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#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

Congratulations Alejandro Lemor MD, MS ! Well deserved! The University of Mississippi Medical Center UMMC Department of Medicine

Contemporary American & European Guidelines for the Management of #HeartFailure: JACC Journals #JACCHF Guideline Comparison jacc.org/doi/10.1016/j.…

Comparison between American and European guidelines for the management of Heart Failure

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

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 🧩⬇️

Richard Ferraro JACC Journals Steve Greene Duke Clinical Research Institute AHA Science Harriette Van Spall, MD MPH 🇨🇦 Javed Butler Muthu Vaduganathan Larry A. Allen, MD Clyde Yancy, MD, MSc Shahzeb Khan @JJheart_doc doi.org/10.1016/j.jchf… sciencedirect.com/science/articl… doi.org/10.1161/cirche… doi.org/10.1161/circou…

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

@ezmanshariff Andrew J Sauer MD Anu Lala-Trindade Robert Mentz, MD Novi Yanti Sari @JJheart_doc Vebiona Kartini Prima Putri Shelley Zieroth Harriette Van Spall, MD MPH 🇨🇦 Rapid initiation of quadruple medical therapy for newly diagnosed HFrEF would yield large absolute reductions in mortality ACEI/ARB+BB only ➡️ 🏨/☠️ which could have been prevented doi.org/10.1016/j.jchf… Steve Greene Muthu Vaduganathan Javed Butler Harriette Van Spall, MD MPH 🇨🇦 JACC Journals

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

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

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

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 ?

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

🚨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

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…

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

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:

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