Craig Long (@ummchfdoc) 's Twitter Profile
Craig Long

@ummchfdoc

Husband, #Fatherof4, #AdvancedHFCardiologist

ID: 437294616

calendar_today15-12-2011 07:07:02

1,1K Tweet

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Marat Fudim, MD MHS (@fudimmarat) 's Twitter Profile Photo

#1 The Pandemic That Never Left ➡️ HEART FAILURE sciencedirect.com/science/articl… 🚨Although the mortality related to COVID-19 has eased significantly from 2021 highs, COVID-19-related mortality was LOWER than Heart Failure-related mortality both at its peak and throughout the pandemic

#1
The Pandemic That Never Left ➡️ HEART FAILURE
sciencedirect.com/science/articl…

🚨Although the mortality related to COVID-19 has eased significantly from 2021 highs, COVID-19-related mortality was LOWER than Heart Failure-related mortality both at its peak and throughout the pandemic
Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

Nationwide US cohort 🏨 for newly diagnosed HFrEF n=33,036 >4 of 5 patients eligible for quadruple GDMT (>9 of 10 triple GDMT) <than 1 in 6 were prescribed it Substantial survival benefits being missed doi.org/10.1016/j.jchf… JACC Journals Steve Greene Duke Clinical Research Institute AHA Science

Nationwide US cohort 🏨 for newly diagnosed HFrEF n=33,036

&gt;4 of 5 patients eligible for quadruple GDMT (&gt;9 of 10 triple GDMT)

&lt;than 1 in 6 were prescribed it

Substantial survival benefits being missed

doi.org/10.1016/j.jchf…

<a href="/JACCJournals/">JACC Journals</a> <a href="/SJGreene_md/">Steve Greene</a> <a href="/DCRINews/">Duke Clinical Research Institute</a> <a href="/AHAScience/">AHA Science</a>
Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

Dr. Deepak L. Bhatt Paul Heidenreich BiykemBozkurt Marco Metra Robert Mentz, MD Adam DeVore, MD, MHS Eldrin Lewis Michelle Kittleson MD PhD HFSA There is a common perception that patients with HFrEF encountered in clinical practice are not well represented in HFrEF RCTs and thus results of RCTs may not generalize Yet, prior analyses included RW patients with HFrEF/HFpEF being compared to HFrEF trial patients 🧩⬇️

<a href="/DLBHATTMD/">Dr. Deepak L. Bhatt</a> <a href="/paheidenreich/">Paul Heidenreich</a> <a href="/BiykemB/">BiykemBozkurt</a> <a href="/MarcoMetra/">Marco Metra</a> <a href="/robmentz/">Robert Mentz, MD</a> <a href="/_adevore/">Adam DeVore, MD, MHS</a> <a href="/EldrinL/">Eldrin Lewis</a> <a href="/MKIttlesonMD/">Michelle Kittleson MD PhD</a> <a href="/HFSA/">HFSA</a> There is a common perception that patients with HFrEF encountered in clinical practice are not well represented in HFrEF RCTs and thus results of RCTs may not generalize 

Yet, prior analyses included RW patients with HFrEF/HFpEF being compared to HFrEF trial patients

🧩⬇️
Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

Dr. Deepak L. Bhatt Paul Heidenreich BiykemBozkurt Marco Metra Robert Mentz, MD Adam DeVore, MD, MHS Eldrin Lewis Michelle Kittleson MD PhD HFSA In n=79 hospitals, not a single eligible HFrEF patient was discharged home with quadruple therapy Despite Class 1 American Heart Association American College of Cardiology HFSA guideline recommendations to do so Little association with patient demographics, clinical characteristics, or 🏨 characteristics

<a href="/DLBHATTMD/">Dr. Deepak L. Bhatt</a> <a href="/paheidenreich/">Paul Heidenreich</a> <a href="/BiykemB/">BiykemBozkurt</a> <a href="/MarcoMetra/">Marco Metra</a> <a href="/robmentz/">Robert Mentz, MD</a> <a href="/_adevore/">Adam DeVore, MD, MHS</a> <a href="/EldrinL/">Eldrin Lewis</a> <a href="/MKIttlesonMD/">Michelle Kittleson MD PhD</a> <a href="/HFSA/">HFSA</a> In n=79 hospitals, not a single eligible HFrEF patient was discharged home with quadruple therapy 

Despite Class 1 <a href="/American_Heart/">American Heart Association</a> <a href="/ACCinTouch/">American College of Cardiology</a> <a href="/HFSA/">HFSA</a> guideline recommendations to do so

Little association with patient demographics, clinical characteristics, or 🏨 characteristics
Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

John M. Clymer In 79 hospitals, not a single eligible patient with HFrEF was discharged with quadruple GDMT Despite: Class 1 guideline recommendations Rapid symptom relief/QoL ⬆️ Rapid ⬇️ re-🏨 risk Rapid ⬇️ ☠️ NNT to save a life of 4 Cost-effectiveness, high value

<a href="/JohnClymer/">John M. Clymer</a> In 79 hospitals, not a single eligible patient with HFrEF was discharged with quadruple GDMT 

Despite:

Class 1 guideline recommendations 

Rapid symptom relief/QoL ⬆️

Rapid ⬇️ re-🏨 risk

Rapid ⬇️ ☠️

NNT to save a life of 4

Cost-effectiveness, high value
Alfonso Valle (@vallealfonso) 's Twitter Profile Photo

Excelent review👉Contemporary pharmacological treatment and management of #HF 👉stage A pre-HF might benefit from close monitoring and early treatment and prevention strategies 👉The first-line treatment of patients with HFrEF includes initiation and optimization of

Excelent review👉Contemporary pharmacological treatment and management of #HF

👉stage A pre-HF might benefit from close monitoring and early treatment and prevention strategies

👉The first-line treatment of patients with HFrEF includes initiation and optimization of
Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

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

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 &gt;&gt;&gt;triple&gt;&gt;&gt;double

Fast &gt;&gt;&gt;&gt;slow 

Now&gt;&gt;&gt;later
Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

Which therapeutic regimen ⬇️ all-cause mortality by 24.8% (ARR) at 12 months NNT=4 to prevent ☠️ Safe, well tolerated AE rates similar to placebo Cost effective-high value Yet, is routinely not/only partially used, delayed, deferred, deprioritized ?

Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

David J. Cohen, MD, MSc The PARTNER trial results with TAVI for patients with severe AS, not candidates for surgical AVR, were spectacular NNT for ☠️ at 12 months = 5! Rapid adoption, perceived high value despite $65K cost Quad GDMT (NNT =4) Slow adoption, perceived far too expensive, <15K cost/12m

Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

🚨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😱🆘 jamanetwork.com/journals/jamac… JAMA Cardiology Marat Fudim, MD MHS

🚨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😱🆘

jamanetwork.com/journals/jamac…

<a href="/JAMACardio/">JAMA Cardiology</a> <a href="/FudimMarat/">Marat Fudim, MD MHS</a>
Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

Urgent need to: Quadruple efforts to prevent HF Quadruple efforts to optimize use of quadruple GDMT Quadruple efforts to address SDOH and health equity Quadruple efforts to end HRRP Quadruple efforts to better track HF quality/outcomes JAMA Cardiology jamanetwork.com/journals/jamac…

Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

304,857 patients with HFrEF Medicare Part D drug coverage 2,600 US counties 2013-2019 The median for triple GDMT use was only…. 14.3% (IQR: 10.3%-18.8%) jacc.org/doi/10.1016 Muthu Vaduganathan JACC Journals

304,857 patients with HFrEF 

Medicare Part D drug coverage

2,600 US counties 

2013-2019

The median for triple GDMT use was only….

 14.3% (IQR: 10.3%-18.8%) 

jacc.org/doi/10.1016

<a href="/mvaduganathan/">Muthu Vaduganathan</a> <a href="/JACCJournals/">JACC Journals</a>
Cardiac Trials (@cardiactrials) 's Twitter Profile Photo

When to suspect cardiac amyloidosis? Echo features: 🔹Nondilated LV with thickened walls 🔹E/A > 2 and E/e’ > 14 🔹Biatrial enlargement 🔹Valvular thickening 🔹Apical sparing strain pattern …and the following clinical features, 🖼️ via British Society of Echocardiography:

When to suspect cardiac amyloidosis?

Echo features: 
🔹Nondilated LV with thickened walls
🔹E/A &gt; 2 and E/e’ &gt; 14
🔹Biatrial enlargement 
🔹Valvular thickening
🔹Apical sparing strain pattern

…and the following clinical features, 🖼️ via British Society of Echocardiography:
Gregg Fonarow MD (@gcfmd) 's Twitter Profile Photo

Official New ACC/AHA Heart Failure Performance Measure ✅ PM-1: Quadruple GDMT at Discharge from HF Hospitalization (HFrEF) A quadruple GDMT measure was 1st created and applied in AHA’s GWTG-HF and IMPLEMENT-HF Incentivized and facilitated substantial improvements in HF care

Official New ACC/AHA Heart Failure Performance Measure ✅

PM-1: Quadruple GDMT at Discharge from HF Hospitalization (HFrEF)

A quadruple GDMT measure was 1st created and applied in AHA’s GWTG-HF and IMPLEMENT-HF

Incentivized and facilitated substantial improvements in HF care