Gregg Fonarow MD

Empagliflozin in De Novo vs Acute Decompensated Chronic Heart Failure: A Prespecified Analysis From EMPULSE In-hospital initiation of empagliflozin produced similar clinical benefits in NHF and ADHF despite the reduced diuretic response in participants with ADHF and was well tolerated. This supports in-hospital initiation of empagliflozin in all patients with acute HF #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @JACCJournals @ACCinTouch @JavedButler1 @mvaduganathan @dranulala @DrMarthaGulati @hvanspall @AndrewJSauer @ankeetbhatt jacc.org/doi/10.1016/j.…

@SJGreene_md @DCRINews @JAHA_AHA @JavedButler1 @ankeetbhatt @AndrewJSauer @AndrewPAmbrosy @dranulala @drbennisahmed @HanCardiomd @ShelleyZieroth @ShahzebKhanMD Quadruple GDMT use in only 2% 🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘🆘

🚨The latest alarming look at real-world use of #GDMTworks for #HF 🇺🇸Optum database 2020-2023 -Enormous gaps in #GDMT use, across the LVEF spectrum -When initiated, usually only after a substantial delay 🤯🤯🤯 @DCRINews @JAHA_AHA ahajournals.org/doi/10.1161/JA…

@juancbatlle @JCardFail @TradIMYale @YaleCardiology Evidence-based strategies to improve the use and dosing of foundational, disease-modifying, life-extending quadruple GDMT for HFrEF

New editorial! 🚨 No Heart Failure Patient Left Behind: Making GDMT a Reality for All @JCardFail @TradIMYale @YaleCardiology onlinejcf.com/article/S1071-…

Medical treatments at 6 months in hospitalized and ambulatory HFrEF patients in the BRING-UP 3 Heart Failure study In this large nationwide cohort, guideline-directed therapies for HFrEF were widely implemented and maintained over 6 months with excellent treatment persistence. However, dose optimization remains a key unmet need in routine clinical practice. #Cardiology #MedTwitter #CardioTwitter #HeartHealth #Healthcare @hfcollaboratory @mvaduganathan @ShelleyZieroth @hvanspall @dranulala @safchat @EJHFEiC @ESC_Journals @escardio academic.oup.com/eschf/article/…

@orion7710 doctorsmagazine.co/qa/how-do-phys…

@gcfmd Any thoughts as to how I should proceed, Dr. Fonarow, as I agree with you over this Cardiologist? Thanks! 4/

@gcfmd Hi! I have an 82 yr-old w HFpEF (EF 60%) whose Creatinine went from Cr 1.26 to Cr 0.90 after Jardiance 10 mg PO qam was held several days. He does not drink enough during the day due to Mild Cognitive Impairment. He also takes Losartan 25 mg po qam for HTN. 1/

An estimated 148 million US adults meet FDA-approved indications for at least one #CKM therapy, including 11 million with eligibility for all three medication classes. ja.ma/3OIEYbc

@orion7710 jacc.org/doi/10.1016/j.…

@gcfmd I can't seem to find the article on syncope/fall risk in people with HFpEF + SGLT2is! I am checking this site.

@brendonneuen doi.org/10.1093/ndt/gf…

Delighted that FIND CKD has meet its primary endpoint. Fantastic news for patients with non-diabetic CKD, including those with GNs, including IgAN Thank you to Bayer, all the investigators, study teams & patients who have made FIND-CKD possible bayer.com/media/en-us/fi…

@orion7710 Current evidence does not show that SGLT2 inhibitors increase syncope or fall risk in patients with HFpEF Large HFpEF trials report no significant rise in symptomatic hypotension, syncope, or falls compared with placebo. acc.org Avoid overdiuresis/vol depletion

@orion7710 Vs placebo, empagliflozin-treated patients had a higher likelihood of being in a lower Frailty category at Weeks 12, 32 and 52 (P < 0.05), odds ratio: 1.12 [95% CI 1.01-1.24] at Week 12, 1.21 [1.09-1.34] at Week 32 and 1.20 [1.09-1.33] at Week 52 doi.org/10.1002/jcsm.1…

Influenza is a well-established trigger for HF , increasing risks of hospitalization, and death. Evidence from RCTs support flu vaccination as a low-cost, scalable strategy to improve outcomes, yet uptake remains suboptimal worldwide (link.springer.com/article/10.100…). #HREV @TorBiering

@dmljmd Agree Both these RCTs conducted in single academic centers How this plays out for invasive testing/revascularization in other settings is less well defined and deserving of further study

@gcfmd But no coronary angios Gregg

There was also more coronary artery disease testing in the notification arm (15.1% [13/86] versus 2.3% [2/87]; P=0.008 In contrast, the Eisner RCT of CAC screening, rates of noninvasive or invasive testing were very similar between CAC and no‑CAC groups (~10% in each arm)

Transparent pricing strategies, value-based contracting, and streamlined access pathways are essential to ensure that therapeutic advances reach all those in need, offering the full potential for clinical impact @NMHheartdoc @AnnMarieNavar

@ATSandhu @boback @HeartBobH @kewatson @HeartDocSadiya @DLBHATTMD @djc795 @texhern Ideally, the strongest evidence for establishing effectiveness, uncovering potential unintended consequences, and being able to determine cost effectiveness/value would come from RCTs powered for clinical outcomes In many cases should be feasible jacc.org/doi/10.1016/j.…

@gcfmd @boback @HeartBobH @kewatson @HeartDocSadiya @DLBHATTMD @djc795 @texhern Yes but to evaluate if they lead to better care quality based on evidence-based processes and to understand right way to implement risk models. Trials to demonstrate plausible (but meaningful) outcome differences probably often too impractical I think

Should risk models, biomarkers, and imaging tests be evaluated in RCTs to evaluate effects on care quality and clinical outcomes? Or unnecessary as it seems highly plausible and self evident they will?

@orion7710 A >10% initial decline in eGFR with SGLT2i was not associated with greater long-term decline in eGFR or more adverse events Further these patients have better HF outcomes Can restart the evidence-based 10 mg dose ahajournals.org/doi/10.1161/CI…

Should the Jardiance be decreased to 5 mg po qam for CHF benefit, if he cannot increase his PO intake, and his Cr rechecked? Thanks! 2/

Influenza vaccination in patients with heart failure: comprehensive review of evidence, challenges, and clinical implications trebuchet.public.springernature.app/get_content/b4… @HFSA @AAHFN @ACCinTouch @AHAScience