Vijay Rao, MD, PhD

Honored to co-chair this effort with @mayocvonc and ACC Cardioonc council and @ICOSociety to lay the framework for quality initiatives in #Cardioonc @JACCJournals @ACCinTouch jacc.org/doi/10.1016/j.… @AnaBaracCardio @sdent_cardioonc @SarjuGanatraMD @Richardkcheng2 @anita_deswal

An important addition to the literature. Interestingly- and let me know if you see things differently- this should not change the practice among those who were already following the @AHAScience @ACCinTouch @HRSonline guidelines: if an AF patient at risk for stroke truly cannot safely tolerate long-term anticoagulation, it remains reasonable (as a 2A recommendation) to place one of these devices. Also, more based on anecdote and common sense, those with a prior LAA clot, particularly if found while on a #DOAC, may still benefit from placement of an LAA occlusion device AND continuation of an anticoagulant. There really never was adequate evidence to support large scale use of these devices as straight-up substitutes for DOACs. @DrJMarine @UCSF @UCSFCardiology @UCSFHospitals @drjohnm @ethanjweiss @DrDave01 @DrRoderickTung @JonPicciniSr

@LongeneckerBob Terrific wine, baby brother to the mighty schrader cabs. Silky with a unique fruitcake finish. One of my favorites! #wine

A very nice Cabernet from Schrader and Thomas Rivers Brown. Always have a few in my cellar. Cheers!

A 102-year-old woman who had been married for 78 years was asked on her deathbed what she wished she had done differently. Her answer made her 80-year-old daughter weep. Here is what she said…

Schrödinger's dumpster!

@MoutonIsAClaret @Foodporn00001 Love that decanter!

Welcome to Wine Wednesday. The 2010 Château Léoville Poyferré is one of my favourite vintages from the estate following a vertical tasting.

Wine down Wednesday! Quilceda Creek 2019 Columbia Valley Cab; first time trying, such a beautiful wine, silky cherry and currant with no hard edges. Cheers! #wine ⁦@jwalkermobile⁩ ⁦@jebdunnuck⁩ ⁦@RyanTedfordMD⁩ ⁦@DrRyanPDaly⁩ ⁦@MondaviSisters⁩

It’s like a beautiful message from the universe.

There have been thousands of generations of humans, and you are alive to witness the first photo of a Sunset on another World. This is a real photo of the sunset on Mars.

ENCORE: One of JACC Heart Failure @JACCJournals most-read papers of 2025 — and the timing couldn’t be better. If you care about heart failure outcomes and the aldosterone–mineralocorticoid receptor axis, this state-of-the-art review is worth a spot on your reading list. Why now? We’re at an inflection point in the MRA space. Traditional steroidal MRAs (spironolactone/eplerenone) remain foundational in HFrEF with Class I, Level A evidence, yet real-world use is still strikingly low, often driven by concerns about hyperkalemia, kidney function, and endocrine side effects. Meanwhile, the evidence base for nonsteroidal MRAs (nsMRAs) has matured fast, especially for patients who live at the intersection of HFpEF/HFmrEF, CKD, and diabetes. What this review does: Clarifies the “why” behind class differences: nsMRAs lack a steroid nucleus and have different receptor selectivity, PK/PD, and heart–kidney tissue distribution, which may translate into a distinct efficacy/safety signature. Synthesizes the clinical trial landscape: from the established HFrEF benefit of sMRAs to the more mixed HFpEF story (including the well-known TOPCAT regional issues), and then the expanding outcomes data for nsMRAs. Frames what’s next (and what we still don’t know): head-to-head outcomes comparisons remain limited, and the pipeline (MR modulators, aldosterone synthase inhibitors) is evolving quickly. Why it matters clinically: For many of our patients with HF (especially those with CKD/diabetes), we’re constantly balancing: ---“Will they tolerate an MRA?” ---“Can we keep them on it safely?” ---“Which phenotype gets the most net benefit?” This review is a pragmatic map of that terrain and a useful way to align clinicians, pharmacists, and trialists around the next set of questions that actually matter at the bedside. If you’re following the MRA evolution across the EF spectrum, or designing trials/implementation strategies in this space, this is a worthwhile download for your files. doi.org/10.1016/j.jchf…

Just published in The Lancet: ONCO-ACS, the first risk score for🎗️#CANCER & ❤️#ACS, outperforming standard ACS risk models. A major step toward🎯personalized decision-making in #CardioOnc🚀@ICOSociety @DNFeldmanMD thelancet.com/journals/lance…

BREAKING: Philadelphia just drew a hard line on ICE. They have INTRODUCED legislation to rein in ICE. - Agents can’t wear masks - Must show ID - Judicial warrants only - Assault a bystander → arrested This is what accountability looks like. This isn’t law yet, but it’s the blueprint. Pass it. Enforce it. Take it nationwide.

You can ignore the science, but you can't ignore the consequences of ignoring the science.

BREAKING: STATEMENT BY PRESIDENT OBAMA AND MRS. OBAMA The killing of Alex Pretti is a heartbreaking tragedy. It should also be a wake-up call to every American, regardless of party, that many of our core values as a nation are increasingly under assault. Federal law enforcement and immigration agents have a tough job. But Americans expect them to carry out their duties in a lawful, accountable way, and to work with, rather than against, state and local officials to ensure public safety. That’s not what we’re seeing in Minnesota. In fact, we’re seeing the opposite. For weeks now, people across the country have been rightly outraged by the spectacle of masked ICE recruits and other federal agents acting with impunity and engaging in tactics that seem designed to intimidate, harass, provoke and endanger the residents of a major American city. These unprecedented tactics—which even the former top lawyer of the Department of Homeland Security in the first Trump administration has characterized as embarrassing, lawless and cruel—have now resulted in the fatal shootings of two U.S. citizens. And yet rather than trying to impose some semblance of discipline and accountability over the agents they’ve deployed, the President and current administration officials seem eager to escalate the situation, while offering public explanations for the shootings of Mr. Pretti and Renee Good that aren’t informed by any serious investigation—and that appear to be directly contradicted by video evidence. This has to stop. I would hope that after this most recent tragedy, administration officials will reconsider their approach, and start finding ways to work constructively with Governor Walz and Mayor Frey as well as state and local police to avert more chaos and achieve legitimate law enforcement goals. In the meantime, every American should support and draw inspiration from the wave of peaceful protests in Minneapolis and other parts of the country. They are a timely reminder that ultimately it’s up to each of us as citizens to speak out against injustice, protect our basic freedoms, and hold our government accountable.

We are actively recruiting for academic cardiac intensivists to staff our growing cardiac intensive care unit demands and needs; interested applicants, please email me at KalraA@upstate.edu and/or Malcolm Miles at MilesMa@upstate.edu.

His name is Alex Jeffrey Pretti. He was 37 years old. He was a licensed nurse. He was recording ICE and defending a female protester from their aggression. And they executed him.

They literally hold hands to stop themselves from drifting apart. Proof that sea otters have the best sleep routine😭 This behavior, known as rafting, is officially the cutest thing on earth.

Beyond the Statin: Navigating the New Frontier of Heart Health 🚀❤️ The "statin-only" era has officially evolved! A 2025 appraisal in JACC: Advances reveals that while statins remain the foundational therapy, we've entered a "Post-Statin Era" defined by a massive, personalized toolkit to slash cardiovascular risk. The 2026 Game-Changers 🧬 The PREVENT Revolution: New PREVENT equations are replacing older models to offer more accurate, race-free risk estimation. However, they often yield lower risk scores, requiring clinicians to use sharper judgment to ensure high-risk patients aren't overlooked. The Power of "Plus": Doubling a statin dose only adds about 6% more LDL-C lowering. But adding non-statin therapies like ezetimibe, PCSK9 inhibitors, or bempedoic acid can reduce levels by an additional 20–50%! The CAC "Tie-Breaker": Coronary Artery Calcium (CAC) scoring is now the ultimate tool for personalizing care. 📸 CAC = 0: May allow for the safe deferral of statins in many patients. CAC ≥ 300: This is considered "Very High Risk"—a danger level similar to having already survived a heart attack. Precision for Every Population 🌍 The findings emphasize that "average" care isn't enough: South Asian Populations: Often face more aggressive disease at lower "traditional" risk levels and may benefit from earlier screening. Younger Adults: 10-year scores often hide a massive lifetime risk; we must look at the 30-year horizon. Women's Health: Managing severe cholesterol during pregnancy requires a careful balance using safe options like bile acid sequestrants. Heart health in 2026 is no longer about a single pill—it’s about a strategy tailored to your unique biology. 🤝✨ #Cardiology #HeartHealth #MedEd #LipidManagement #PostStatinEra #PreventiveMedicine

We urge Indiana lawmakers to reject a appeal and uphold safety provisions that ensure all schools in the state have AEDs, CPR training and emergency action plans- lifesaving tools for kids across the Hoosiers state and the country. @rbehning @mjlehman23 @inacc @ACCinTouch #AED

🫀 The heart doesn’t start beating the way we thought it did. There is no single “starter switch” for the first heartbeat. Recently, scientists captured the exact moment a developing heart goes from complete silence to rhythm, and it happens as a sudden collective event. Instead of a pre-built pacemaker turning on, many heart cells slowly become electrically active. When enough of them cross a critical threshold, the entire tissue synchronizes at once—producing the first coordinated beat. The earliest heartbeats are irregular, but they already spread across the heart, driven by calcium-based electrical signals. The heartbeat begins as a system-level phase transition, one of the clearest examples of emergence in living tissue. Based on research published in Nature (Jia et al., 2023).

Lightning storm over the sea 😲 📍Rio de Janeiro, Brazil ⚡🌊