A Deep Dive into Heart Failure…. With Michelle Kittleson, MD, PhD
Welcome back to MedscapeLIVE! Cardiology E-News. This month we are joined by Dr. Michelle Kittleson, who is a professor of cardiology at the Smidt Heart Institute at Cedars-Sinai in Los Angeles, and who also served as chair of the writing committee for the latest American College of Cardiology (ACC) update to the HFpEF management pathway. Dr. Kittleson is a well-known thought leader who also devotes time to being part of the Heart of Cardiology conference faculty. We took some time to speak with Dr. Kittleson about what’s new and exciting in the cardiology pipeline, whether we are at a turning point in heart failure treatment, the role of weight loss medications in the new heart failure treatment paradigms, and who the Heart of Cardiology meeting serves best.
Last month, HOC faculty opined on all things obesity- and cardiology-related, including the disease itself, best approaches to it, and new and exciting medication and treatment options.
Make sure to also check out this issue’s Pulse, with several heart failure-related articles from the Journal of the American Heart Association, Circulation, European Heart Journal, Journal of the American College of Cardiology, Cardiology News, and New England Journal of Medicine.
Need CME? We’ve got you covered—Don’t Miss!
Going Back to the Heart of Cardiology Medscape Conference (6th Annual)
- Earn up to 14 CME/CE credits
- Location and dates:
- January 30-February 1, 2026
- Miami, Florida –Fontainebleau Miami Beach Hotel
- Sign up for updates— click here!
- View Agenda: https://www.heartofcardio.com/agenda
- To register, click here!
Thank you to Dr. Kittleson for sharing her time and expertise! Please contact me at colleen@cmhadvisors.com with any comments and/or suggestions! –Colleen Hutchinson
A Deep Dive into Heart Failure…. with Dr. Michelle Kittleson
Michelle Kittleson, MD, PhD, is a professor of cardiology at the Smidt Heart Institute at Cedars-Sinai in Los Angeles and chair of the writing committee for the latest American College of Cardiology (ACC) update to the HFpEF management pathway.
Are we at a turning point in heart failure treatment?
Dr. Kittleson: We are absolutely at a turning point in heart failure treatment. For heart failure with reduced EF, we have four pillars of therapy (the ARNI, beta-blocker, MRA, and SGLT2 inhibitor) that effectively help people to feel better, stay out of the hospital, live longer, and potentially improve heart function. For HFpEF, we now have two effective therapies, the SGLT2 inhibitor and MRA, and more amazing options on the horizon, namely the incretin-based anti-obesity medications semaglutide and tirzepatide. There are also advances for patients with specific forms of HF, like amyloidosis—for which the therapeutic landscape includes tafamidis and acoramidis, and potentially vutrisiran on the horizon, and hypertrophic cardiomyopathy (HCM)—for which we have mavacamten and potentially aficamten soon as well.
What is the role of weight loss medications in the new paradigms in heart failure treatment?
Dr. Kittleson: There's no question that weight loss with semaglutide helps people with obesity and HFpEF feel better and be more active. There's a possibility that tirzepatide may also reduce the risk of death and HF hospitalization in people with obesity and HFpEF, though this requires further study and confirmation.
What is headed down the cardiology pipeline in 2025 that’s exciting?
Dr. Kittleson: I'm excited to learn more about the incretin-based anti-obesity medications in HFpEF and understand their safety and efficacy in HFrEF, and the role of vutrisiran in patients with transthyretin amyloid cardiomyopathy.
As the writing committee chair for the latest American College of Cardiology (ACC) update to the HFpEF management pathway, what would you say is new and critical since then?
Dr. Kittleson: That management pathway came out in 2023 and so much has changed since then, which is exciting! Now, we should look to SGLT2i and MRA as standard of care in HFpEF, and be sure to treat obesity in HFpEF with incretin-based anti-obesity medications where there are FDA-approved indications such as diabetes, BMI > 30, CAD, or sleep apnea.
Are we adequately screening for potential future heart failure in adolescents and teenagers whose family includes a history of HF?
Dr. Kittleson: The 2022 HF Guidelines recommend a 3-generation family history in anyone with a newly diagnosed cardiomyopathy (MC), as nonischemic CM can be familial/genetic in about 30% of cases. However, specific guidelines on screening adolescents and teenagers is not clear. If an affected family member has a pathogenic variant for a CM-causing gene, then first-degree relatives should have genetic testing (if desired) to determine the need for screening echocardiograms as intervals ranging from every 2 to 5 years depending on their age and the variant. If there is a strong family history of CM and no identified variant (or the first-degree relative declines genetic testing), then an echocardiogram for screening every 2-5 years is often done, with the frequency depending on the age and history.
Do you think the Heart of Cardiology (HOC) meeting meets the needs of most cardiologists looking to stay current in cardiology research and treatment? Or do you think it’s better geared toward cardiologists who have the goal of taking a deeper dive into specific, targeted areas of cardiology?
Dr. Kittleson: I think HOC is perfect for anyone who wants the latest evidence—along with practical guidance on how this evidence can improve clinical practice. So it's for all cardiologists—those who need to stay current, as well as those who need a deeper dive in specific targeted areas… because even those latter cardiologists can't be experts in everything and will learn something!
The Pulse
Medscape Medical News MedBrief: Empagliflozin Benefits Heart Failure Even With Low BP
NEJM Original Article: Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia
Medical Intelligence Quiz: Coffee consumption and heart failure
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