American Heart Association

Nicholas Hawkes

Female HCM patients with obstructive physiology undergo myectomy later and have worse diastolic dysfunction but more compliant titin

Contributor: Nick Hawkes

Hypertrophic Cardiomyopathy (HCM) is a genetic condition characterized by unexplained left ventricular hypertrophy often with a wall thickness of greater than or equal to 15mm. it often disproportionately affects the septum and can lead to development of left ventricular outflow obstruction (LVOTO). Myectomy is a targeted surgical reduction in LV mass — thereby reducing LVOTO. Nijenkamp et al analyzed samples obtained during myectomy as well as pre-myectomy echocardiographic markers of diastolic dysfunction in 71 HCM patients. The authors also compared control myocardium to HCM. In this study, female HCM patients presented later, had a higher degree of diastolic dysfunction, a higher amount of fibrosis, more compliant titin, and greater septal thickness when indexed to body surface area (IVSi) compared to males.

Low Adoption Rates of Sacubitril/Valsartan Use in the US

Contributor: Nick Hawkes

Sacubitril/valsartan reduces morbidity and mortality in patients with HFrEF, so why has the adoption of this therapy in the outpatient setting been so slow?

Slow Adoption and Low Adherence of Sacubitril/Valsartan for HFrEF

Contributor: Nick Hawkes

PARADIGM – HF demonstrated that Sacubitril/Valsartan reduces morbidity and mortality in patients with HFrEF compared to ACE-I/ARB therapy, so why is its adoption in the real world delayed?

Sangaralingham et al. accessed data from OptumLabs Data Warehouse, a large database of de-identified medical and pharmacy claims. Among patients identified based on systolic HF ICD codes, those prescribed sacubitril/valsartan were compared to those who were not. Patient variables included health plan, age, gender, race, region, comorbidities, other prescription medications, and provider specialty. Additionally the costs, out-of-pocket (OOP) and to the health plan, were captured.

Precision medicine for cardiac resynchronization: Predicting quality of life benefits

Contributor: Nicholas Hawkes

Who benefits from cardiac resynchronization therapy (CRT)? Studies show that among select HF patients CRT improves longevity, ventricular remodeling, and quality of life (QoL). The precision medicine approach asks the question, “Are there individual factors that predict QoL improvements?” Spertus and colleagues demonstrated that age, baseline QoL, and QRS duration predict individual QoL after CRT.

Octreotide may prevent recurrent GI bleeds in CF-LVAD patients

Contributor: Nick Hawkes

CF-LVAD patients experience high rates of gastrointestinal (GI) bleeding. A multicenter, retrospective analysis by Shah et al demonstrated that patients with a prior GI bleed after CF-LVAD implantation had a lower rate (24% vs 43%) of recurrent GI bleed when receiving octreotide.

Fifty-one patients were identified from 5 participating centers. All patients had one previous GI bleed following CF-LVAD implantation, and received octreotide treatment for at least 6 months following index GI bleed. Octreotide was dosed as a monthly depot injection in 72% of patients or twice daily subcutaneous injection in 28%. Shah et al used a comparison group of HMII CF-LVAD patients who had experienced a GI bleed in clinical trials using HMII bridge-to-transplant (BTT) and destination therapy (DT). Patients were propensity matched based on HF etiology, CF-LVAD indication, CF-LVAD support time, sex, and age. Of the 51 CF-LVAD patients analyzed, 50% were DT. Twelve patients (24%) who received octreotide experienced a recurrent bleed vs 22 (43%) of the comparison group (p<0.04).