JACC Heart Failure Editor's Update, September 2019
September 2019 JACC: Heart Failure—Mini-Focus Issue: Socioeconomic Factors and Heart Failure
To arm heart failure clinicians for future policy changes, Jonathan Wolfe and Karen Joynt Maddox outline the benefits and potential drawbacks of the Affordable Care Act (ACA) in a State-of-the-Art review. The care of heart failure patients has been profoundly affected by the ACA. Since the increasing prevalence and high cost of heart failure will assure that it will continue to be an area of focus for policy makers, a thorough understanding of the impact of the ACA is critical to help us provide optimum care for our patients now and plan for changes that are sure to come in the future.
Heart Failure and the Affordable Care Act: Past, Present, and Future
Jonathan D. Wolfe and Karen E. Joynt Maddox
Is lack of insurance a primary driver of health inequality and poor outcomes? Inge Schjødt et al looked at hospital stay, readmission, and mortality data in newly diagnosed HFrEF patients in Denmark, a country with universal health care, to determine the association of socioeconomic factors with clinical outcomes and identify specific factors that appear to play major roles.
Socioeconomic Factors and Clinical Outcomes Among Patients With Heart Failure in a Universal Health Care System
Inge Schjødt, Brian B. Løgstrup, et al.
Predicting the risk of trastuzumab-related cardiotoxicity (TRC) would allow earlier intervention and may result in improved outcomes for breast cancer survivors treated with that drug. CATS (Cardiotoxicity of Adjuvant Trastuzumab Study) provides additional data to help stratify risk. Through this study Shom Goel and colleagues examined changes in LVEF pre- and post-anthracycline, and clinical, serum, and genetic biomarkers, to determine predictors of the risk of TRC and help clarify inconsistencies from previous studies.
Decline in Left Ventricular Ejection Fraction Following Anthracyclines Predicts Trastuzumab Cardiotoxicity
Shom Goel, Jane Beith, et al.
A better understanding of heart failure populations at risk for sudden cardiac death (SCD) is important for disease control. Persons living with HIV are at high risk for SCD. Raza Alvi et al examined the risk of SCD in heart failure patients living with HIV to help determine appropriate management strategies.
The Risk for Sudden Cardiac Death Among Patients Living With Heart Failure and Human Immunodeficiency Virus
Raza M. Alvi, Tomas G. Neilan, et al.
Heart Failure Hall of Fame—Getting to Know the Pioneers Who Inspire Us
Our Heart Failure Hall of Fame series brings information about leaders in the field of heart failure beyond their publications and extensive work. This month we feature Arthur M. Feldman, MD, PhD. Dr. Feldman has served as President of the Heart Failure Society of America (HFSA) and as President of the Association of the Professors of Cardiology and was the founding Editor-in-Chief of Clinical and Translational Science (CTS) and the Journal of Clinical and Translational Science. He was the recipient of the HFSA Lifetime Achievement Award and the Barry Coller Award from the Association for Clinical and Translational Science. His research has focused on the molecular biology of dilated cardiomyopathy and heart failure
What first made you interested in a career in heart failure?
I think there were two experiences that led me to heart failure. The first was the fact that my father, who was born in 1901, had rheumatic fever as a child and was left with a scarred mitral valve. Despite having a loud heart murmur, he didn't have antibiotic prophylaxis during a cholecystectomy and developed his first of what would be two episodes of subacute bacterial endocarditis.
The second was two patients I saw when I was a fellow and very young attending. The first was a young woman who I cared for in the cardiac care unit at Hopkins when I was an intern. At the time we had little to offer patients with symptomatic heart failure other than a diuretic, digoxin, and intravenous dobutamine and I realized that it was an area that was ripe for research. Interestingly, twenty years later I saw a woman in consultation who had a marked family history of dilated cardiomyopathy. It took almost nine years—but we eventually identified the genetic mutation responsible for their disease: a small deletion causing a large truncation of BAG3. Only afterwards did I find that the proband was the aunt of the young woman I had seen 20 years earlier in the cardiac care unit. The second patient was a young man who was a student at the University of Maryland who presented with marked shortness of breath due to a dilated cardiomyopathy. His physical examination and his laboratory evaluation demonstrated profound hypothyroidism. An initial biopsy and a follow-up biopsy revealed for the first time that with appropriate therapy, the fetal-gene program that is a characteristic feature of heart failure is reversible. This led me to posit that if we could identify and alter the right therapeutic target, we might actually be able to cure disease—at least in some people.
Which of your many accomplishments are you most proud of?
I am most proud of the success of the residents and fellows who I trained and the junior faculty who I recruited and mentored over the past 35 years. I am proud to say that many now lead their own divisions, departments, centers and schools. I am also extremely proud of the fact that my wife and I have raised two incredible young women. They are very different. One is a young playwright who will have her first New York play in 2020 and is a graduate student at Julliard and the other is an intern on the Osler Medical Service at the Johns Hopkins Hospital.
Who inspires you, in your career or otherwise?
I was inspired to pursue a career as a physician-scientist by many incredible mentors, several of whom are now close friends and colleagues. The first was Dr. Saul Brusilow, my post-doctoral mentor, who taught me to be a scientist. Dr. Michael Bristow taught me how to be a physician-scientist and the importance of linking the bench and the bedside. Dr. Myron Weisfeldt and Dr. Edward Benz inspired me to be a physician-leader and served as great role models. I had the good fortune to work for both but also to learn from them by watching how they handled the day-to-day management of a division or a department as well as how they solved problems both big and small. And finally, I was inspired to be a complete heart failure clinician by the late Dr. Kenneth Baughman, who instilled in me the concept of thoroughness in patient evaluation and care.
What is your favorite, or last book you read?
My favorite book is Killer Angels and specifically the story of the life of Joshua Lawrence Chamberlain. Many people know the story of how Chamberlain, a rhetoric teacher at Bowdoin College, saved the Union by thwarting multiple attempts of Confederate soldiers to capture Little Round Top on the second day of the Battle of Gettysburg. But most people don't know that Chamberlain was a model of resilience. Despite suffering severe wounds that would cause lifelong difficulties, he fought throughout the war and then went on to be governor of Maine and president of Bowdoin College. But what really set him apart was his actions at the surrender of the Confederate troops under Robert E. Lee at Appomattox Court House in 1865. Chamberlain ordered his troops to salute Lee as he left the field after his surrender. He was widely criticized for this action, but he astutely recognized that the nation needed to heal itself and that showing respect to Lee could facilitate that process.
3 Things People May Not Know About Me
- I have a wonderful Brittany named Rocky
- I paint landscapes and waterscapes when I have a free minute
- I collect autographed baseballs.
Learn More about Dr. Feldman
Dr. Feldman received his B.A. from Gettysburg College followed by an M.S. in Zoology and a Ph.D. in Physiology from the University of Maryland, College Park. After completing a post-doctoral fellowship in the laboratory of Dr. Saul Brusilow in the Department of Pediatrics at the Johns Hopkins University School of Medicine, he pursued the M.D. degree at the Louisiana State University School of Medicine, Shreveport, where he was elected to Alpha Omega Alpha. He then returned to Baltimore where he completed his internship, residency, and fellowship in cardiovascular disease at the Johns Hopkins Hospital, joining the faculty in the Department of Medicine in July 1986 as an Assistant Professor. In 1990, he received a joint appointment in the Department of Physiology. He subsequently was appointed Associate Professor and became the Co-Director of the Belfer Laboratories and Director of the Belfer Laboratory for the Molecular Biology of Heart Failure.
In 1994, Dr. Feldman was recruited to the University of Pittsburgh as the Harry S. Tack Professor of Medicine, Professor of Cell Biology and Physiology, Director of the University of Pittsburgh Heart Institute and Chief of the Division of Cardiology. In 1998, he joined the Graduate Faculty of the Department of Human Genetics. The following year, he became the Director of the Cardiovascular Institute of the UPMC Health System, an amalgamation of the primary focus at Presbyterian University Hospital and 14 sites of care across western Pennsylvania.
In 2002, Dr. Feldman was recruited to Jefferson Medical College of Thomas Jefferson University as the Magee Professor and Chair of the Department of Medicine, a position he held until 2011, when he was recruited to Temple University as the Executive Dean of the School of Medicine and Chief Academic Officer of the Temple Health System. Since 2016, he has been the Laura H. Carnell Professor of Medicine. Dr. Feldman’s research, supported through grants from the National Institutes of Health, has focused on the molecular biology of dilated cardiomyopathy and heart failure.
He has received numerous awards and honors for his work, including election to the American Society for Clinical Investigation, the Association of University Cardiologists, the Association of American Physicians, the American Clinical and Climatologic Association, and the Johns Hopkins University Society of Scholars. He has served as the President of the Heart Failure Society of America and as the President of the Association of the Professors of Cardiology and was the founding Editor-in-Chief of Clinical and Translational Science (CTS) and the Journal of Clinical and Translational Science. He was the recipient of the Lifetime Achievement Award from the Heart Failure Society of America and the Barry Coller Award from the Association for Clinical and Translational Science. Since 1998 he has been listed with regularity in “Best Doctors in America.”