JACC Heart Failure Editor's Update, March 2020
March 2020 JACC: Heart Failure—Mini-Focus Issue: MRAs and Diuretics
Is there an ideal diuretic regimen to overcome loop diuretic resistance in acute heart failure? Diuretic resistance complicates in-hospital management and increases the risk of death and rehospitalization. In this single center study, Zachary Cox et al examined alternate strategies. The authors compared the effect of three agents on change in weight as a result of their use as adjunctive therapy in 60 hospitalized, diuretic-resistant heart failure patients.
Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure: The 3T Trial
Zachary L. Cox, Jeffrey M. Testani, et al.
A better understanding of differences in biologic processes among the various phenogroups of HFpEF patients may lead to more effective therapy. Jordana Cohen et al examined biosamples from TOPCAT to identify possible differences in biomarkers, cardiac and arterial structure/function, prognosis, and response to spironolactone across clinical HFpEF phenogroups to add to our knowledge of this heterogenous patient population and help point the way to more targeted treatment.
Clinical Phenogroups in Heart Failure With Preserved Ejection Fraction: Detailed Phenotypes, Prognosis, and Response to Spironolactone
Jordana B. Cohen, Julio A. Chirinos, et al.
Are concerns that MRAs cause hypotension in HFrEF patients well founded? Despite evidence that MRAs reduce mortality in HFrEF patients, this therapy is greatly underused, possibly due to concerns about hypotension. Matteo Serenelli and colleagues examined data from RALES and EMPHASIS-HF to determine the effect of spironolactone and eplerenone on blood pressure in patients with HFrEF.
Mineralocorticoid Receptor Antagonists, Blood Pressure, and Outcomes in Heart Failure With Reduced Ejection Fraction
Matteo Serenelli, John J.V. McMurray, et al.
David Kao et al discuss innovative uses of EHR technology to improve the quality and efficiency of heart failure treatment and management in their state-of-the-art review. The EHR can revolutionize the care of chronic diseases such as heart failure. Existing EHR tools to standardize care, promote adherence to guidelines, facilitate patient engagement and adherence, and support clinical research are described.
Heart Failure Management Innovation Enabled by Electronic Health Records
David P. Kao, Chen-Tan Lin, 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, 11 years after his untimely death from a heart attack on March 4, 2009 at age 65, we feature an in-memoriam tribute to Professor Philip Poole-Wilson, FRCP, FESC, FACC, FMedSci.
At the time of his passing, Professor Poole-Wilson was Emeritus Professor of Cardiology at the National Heart and Lung Institute; on the Faculty of Medicine of Imperial College, London; and Honorary Consultant Physician, Royal Brompton Hospital. He was formerly British Heart Foundation Simon Marks Professor of Cardiology, and past president of both the European Society of Cardiology and the World Heart Federation. He was chairman or a member of the steering committee of many international clinical trials including ATLAS, COMET, ACTION, and SENIORS, and authored 550+ articles.
Our practice has been to ask our Hall of Fame honorees the same questions and encourage them to amplify and modify the answers. An in-depth interview with Professor Poole-Wilson was published in Circulation, on March 3rd, the day before his death (1). From that interview and articles about Prof. Poole-Wilson in the medical literature and media, we have developed the following profile as a tribute to his outstanding career and the indelible imprint his legacy left on the treatment of heart failure.
JACC: Heart Failure Associate Editor Martin Cowie worked closely with Prof. Poole-Wilson and observed:
“Philip was always inspirational: level-headed and endlessly fascinated by what we did, and did not, know. I remember him kindly challenging colleagues with “I have a rather different take on the data….” And then he would proceed to put everything in context with the key issues laid out one by one. He is still sorely missed, but his enduring legacy is that of a whole new generation of clinical scientists moving heart failure science and practice forward.”
Our thanks to Prof. Cowie for his invaluable assistance in preparing this tribute.
What first made Professor Poole-Wilson interested in a career in heart failure?
In the interview in Circulation, he reported that, although his father was one of the first genitourinary surgeons in England, he initially entered Trinity College, Cambridge intending to become a physical chemist, but in part, because his time in the Physiology Department overlapped with Nobel Prize winners Hodgkin [OM, KBE, FRS] and Huxley [OM, FRS], he “decided a career in pure physiology might be difficult and switched to medicine.” He went on to say that his study of math and physics made his understanding of hemodynamics straightforward and that it was natural to specialize in cardiology and apply those principles to heart failure.
Which of his many accomplishments was he most proud of?
Professors John Cleland and Karl Swedberg noted in the obituary published in the European Journal of Heart Failure that Professor Poole-Wilson’s greatest legacy is the “scientific infrastructure for cardiology research that he helped to create on a grand scale across Europe and many other parts of the world.” They noted that he was a key policymaker on the European Heart House, helped mold the modern, professional structure of the ESC, and identified and nurtured many of the leading scientific minds in cardiology in many different nations. (2)
When asked by the interviewer for Circulation which of his research topics he rated most highly, Professor Poole-Wilson mentioned work showing the involvement of calcium in the death of heart cells due to hypoxia and ischemia; the demonstration that, in man, acidosis and the intracellular loss of potassium ions were largely responsible for the changes in the electrocardiogram and contractility within 2 to 3 beats of heart muscle becoming ischemic; early work with cardiac myocytes, which formed the basis for early trials of gene therapy for heart failure; and the part he had played in the introduction of the six-minute walk test for assessing exercise tolerance in heart failure because, unlike other methods of measuring exercise tolerance, "the 6-minute-walk test is so easy; all you need is a level corridor of a certain length!”
His Favorite Book
His favorite book was Candide by Voltaire—especially the tutor Dr Pangloss, whose motto is “all is for the best in the best of all possible worlds.”
3 Things People May Not Know About Professor Poole-Wilson
- His favorite film was Dr. Zhivago; favorite actors Julie Christie, Shirley MacLaine, and Jean Moreau; favorite opera, Norma by Bellini; and favorite composers Brahms and Wagner.
- He enjoyed ornithology and gardening.
- He had never done a day’s work in his life because, as he was so happy to say, his work in cardiovascular medicine was his hobby—but maybe many of us did know that.
Learn More about Professor Poole-Wilson
At the time of his passing, Professor Philip Poole-Wilson, FRCP, FESC, FACC, FMedSci, was Emeritus Professor of Cardiology, National Heart and Lung Institute (NHLI); on the Faculty of Medicine, Imperial College, London; and Honorary Consultant Physician, Royal Brompton Hospital. Although he had retired from clinical practice in 2008, he remained very active in the field and died of a heart attack while travelling to lecture medical students.
He trained at St Thomas’ Hospital, the Royal Brompton, and Hammersmith. In 1973, he was awarded a British Heart Foundation/AHA-sponsored Travelling Research Fellowship at the UCLA Cardiovascular Research Laboratory and worked under Kenneth I. Shine, MD, who went on to become Dean, AHA President, and head of the Institute of Medicine.
In 1976, he was appointed senior lecturer at the Cardiothoracic Institute, later to become NHLI, with honorary consultant physician status at the National Heart Hospital, which allowed him to continue his research on K ion concentration and pH in human coronary vessels. He was Professor of Cardiology at the University of London and became the British Heart Foundation Simon Marks Professor of Cardiology at NHLI in 1988. He was also Honorary Consultant Physician at the Royal Brompton Hospital London, and, from 2003, head of cardiovascular sciences at NHLI.
During the late 1980s, he became interested heart failure and that became the focus of his research, which included the neurohormonal response in heart failure and its relationship to diuretics, and muscle changes in heart failure and the implications of those changes for exercise limitations in chronic heart failure patients.
He also played a major role in developing the six-minute walk test, and, in 2000, Professor Poole-Wilson and colleagues were the first to implant an LVAD as destination therapy. He was lead investigator or a member of the steering committee of many international clinical trials including ATLAS, COMET, ACTION, and SENIORS, and published 550+ articles. He was past president of both the European Society of Cardiology and the World Heart Federation and the recipient of Le Prix Europe et Medecine 2001 de l’Institut des Sciences de la Santé, Paris, France, and the Mackenzie Medal of the British Cardiovascular Society.