Zachary Cox

Join @Zac0x, @BenWangPharmD, and I as we take a deep dive into alternative decongestion strategies in AHF. Conversation will focus on practical considerations and allow for audience discussion and engagement. Oh yeah, and it’s Free! @HFSA @accpcardprn

A scoping review of HF guideline-directed medical therapy scoring systems highlights major heterogeneity in how GDMT implementation is defined, measured, & applied. Check it out, ahead of print in Circulation: Heart Failure Journal @DouglasLeeMD @nimamogh ahajrnls.org/4mpPAZo

@wbaker0531 @EiranGorodeski We are currently using similar methods for bolus doses up to 500mg of iv furosemide equivalents with a controlled infusion rate in multiple cohorts. Hope to publish this data soon and share the results.

BUSTING A #MYTH: High-dose loop diuretics do not result in hearing loss!! #HFSA2025

@wbaker0531 @EiranGorodeski I agree. Infusion rate is an important factor. This data is from the FASTR trial where iv lasix was given as a continuous infusion. This is a big step forward in that high cumulative dose is not associated with ototoxicity measures but doesn’t directly address large bolus doses.

We randomized patients with diuretic resistance to IV loop dose increase vs adding a thiazide in the LOT-MDR trial. I will present the late-breaking results shortly at #ESCCongress Join us if you are available.

Our review on drugs and devices for decongestion in #heartfailure is available @NatRevCardiol x.com/NatRevCardiol/… @LipscombPharmD @YaleHF @kevin_damman

🔥 New brief report describes a first-in-human feasibility study to evaluate the safety/efficacy of the Reprieve System, a bedside fluid mgmnt device that can 1) measure UO 2) semi-auto titrate IV diuretics 3) titrate saline replacement #THT2025 🔗 bit.ly/4huGrvq

At #THT2025, experts dive into the complex role of salt in #HeartFailure 🧂, from molecular mechanisms 🧬 to clinical trials 📊 and real-world management 🏥. Don’t miss the latest insights, crucial data, and a debate on salt restriction! ⚖️💡 @mrchrtfaildoc @JanBiegus @zac0x

A 🕵🏽‍♀️ theme for our session on myocardial recovery vs. remission — drugs, devices, and the interplay of them all with @VarinderKaurRa1 @FilioBillia @Zac0x @docbhardwaj Dr. Joe Rogers and Dr. Jerry Estep #HFSA2024 @HFSA

Costs? Intolerance? Inertia? Other? Primary reason for gaps in #GDMTworks endlessly debated. 🤔What if we had US physicians audit their own patient charts & report *WHY* they didn’t prescribe #GDMT for #HFrEF in each case? 🚨 Results in @JACCJournals jacc.org/doi/epdf/10.10…

Join us at kick off sessions #HFSA2024 on Heart Recovery: Just the Facts, Ma'am! Looking forward to share thoughts on temporary #MCS & insightful discussions with thought leaders! 📆 9/27/24 🕰️ 500 pm EST @JRogersMD1 @JerryEstepMD @Zac0x @FilioBillia @emanrashed01 @noshreza

@DmitryAbramovMD @FH_Verbrugge @kevin_damman Not to my knowledge. Would love to learn of one if someone knows.

Are there any trials of escalation of oral vs. IV diuretics in AHF ongoing/planned? Given rise of IV diuretics clinics, subq furosemide, hospital-at-home, etc, seems like an important clinical question, and can use uNa as a surrogate outcome. @Zac0x @FH_Verbrugge @kevin_damman

Check out our review on "SGLT2i and GU infections" in @JACCJournals 🔗: shorturl.at/gsGL7 Here we discuss - SGLT2i mechanisms/benefits - Trial/real-world evidence of SGLT2i/GU ifx - Risk factors - Practice considerations 🧵 to follow (1/5)

In #DICTATE trial, dapagliflozin was safe to start first day of AHF hospitalization before stabilization to optimize #GDMT & improve some measures of diuresis. #SGLT2i should be started immediately or continued in most pts hospitalized for AHF bit.ly/3VK4fmK #JACC @Zac0x

2) Compared to a standardized IV diuretic titration protocol (net negative goal of 2-3L/day), dapagliflozin did not improve weight-based diuretic efficiency but did improve several other key measures of diuretic efficacy including UOP, natriuresis, and shorter time of IV diuresis

1) Initiation of dapa within 24hrs of presentation for AHF before stabilization was safe across cardiorenal, infectious, and diabetic outcomes in-hospital alleviating concerns of increased of AE during hospitalization.

Our findings on early initiation of #dapagliflozin in acute HF are out in @JACCJournals now. #DICTATE @VUMC_heart @LipscombPharmD authors.elsevier.com/a/1isAB2d9GH%7… A quick thread on the key findings

Despite #dapagliflozin not improving diuretic efficiency in the setting of acute HF hospitalization, it was associated with fewer diuretic doses to achieve the same weight change as usual care @ACCinTouch @Zac0x #Cardiotwitter @LipscombPharmD Read more👇 healio.com/news/cardiolog…

Happy #WorldDownSyndromeDay My son Cooper brightens our day. Hope you have a friend with Down Syndrome in your life to enrich your days too.