John Spertus

@f2harrell @wbaker0531 @AndrewJSauer @JACCJournals @RyanTedfordMD @noshreza @mpsotka @suzannevarnold @hvanspall @AHajduczok @TomCascinoMD @robmentz @JeffTeuteberg @MidAmericaHeart This is more complicated than Twitter allows, but would love to discuss with you. We don't feel change is as problematic when adjusted for baseline and the purpose is not to assess differences, but to interpret mean population differences in a clinical framework.

@wbaker0531 @AndrewJSauer @JACCJournals @jspertus @RyanTedfordMD @noshreza @mpsotka @suzannevarnold @hvanspall @AHajduczok @TomCascinoMD @robmentz @JeffTeuteberg @MidAmericaHeart As detailed in the link you quoted, responder analysis is a travesty. I am absolutely stunned that authors as talented as those made such colossal mistakes. NEVER categorize raw data! Rephrase full-information model estimates to give you exactly what you need.

Making Sense of Patient-Reported Outcomes (PROs) and Role for Responder Analyses in Heart Failure Trials A 🧵 highlighting commentary by our group today in @JACCJournals led by @jspertus doi.org/10.1016/j.jacc…

@DocStrom @nih_nhlbi @SmithBIDMC @BidmcCvi @rwyeh @rkwadhera @EricSecemskyMD @kardiologykazi @ZimetbaumP @ASE360 @AKrawisz @BIDMCVFellows @BIDMC_IM @BIDMChealth Congrats!!!!

Well this was a nice email to wake up to today. It's official! Incredibly grateful to be awarded an R01 from @nih_nhlbi to study AS progression through the lens of CKD. Thank you to my mentors @SmithBIDMC @BidmcCvi especially @rwyeh for their support!

@SammourMD @SCAI @HMHCardioFellow @SachinGoelMD @tavrkapadia @djc795 @arnoldgehrke @n_kleiman @WilliamZoghbi @SLittleMD @NadeenFaza So proud of you!!!

Excited to present this work from the TVT registry at @SCAI

@arnoldgehrke @bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD Unlike vague ?s that used to be used (e.g., how much better do you feel now compared with before the trial?), PROs (e.g., KCCQ) ask very concrete questions referring to the last 2 weeks. Seems less likely that patients would have a Rx done a year before influence their answers.

@bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD @jspertus Placebo effect will be larger with procedure vs med, making these shams even more critical (when ethical). Else we have to be more creative in how we try to prove the QOL benefit is not placebo—doable but certainly more difficult. Listened to this podcast this AM—good timing!

Excellent #TranscatheterMitral meeting in York Lots of discussion about the PRIMARY trial - TEER vs surgical MV repair in >65yr olds with DMR Is there sufficient equipoise? Does 🇬🇧 have enough TEER experience to take part? Would TEER vs mini MV rep be better trial? Lots of Qs!

@arnoldgehrke @bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD Also, i find support that the effect was real in ISCHEMIA (no sham) because no SAQ benefit seen in ISCHEMIA-CKD (why would only those without CKD be susceptible to placebo effect?) and the effect size in ISCHEMIA was remarkably similar to ORBITA's, a sham trial of PCI.

@arnoldgehrke @bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD Unlike vague ?s that used to be used (e.g., how much better do you feel now compared with before the trial?), PROs (e.g., KCCQ) ask very concrete questions referring to the last 2 weeks. Seems less likely that patients would have a Rx done a year before influence their answers.

@arnoldgehrke @bjcohenmd @hvanspall @djc795 @ATSandhu @kaulcsmc @dr_benoy_n_shah @drjohnm @FabienPraz @ThomPilgrim @BashirAlaour @drandrewsharp @iamritu @AugustinCoisne @JGrapsa @MadalinaGarbi @Umair2017 @SachinGoelMD While there is no doubt that sham trials are better than open label, I (as you would expect) still feel that the QoL benefits are critical outcomes and not as subject to placebo biases as many inherently believe.

@gcfmd @JeremySussman @ATSandhu @djc795 @HeartBobH @NMHheartdoc @paheidenreich @hmkyale @hvanspall @texhern @JAMACardio The critical need for risk models to have an impact is for there to be a clear difference in management for high vs. low risk pts. How should risk of dying alter care here? Shouldn’t all patients be on GDMT??

@JeremySussman @ATSandhu @djc795 @HeartBobH @NMHheartdoc @paheidenreich @hmkyale @hvanspall @texhern @jspertus @JAMACardio GWTG-HF, OPTIMIZE-HF, IMPROVE-HF, and PROMPT-HF (PI/CDS to ⬆️GDMT) Yet, there have been hundreds of HF risk models published, often stating the rationale being they can be useful/informative for improving care/outcomes Here was a very well conducted RCT test of that hypothesis

Does providing mortality risk prediction improve care/outcomes in 🏨HF? @yaleHFdoc @rkwadhera @NMHheartdoc @texhern Alerting Clinicians to 1-Year Mortality Risk in Patients Hospitalized With Heart Failure ja.ma/3AbRE0p via @JAMACardio part of @JAMANetwork

@hvanspall @gcfmd @ATSandhu @djc795 @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF @StanfordMed Today I was approached by our interventionalists on how to risk stratify elective PCI cases in the setting of a severe contrast shortage. They are going to use the SAQ. Amazing!!

@jspertus @gcfmd @ATSandhu @djc795 @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF @StanfordMed 💯. #HealthStatus data are likely more useful in guiding HF care than diagnostics or intracardiac devices that monitor for decompens’n.. but the latter 2 are viewed as revenue generating (drives use), while former isn’t. How to change this in clinical care? Business plan for 🏥s?

Steep declines in health status immediately before worsening of #HeartFailure Should we me measuring health status of people who contact us with worsening symptoms? ahajournals.org/doi/epdf/10.11… @DLBHATTMD

@hvanspall @gcfmd @ATSandhu @djc795 @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF @StanfordMed I definitely think we need to reimburse for the collection, scoring and interpretation of PROs. Insurance pays $35 for a HbA1c. Why not $5 for a PRO??

@gcfmd @ATSandhu @hvanspall @djc795 @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF @StanfordMed As noted, the costs can be small (much less than what we pay for most tests) and could readily be incorporated into routine care. Once available the advantages for engaging patients, pop health and even triaging btwn virtual and in person visits is limitless

@ATSandhu @hvanspall @djc795 @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @jspertus @EldrinL @paheidenreich @texhern @TheBHF @StanfordMed Getting clinicians to actually act on actionable data is quite the challenge Whether documented medication use gaps, dosing gaps, elevated BP, elevated LDL, symptoms, PROs, etc>… Inertia dominates in most settings

@djc795 @gcfmd @hvanspall @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @EldrinL @paheidenreich @texhern @TheBHF To me, the critical challenge is to have providers value and understand PROs. Patients like to fill them out but are frustrated if providers don’t discuss them. We learned to read ECGs and these are much easier and more useful.

@gcfmd @hvanspall @cpgale3 @MkosiborodMD @mvaduganathan @AmarPut @mmamas1973 @kamleshkhunti @DLBHATTMD @AnastasiaSMihai @DrMarthaGulati @Claire_A_Lawson @escardio @amibanerjee1 @jspertus @EldrinL @paheidenreich @texhern @TheBHF Data completeness is running around 85% at 30-days and 70% at 1-year at this point, but it's a decent amount of unfunded work for the hospitals. It's clear to me that we need a simple way to do this via smartphone to make it a viable long-term strategy.

So Proud of @GreenDirtFarm kshb.com/news/one-tank-…

@akcmahi @kaulcsmc @djc795 @mmamas1973 @fischman_david @SVRaoMD @GreggWStone @agtruesdell @DocSavageTJU @aymanka @AGoldsweig @timir_paul @mirvatalasnag @nolanjimradial @Jakeadoll @StephenWaldoMD 2/2: there is no current economic model to incentivize them to improve. Hospitals don't see the 'costs' of complications, don't really care about value, and won't invest in an infrastructure for delivering personalized medicine.

@akcmahi @kaulcsmc @djc795 @mmamas1973 @fischman_david @SVRaoMD @GreggWStone @agtruesdell @DocSavageTJU @aymanka @AGoldsweig @timir_paul @mirvatalasnag @nolanjimradial @Jakeadoll @StephenWaldoMD 1/2 Very interesting conversation. Key points: 1) Models are useful if you will do something different if they are high or low risk; 2) Clinicians already think they do this intuitively, feel their care is perfect and don't see a need to use a tool to help them and...

So we have established we don’t use bivalurudin in #PCI, how about risk models? @SVRaoMD @GreggWStone @agtruesdell @djc795 @DocSavageTJU @mmamas1973 @aymanka @AGoldsweig @timir_paul @mirvatalasnag @kaulcsmc @nolanjimradial @Jakeadoll @StephenWaldoMD #cardiotwitter

Congrats to the #CHIEF_HF investigators…digital first trial, with drug, & for regulatory indication expansion. Canagliflozin improved quality of life in patients with heart failure. But the trial design even bigger news. Heralds new era in trial implementation. @jspertus #AHA21

@djc795 @DavidLBrownMD @kaulcsmc @GreggWStone @vlgmrc @hect2701 @angioplastyorg @drjohnm @SABOURETCardio @Drroxmehran @ajaykirtane @Hragy @AnastasiaSMihai @JEscaned @MarcoJe80135689 @transradial @DrMarthaGulati @BillONeillMD @DrCindyGrines @webmd11 @DLBHATTMD @rallamee @ProfDFrancis @sbrugaletta @Ortega_Paz @NicolaRyanI1 @DrPascalMeier @w_jyg @AsherElad @ANazmiCalik @aayshacader @ICigalini @guilbon Please Sanjay. Benefits in ISCHEMIA same as ORBITA, but lasted for >3 years. Also, difference >5 points seen in those with SAQ AF Score <=80. We even gave curves you can use for shared decision making to be angina free. You don’t have to judge what is best, let Ur Pts decide!

@DavidLBrownMD @kaulcsmc @jspertus @GreggWStone @vlgmrc @hect2701 @angioplastyorg @drjohnm @SABOURETCardio @Drroxmehran @ajaykirtane @Hragy @AnastasiaSMihai @JEscaned @MarcoJe80135689 @transradial @DrMarthaGulati @BillONeillMD @DrCindyGrines @webmd11 @DLBHATTMD @rallamee @ProfDFrancis @sbrugaletta @Ortega_Paz @NicolaRyanI1 @DrPascalMeier @w_jyg @AsherElad @ANazmiCalik @aayshacader @ICigalini @guilbon 😂

Presented at #EuroPCR, this meta-analysis of ~20,000 stable patients in 25 RCTs showed significant benefit for revasc + MT as opposed to MT alone. Major ICs co-authored: @djkereiakes @Kandzari @MartyMleon @RonWaxman, etc. Controversial? Comments welcomed. buff.ly/2S76G4h

@GreggWStone @DavidLBrownMD @vlgmrc @hect2701 @djc795 @angioplastyorg @drjohnm @kaulcsmc @SABOURETCardio @Drroxmehran @ajaykirtane @Hragy @AnastasiaSMihai @JEscaned @MarcoJe80135689 @transradial @DrMarthaGulati @BillONeillMD @DrCindyGrines @webmd11 @DLBHATTMD @rallamee @ProfDFrancis @sbrugaletta @Ortega_Paz @NicolaRyanI1 @DrPascalMeier @w_jyg @AsherElad @ANazmiCalik @aayshacader @ICigalini @guilbon What baffles me is the insistence by many that recasc needs to improve survival to be valuable and the tortured efforts to show it. If patients have angina it improves symptoms and QoL. That is great! Isn’t it enough???

@DavidLBrownMD @vlgmrc @hect2701 @djc795 @angioplastyorg @drjohnm @kaulcsmc @SABOURETCardio @Drroxmehran @ajaykirtane @Hragy @AnastasiaSMihai @JEscaned @MarcoJe80135689 @transradial @DrMarthaGulati @BillONeillMD @DrCindyGrines @jspertus @webmd11 @DLBHATTMD @rallamee @ProfDFrancis @sbrugaletta @Ortega_Paz @NicolaRyanI1 @DrPascalMeier @w_jyg @AsherElad @ANazmiCalik @aayshacader @ICigalini @guilbon The total number of deaths in the two arms in Ischemia were within one of each other. Long-term all cause mortality was identical, with less than a 10% chance of a 10% or greater difference between treatments.

@thomasjwang1 @UTSWNews So impressive! Great work Will and great for your employees!!

Real world data from @UTSWNews. #VaccinesWork nejm.org/doi/full/10.10…

@KashviGupta @umkcIM @bnallamo @JRGolbus @RamanathanVidya @venkmurthy @RogueRad @JM_Goodrich_EHS @umichsph @samiranmukher93 Speaking on behalf of @umkcIM and @MidAmericaHeart i can say we are so happy to have you joining us. Your reputation precedes you and we are just thrilled to welcome you to Kansas City and see all the great things you will do. Thanks for choosing us!!

Beyond excited to match at my top choice @umkcIM ! Dreams do come true with mentors who believe in us no matter what & I was blessed to have more than one. @bnallamo @JRGolbus @RamanathanVidya @venkmurthy @RogueRad @JM_Goodrich_EHS @umichsph @samiranmukher93