB) ✅ BB 3-4 yrs ✅ MRA 2-3 yrs ✅ SGL2i 1-2 yrs Clinical benefits non-overlapping, incremental, additive Quadruple >>>triple>>>double>>>single

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Gregg Fonarow MD

@gcfmd

11 months

🏨 HFrEF Early in-🏨 initiation effects on early clinical outcomes: ARNI ➡️ -42% risk CV☠️/HF🏨 BB ➡️ -25% risk ☠️ MRA ➡️ -37% risk CV☠️/HF🏨 SGLTi ➡️ -58% risk CV☠️/HF🏨 or ER/UC visit Unnecessary delays in GDMT ➡️ clinical events which could have been prevented @JAMACardio

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Gregg Fonarow MD

@gcfmd

4 years

The Four Pillars of Survival Enhancing Medical Therapy for HFrEF @NMHheartdoc @JavedButler1 @JJheart_doc @MKIttlesonMD @BiykemB @texhern @HFSA #GDMTWorks Optimal Implementation of SGLT2-i Therapy and Outcome for HF via @JAMACardio part of @JAMANetwork

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Gregg Fonarow MD

@gcfmd

2 months

🚨Stunning!🚨 REVERSAL in the decline of heart failure ☠️ in the US 1999-2021 1999-2005 ⬇️ ☠️ 2005-2012 ⬇️ ☠️ 2012-2019 ⬆️ ☠️ 2019-2021 ⬆️⬆️☠️ Age-adjusted HF related ☠️ rates higher in 2021 vs 1999! WT😱🆘 @JAMACardio @FudimMarat

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Gregg Fonarow MD

@gcfmd

5 years

DAPA-HF, impressive results! ⬇️26% in primary outcome ⬇️30% WHF ⬇️18% CV death and 17% all cause mortality ⬆️ PRO with KCCQ With and without diabetes @escardio @JavedButler1 @JJheart_doc #ESCcongress2019 @kewatson @NMHheartdoc @DLBHATTMD @mvaduganathan @SJGreene_md @jesse8850

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Gregg Fonarow MD

@gcfmd

3 years

Want to improve Use: Start in-🏨 ✅ ARNI ✅ BB ✅ MRA ✅ SGLT2i Adherence: Start in-🏨 ✅ ARNI ✅ BB ✅ MRA ✅ SGLT2i Early Outcomes: Start in-🏨 ✅ ARNI ✅ BB ✅ MRA ✅ SGLT2i @HFSA @JavedButler1 @SJGreene_md @jesse8850 @NMHheartdoc @_adevore @mvaduganathan @AHA_Research

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Gregg Fonarow MD

@gcfmd

3 years

If you are not considering switching a HFrEF patient from ACEI to ARNI during a HF hospitalization, in the absence of contraindications or prior intolerance, please transfer their care to someone who is. @JavedButler1 @texhern @NMHheartdoc @MKIttlesonMD

James Januzzi Jr MD

@JJheart_doc

3 years

A useful pearl: if you are considering changing a patient with acute HFrEF from a home ACEi to sacubitril/valsartan during their hospitalization, on admission change them to an ARB so you won't need a 36 hour period of RASi wash out. #GDMTworks

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Gregg Fonarow MD

@gcfmd

4 years

Cardiovascular and Renal Outcomes with Empagliflozin in Heart Failure | NEJM

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Gregg Fonarow MD

@gcfmd

3 years

In-🏨 initiation of GDMT for HFrEF evidence ✅ BB IMPACT-HF, OPTIMIZE-HF ✅ MRA EPHESUS-HF, GWTG-HF ✅ ARNI PIONEER-HF, GWTG-HF ✅ SGLT2i EMPA-RESPONSE-AHF, SOLOIST-WHF, #EMPULSE #AHA21

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Gregg Fonarow MD

@gcfmd

4 years

Quadruple Therapy Is the New Standard of Care for HFrEF The time is now for comprehensive disease modifying medical therapy for HFrEF. @JACCJournals @HFSA @BiykemB @JJheart_doc @mfiuzat @JavedButler1 @mvaduganathan @JavedButler1 @MKIttlesonMD #GDMTWorks

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Gregg Fonarow MD

@gcfmd

3 years

Empagliflozin in Heart Failure with a Preserved Ejection Fraction | NEJM ⁦ @JavedButler1 ⁩ ⁦ @mvaduganathan ⁩

Empagliflozin in Heart Failure with a Preserved Ejection Fraction | NEJM

Sodium–glucose cotransporter 2 inhibitors reduce the risk of hospitalization for heart failure in patients with heart failure and a reduced ejection fraction, but their effects in patients with hea...

www.nejm.org

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Gregg Fonarow MD

@gcfmd

3 years

For patients with HFrEF ARNI+BB+MRA+SGLT2i <65 yo Benefits>>>Risks 65-74 yo Benefits>>>Risks >=75 yo. Benefits>>>Risks Omissions, delays, discontinuations ➡️ 🏨+ premature ⚰️ @JavedButler1 @SJGreene_md @mvaduganathan @HFSA @hvanspall #GDMTworks

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Gregg Fonarow MD

@gcfmd

1 year

HFrEF Compared to 💊💊 therapy, treatment with disease-modifying 💊💊💊💊 therapy in eligible patients ➡️ additional years of survival free from CV ☠️ or HF 🏨 55 yo: 8.3 years 65 yo: 6.3 years 70 yo: 5.2 years 75 yo: 4.1 years 80 yo: 2.7 years Start ARNI+BB+MRA+SGLT2i now

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Gregg Fonarow MD

@gcfmd

2 years

HFrEF Why provide rapid (but incomplete) clinical benefits with: 1 💊, but delay the other 3? 2 💊, but delay the other 2? 3💊, but delay the other 1? When all 4💊 foundational #GDMT can be safely, efficiently, and effectively started simultaneously or in ultra-rapid sequence

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Gregg Fonarow MD

@gcfmd

2 years

Proud to receive this @American_Heart honor together with colleagues and friends @Braindoc_MGH and @NMHheartdoc @HeartNews #GWTG @UCLAHealthNews @DOM_UCLA @UCLAHealth

Doctors honored for helping develop evidence-based treatment guidelines that improve patient...

Drs. Gregg Fonarow, Lee Schwamm and Clyde Yancy have spent more than 20 years developing and supporting the AHA's Get With The Guidelines program.

www.heart.org

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Gregg Fonarow MD

@gcfmd

3 years

Among patients hospitalized for HFrEF, deferring initiation of lifesaving medication to the outpatient setting carries >75% chance therapy will not be started within the next year Simultaneous or Rapid Sequence Initiation of Quadruple Medical Therapy

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Gregg Fonarow MD

@gcfmd

2 years

Want to ⬇️ ☠️/🏨 in HFrEF? Start with: ARNI or BB or MRA or SGLT2i Want to ⬇️⬇️⬇️⬇️ ☠️/🏨 in HFrEF within days? Start with: ARNI+BB+MRA+SGLT2i @SJGreene_md @JavedButler1 @DrNancySweitzer @HFSA @MKIttlesonMD @mvaduganathan

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Gregg Fonarow MD

@gcfmd

4 years

The serial strategy of ACEI, then titrate, BB then titrate, then MRA, then titrate, then switch to ARNI, then titrate, then start SGLT2i...... Takes way too long Fails too often due to clinical inertia Leaves patient with worse QOL Results in too many preventable events

Gregg Fonarow MD

@gcfmd

4 years

Ideal sequence for the pillars of survival enhancing GDMT for HFrEF is......... Start all 4 therapies at time of diagnosis, then optimize 🎯dosing. Don’t let your patient have HF hospitalizations or CV deaths due to delays in initially following historical sequences of meds.

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Gregg Fonarow MD

@gcfmd

2 years

Billions spent on Vitamin D testing and supplementation each year Yet another large scale, well powered RCT shows 🚫 health gains The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality @boback @kewatson @ErinMichos

The D-Health Trial: a randomised controlled trial of the effect of vitamin D on mortality

Administering vitamin D3 monthly to unscreened older people did not reduce all-cause mortality. Point estimates and exploratory analyses excluding the early follow-up period were consistent with an...

www.thelancet.com

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Gregg Fonarow MD

@gcfmd

2 years

First proposed in 2020 Much discussion, debate, and alternatives offered since Yet, ESC-HFA has now endorsed in this position paper, for HFrEF with eGFR > 60, with triple Rx ASAP eGFR 30-60 Experts Tout Immediate Quadruple Therapy for HFrEF Patients

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Gregg Fonarow MD

@gcfmd

1 year

This review by Milton Packer explains how SGLT2i may reverse the nutrient, metabolic and cellular abnormalities observed in HF SGLT2 inhibitors: role in protective reprogramming of cardiac nutrient transport and metabolism | Nature Reviews Cardiology

SGLT2 inhibitors: role in protective reprogramming of cardiac nutrient transport and metabolism

Nature Reviews Cardiology - In this Review, Packer summarizes the latest advances in our understanding of the mechanisms that underlie the benefits of sodium–glucose cotransporter 2 (SGLT2)...

www.nature.com

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Gregg Fonarow MD

@gcfmd

8 months

For those who like the NNTs for all-cause mortality prevention to be in single digits Quadruple GDMT for HFrEF 4 That’s it Four patients treated for 24 months with 4 💊 to save a life Plus safe, well tolerated, cost-effective, high value #AHA2023

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Gregg Fonarow MD

@gcfmd

11 months

GDMT for HFrEF ✅ Quadruple, rather than double/triple ✅ Simultaneously, rather than sequentially ✅ Today, rather than someday ✅ Urgently, rather than lackadaisically ✅ Expeditiously, rather than delayed ✅ Now, rather than later ✅ Systematically rather than haphazardly

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Gregg Fonarow MD

@gcfmd

11 months

Early in-🏨 initiation of SGLTi in patients 🏨 with AHF/WHF, irrespective of EF ✅ Rapid ⬇️ HF symptoms ✅ Rapid ⬆️ QoL and health status ✅ Rapid ⬇️⬇️ re-WHF ✅ Rapid ⬇️⬇️ re-🏨/CV ☠️ ✅ Safe/well tolerated Do you systematically implement this standard of care?

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Gregg Fonarow MD

@gcfmd

3 years

Simultaneous or Rapid Sequence Initiation of Quadruple Medical Therapy for HF via @JAMACardio part of @JAMANetwork @SJGreene_md @JavedButler1 #GDMTWorks @HFSA @mvaduganathan @NMHheartdoc @MKIttlesonMD @JJheart_doc @texhern @jesse8850 @MarcoMetra @DCRINews

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Gregg Fonarow MD

@gcfmd

2 years

🏨 with HFrEF Discharge w/o ARNI can be ☠️ Discharge w/o BB can be ☠️ Discharge w/o MRA can be ☠️ Discharge w/o SGLT2i can be ☠️ Optimizing GDMT in-🏨 ➡️ ⬇️⬇️⬇️☠️ and ⬇️⬇️⬇️ re-🏨 Avoid ☠️ medical errors of omission

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Gregg Fonarow MD

@gcfmd

4 years

I would recommend prioritizing the therapies with the following clinically relevant relative risk reductions in all-cause mortality: ARNI 28% BB34% MRA30% SGLT2i17% Non-significant: Dig 1%, Ivabradine 10%, Vericiquat 5%, Omecamtiv Mecarbil ?

Joel Niznick

@jniznick

4 years

@ValleAlfonso @ShelleyZieroth @secardiologia @paomorejon @mvaduganathan @HanCardiomd @SIAC_cardio @Dr_Manito @gcfmd @mendez_bailon @JoseJuanatey I’ll take the 25% reduction in all caus MR and HFH in the Dig trial any day over omecantiv mecarbil or Vericiguat for that matter.

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Gregg Fonarow MD

@gcfmd

9 months

🏨 with HFrEF Take your time Go slow Defer Be cautious What is the worst that can happen? Delay ARNI ➡️ 42% ⬆️ risk CV☠️/HF🏨 Delay BB ➡️ 25% ⬆️ risk ☠️ Delay MRA ➡️ 37% ⬆️ risk CV☠️/HF🏨 Delay SGLTi ➡️ 58% ⬆️ risk CV☠️/HF🏨/ER Urgency needed!

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Gregg Fonarow MD

@gcfmd

10 months

HFrEF newly diagnosed or recognized* ✨ARNI, 1st line Rx, best if started <24hr ✨BB, 1st line Rx, best if started <24hr ✨MRA, 1st line, best if started <24hr ✨SGLT2i, 1st line, best if started <24hr Rapid additive benefits, well tolerated in combo *hemodynamically stable

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Gregg Fonarow MD

@gcfmd

4 years

Comprehensive disease modifying therapy for HFrEF. The time is now. @NMHheartdoc @BiykemB @MKIttlesonMD @mvaduganathan @JavedButler1 @coconnormd @mfiuzat @texhern @AliNsairMD @MinnowWalsh @jspertus @jteerlinkmd @paheidenreich @jesse8850 @HFSA @AHAScience @ACCinTouch

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Gregg Fonarow MD

@gcfmd

3 months

HFrEF ↘️↘️↘️median survival 7-18 years GDMT ↗️↗️↗️ median survival: ✅ ARNI 2-3 yrs (1-2 yrs vs ACEI or ARB) ✅ BB 3-4 yrs ✅ MRA 2-3 yrs ✅ SGLTi 1-2 yrs Clinical benefits non-overlapping, incremental, additive Quadruple >>>triple>>>double Fast >>>>slow Now>>>later

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Gregg Fonarow MD

@gcfmd

1 year

GDMT for HF Immediate vs delayed Quadruple vs double or triple Comprehensive vs incomplete Target dosing vs suboptimal The difference between Optimal clinical outcomes vs events that could have been prevented but were unfortunately not

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Gregg Fonarow MD

@gcfmd

4 years

Clinically relevant outcome benefits evident within 30 days of initiation in HFrEF with: 1. ARNI ✅ 2. BB ✅ 3. MRA ✅ 4. SGLT2i ✅ Timely initiation can markedly improve patient-centered outcomes in the short, intermediate and long-term.

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Gregg Fonarow MD

@gcfmd

3 years

In hospital initiation of SGLT2i for HFrEF Now. Now. Now. Now. Now. Now. Now. Now. @SJGreene_md @mvaduganathan @JavedButler1 @KSharmaMD @JACCJournals @robmentz From @jaccjournals

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Gregg Fonarow MD

@gcfmd

2 years

The “best” approach to treat HF is to prevent it in the first place Prioritize HF prevention! ✅SBP control ✅SGLT2i for T2DM or CKD ✅MRA for T2DM+CKD ✅1/2 Prev for ASCVD ✅Physical activity/no smoking ✅Team based care for higher risk individuals @kewatson @boback

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Gregg Fonarow MD

@gcfmd

1 year

Comprehensive Quadruple Therapy for HFrEF 4️⃣💊 ARNI+BB+MRA+SGLT2i vs historic 3️⃣&2️⃣💊 ACEI+BB+MRA, ACEI+BB ✅ ⬆️⬆️ survival ✅ ⬇️⬇️ 🏨 ✅ ⬆️⬆️ health status/QoL ✅ ⬆️⬆️ quality time at home Remaining ? Economic value ✅ cost effective

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Gregg Fonarow MD

@gcfmd

4 years

Evidence-based, comprehensive disease modifying medical therapy to reduce all-cause mortality in HFrEF remains ARNI, BB, MRA, and SGLT2i. Quadruple therapy. Implement in all eligible. #ACC20 @NMHheartdoc @scottdsolomon @BiykemB @JJheart_doc @MKIttlesonMD @MinnowWalsh @texhern

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Gregg Fonarow MD

@gcfmd

3 years

Discharged after HFrEF 🏥 without ARNI 92% of eligible patients without contraindications or intolerance remain untreated through 365 days of f/u. Defer to outpatient = never Rx Sacubitril/Valsartan Initiation and Postdischarge Adherence Among Pati...

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Gregg Fonarow MD

@gcfmd

3 years

Optimizing GDMT in HFrEF: The need for speed or Go slow, delay, omit, wait and see, individualize, wait, some day, defer Simultaneous or Rapid Sequence Initiation of Quadruple Medical Therapy for Heart Failure via @JAMACardio part of @JAMANetwork

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Gregg Fonarow MD

@gcfmd

4 years

DAPA-CKD “also met all its secondary endpoints in CKD patients with and without type-2 diabetes (T2D), making dapagliflozin the first medicine to significantly reduce the risk of death from any cause in this patient population.” ⁦ @HFSA ⁩ ⁦

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Gregg Fonarow MD

@gcfmd

3 years

Priority 1: Initiate ARNI+BB+MRA+SGLT2i, at low dose Priority 2: Titrate BB to target dose, as tolerated Priority 3: Titrate ARNI, MRA, as tolerated Simultaneous or Rapid Sequence Initiation of Quadruple Rx @JavedButler1 @SJGreene_md @JAMACardio

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Gregg Fonarow MD

@gcfmd

4 years

HFrEF can reduce median survival by >15 years, despite use of ACEI or ARB + BB. Providing comprehensive disease modifying medical Rx (ARNI+BB+MRA+SGLT2i) can help patients get 6 or more of those years back. The time is now. @mvaduganathan @JavedButler1 @BiykemB @HFSA @texhern

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Gregg Fonarow MD

@gcfmd

1 year

Simultaneous or rapid sequence initiation of disease modifying medical therapy is the foundation of treating HF with the sense of urgency it deserves From @jaccjournals @SJGreene_md @JACCJournals

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Gregg Fonarow MD

@gcfmd

2 years

Managing Heart Failure in Patients on Dialysis: State-of-the-Art Review @ShahzebKhanMD @JavedButler1 @MKIttlesonMD @mfiuzat @SJGreene_md @JCardFail

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Gregg Fonarow MD

@gcfmd

1 year

#GDMTCantWait ✅ clinical benefits (⬇️ ☠️/🏨) of each of the 4 pillars appear within days of initiation ✅ benefits of each 💊💊💊💊 are fully additive ✅ early in-🏨 Rx ➡️ >benefit, safe, tolerated ✅ ⬆️ use, adherence, persistence ARNI+BB+MRA+SGLT2i w/o delay

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Gregg Fonarow MD

@gcfmd

4 years

If eligible HFrEF patients are not discharged with ARNI, there is a >95% chance they will not be started as outpatients over the next year. Clinical inertia harms. Sacubitril/valsartan Initiation and Adherence Patterns Following Hospitalization for HF

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Gregg Fonarow MD

@gcfmd

1 year

🆘 Every hour of every day 11 patients with HFrEF in the US have a death that could have been prevented with optimal implementation of quadruple GDMT Do not delay Do not let inertia or other barriers cause harm Do not commit errors of omission

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Gregg Fonarow MD

@gcfmd

2 years

In-hospital initiation of quadruple medical therapy for HFrEF is the most effective, practical, and patient-centered strategy for improving clinical outcomes @SJGreene_md @JavedButler1 @ESC_Journals #GWTG

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Gregg Fonarow MD

@gcfmd

11 months

Quadruple GDMT optimization in HFrEF can save a substantial # of lives Vital need to: OPTIMIZE-HF IMPROVE-HF GET WITH THE GUIDELINES-HF TARGET-HF EPIC-HF PROMPT-HF STRONG-HF BETTER CARE-HF IMPLEMENT-HF Every eligible patient, every time, every care setting

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Gregg Fonarow MD

@gcfmd

10 months

Impressive findings @shivkumarmd @AliNsairMD Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation | NEJM

Catheter Ablation in End-Stage Heart Failure with Atrial Fibrillation | NEJM

The role of catheter ablation in patients with symptomatic atrial fibrillation and end-stage heart failure is unknown. We conducted a single-center, open-label trial in Germany that involved patien...

www.nejm.org

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Gregg Fonarow MD

@gcfmd

3 years

ARNI+BB+MRA+SGLT2i for HFrEF Incremental, additive, non-overlapping, cumulative patient-centered benefits Reduce ☠️ by 74% Reduce HF 🏨 by 85% Improve health status Benefits within days of initiation of Rx High value Now, now, now, now

Henry Han

@HanCardiomd

3 years

#SGLT2 inhibitor works just as well in terms of relative risk reduction for mortality and hospitalization whether the patient is on an #ARNI or not on an ARNI, whether they're on a beta-blocker or not on a beta-blocker #ESCardioAsia #CVCT2021 @JavedButler1

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Gregg Fonarow MD

@gcfmd

5 years

Thank you very much to the AHA QCOR Council for this honor. It is a privilege to be able collaborate with so many talented individuals dedicated to improve cardiovascular quality of care and outcomes.

Boback Ziaeian 🤦🏻‍♂️

@boback

5 years

Dr. Fonarow receiving the Outstanding Lifetime Achievement Award at #QCOR19 @AHAScience @AHAMeetings @CircOutcomes @UCLAHealth #BruinHearts

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Gregg Fonarow MD

@gcfmd

10 months

Fantastic to admire/applaud the RCT success in heart failure over the past 2-3 decades Devastating to lament the limited impact on HF clinical outcomes in the community/clinical practice Substantial opportunity to innovate and improve implementation

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Gregg Fonarow MD

@gcfmd

7 months

The mistaken beliefs that: 🧨GDMT can be deferred to after discharge 🫣SBP < 100 mm Hg is too low for GDMT 🫣Cr ⬆️ > 0.3 mg/dl is too much ⚠️ Simultaneous GDMT not well tolerated 🐌 historic sequencing is preferred 💸 GDMT too costly ➡️ 🆘 ⬆️⬆️⬆️ risk of preventable ☠️/🏨

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Gregg Fonarow MD

@gcfmd

3 months

Polypill for HFrEF 💊 ARNI+BB+MRA+SGLT2i 82.2% of patients with HFrEF potentially eligible NNT = 4 to prevent one death, over 12 months @JACCJournals @SJGreene_md @NMHheartdoc @HeartDocSadiya @AndrewJSauer @hvanspall @AHAScience @HFSA @DLBHATTMD

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Gregg Fonarow MD

@gcfmd

3 years

2021 Update to the 2017 ACC Expert Consensus Decision Pathway for Optimization of Heart Failure Treatment: Answers to 10 Pivotal Issues About Heart Failure With Reduced Ejection Fraction @JJheart_doc @NMHheartdoc @MKIttlesonMD @ACCinTouch

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Gregg Fonarow MD

@gcfmd

11 months

GDMT for HFrEF ✅ Quadruple, rather than double/triple ✅ Simultaneously, rather than 🐢 sequentially ✅ Comprehensively, rather than partial ✅ Urgently 🚨, rather than lackadaisically 😴 ✅ Expeditiously, rather than delayed ✅ Systematically rather than haphazardly

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Gregg Fonarow MD

@gcfmd

4 months

2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee | @JJheart_doc @JACCJournals

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Gregg Fonarow MD

@gcfmd

1 year

TheracosBio will charge $47.85 plus shipping and handling for a 30-day supply of the SGLT2i bexagliflozin TheracosBio teams with Mark Cuban's Cost Plus to launch Brenzavvy at bargain price @kardiologykazi @paheidenreich @boback @mvaduganathan

TheracosBio teams with Mark Cuban's Cost Plus to launch Brenzavvy at bargain price

As another SGLT2 diabetes drug hits the market, the obvious question is: How will it find a way to compete against formidable blockbusters Farxiga and Jardiance? | TheracosBio and Mark Cuban's online...

www.fiercepharma.com

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Gregg Fonarow MD

@gcfmd

10 months

Irrespective of HFrEF duration ⏱️ ✅ ARNI works ✅ BB works ✅ MRA works ✅ SGLT2i works To modify HF disease progression and ⬇️⬇️⬇️⬇️ ☠️/HF 🏨 Clinical benefits are additive, incremental, cumulative

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Gregg Fonarow MD

@gcfmd

3 years

The current generalized lack of therapeutic urgency in HF translates to an unfortunate cycle whereby clinical risk is under appreciated, medications deferred, time lavished, and patients sustain ☠️ or 🏨, without receiving therapies proven to prevent these events

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Gregg Fonarow MD

@gcfmd

4 years

SGLT2i markedly/consistently improve outcomes in HFrEF and in CKD. Benefits for those with and without T2DM. Remarkable discovery science. The time is now for implementation science. @texhern @califf001 @HeartBobH @NMHheartdoc @ericpetersonMD @AnnMarieNavar @JavedButler1

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Gregg Fonarow MD

@gcfmd

1 year

Which is the worse outcome? A) Starting rapid/intensive GDMT and side effects emerge requiring dose adjustments B) Not starting rapid/intensive GDMT and underlying HF progresses resulting in 🏨 or ☠️ @SJGreene_md @JACCJournals

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Gregg Fonarow MD

@gcfmd

2 years

What is the value in HFrEF of ACEI+BB ➡️ ARNI+BB+MRA+SGLT2i ✳️ Extend median survival 55,200 hours 2300 days 329 weeks 76 months 6.3 years #GDMTWorks @mvaduganathan @HFSA

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Gregg Fonarow MD

@gcfmd

4 years

One in 4 pts hospitalized with HFrEF die/rehospitalized within 30 days of discharge. OK to delay initiation of 1) ARNI? 2) BB? 3) MRA? 4) SGLT2i? Just to adhere to historic approaches. If discharged without any one of the med, >90% certain won’t be started next year.

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Gregg Fonarow MD

@gcfmd

2 years

The most precise, personalized, tailored, patient-centered regimen of medical therapy for all individuals with HFrEF is: ARNI+BB+MRA+SGLT2i STAT/ASAP In the absence of absolute contraindications #GDMTWorks

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Gregg Fonarow MD

@gcfmd

2 years

In the next 24 hours, there will be 265 preventable deaths in patients with HFrEF While challenges exist, is it not imperative to overcome the inertia and resistance to implementing proven evidence-based, guideline-recommended, high-value, survival-enhancing therapies?

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Gregg Fonarow MD

@gcfmd

3 years

In HFrEF, want the best chance of ⬆️ or normalizing EF Rapidly enhancing health status ⬇️ risk of 🏨 ⬇️ risk of re-🏨 ⬇️ risk of CV ⚰️ ⬇️ risk of all-cause⚰️ Then implement ARNI+BB+MRA+SGLT2i #HFWeek2021 @JavedButler1 @MKIttlesonMD @BiykemB @texhern @NMHheartdoc @HFSA

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Gregg Fonarow MD

@gcfmd

2 years

Today, 1250 patients with HFrEF will be discharged from the 🏨 in 🇺🇸 with primary HF diagnosis (another 2500 secondary) Under usual care, they experience very extreme high risk of worsening HF events/☠️ Foundational GDMT ⬇️⬇️⬇️⬇️ this risk within days Implement now

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Gregg Fonarow MD

@gcfmd

4 years

Use of SGLT2i together with MRA ⬇️ risk of hyperkalemia Use of ARNI together with MRA ⬇️ risk of hyperkalemia Further rationale to start with ARNI+BB+MRA+SGLT2i from day 1 in HFrEF #GDMTworks @JavedButler1 @SJGreene_md @mvaduganathan @JJheart_doc @MKIttlesonMD @HFSA @texhern

theheartorg | Medscape

@theheartorg

4 years

MRAs are underutilized in North America. This data could facilitate broader use of the life-saving therapy. #KidneyWk

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Gregg Fonarow MD

@gcfmd

1 year

In patients with HFpEF and inadequate response of heart rate to exertion, implantation of a pacemaker to enhance exercise HR did not improve exercise capacity, symptoms, or exercise cardiac output. Atrial Pacing in HFpEF via @JAMA_current

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Gregg Fonarow MD

@gcfmd

11 months

🏨 with HFrEF 35% risk of ☠️ in the first year post-🏨 discharge 💊 ⬇️ ☠️ to 25% 💊💊 ⬇️ ☠️ to 16% 💊💊💊 ⬇️ ☠️ to 12% 💊💊💊💊 ⬇️ ☠️ to 9% ☠️ ARR 26% with 💊💊💊💊 ✅ NNT to save a life = 4 with 💊💊💊💊 💸 Quadruple Rx cost effective

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Gregg Fonarow MD

@gcfmd

2 years

Efficacy of ARNI+MRA+SGLT2i by EF Outcome: CV☠️ / HF🏨 EF 0-40%: ⬇️ 62% (CI 53-70) EF 45-54%: ⬇️ 51% (CI 26-68) EF 55-64%: ⬇️ 46% (CI 20-63) EF >=65%: ⬆️ 17% (CI -35-+210) Delta in response to GDMT as function of EF categorization

Sanjay Kaul

@kaulcsmc

2 years

@gcfmd @mvaduganathan @JavedButler1 What is a true HFpEF? Why the obsession with first dichotomizing, then trichotomizing, and now 'quadratomizing' HF?

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Gregg Fonarow MD

@gcfmd

1 year

🏨HFrEF ⬆️⬆️⬆️ ☠️/re-🏨 event risk, highest in 1st 30 days 4 💊💊💊💊 that can rapidly ⬇️⬇️⬇️ risk Safe and well tolerated alone or in combo Start 💊 and wait? Start 💊💊 and wait? Start 💊💊💊 and wait? Or start all 💊💊💊💊?

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Gregg Fonarow MD

@gcfmd

4 years

Gregg Fonarow MD

@gcfmd

4 years

Well tolerated in most denovo patients at initial starting doses. Side effect profile similar or better than placebo in RCTs. Emphasis on uptitrating beta-blockers first as they have the steepest dose benefit curve. However, if low SBP or coming off inotropes can stage.

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Gregg Fonarow MD

@gcfmd

3 years

Don’t: let your HFrEF patients lose >6 years median survival Don’t: get defeated by inertia Do: apply simultaneous/rapid sequence/optimal ARNI+BB+MRA+SGLT2i Do: be a champion for your patients @JavedButler1 @MKIttlesonMD @SJGreene_md @NMHheartdoc @HFSA #HFWeek2021 @texhern

Sergio Kaiser MD, PhD, FACC, FESC 🇧🇷🇮🇱🇷🇴🇺🇦

@pabeda1

3 years

2nd day of #GlobalTrialsSummit : Dr Faiez Zannad: The interplay between heart and kidney. Remember the lessons from CHAMP👇👇👇 @mvaduganathan @gcfmd

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Gregg Fonarow MD

@gcfmd

1 year

🔑 to improving clinical outcomes in HF 🎯 Early in-🏨 initiation of quad GDMT 🎯 Optimization of dosing and adherence 🎯 Timely f/u and careful monitoring 🎯 Address related risks, comorbidities, and SDOH OPTIMIZE-HF Get With The Guidelines-HF IMPLEMENT-HF STRONG-HF

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Gregg Fonarow MD

@gcfmd

3 years

Very early clinical benefit with SGLT2i in HFmrEF/HFpEF Effect of Empagliflozin on Worsening Heart Failure Events in Patients with Heart Failure and a Preserved Ejection Fraction: The EMPEROR-Preserved Trial @JavedButler1 @mvaduganathan @SJGreene_md

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Gregg Fonarow MD

@gcfmd

10 months

Early In-🏨 initiation of HF GDMT Despite evidence of very early clinical benefit Despite evidence of safety/tolerability Despite evidence of improved use/adherence Despite guideline recommendations Hesitancy remains ➡️ Gaps in care Unnecessary ☠️ and 🏨s ✨Implement

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Gregg Fonarow MD

@gcfmd

4 years

4 drugs, 5 pathways, 6 + years of life extension, beyond that achieved with ACEI+BB in HFrEF. The time is now for optimal and equitable implementation to all eligible patients. #GDMTWorks . @mvaduganathan @NMHheartdoc @MKIttlesonMD

Javed Butler

@JavedButler1

4 years

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Gregg Fonarow MD

@gcfmd

2 years

Making the Post-Discharge Phase Far Less Vulnerable in HFrEF @SJGreene_md @JavedButler1 @MarcoMetra @ESC_Journals

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Gregg Fonarow MD

@gcfmd

4 years

Randomization: There is no substitute (for evaluating efficacy and safety of medications, devices, management strategies, or policies) @HeartBobH @NMHheartdoc @DLBHATTMD @boback The Magic of Randomization versus the Myth of Real-World Evidence | NEJM

The Magic of Randomization versus the Myth of Real-World Evidence | NEJM

Nonrandomized observational analyses have been promoted as alternatives to randomized clinical trials. However, randomization ensures balance between groups, whereas nonrandomized studies are often...

www.nejm.org

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Gregg Fonarow MD

@gcfmd

3 years

If a medication ⬇️ CV☠️/HF🏨 by 39-49% in the first 4 weeks after initiation and was safe, as well tolerated as placebo, and ⬆️ health status How many hours, weeks, months, or years would you wait to start it? @SJGreene_md @JavedButler1 @HFSA

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Gregg Fonarow MD

@gcfmd

10 months

🏨 for HF 1 in 4 chance of re-🏨 or ☠️ within the first 30 days 🚨🚨urgency needed 🚨🚨 Intensive GDMT strategy >>>> usual go slow, go sequential, go hesitant, go nowhere care

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Gregg Fonarow MD

@gcfmd

1 year

✳️ Initiate foundational GDMT for HFrEF (ARNI+BB+MRA+SGLT2i) as if your patient’s life depended on it Because it does ✳️ Continue foundational GDMT as if your patient’s life depended on it Because it does

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Gregg Fonarow MD

@gcfmd

5 years

HF hospitalization was included as a secondary/exploratory endpoint in all three trials: 27% ⬇️ with dapagliflozin 35% ⬇️ with empagliflozin 33% ⬇️ with canagliflozin SGLT2 Inhibitor Poised to Reach Beyond Diabetes Into HF @JavedButler1 @JJheart_doc

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