Hot Topics in Cardiology: Talking HFpEF, New Agents, and Guidelines with Shelley Zieroth, MD, FCCS, FHFSA(hon), FESC, FACC, FHFA, FRCPC
Welcome back to this month’s MedscapeLIVE! Cardiology E-News. This month I speak with Dr. Shelley Zieroth, who is Professor of Medicine at Max Rady College of Medicine, University of Manitoba in Winnipeg, Canada. She is Past President of the Canadian Heart Failure Society and co-chair of the Canadian Cardiovascular Society Heart Failure Guidelines. We discussed some upcoming conference highlights, some pearls from her talk on updates in HFpEF, and how recent data will impact clinical care of patients with HFpEF and guidelines—and what the most promising of these agents on the horizon are. Also, don’t miss her Suggested Reading in the Journal of Cardiac Failure, “JCF Heart Failure Year-In-Review 2022… The Best is Yet to Come!”—a compendium of advances in HF treatment in 2023 that highlights several landmark trials and summarizes key results—worth a read!
In our last issue, the faculty of Medscape’s Going Back to the Heart of Cardiology 2022 came together and shared the year’s cardiology happenings that represent a critical step forward in patient care. If you missed that interview, you can view it here.
Also check out this issue’s Pulse, with 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.
Housekeeping: CME 2023—Add this to your calendar now and sign up for updates:
Going Back to the Heart of Cardiology Conference (4th Annual)
Saturday-Monday December 8-10, 2023; Anaheim, California
· Cath Lab Challenge!: Virtual Interventional Session: Interventional cath lab teams from Columbia, Duke, Stanford, Vermont present/discuss innovative cases of best practice approaches to conquering novel complex coronary, structural, and peripheral disease challenges.
· Sessions 1-6: Cardiopulmonary Failure; Atherosclerosis and Thrombosis; and Cardiometabolic Disease; Electrical Failure; Valvular Disease: Special Topics in Cardiology
· View Faculty & Agenda: https://na.eventscloud.com/website/36345/savethedate/
· Access CME from HOC 2022: https://na.eventscloud.com/website/36345/home/
· View 2022 HOC Recap—Click HERE!
Thank you to Dr. Zieroth for her time and expertise as faculty and in this interview. Don’t forget to register and access Medscape’s Going Back to the Heart of Cardiology 2022 conference if you missed it—go online now here and gain the best CME opportunity available! Please contact me at colleen@cmhadvisors.com with any comments and/or suggestions! –Colleen Hutchinson
Catching Up with Shelley Zieroth, MD, FCCS, FHFSA(hon), FESC, FACC, FHFA, FRCPC
Dr. Dr. Zieroth is Professor of Medicine at Max Rady College of Medicine, University of Manitoba in Winnipeg, Canada. She is Past President of the Canadian Heart Failure Society and co-chair of the Canadian Cardiovascular Society Heart Failure Guidelines and served as faculty at the 3rd Annual Going Back to the Heart of Cardiology conference.
Colleen: What’s happened in cardiology in 2022 that feels like a big step forward for patient care?
Dr. Zieroth: No doubt about it—2022 was the year of implementation studies advancing care protocols for patients living with heart failure. STRONG HF demonstrated that rapid up titration guideline-recommended therapies under close followup and monitoring early after discharge from hospital was safe and resulted in reductions in all cause death or heart failure readmission at 180 days.
PROMPT HF with the real-time targeted untailored HER-based alerting system for a patient with hep Rep and the use of best practice alerts resulted in an increase in the number of GDMT classes prescribed at 30 days.
The Canadian COACH trial demonstrated that the use of a hospital-based strategy to support clinical decision making and rapid followup in patients presenting to the emergency room with acute heart failure led to a lower risk of the composite of death from any cause or hospitalization for cardiovascular causes within 30 days than usual care.
STRONG HF Mebazaa A et al, Lancet. 2022 Dec 3;400(10367):1938-1952. doi: 10.1016/S0140-6736(22)02076-1. Epub 2022 Nov 7. PMID: 36356631.
PROMPT HF Ghazi et al, J Am Coll Cardiol. 2022 Jun, 79 (22) 2203–2213
COACH: Lee et al, N Engl J Med 2023; 388:22-32
DOI: 10.1056/NEJMoa2211680
How will recent data impact clinical care of patients with HFpEF and guidelines?
Dr. Zieroth: We now have two large randomized controlled trials evaluating the use of SGLT 2 inhibitors in patients with symptomatic HFpEF that have demonstrated a statistically significant reduction in their primary endpoint. I anticipate we will see international guidelines revisiting and revising their documents to likely include a Class 1 level of recommendation for reduction of clinical events and improvements in quality of life for these patients.
What are some pearls (or main takeaway) from your presentation?
Dr. Zieroth: I got to present on updates in HFpEF. I think the most important takeaway is that we now have an evidence-based therapy for the treatment of patients living with HFpEF and there are many more promising agents being evaluated in ongoing and future clinical trials.
What are some of these agents on the horizon that you feel are most promising?
Dr. Zieroth: I'm really hoping that all of the impressive data we're seeing with finerenone in patients with diabetic albuminuric chronic kidney disease translates to the same impressive reduction in cardiovascular events in patients with HFpEF. The FINEARTS HF trial will provide us with relevant data in this study population (https://clinicaltrials.gov/ct2/show/NCT04435626).
Was there a presentation or panel at the Going Back to the Heart of Cardiology 2022 you found particularly valuable to listen to?
Dr. Zieroth: I deliberately stepped out of my lane at this conference. The long Covid discussion was an eye-opener. Not all of us see it or recognize it in the patients we interact with every day. I would also have to add that the panel discussion on women's cardiovascular health led by Dr. Gulati was exceptional.
What makes the HOC conference such a valuable conference for attendees?
Dr. Zieroth: The opportunity to engage with national and international experts is truly exceptional. You're not lost in the shuffle and the genuine networking opportunities occur on a daily basis.
Suggested Reading
Article: Blumer et al. Editor's Page: We've Been Thinking…| JCF Heart Failure Year-In-Review 2022… The Best is Yet to Come! Journal of Cardiac Failure 2023;29:1-5.
Dr. Zieroth: Don't have time to read ten articles? Check out the Journal of Cardiac Failure Editor’s Page from the January 2023 issue with an impressive table of the top ten clinical trials in heart failure from 2022
The Pulse
European Heart Journal Article: Prevention of nuclear war: a call to action for cardiovascular professionals
https://academic.oup.com/eurheartj/issue
Circulation: Cardiovascular Intervention Original Investigation: BioMatrix Versus Orsiro Stents for Coronary Artery Disease: A Multicenter, Randomized, Open-Label Study
https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.122.012307
JAMA Cardiology Original Investigation: Results of a Remotely Delivered Hypertension and Lipid Program in More Than 10 000 Patients Across a Diverse Health Care Network
https://jamanetwork.com/journals/jamacardiology/article-abstract/2798467
Cardiology News: Managing respiratory symptoms in the ‘tripledemic’ era
https://www.mdedge.com/cardiology/article/260952/pulmonology/managing-respiratory-symptoms-tripledemic-era
The 2023 4th Annual Going Back to the Heart of Cardiology:
https://na.eventscloud.com/website/36345/savethedate/
JACC Original Investigation: Improving the Quality of Life for Patients With Heart Failure and Preserved Ejection Fraction
https://www.sciencedirect.com/science/article/abs/pii/S0735109722075283
NEJM Perspective: Aldosterone and Treatment-Resistant Hypertension
https://www.nejm.org/doi/full/10.1056/NEJMe2213559?query=featured_cardiology
Medical Intelligence Quiz:
Circulation: Heart Failure Article: Epidemiology and Outcomes of Aortic Stenosis in Acute Decompensated Heart Failure: The ARIC Study
https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.122.009653
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