JACC Heart Failure Editor's Update, April 2019
APRIL 2018 JACC: HEART FAILURE—MINI-FOCUS ISSUE: PROGNOSTIC MEASURES IN HEART FAILURE
Frailty is common in older adults with heart failure and is associated with poor outcomes. Therapies for these patients could bring about substantial improvement in quality of life, and while current assessment tools have good prognostic value, we explore more simplified measures. Shirley Sze and colleagues looked at several brief easy to use frailty screening tools and their effectiveness at measuring frailty compared to lengthy, more in-depth assessments.
Identification of Frailty in Chronic Heart Failure
Shirley Sze, Pierpaolo Pellicori, et al.
Exercise intolerance is an important predictor of prognosis in HFpEF patients. Various causal models have been put forth but the underlying mechanisms that limit exercise capacity are not well understood. Through an analysis of HFpEF patients in two clinical trials and a population study, Emil Wolsk et al identified central and peripheral factors that were strongly associated with HFpEF patients versus controls during exercise to help point the way to therapies that might improve exercise capacity in this patient population.
Central and Peripheral Determinants of Exercise Capacity in Heart Failure Patients With Preserved Ejection Fraction
Emil Wolsk, David Kaye, et al.
To what extent does income inequality explain variation in outcomes of global heart failure trials? Learn more about this important topic through pooled data from 54 countries in PARADIGM-HF and ATMOSPHERE. Pooja Dewan and colleagues analyzed data from two large clinical trials conducted in 54 countries, PARADIGM-HF and ATMOSPHERE, categorized participants by level of income inequality of the enrolling country, and looked at the association between income inequality and heart failure outcomes, to better understand variability in outcomes among countries.
Income Inequality and Outcomes in Heart Failure: A Global Between-Country Analysis
Pooja Dewan, Rasmus Rørth, et al.
Advances in medical therapy have resulted in a substantial reduction of poor outcomes in HFrEF patients. Although national guidelines encourage the target medication doses established through clinical trials, patients are frequently not titrated to the recommended dosage. This in-depth analysis from the CHAMP-HF registry takes a closer look at achieving guideline directed therapy. Poghni A. Peri-Okonny and colleagues looked at the relationship between systolic blood pressure category and achievement of guideline directed management therapy target dosage to determine if concerns regarding hypotension may explain the discrepancy between dosage in clinical practice and target.
Target Doses of Heart Failure Medical Therapy and Blood Pressure: Insights From the CHAMP-HF Registry
Poghni A. Peri-Okonny, Xiaojuan Mi, et al.
HEART FAILURE HALL OF FAME—GETTING TO KNOW THE PIONEERS WHO INSPIRE US
In the first series of my Editor’s Update, we provided biographical details and little-known facts about our amazing Editorial Team. I am now introducing a feature called the Heart Failure Hall of Fame. Each month, I will interview one of the outstanding leaders in the field to learn a little more about the person beyond their academic accomplishments. I’m excited about this new feature and hope you enjoy reading these interviews.
I am honored to begin this new series with an interview with Dr. Eugene Braunwald.
Dr. Braunwald, our readers are familiar with your excellent work through your publications and talks, but I would like to discuss some of the less well-known aspects of your life:
What first made you interested in a career in heart failure?
I went to an elite high school—Brooklyn Tech—planning to become an engineer. I found it to be too impersonal and wanted a career that involved people. That led to medicine. Cardiology is the specialty closest to engineering—pumps, pipes, electrical signals, etc.
Which of your many accomplishments are you most proud of?
Developing the concept of protecting ischemic myocardium from becoming necrotic in patients developing a myocardial infarction. In other words, limitation of infarct size. Demonstrated in dogs and published in Circulation in 1971.
Also, first measurements of ejection fraction in patients—also published in Circulation in 1962.
Who inspires you, in your career or otherwise?
Nobel Prize winners in medicine, e.g., Andre Cournand, considered to be the father of cardiac catheterization and hemodynamics, in whose laboratory I served a fellowship.
What is your favorite, or last book you read?
Becoming—the autobiography of Michelle Obama. Beautifully written, honest.
3 Things People May Not Know About Me
- While in college and medical school—both at New York University—I was an “extra” in crowd scenes in the Metropolitan Opera. I made my “debut” in La Tosca. I have been an opera buff since then.
- My wife Elaine and I are now blessed with two great grandchildren (both girls!)
- I have become an avid Patriots fan.
EUGENE BRAUNWALD, M.D. is the Distinguished Hersey Professor of Medicine at Harvard Medical School, and the founding Chair of the TIMI Study Group at the Brigham and Women’s Hospital.
Dr. Braunwald trained at New York University School of Medicine and served his Medical Residency at the Johns Hopkins Hospital. He served as Chief of Cardiology and as Clinical Director of the National Heart, Lung and Blood Institute, and founding Chair of Medicine at the University of California, San Diego. From 1972 to 1996 he was Chairman of the Department of Medicine at the Brigham and Women's Hospital. From 1980 to 1989 he also served as Chairman of the Department of Medicine at the Beth Israel Hospital and Blumgart Professor of Medicine at Harvard Medical School. He was a founding trustee and Chief Academic Officer of Partners HealthCare System.
Dr. Braunwald’s first major paper was published in Circulation Research in July 1954, and he has been a major force in cardiology since then. His early work focused on the control and assessment of ventricular function and he was the first to measure both left ventricular ejection fraction and left ventricular dp/dt in patients. His group showed the first neurohumoral defect in human heart failure, defined the pathophysiology of hypertrophic cardiomyopathy and demonstrated salvage of ischemic myocardium following coronary occlusion. For the past 32 years, he and his colleagues at the TIMI Study Group demonstrated improved outcome with a patent coronary artery which led to the widely accepted “open artery hypotheses.” They were the first to show the benefit of preventing adverse remodeling of the infarcted ventricle with ACE inhibition. In the PROVE-IT TIMI 22 Trial, they demonstrated the benefit of more intensive reduction of LDL cholesterol in high risk coronary artery patients, which changed practice guidelines and favorably affected the lives of millions.
Dr. Braunwald was an editor of Harrison's Principles of Internal Medicine for 12 editions and the founding editor of Heart Disease, now in its 11th edition, the most influential textbooks in their fields.
Science Watch listed Dr. Braunwald as the most frequently cited author in Cardiology; he has an h-index of 208. He has received numerous honors and awards including the Distinguished Scientist and Lifetime Achievement Awards of the American College of Cardiology, Research Achievement, and Herrick Awards of the American Heart Association, and the Gold Medal of the European Society of Cardiology. He received an honorary Doctor of Science from the University of Oxford and is the recipient of honorary doctorates from twenty-two other distinguished universities on three continents. The American College of Cardiology and the Heart Failure Association of the European Society of Cardiology have established annual lectures in his name. Harvard University established the Eugene Braunwald endowed Chair in Medicine. Dr. Braunwald was the first adult cardiologist elected to the National Academy of Sciences of the U.S. The living Nobel Prize winners in medicine voted Dr. Braunwald as “the person who has contributed the most to cardiology in recent years.”
CALL FOR PAPERS: HEART FAILURE IN THE ELDERLY
Heart failure is a significant global epidemic; however, in the elderly, there may be differences in treatment effects, treatment options, epidemiology, pathophysiology, risk factors, and outcomes. JACC: Heart Failure is focusing on the growing body of literature with a special issue on this topic. In line with our commitment to advance scientific understanding and patient care, we will publish a uniquely themed issue to highlight this emerging theme.
Topics spanning this theme will be considered, including epidemiology, diagnosis and prognosis, short- and long-term outcomes, clinical management, phenotyping, emerging therapies, comorbidities, the role of biomarkers, and other relevant issues.
How will this process work?
- We welcome papers addressing the broad topic of "Heart Failure in the Elderly" – these can be in the form of original research, clinical trials, meta-analysis, or position statements from societies or advocacy groups. Other formats will be considered if sufficiently rigorous and impactful.
- Interested authors should submit their papers via https://www.jaccsubmit-heartfailure.org on or before August 1, 2019. When entering manuscript information, please select "Heart Failure in the Elderly" from the "Special Issues" pull-down menu in the Keywords, Categories, Special Sections tab.
- We plan for the final publication to appear in the December 2019 issue of JACC: Heart Failure. Please see instructions to authors on the Journal webpage (https://heartfailure.onlinejacc.org).
- Accepted papers will also be displayed on the JACC: Heart Failure website in an “online before print” format.