Podcasts about hfpef

In this episode, Dr. Harlan Krumholz reviews the September 9, 2025 issue of JACC, covering key studies on artificial intelligence in cardiovascular research, the effects of tirzepatide in heart failure with preserved ejection fraction (HFpEF), and how social, racial, and genetic factors influence heart failure risk. He discusses the growing burden of heart failure in the elderly, the need to disaggregate data in Asian American and Pacific Islander populations, and the role of rare genetic variants in atrial fibrillation outcomes. The episode also features perspectives on clinical trial design, complex case reports, and emphasizes the need for AI submissions to meet high standards of clinical relevance, feasibility, and long-term impact.

Please visit answersincme.com/QWE860 to participate, download slides and supporting materials, complete the post test, and obtain credit. In this activity, an expert in cardiology discusses the evolving role of mineralocorticoid receptor antagonists (MRAs) to treat patients with heart failure. Upon completion of this activity, participants should be better able to: Identify the evolving role of mineralocorticoid receptor antagonists (MRAs) to treat patients with heart failure; Evaluate clinical implications of the latest data on nonsteroidal MRAs for the treatment of heart failure and mildly reduced ejection fraction (HFmrEF) or heart failure and preserved ejection fraction (HFpEF), in the context of current standard-of-care; and Describe strategies to incorporate nonsteroidal MRAs into the treatment plans of patients with HFmrEF or HFpEF.

Interview with Margaret Infeld, MD, MS, author of Clinical Outcomes With Personalized Accelerated Physiologic Pacing in Heart Failure With Preserved Ejection Fraction: Follow-Up of the myPACE Trial. Hosted by Robert Bonow, MD. Related Content: Clinical Outcomes With Personalized Accelerated Physiologic Pacing in Heart Failure With Preserved Ejection Fraction

Interview with Margaret Infeld, MD, MS, author of Clinical Outcomes With Personalized Accelerated Physiologic Pacing in Heart Failure With Preserved Ejection Fraction: Follow-Up of the myPACE Trial. Hosted by Robert Bonow, MD. Related Content: Clinical Outcomes With Personalized Accelerated Physiologic Pacing in Heart Failure With Preserved Ejection Fraction

Join us as we review recent practice-changing articles on cannabidiol (CBD)-induced liver injury, IV iron for HFrEF, bedtime administration of blood pressure meds, carpal tunnel syndrome & rheumatoid arthritis , & FDA approval of finerenone for HFpEF. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), Nora Taranto (@norataranto) and Matt Watto (@doctorwatto). Claim CME for this episode at curbsiders.vcuhealth.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Credits Written and Hosted by: Rahul Ganatra MD, MPH; Nora Taranto MD, Paul Williams, MD, FACP, Matthew Watto MD, FACP Cover Art: Rahul Ganatra MD, MPH Reviewer: Emi Okamoto, MD Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer CBD-induced liver injury IV Iron in HFrEF Bedtime administration of BP medications Carpal tunnel syndrome and RA FDA approves Finerenone for HFpEF Outro Sponsor: Permanente Want to join thousands of physicians who've made TPMG their career destination? Discover more at northerncalifornia.permanente.org

CardioNerds (Drs. Rick Ferraro and Georgia Vasilakis Tsatiris) discuss ATTR cardiac amyloidosis with expert Dr. Justin Grodin. This episode is a must-listen for all who want to know how to diagnose and treat ATTR with current available therapies, as well as management of concomitant diseases through a multidisciplinary approach. We take a deep dive into the importance of genetic testing, not only for patients and families, but also for gene-specific therapies on the horizon. Dr. Grodin draws us a roadmap, guiding us through new experimental therapies that may reverse the amyloidosis disease process once and for all.  Audio editing by CardioNerds academy intern, Christiana Dangas. This episode was developed in collaboration with the American Society of Preventive Cardiology and supported by an educational grant from BridgeBio.  Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here.  CardioNerds Cardiac Amyloid PageCardioNerds Episode Page Pearls: You must THINK about your patient having amyloid to recognize the pattern and make the diagnosis. Start with a routine ECG and TTE, and look for a disproportionately large heart muscle with relatively low voltages on the ECG.  Before you diagnose ATTR amyloidosis, AL amyloidosis must be ruled out (or ruled in) with serum light chains, serum/urine immunofixation, and/or tissue biopsy.  Genetic testing is standard of care for all patients and families with ATTR amyloidosis, and the future is promising for gene-specific treatments. Current FDA-approved treatments for TTR amyloidosis are TTR stabilizers and TTR silencers, but TTR fibril-depleting agents are on their way.  Early diagnosis of ATTR affords patients maximal benefit from current amyloidosis therapies.   TTR amyloidosis patients require a multidisciplinary approach for success, given the high number of concomitant diseases with cardiomyopathy.  Notes: Notes: Notes drafted by Dr. Georgia Vasilakis Tsatiris.  What makes you most suspicious of a diagnosis of cardiac amyloidosis from the typical heart failure patient?  You must have a strong index of suspicion, meaning you THINK that the patient could have cardiac amyloidosis, to consider it diagnostically. Some characteristics or “red flags” to not miss:   Disproportionately thick heart muscle with a relatively low voltages on EKG   Bilateral carpal tunnel syndrome – estimated that 1 in 10 people >65 years old will have amyloidosis   Previously tolerated antihypertensive medications  Atraumatic biceps tendon rupture   Bilateral carpal tunnel syndrome  Spinal stenosis   Concomitant with other diseases: HFpEF, low-flow low-gradient aortic stenosis  How would you work up a patient for cardiac amyloidosis?   Start with a routine ECG (looking for disproportionally low voltage) and routine TTE (looking for thick heart muscle)  CBC, serum chemistries, hepatic function panel, NT proBNP, and troponin levels  NOTE: It is critical to differentiate between amyloid light chain (AL amyloidosis) and transthyretin ATTR amyloidosis, as both make up 95-99% of amyloidosis cases.   Obtain serum free light chains, serum & urine electrophoresis, and serum & urine immunofixation to rule out AL amyloidosis. (See table below)  AL Amyloidosis ATTR Amyloidosis  → Positive serum free light chains and immunofixation (Abnormal M protein) → Tissue biopsy (endomyocardial, fat pad) to confirm diagnosis → Negative serum free light chains and immunofixation (ruled out AL amyloidosis) → Cardiac scintigraphy (Technetium pyrophosphate with SPECT imaging)  What treatment options do we have to offer now for ATTR CM, and how has this compared to prior years?   Before 2019, treatment options were limited outside of cardiac tr...

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Dr. Warick Bishop, a cardiologist and CEO of the Healthy Heart Network, invites Dr. Fiona Foo, a cardiologist specializing in heart failure, to discuss heart failure with preserved ejection fraction (HFpEF). HFpEF is defined as the heart's inability to relax well, leading to symptoms like shortness of breath and fluid buildup. Risk factors for HFpEF include age, hypertension, obesity, diabetes, and certain medical conditions like chronic kidney disease and chronic obstructive pulmonary disease. Women, especially after menopause, are at higher risk due to specific factors like pregnancy-related hypertensive disorders. The podcast concludes with a teaser for a part two episode focusing on HFpEF management and prevention strategies. Dr. Bishop emphasizes the importance of feedback and sharing the podcast to help raise awareness about heart health.

Drs. Rick Ferraro and Sneha Nandy discuss ‘Diagnosis of ATTR Cardiac Amyloidosis' with Dr. Venkatesh Murthy.  In this episode, we explore the diagnosis of ATTR cardiac amyloidosis, a condition once considered rare but now increasingly recognized due to advances in imaging and the availability of effective therapies. Dr. Venkatesh Murthy, a leader in multimodality imaging, discusses key clinical and laboratory features that should raise suspicion for the disease. We also examine the role of nuclear imaging and genetic testing in confirming the diagnosis, as well as the importance of early detection. Tune in for expert insights on navigating this challenging diagnosis and look out for our next episode on treatment approaches for cardiac amyloidosis! Audio editing for this episode was performed by CardioNerds Intern, Julia Marques Fernandes. Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here.  CardioNerds Cardiac Amyloid PageCardioNerds Episode Page Pearls: - Diagnosis of Transthyretin amyloid cardiomyopathy 1. Recognizing the Red Flags – ATTR cardiac amyloidosis often presents with subtle but telling signs, such as bilateral carpal tunnel syndrome, low-voltage ECG, and a history of lumbar spinal stenosis or biceps tendon rupture. If you see these features in a patient with heart failure symptoms, think amyloidosis!    2. “Vanilla Ice Cream with a Cherry on Top” – On strain echocardiography, apical sparing is a classic pattern for cardiac amyloidosis. While helpful, it's not foolproof—multimodal imaging and clinical suspicion are key!   3. Nuclear Imaging is a Game-Changer – When suspicion for cardiac amyloidosis is high à a positive PYP scan with SPECT imaging (grade 2 or 3 myocardial uptake) in the absence of monoclonal protein (ruled out by SPEP, UPEP, and free light chains) is diagnostic for ATTR amyloidosis—no biopsy needed!   4. Wild-Type vs. Hereditary? Know the Clues – Older patients (70+) are more likely to have wild-type ATTR, while younger patients (40s-60s), especially those with neuropathy and a family history of heart failure, should raise suspicion for hereditary ATTR. Genetic testing is crucial for distinguishing between the two. Note that some ATTR variants may predispose to a false negative PYP scan!  5. Missing Amyloidosis = Missed Opportunity – With multiple disease-modifying therapies now available, early diagnosis is critical. If you suspect cardiac amyloidosis, don't delay the workup—early treatment improves outcomes!   Notes - Diagnosis of Transthyretin amyloid cardiomyopathy What clinical features should raise suspicion for ATTR cardiac amyloidosis?   ATTR cardiac amyloidosis is underdiagnosed because symptoms overlap with other forms of heart failure.   Red flags include bilateral carpal tunnel syndrome (often years before cardiac symptoms), low-voltage ECG despite increased LV wall thickness, heart failure with preserved ejection fraction (HFpEF) with a restrictive pattern, and history of lumbar spinal stenosis, biceps tendon rupture, and/or peripheral neuropathy, including possible autonomic dysfunction (e.g., orthostatic hypotension).  Remember: If an older patient presents with heart failure and unexplained symptoms like neuropathy or musculoskeletal issues, think amyloidosis!   What is the differential diagnosis for a thick left ventricle (LVH) and how does ATTR amyloidosis fit into it?    Hypertension: Most common cause of LVH, typically with a history of uncontrolled high blood pressure.   Aortic stenosis: May present with concentric LVH.   Hypertrophic cardiomyopathy (HCM): Genetic disorder typically presenting with asymmetric LVH, especially in younger patients.   Infiltrative cardiomyopathy: Often due to amyloidosis, sarcoidosis,

In this episode of JACC This Week, Editor-in-Chief Dr. Harlan Krumholz introduces the journal's new design and highlights key studies from the July 29, 2025 issue. Topics include the under-expansion analysis of the ACURATE NEO2 valve, the impact of tirzepatide in obesity-related HFpEF, the effects of private equity ownership on heart failure care, and evolving strategies for managing multivalve disease.

Welcome to HCPLive's 5 Stories in Under 5—your quick, must-know recap of the top 5 healthcare stories from the past week, all in under 5 minutes. Stay informed, stay ahead, and let's dive into the latest updates impacting clinicians and healthcare providers like you! Interested in a more traditional, text rundown? Check out the HCPFive! Top 5 Healthcare Headlines for July 7-13, 2025: FDA Approves Finerenone (Kerendia) for Heart Failure with Ejection Fraction of 40% or More Finerenone (Kerendia) was approved on July 14, 2025, to reduce cardiovascular death and heart failure hospitalizations in adults with HFmrEF or HFpEF, based on data from the FINEARTS-HF trial. Baxdrostat Meets Efficacy Endpoint in Phase 3 Trial for Resistant Hypertension In the phase 3 BaxHTN trial, baxdrostat significantly reduced systolic blood pressure in patients with resistant hypertension, supporting its potential as a first-in-class aldosterone synthase inhibitor. FDA Approves Updated VARIPULSE Platform Irrigation Flow Rate for Heart Disease The FDA approved an updated irrigation flow rate for the VARIPULSE Platform, which has been used in over 10,000 procedures with a reported neurovascular adverse event rate of less than 0.5%. Palopegteriparatide Provides Sustained Response in Adults with Hypoparathyroidism Palopegteriparatide showed durable 3-year improvements in biochemistries, kidney function, and quality of life across all forms of hypoparathyroidism in the phase 3 PaTHway trial. FDA Grants Orphan Drug Designation to Taladegib, Potential Idiopathic Pulmonary Fibrosis Treatment Taladegib received Orphan Drug Designation on July 16, 2025, as a potential treatment for idiopathic pulmonary fibrosis, currently being studied in the phase 2b WHISTLE-PF trial.

Witam Państwa, nazywam się Jarosław Drożdż, pracuję w Centralnym Szpitalu Klinicznym Uniwersytetu Medycznego w Łodzi, skąd nagrywam podcast Kardio Know-How. W tym odcinku przedstawiam nową możliwość terapeutyczną w amyloidozie. Amyloidoza transtyretynowa (ATTR) to rzadka choroba spichrzeniowa, w której nieprawidłowe białko TTR odkłada się w sercu, prowadząc do kardiomiopatii przerostowej i niewydolności serca typu HFpEF. Wyróżniamy dwie postaci ATTR: dziedziczną (ATTRv) z mutacjami w genie TTR oraz postać dziką (ATTRwt), występującą głównie u starszych mężczyzn. Przełomem terapeutycznym stał się tafamidis – lek stabilizujący tetramer TTR, a ostatnio także vutrisiran – siRNA redukujące syntezę TTR w wątrobie, który w badaniu HELIOS-B wykazał 36% redukcji śmiertelności. Rozpoznanie ATTR opiera się na scyntygrafii, badaniach genetycznych i obrazowych (ECHO, CMR). Wczesna diagnoza i wdrożenie leczenia mogą znacząco poprawić rokowanie pacjentów, dlatego interdyscyplinarna współpraca i znajomość nowych terapii są kluczowe. Szczegółowy TRANSKRYPT do odcinka.Podcast jest przeznaczony wyłącznie dla osób z profesjonalnym wykształceniem medycznym.

Witam Państwa, nazywam się Jarosław Drożdż, pracuję w Centralnym Szpitalu Klinicznym Uniwersytetu Medycznego w Łodzi, skąd nagrywam podcast Kardio Know-How. W tym odcinku omawiam doniesienia z HFA ESC 2025.1. Kongres HFA ESC 2025 odbył się w Belgradzie, a omawiane były tam nowe dane z badania FINEARTS-HF, dotyczącego działania finerenonu u pacjentów z HFmrEF i HFpEF.2. Finerenon zmniejszał zgony sercowo-naczyniowe i hospitalizacje z powodu NS o 17%, ale nie osiągnięto istotności statystycznej w zakresie przeżycia.3. Analiza wykazała, że wcześniejsze wdrożenie finerenonu po zaostrzeniu NS daje lepsze efekty kliniczne.4. Nowością było badanie efektu odstawienia finerenonu, podobne do wcześniejszego badania flozyn (EMPEROR), gdzie po odstawieniu leku pogarszały się wyniki kliniczne.5. W FINEARTS-HF odstawienie finerenonu powodowało 180% wzrost powikłań, co stanowi silny argument za jego kontynuacją.6. Nowe japońskie wytyczne jako pierwsze zalecają finerenon w HFpEF – pełny tekst: https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-25-0002/_pdf/-char/en7. Opublikowane wyniki FINEARTS-HF: https://pubmed.ncbi.nlm.nih.gov/405051588. FAIR-HF-2 z kolei potwierdziło skuteczność dożylnego żelaza (karboksymaltozy) u pacjentów z NS i TSAT

In this episode of Medicine Grand Rounders, Dr. Sanjeeb Bhattacharya - Director of the HFpEF clinic and Associate Program Director of the HVTI heart failure fellowship - goes over various clinical presentations of heart failure with preserved ejection fraction. Moderated by: Yasmine K. Elghoul, MD

“Obesity Rx

CME credits: 1.00 Valid until: 20-06-2026 Claim your CME credit at https://reachmd.com/programs/cme/expert-perspectives-on-nonsteroidal-mras-and-cardiorenal-protection/32990/ Heart failure with mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) represent a significant and growing burden for patients and the healthcare system, not only in cardiovascular medicine, but also in the context of cardio-kidney-metabolic (CKM) syndrome. Trials are underway evaluating new therapies that may offer benefits to patients with HFmrEF/HFpEF and may also have broader, multisystem effects. Tune in to stay up to date! =

In this podcast, Ty J. Gluckman, MD, MHA, discusses the pivotal phase III FINEARTS-HF trial and how the treatment landscape is evolving for patients with heart failure (HF) with mildly reduced or preserved ejection fraction, including:The emerging role of mineralocorticoid receptor antagonists in HF careFinerenone's efficacy in reducing composite cardiovascular death and worsening HF events Why safety must be monitored, especially considering hyperkalemia riskWhere HF guideline recommendations lack compared with the current evidence PresenterTy J. Gluckman, MD, MHAMedical Director, Center for Cardiovascular Analytics, Research, and Data Science (CARDS)Providence Heart InstituteProvidence Health SystemPortland, OregonProgram page: https://bit.ly/448XcH0

With Kevin Damman, University Medical Center Groningen, Groningen - The Netherlands, Floran Sahiti, University Hospital of Wurzburg, Wurzburg - Germany, Joao Pedro Ferreira, University of Porto, Porto - Portugal, Novi Yanti Sari, Siloam Hospitals Group, Jakarta - Indonesia, Marat Fudim, Duke University Medical Center, Durham, NC - USA, Gregorio Tersalvi, Mayo Clinic, Rochester, MN - USA, Jose Luis Morales Rull, University Hospital Arnau de Vilanova, Lleida - Spain and Cornelia Margineanu, Bucharest - Romania. In this episode, we discuss four late-breaking clinical trials presented at the Heart Failure Congress 2025 in Belgrade, Serbia. First, Kevin Damman presents the results of FUTURE-HF, a first-in-human study evaluating the long-term safety, accuracy, and clinical utility of a novel implantable IVC sensor for remote heart failure management. Next, Joao Pedro Ferreira highlights the key findings of SOGALDI-PEF, a crossover trial comparing SGLT2 inhibitor monotherapy versus combination therapy with an SGLT2 inhibitor and a mineralocorticoid receptor antagonist (MRA) in reducing NT-proBNP levels. Third, Marat Fudim reports on the MUSIC-HFpEF phase 1/2a trial, which explores the safety and preliminary efficacy of a novel gene therapy using adeno-associated virus vectors in patients with HFpEF. Finally, Jose Luis Morales Rull shares insights from PREFER-HF, a study assessing the effects of intravenous or oral iron therapy versus placebo in patients with HFpEF and iron deficiency anemia. FUTURE-HF: Long-term safety, accuracy, and utility of a novel implantable IVC sensor for remote HF management - Kevin Damman, University Medical Center Groningen, Groningen, The Netherlands. Host: Floran Sahiti, University Hospital of Wurzburg, Wurzburg, Germany doi: 10.1016/j.jchf.2025.01.019. SOGALDI-PEF: SOdium-Glucose cotransporter 2 inhibitor with and without an ALDosterone AntagonIst for heart failure with preserved ejection fraction – Joao Pedro Ferreira, University of Porto, Porto, Portugal. Host: Novi Yanti Sari, Siloam Hospitals Group, Jakarta (Indonesia).  MUSIC-HFpEF: Gene therapy in Heart Failure with Preserved Ejection Fraction – Marat Fudim, Duke University Medical Center, Durham, NC, USA. Host: Gregorio Tersalvi, Mayo Clinic, Rochester, MN, USA PREFER¬-HF: Effects intravenous iron or oral iron therapy compared to placebo in HFpEF with iron deficiency anemia - Jose Luis Morales Rull, University Hospital Arnau de Vilanova, Lleida, Spain. Host: Cornelia Margineanu, Bucharest, Romania. This 2025 HFA Cardio Talk podcast series is supported by Bayer AG in the form of an unrestricted financial support. The discussion has not been influenced in any way by its sponsor.

CME credits: 0.25 Valid until: 10-06-2026 Claim your CME credit at https://reachmd.com/programs/cme/innovative-approaches-to-managing-ckm-syndrome-and-hfmrefhfpef/29912/ Listen to Dr. Riccardo Inciardi's summary from the ESC Preventive Cardiology 2025 meeting, where he highlights new therapies reshaping the management of cardio-kidney-metabolic (CKM) syndrome and heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). Watch as he breaks down the latest clinical trial data showing that SGLT2 inhibitors, GLP-1 receptor agonists, and the nonsteroidal MRA finerenone can meaningfully reduce hospitalizations, kidney disease progression, and cardiovascular mortality. A real-life patient case illustrates how combining these therapies—under the care of a multidisciplinary team—can transform outcomes.=

Listener feedback on cardiac sarcoidosis, out-of-hospital cardiac arrest, less is more when it comes to post-stent antiplatelets, lipoprotein(a), and atrial fibrillation in HFpEF are discussed by John Mandrola, MD, in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Mathijssen https://doi.org/10.1093/eurheartj/ehaf338 Poyhonen https://doi.org/10.1161/CIRCEP.124.013239 II News in out of hospital cardiac arrest AHA Press Release https://newsroom.heart.org/news/nfl-safety-justin-reid-expands-cpr-education-for-youth-through-summer-program Chan et al https://www.ahajournals.org/doi/abs/10.1161/CIRCOUTCOMES.124.011799 III Post-Stent Antiplatelet 4D ACS trial https://eurointervention.pcronline.com/article/one-month-dual-antiplatelet-therapy-followed-by-prasugrel-monotherapy-at-a-reduced-dose-the-4d-acs-randomised-trial IV Lp(a) and the new PREVENT equation for Predicting cardiac events Aug 02, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001429 Bhatia et al https://jamanetwork.com/journals/jamacardiology/fullarticle/2835022 V AF in HFpEF Saksena et al https://doi.org/10.1093/europace/euad095 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

In this episode, CardioNerds Dr. Anna Radakrishnan and Dr. Apoorva Gangavelli are joined by prevention expert Dr. Martha Gulati and heart failure expert Dr. Anu Lala to discuss heart failure with preserved ejection fraction (HFpEF), a multifactorial, evolving challenge, particularly in women. In this episode, we delve into the distinctive clinical presentation and pathophysiology of HFpEF among women, exploring both traditional and gender-specific risk factors, from metabolic and inflammatory processes to the impact of obesity, sleep apnea, and gender-specific conditions. We also discussed the latest evidence on prevention strategies and emerging therapies that not only target HFpEF symptoms but also address underlying risk factors. This conversation highlights the importance of multidisciplinary, holistic care to advance diagnosis, management, and ultimately, patient outcomes for women with HFpEF. Audio editing by CardioNerds academy intern, Christiana Dangas.  Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - HFpEF in Women HFpEF Is a Multisystem Syndrome:HFpEF in women involves more than just diastolic dysfunction—it represents a convergence of metabolic, inflammatory, and hormonal factors that make its diagnosis and management uniquely challenging. Visceral Adiposity Drives Risk:Obesity isn't just excess weight; central or visceral adiposity actively promotes inflammation, insulin resistance, and microvascular dysfunction, which are crucial in triggering HFpEF in women. Early Identification Is Key:Recognizing—and treating—subtle risk factors such as sleep-disordered breathing, hypertension, and subtle metabolic dysfunction early, especially in women who may underreport symptoms, can prevent progression to HFpEF. Holistic, Lifespan Approach Matters:Effective HFpEF care involves managing the whole cardiometabolic profile with tailored lifestyle interventions, advanced medications (e.g., SGLT2 inhibitors, GLP-1 agonists), and even cardiac rehabilitation, which remain critical at every stage, even after diagnosis. Tailoring Prevention to Unique Risks in Women:Gender-specific factors such as postmenopausal hormonal changes, pregnancy-related complications, and autoimmune conditions demand a customized prevention strategy, reminding us that prevention isn't one-size-fits-all. Show notes - HFpEF in Women Notes drafted by Dr. Apoorva Gangavelli 1. What are the gender-based differences in HFpEF presentation? HFpEF in women often presents with more subtle symptoms such as exertional dyspnea and fatigue, which may be mistakenly attributed to aging or obesity. Women tend to have a higher prevalence of preserved ejection fraction despite a similar heart failure symptom burden to men. The diagnostic challenge is compounded by lower natriuretic peptide levels influenced by hormonal factors, particularly postmenopausal estrogen deficiency, leading to false negatives and underdiagnosis. 2. How do traditional and gender-specific risk factors contribute to the development of HFpEF in women? Traditional risk factors include obesity, hypertension, diabetes, and metabolic syndrome. Gender-specific risk factors encompass pregnancy-related complications, menopause, and autoimmune diseases, which may uniquely affect cardiovascular structure and function in women. The interaction between visceral adiposity and systemic inflammation is central in predisposing women to HFpEF. 3. What underlying pathophysiological mechanisms make women more susceptible to HFpEF? Chronic inflammation and endothelial dysfunction contribute to myocardial stiffness and diastolic dysfunction. ...

The literature shows that the incidence of heart failure with preserved ejection fraction (HFpEF) increases significantly in postmenopausal women, but how can researchers study the underlying mechanisms? In our latest episode, Dr. Jonathan Kirk (Loyola University Chicago) interviews lead author Dr. Mei Methawasin (University of Missouri, Columbia) and expert Dr. Glen Pyle (University of Guelph) about the recent study by Methawasin and co-authors investigating sex differences, menopause and HFpEF. The authors created an animal model that resembles HFpEF in women undergoing natural menopause by using 4-vinylcyclohexene dioxide (VCD) to induce “ovary-intact” menopause, combined with the 2hit regimen (HFpEF inducing regimen) to model postmenopausal HFpEF. Combining echocardiography, pressure-volume and single-cell analyses, the authors found that VCD mice, compared to ovariectomized mice and premenopausal mice, have higher testosterone levels compared to other models. By developing this robust phenotype animal model, the authors open new avenues for investigating therapeutic targets in other hormones beyond estrogen alone. Ready to explore the estrobolome, the importance of animal models of human disease, and the complex family of hormones comprising estrogen? Listen now.   Mei Methawasin, Joshua Strom, Vito A. Marino, Jochen Gohlke, Julia Muldoon, Shelby R. Herrick, Robbert van der Piji, John P. Konhilas, Henk Granzier An ovary-intact postmenopausal HFpEF mouse model; menopause is more than just estrogen deficiency Am J Physiol Heart Circ Physiol, published March 10, 2025. DOI: 10.1152/ajpheart.00575.2024

CME credits: 0.25 Valid until: 30-05-2026 Claim your CME credit at https://reachmd.com/programs/cme/shifting-treatment-paradigm-in-hfmrefhfpef-steroidal-and-nonsteroidal-mras/29908/ Join Drs. John McMurray and Faiez Zannad as they explore the evolving role of MRAs in heart failure management. From RALES and TOPCAT to the recent FINEARTS-HF trial, they highlight key findings that shape how steroidal and nonsteroidal MRAs are used in clinical practice. Discover how the nonsteroidal MRA finerenone is expanding treatment options for patients with HFmrEF and HFpEF.=

Hosts Mitsuaki Sawano, MD, and co-hosts Kentaro Ejiri, MD, and Satoshi Shoji, MD, are joined by HFpEF expert Hidehiro Yaku, MD, from Northwestern University, for a deep dive into early treatment response to acoramidis, an amyloid stabilizer recently approved in Japan. They discuss its impact on serum transthyretin (sTTR) levels and the emerging role of sTTR as a dynamic biomarker of treatment efficacy. The episode explores the clinical relevance of early sTTR elevation, key insights from the ATTRibute-CM trial—including mediation and logistic regression analyses—and the use of waterfall plots to visualize treatment response. The team also compares acoramidis with tafamidis and vutrisiran, and looks ahead to the evolving therapeutic landscape of ATTR-CM, including gene editing and amyloid removal strategies.

In a Deep Dive in our May 13 issue, Editor-in-Chief Harlan Krumholz, MD, SM, FACC, discusses a study led by Barry Borlaug that investigates whether excess weight or metabolic dysfunction has a greater impact on heart failure with preserved ejection fraction (HFpEF). The findings showed that obesity—more than insulin resistance—was strongly associated with worse hemodynamic and functional outcomes. Reviewers praised the study's nuanced approach and use of invasive measures, while editorialists emphasized the ongoing importance of addressing both adiposity and metabolic health in HFpEF management.

This JACC Deep Dive in our May 13 issue highlights new findings from the SUMMIT CKD study, showing that terzepatide improves symptoms, function, and weight in patients with HFpEF and obesity—regardless of kidney function. The analysis also underscores the importance of using both creatinine and cystatin C to better assess kidney health. Reviewers praised the study's methodological rigor and dual focus, while noting the need for larger, long-term trials to confirm renal outcomes.

In this podcast, Dr. Valentin Fuster reviews findings from the SUMMIT trial, which examined how tirzepatide impacts patients with obesity-related heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease (CKD). The study revealed that while tirzepatide improved cardiovascular outcomes and slightly boosted kidney function, the benefits in CKD patients may stem from mechanisms beyond glomerular filtration alone.

Drs Carol H. Wysham and Christopher M. Kramer discuss heart failure and type 2 diabetes, and the role of incretin therapies in the management of HFpEF. Relevant disclosures can be found with the episode show notes on Medscape https://www.medscape.com/viewarticle/1002048. The topics and discussions are planned, produced, and reviewed independently of advertisers. This podcast is intended only for US healthcare professionals. Resources The Incidence of Congestive Heart Failure in Type 2 Diabetes: An Update https://pubmed.ncbi.nlm.nih.gov/15277411/ Hypertension in Diabetes: An Update of Basic Mechanisms and Clinical Disease https://pubmed.ncbi.nlm.nih.gov/34601960/ Type 2 Diabetes Mellitus and Heart Failure: A Scientific Statement From the American Heart Association and the Heart Failure Society of America: This statement does not represent an update of the 2017 ACC/AHA/HFSA heart failure guideline update https://pubmed.ncbi.nlm.nih.gov/31167558/ Insulin Resistance and Hyperinsulinaemia in Diabetic Cardiomyopathy https://pubmed.ncbi.nlm.nih.gov/26678809/ Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2024 https://pubmed.ncbi.nlm.nih.gov/38078592/ The Paradox of Low BNP Levels in Obesity https://pubmed.ncbi.nlm.nih.gov/21523383 Tirzepatide for Heart Failure With Preserved Ejection Fraction and Obesity https://pubmed.ncbi.nlm.nih.gov/39555826/ Cardiovascular Effects of Incretin-Based Therapies: Integrating Mechanisms With Cardiovascular Outcome Trials https://pubmed.ncbi.nlm.nih.gov/35050311/ Beyond Weight Loss: the Emerging Role of Incretin-Based Treatments in Cardiometabolic HFpEF https://pubmed.ncbi.nlm.nih.gov/38294187/ Heart Failure With Preserved Ejection Fraction: Mechanisms and Treatment Strategies https://pubmed.ncbi.nlm.nih.gov/34379445/ Obesity and Heart Failure With Preserved Ejection Fraction: New Insights and Pathophysiological Targets https://pubmed.ncbi.nlm.nih.gov/35880317/ Epidemiology of Heart Failure in Diabetes: A Disease in Disguise https://pubmed.ncbi.nlm.nih.gov/38334818/ Semaglutide in Patients With Heart Failure With Preserved Ejection Fraction and Obesity https://pubmed.ncbi.nlm.nih.gov/37622681/ Mechanisms of Benefits of Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure With Preserved Ejection Fraction https://pubmed.ncbi.nlm.nih.gov/37674356/ Finerenone in Heart Failure With Mildly Reduced or Preserved Ejection Fraction https://pubmed.ncbi.nlm.nih.gov/39225278/ Effects of Tirzepatide on Circulatory Overload and End-Organ Damage in Heart Failure With Preserved Ejection Fraction and Obesity: A Secondary Analysis of the SUMMIT Trial https://pubmed.ncbi.nlm.nih.gov/39551891/ Effects of Tirzepatide on the Clinical Trajectory of Patients With Heart Failure, a Preserved Ejection Fraction, and Obesity https://pubmed.ncbi.nlm.nih.gov/39556714/ Tirzepatide Reduces LV Mass and Paracardiac Adipose Tissue in Obesity-Related Heart Failure: SUMMIT CMR Substudy https://pubmed.ncbi.nlm.nih.gov/39566869/6 Spironolactone for Heart Failure With Preserved Ejection Fraction https://pubmed.ncbi.nlm.nih.gov/24716680/

N337 - STEP-HFpEF TRIAL: Confira os desfechos recentes do estudo! Dra. Dhiãnah Santini by SBD

In this special episode on Treatment of Heart Failure with Preserved Ejection Fraction (HFpEF) our host, Dr. Neil Skolnik will lead a case-based discussion on HFpEF, presenting challenges and integration of emerging evidence into clinical practice. This special episode is supported by an independent educational grant from Roche. Presented by: Neil Skolnik, M.D., Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health Susan Kuchera, M.D. - Clinical Assistant Professor of Family and Community Medicine at the Sidney Kimmel Medical College of Thomas Jefferson University and Program Director of the Family Medicine Residency at Jefferson Health Abington. Muthu Vaduganathan M.D. - Cardiologist and Co-Director, Center for Cardiometabolic Implementation Science at Brigham and Women's Hospital and Harvard Medical School; Associate Editor of the Journal of the American College of Cardiology.   Selected references referred to the in the Podcast: Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association.  Diabetes Care 2022  2023 American College of Cardiology Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction (HFpEF). Journal of the American College of Cardiology 2023 Time to Clinical Benefit of Dapagliflozin in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction. JAMA Cardiology 2022;7(12):1259-1263    

CardioNerds Cardiac Amyloidosis Series Chair Dr. Rick Ferraro and Episode Lead Dr. Anna Radakrishnan discuss the biology of transthyretin amyloid cardiomyopathy (ATTR-CM ) with Dr. Daniel Judge.  Notes were drafted by Dr. Anna Radakrishnan. The audio was engineered by student Dr. Julia Marques.  This episode provides a comprehensive overview of transthyretin (ATTR) cardiac amyloidosis, a complex and rapidly evolving disease process. The discussion covers the key red flags for cardiac amyloidosis, the diagnostic pathway, and the implications of hereditary versus wild-type ATTR. Importantly, the episode delves into the current and emerging therapies for ATTR, including stabilizers, gene silencers, and promising treatments like CRISPR-Cas9 and antibody-based approaches. Dr. Judge shares his insights and excitement about the rapidly advancing field, highlighting the need for early diagnosis and the potential to improve long-term outcomes for patients with this condition.  Enjoy this Circulation Paths to Discovery article to learn more about the CardioNerds mission and journey.  US Cardiology Review is now the official journal of CardioNerds! Submit your manuscripts here.  CardioNerds Cardiac Amyloid PageCardioNerds Episode Page Pearls: - Biology of Transthyretin amyloid cardiomyopathy Maintain a high index of suspicion! Look for subtle (yet telling) signs like ventricular hypertrophy, discordant EKG findings, bilateral carpal tunnel syndrome, and spontaneous biceps tendon rupture.  Utilize the right diagnostic tests. Endomyocardial biopsy remains the gold standard, but non-invasive tools like PYP scan with SPECT imaging and genetic testing are essential for accurate diagnosis.  Differentiating hereditary from wild-type ATTR is critical, as genetic forms may have a more aggressive course and familial implications.  Early diagnosis and intervention significantly improve prognosis, making vigilance in screening and prompt treatment initiation essential.  The future is now! Cutting-edge therapies are transforming the treatment landscape, including TTR stabilizers, gene silencers, and emerging technologies like CRISPR-Cas9 and antibody-based treatments.  Notes - Biology of Transthyretin amyloid cardiomyopathy What is transthyretin amyloid (aTTR) and how is it derived?  Transthyretin (TTR) is a transport protein primarily synthesized by the liver, responsible for carrying thyroid hormones (thyroxine) and retinol (vitamin A) in the blood. It circulates as a tetramer, composed of four identical monomers, which is essential for its stability and function.  In transthyretin amyloid (ATTR) amyloidosis, the TTR protein becomes unstable, leading to its dissociation into monomers. These monomers misfold and aggregate into insoluble amyloid fibrils, which deposit extracellularly in tissues such as the heart, nerves, and gastrointestinal tract. This progressive amyloid deposition leads to organ dysfunction, including restrictive cardiomyopathy and neuropathy.  There are two main forms of ATTR amyloidosis: hereditary (variant) and wild-type (senile) ATTR.  Hereditary ATTR (ATTRv) is caused by mutations in the TTR gene. These mutations destabilize the TTR tetramer, making it more prone to dissociation. This increases misfolding and amyloid fibril formation, resulting in systemic amyloid deposition.   Wild-type ATTR (ATTRwt) occurs without genetic mutations and is primarily age-related. Over time, even normal TTR tetramers can become unstable, leading to gradual misfolding and amyloid deposition, particularly in the heart. ATTRwt is a common but often underdiagnosed cause of heart failure with preserved ejection fraction (HFpEF) in elderly individuals.  How does aTTR lead to deleterious effects in the heart and other organ systems?    Transthyretin amyloidosis leads to organ dysfunction through the deposition of misfolded TTR protein as amyloid fib...

The SUMMIT trial investigated tirzepatide, a dual GIP and GLP-1 receptor agonist, in 731 patients with HFpEF and obesity. This randomized, placebo-controlled study found that tirzepatide reduced heart failure-related events (HR 0.62, P=0.026) and significantly improved quality of life (KCCQ-CSS +19.5 vs. +12.7, P

In this recording introducing the Japanese-language series of videos, JACC Executive Associate Editor Mitsuaki Sawano, MD, speaks with Shun Kohsaka, MD, FACC, and Shingo Matsumoto, MD, on topics from the effect of US government funding cuts on Japanese researchers to an in-depth discussion of the FINE-ARTS trial published in JACC, "Initial Decline in Glomerular Filtration Rate with Finerenone in HFpEF and HFmrEF: A Pre-Specified Analysis of FINEARTS-HF".

We're back, after a brief hiatus! Today we talk about duration of therapy for bacteremia, Factor XI inhibition for atrial fibrillation, whether to stop ACEi or ARB before elective surgery, and whether GLP-1 agonists are beneficial in heart failure with preserved ejection fraction. Go to minute 7:30 to skip the banter. 7 vs 14 Days of Antibiotics for Bacteremia (BALANCE)Abelacimab vs Rivaroxaban for Atrial Fibrillation (AZALEA-TIMI-71)Asenduxian vs Apixaban for Atrial Fibrillation (OCEANIC-AF)ACEi or ARB Discontinuation Before Surgery (STOP or NOT)Tirzepatide for HFpEF and Obesity (SUMMIT)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

This is the second episode in a special three-part series of the Diabetes Core Update podcast, focusing on heart failure with preserved ejection fraction (HFpEF) in people with diabetes. Sponsored by Roche, this series provides primary care clinicians and healthcare professionals with actionable insights into screening, diagnosis, and treatment of HFpEF, a major complication in cardiometabolic care. In this episode, host Dr. Neil Skolnik discusses treatment strategies for HFpEF with expert guest Dr. James Jannuzzi, a cardiologist and professor at Harvard Medical School. Building on the first episode's discussion of screening and diagnosis, this installment highlights evidence-based treatments and their integration into diabetes care. Presented by: ·       Neil Skolnik, MD, Professor of Family and Community Medicine, Sidney Kimmel Medical College, Thomas Jefferson University; Associate Director, Family Medicine Residency Program, Abington Jefferson Health ·       James Jannuzzi, MD, Professor of Medicine at Harvard Medical School, Staff Cardiologist at Massachusetts General Hospital, and Senior Cardiometabolic Faculty at Baim Institute for Clinical Research. Selected references: ·       Heart Failure: An Underappreciated Complication of Diabetes. A Consensus Report of the American Diabetes Association. Diabetes Care 2022 ·       2023 American College of Cardiology Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction. Journal of the American College of Cardiology 2023 Tune in to the third and final episode, where the series will explore clinical decision-making and case-based applications of HFpEF treatments. This special edition of Diabetes Core Update is sponsored by Roche.  

Join CardioNerds Heart Failure Section Chair Dr. Jenna Skowronski, episode lead Dr. Merna Hussein, and expert faculty Dr. Milton Packer as they discuss the SUMMIT trial. The SUMMIT trial randomized 731 patients with HFpEF with LVEF ≥ 50% and obesity with BMI ≥ 30 kg/m2 to receive tirzepatide or placebo for at least 52 weeks. The two co-primary endpoints were a composite of time to cardiovascular death or a worsening heart failure event and quality of life measured by the Kansas City Cardiomyopathy Questionnaire clinical summary score (KCCQ-CSS). Treatment with tirzepatide led to a lower risk of the composite of cardiovascular death or worsening heart failure as well as improved quality of life. This episode was planned in collaboration with the American College of Cardiology Section of the Prevention of Cardiovascular Disease with mentorship from Section Chair Dr. Eugenia Gianos. CardioNerds Journal Club PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! References - The SUMMIT Trial Packer, M., Zile, M. R., Kramer, C. M., Baum, S. J., Litwin, S. E., Menon, V., Ge, J., Weerakkody, G. J., Ou, Y., Bunck, M. C., Hurt, K. C., Murakami, M., Borlaug, B. A., & SUMMIT Trial Study Group. (2024). Tirzepatide for Heart Failure with Preserved Ejection Fraction and Obesity. The New England Journal of Medicine. https://doi.org/10.1056/NEJMoa2410027

Renal denervation, the obesity paradox, JACC and the FINEARTS trial of finerenone in HFpEF, a setback for a PFA system, and coffee are the topics Jon Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. RDN CMS https://www.cms.gov/medicare-coverage-database/view/ncacal-tracking-sheet.aspx?ncaid=318 Messerli https://doi.org/10.1016/j.jacc.2024.09.1244 Filippone https://doi.org/10.1016/j.amjmed.2023.05.010 II. Finerenone FINEHEARTS -HF NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2407107 FIDELIO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2025845 FIGARO-DKD https://www.nejm.org/doi/full/10.1056/NEJMoa2110956 Why Have We Not Been Able to Demonstrate Reduced Mortality in Patients With HFmrEF/HFpEF? https://doi.org/10.1016/j.jacc.2024.08.033 Regional Variation TOPCAT https://www.ahajournals.org/doi/10.1161/circulationaha.114.013255 Time from WHF Subanalysis https://doi.org/10.1016/j.jacc.2024.09.004 REDEFINE - https://clinicaltrials.gov/study/NCT06008197 Health status paper https://doi.org/10.1016/j.jacc.2024.09.023 Obesity subanalysis https://doi.org/10.1016/j.jacc.2024.10.111 Kidney outcomes https://www.sciencedirect.com/science/article/pii/S0735109724102525 Kidney outcomes 2 https://doi.org/10.1016/j.jacc.2024.11.020 Kaul editorial https://doi.org/10.1016/j.jacc.2024.11.024 III. PFA Setback J&J Halts Varipulse Field Ablation for AFib https://www.medscape.com/viewarticle/j-j-halts-varipulse-field-ablation-afib-2025a10000j8 IV. Coffee Stop the Coffee Studies https://www.medscape.com/viewarticle/883709 Coffee drinking timing and mortality in US adults  You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Podcast Overview The podcast, hosted by Valentin Fuster on January 21, 2025, provides an in-depth review of the FINEARTS-HF trial, which evaluated the efficacy of the non-steroidal mineralocorticoid receptor antagonist finerenone in patients with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). The episode highlights findings published in the Journal of the American College of Cardiology (JACC). Introduction to the FINEARTS-HF Trial (00:03:19 – 00:05:56) The FINEARTS-HF trial demonstrated that finerenone reduced heart failure events by 16% compared to placebo in patients with HFmrEF/HFpEF. However, cardiovascular death rates were similar between groups, making the overall clinical impact moderate. Finerenone's Impact on Quality of Life (00:05:59 – 00:12:46) The trial assessed quality of life using the Kansas City Cardiomyopathy Questionnaire (KCCQ), revealing only a slight improvement (1.62 points) with finerenone. Critics, including the FDA, questioned the clinical relevance of these results and suggested the need for simpler, more meaningful patient-reported outcome measures. Finerenone in Patients with Recent Worsening Heart Failure (00:12:58 – 00:20:30) Patients with recent worsening heart failure showed a greater absolute benefit from finerenone, as they were at higher risk of recurrent events and cardiovascular death. However, further studies are needed to confirm these findings. Finerenone's Role in Obese Patients with HFmrEF/HFpEF (00:20:31 – 00:25:20) In obese patients, the benefits of finerenone were consistent across body mass index (BMI) categories, with a possible greater effect in those with higher BMI. Nevertheless, the reliance on BMI as a metric for obesity was criticized, and alternative measures were recommended. Finerenone and Kidney Outcomes (00:25:23 – 00:40:52) Finerenone showed a modest reduction in albuminuria but did not significantly alter kidney disease progression. Initial declines in glomerular filtration rate (GFR) were noted but should not automatically lead to discontinuation of therapy. Mixed findings highlight the need for more research to understand its renal effects. Conclusion (00:40:54 – 00:44:05) The FINEARTS-HF trial was recognized as a landmark study, showcasing modest benefits of finerenone in a challenging patient population. The podcast calls for continued research to refine quality of life metrics, better understand obesity's role in HFmrEF/HFpEF, and explore finerenone's long-term renal and cardiovascular impacts.

Podcast Overview The podcast, hosted by Valentin Fuster on January 21, 2025, provides an in-depth review of the FINEARTS-HF trial, which evaluated the efficacy of the non-steroidal mineralocorticoid receptor antagonist finerenone in patients with heart failure and mildly reduced or preserved ejection fraction (HFmrEF/HFpEF). The episode highlights findings published in the Journal of the American College of Cardiology (JACC). Introduction to the FINEARTS-HF Trial (00:03:19 – 00:05:56) The FINEARTS-HF trial demonstrated that finerenone reduced heart failure events by 16% compared to placebo in patients with HFmrEF/HFpEF. However, cardiovascular death rates were similar between groups, making the overall clinical impact moderate. Finerenone's Impact on Quality of Life (00:05:59 – 00:12:46) The trial assessed quality of life using the Kansas City Cardiomyopathy Questionnaire (KCCQ), revealing only a slight improvement (1.62 points) with finerenone. Critics, including the FDA, questioned the clinical relevance of these results and suggested the need for simpler, more meaningful patient-reported outcome measures. Finerenone in Patients with Recent Worsening Heart Failure (00:12:58 – 00:20:30) Patients with recent worsening heart failure showed a greater absolute benefit from finerenone, as they were at higher risk of recurrent events and cardiovascular death. However, further studies are needed to confirm these findings. Finerenone's Role in Obese Patients with HFmrEF/HFpEF (00:20:31 – 00:25:20) In obese patients, the benefits of finerenone were consistent across body mass index (BMI) categories, with a possible greater effect in those with higher BMI. Nevertheless, the reliance on BMI as a metric for obesity was criticized, and alternative measures were recommended. Finerenone and Kidney Outcomes (00:25:23 – 00:40:52) Finerenone showed a modest reduction in albuminuria but did not significantly alter kidney disease progression. Initial declines in glomerular filtration rate (GFR) were noted but should not automatically lead to discontinuation of therapy. Mixed findings highlight the need for more research to understand its renal effects. Conclusion (00:40:54 – 00:44:05) The FINEARTS-HF trial was recognized as a landmark study, showcasing modest benefits of finerenone in a challenging patient population. The podcast calls for continued research to refine quality of life metrics, better understand obesity's role in HFmrEF/HFpEF, and explore finerenone's long-term renal and cardiovascular impacts.

Dr. K talks with cardiologist Cara Pellegrini, MD, to discuss the key aspects of heart failure, including its types (congestive, systolic, diastolic, HFrEF, and HFpEF), causes, symptoms, and treatment options. They also cover special considerations for frail older adults, heart failure and end of life issues, and much more.

When treating heart failure, how do we distinguish between the expanding list of medications recommended for “Guideline Directed Medical Therapy” (GDMT) and what might be considered runaway polypharmacy? In this week's podcast, we'll tackle this crucial question, thanks to a fantastic suggestion from GeriPal listener Matthew Shuster, who will join us as a guest host. We've also invited two amazing cardiologists, Parag Goyal and Nicole Superville, to join us about GDMT in heart failure with reduced ejection fraction (HFrEF) and in Heart Failure with preserved EF (HFpEF).  We talk about what is heart failure, particularly HFpEF, how we treat it (including the use of sodium–glucose cotransporter-2 inhibitors (SGLT2's), and how we should apply guidelines to individual patients, especially those with multimorbidity who are taking a lot of other medications. I'd also like to give a shout out to a recent ACP article on HFpEF with an outstanding contribution from Ariela Orkaby, geriatrician extraordinaire (we also just did a podcast with her on frailty).  

Reader feedback on LGE pre-ICDs, PFA for AF ablation, CTO-PCI, endovascular ablation of the greater splanchnic nerve in HFpEF, and data sharing are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Listener Feedback Sept 27, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/1001666 JAMA Meta-analysis https://jamanetwork.com/journals/jama/fullarticle/2823869/ II. Pulsed Field Ablation for AF Feb 02, 2024 This Week in Cardiology Podcast https://www.medscape.com/viewarticle/999995 ADMIRE Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070333 ADVENT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2307291 III. PCI for CTO EuroCTO One Year SAQ Results https://doi.org/10.1093/eurheartj/ehy220 EuroCTO Hard Outcomes https://eurointervention.pcronline.com/article/three-year-outcomes-of-eurocto-a-randomized-multicentre-trial-comparing-revascularization-and-optimal-medical-therapy-for-chronic-total-coronary-occlusions Faith Healing and Subtraction Anxiety https://doi.org/10.1161/CIRCOUTCOMES.118.004665 DECISION CTO trial https://doi.org/10.1161/CIRCULATIONAHA.118.031313 ISCHEMIA CTO Rationale and Design https://doi.org/10.1016/j.ahj.2022.11.016 IV. Greater Splanchnic Nerve Ablation for HFpEF REBALANCE HF https://jamanetwork.com/journals/jamacardiology/fullarticle/2823999 V. Data Sharing The Pros and Cons of Clinical Trial Data Sharing https://www.medscape.com/viewarticle/862815 Kramer and Nallamothu, Caution in Data Sharing https://www.ahajournals.org/doi/full/10.1161/CIRCOUTCOMES.124.010257 Nosek, Variability in Analytic Methods https://journals.sagepub.com/doi/10.1177/2515245917747646 Zeraatker, Variability in Analytic Methods   You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

CardioNerds Drs. Jason Feinman, Gurleen Kaur, and Rick Ferraro discuss the implementation of SGLT inhibitors in clinical practice with Dr. Alison Bailey. Notes were drafted by Dr. Jason Feinman. In this episode, we discuss the implementation of SGLTi in clinical practice scenarios, including for individuals with heart failure regardless of ejection fraction, those with chronic kidney disease, and those with diabetes mellitus. The group also discusses important side effects to monitor for, as well as how to counsel patients when prescribing these medications. This episode was produced in collaboration with the American Society of Preventive Cardiology (ASPC) with independent medical education grant support from Lexicon Pharmaceuticals. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Clinical Implementation of SGLT Inhibitors For patients with heart failure with reduced ejection fraction, SGLT inhibitors reduce the composite outcome of cardiovascular death or heart failure hospitalization by 25%. SGLT inhibitors can be safely started in patients with an eGFR as low as 20. There are ongoing trials investigating the safety of these medications in individuals with eGFR lower than 20 or those who are receiving dialysis. An eGFR decrease of 3-5 ml/min on average is expected after starting an SGLTi, but this will stabilize over time and provides protective effects of renal dysfunction in the long run. Early data that suggested an association between SGLTi and bacterial UTI development hasn't panned out in the long run, but there is an association between SGLTi and the development of either genital mycotic infections or yeast infections. Perineal hygiene is important to prevent the development of either. A patient-centered, shared decision-making approach should guide the choice of agents for individuals with type 2 diabetes mellitus. In certain patients, it may be reasonable to choose an SGLTi as the first-line agent. Show notes - Clinical Implementation of SGLT Inhibitors What is the data supporting the use of SGLTi in HFpEF? The EMPEROR-Preserved and DELIVER trials investigated the impact of empagliflozin and dapagliflozin, respectively, on cardiovascular outcomes in patients with mildly reduced or preserved ejection fraction. The SOLOIST-WHF trial investigated a combined SGLT1/2 inhibitor, sotagliflozin, in patients with recently worsening heart failure, irrespective of ejection.SGLTi have been demonstrated to reduce the risk of cardiovascular death or worsening heart failure, including heart failure hospitalization, in these individuals. A meta-analysis of the EMPEROR-Preserved and DELIVER trials demonstrated a hazard ratio of 0.80 for cardiovascular death or first hospitalization for heart failure for empagliflozin or dapagliflozin over placebo in the setting of HFpEF. What is the data supporting the use of SGLTi in HFrEF? In addition to the SOLOIST-WHF trial that was previously discussed, the EMPEROR-HF and DAPA-HF investigated the impact of SGLTi medications in patients with HFrEF. In patients with HFrEF, SGLTi medications have been demonstrated to reduce the risk of either cardiovascular death or heart failure hospitalization. Dapagliflozin and empagliflozin had a pooled risk reduction of all-cause death of 13%, a pooled risk reduction of cardiovascular death of 14%, and a 26% reduction in the combination of CV death or first hospitalization for heart failure. What is the expected impact of SGLTi on renal function? Dapagliflozin, empagliflozin, sotagliflozin, ertugliflozin, and canagliflozin have all been studied for their impact on renal dysfunction in individuals both with and without diabetes. In the CANVAS trial,