Duke Heart Pulse — March 3, 2024

Highlights of the week:

Bashore Selected for TBJ Lifetime Achievement Award

Thomas Bashore

We are excited to share that Thomas Bashore, MD, professor of medicine in cardiology, has been chosen by the Triangle Business Journal (TBJ) as the recipient of their 2024 Health Care Leadership Lifetime Achievement Award.

Bashore was nominated for his decades of service to heart patients at Duke and his outstanding mentorship and skills as an educator. His clinical care specialty has been the care of patients with congenital heart disease. The improvement in both surgical and medical care of infants and children with congenital heart disease in the U.S. has resulted in more children surviving into adulthood and more adults living with adult congenital heart disease. Duke School of Medicine, specifically the division of cardiology, was one of the first programs in the country to recognize the lack of specialists in this area and was one of the first to begin training cardiology fellows in caring for patients with adult congenital heart disease. Bashore was the founder of this training program at Duke along with Duke pediatrician, Tim Garson, MD, in 1993.

Bashore also founded the valvular heart disease program at Duke and he is a co-founder of Duke Heart Center. His career has spanned more than fifty years – the last 40 of which he has spent promoting valvular and adult congenital heart disease clinical care and training. While doing so, he has cared for thousands of patients — helping many of them survive into adulthood and go on to have children of their own.

During his career at Duke, he served as director of the Diagnostic Cardiac Catheterization Laboratories for 10 years, and then as the Director of the Cardiology Fellowship Training Program for 12 years. He has been a member and/or chairman of numerous committees of the American College of Cardiology over the years and is the author of more than 300 manuscripts, over 100 book chapters and reviews, and three books. He has helped train hundreds of cardiologists through his work at Duke, and his mentoring has led many of his trainees into academic teaching careers.

Bashore has been recognized locally and nationally for his clinical care of patients with congenital heart disease and, as a result, he has been the recipient of numerous teaching awards throughout his career. He has been recognized by the Duke University School of Medicine for his skill as an educator with a Master Clinician/Teacher Award (2006); the Leonard Palumbo Jr. Faculty Achievement Award (2014) for clinical care and teaching, as well as a Duke Medical Center Alumni Distinguished Faculty Award (2015). Dr. Bashore has received major national teaching and clinical care awards as well. The American College of Cardiology selected him for its annual Distinguished Teacher Award in 2018, while the American Heart Association awarded him its Laennec Master Clinician Award in 2019.

For the last 40 years, Bashore has been voted into the nation’s Best Doctors and America’s Top Doctors programs where he has consistently been listed among the top 1-5% in the field of cardiology. On a national level, he has continued his commitment to patient care and to educating future clinicians by serving on multiple educational committees, teaching national cardiology board review courses for the Society of Cardiovascular Intervention and the American College of Cardiology (ACC); and he has served as an editor, chairman, or associate editor of many of the ACC self-assessment books and lifelong learning programs, as well as on question-writing committees and assisting with the ACC website educational effort.

The Valvular Disease Program and Adult Congenital Program at Duke are now nationally recognized and Duke continues to serve as a leader in treating complex congenital heart problems — much of this due to Bashore’s commitment and vision.

Bashore and other awardees will be honored by the TBJ at their upcoming awards dinner in April.

Congratulations, Tom – this is very well deserved!

 

Duke Becomes 1st Enroller for PreVail-PH2 Study

Congratulations to Marat Fudim, Richard Krasuski, Rose Burns, and Khalia Stewart and their team on becoming the first enrolling site for an important clinical trial being conducted through the Duke Early Phase Clinical Research Unit (DEPRU).

Duke has become the first enroller for the Pulmonary Artery DenerVation Clinical Study Using the Gradient Denervation System in Heart Failure Patients with Pulmonary Hypertension Group 2 (PreVail-PH2 Study), an early feasibility, device study enrolling heart failure patients with pulmonary hypertension (PH).

Given the association with higher morbidity and mortality as well as the prevalence of the disease, there is a significant unmet need to develop effective therapeutics for this population as well as reason to explore non-pharmacologic options to effectively reduce PH in patients with heart failure with preserved ejection fraction (HFpEF). The Gradient Denervation System, which is being studied, is indicated for pulmonary artery denervation treatment in these patients and is intended to ablate nerves within the pulmonary artery using ultrasonic ablation. The study will enroll approximately 30 patients and is expected to be conducted across eight recruitment sites.

Gearing up for the first enrollment and first procedure day has not been a light lift and has taken significant investigator involvement as well as all-star coordinator efforts, according to Fudim, study PI. Krasuski serves as co-investigator; Burns is the lead CRNC, and Stewart is CRC for PreVail-PH2.

The investigators are grateful to the entire CRU team and appreciate their commitment to not only ensuring Duke is taking part in important research but also helping the team stand out as top performers and site leaders in the trials we choose to undertake. They want to thank the groups that support the team, especially their specific representatives who helped facilitate the team’s success by helping expedite study set-up requirements, including Diane Bresch of DOCR, Ashley Madison of ORC, Stephanie Minter with DOCR start-up, Helen Bran with the Cath lab, and Aubrie Coburn with CDU. The team is particularly proud of becoming the first enroller just three weeks following site activation.

Congratulations to all – great teamwork!

 

Heart Transplant Team Recognized During Duke MBB Game

We are thrilled to share that our amazing advanced heart failure and heart transplant team was recognized on the court during a break in play in the Duke vs. Virginia men’s basketball game last night (March 2).

Members of the team were brought onto the court during the second half and recognized for their recent team milestones, contributions to the field of transplantation, and overall excellence in the care of heart transplant patients.

You can read more about the complex care our cardiothoracic transplant program provides in Duke Cardiothoracic Transplant Program Accepts the Most Complex Cases, a recent article for referring providers.

Congratulations!

 

Krasuski & ACHA In DC

Cardiologist Rich Krasuski had a busy day in Washington on Thursday. Krasuski was at the Capitol with the Adult Congenital Heart Association (ACHA) discussing the work they do and the importance of supporting the Congenital Heart Futures Reauthorization Act, legislation that would extend funding for public health efforts at the Centers for Disease Control and Prevention to improve childhood survival rates, prevent premature death and disability, and increase quality of life for the 2.5 million Americans living with congenital heart disease. This is an important piece of legislation for the future of ACHD.

Krasuski and the team met with Senator Dick Durbin in his office. Left to right: Mark Roeder, CEO of the ACHA; Richard Krasuski, MD; Senator Durbin; Aliza Marlin; Scott Leezer, vice president of Government Relations at CURA Strategies, and Jim Rumple, Chair of the Board of Directors of the ACHA.

Great job, Rich!

 

ICYMI: Swaminathan Recognized for Advocacy

Madhav Swaminathan

Madhav Swaminathan, MD, a professor of anesthesiology at Duke specializing in cardiothoracic anesthesiology and critical care medicine, was recently highlighted for his DEI and advocacy work with Duke’s Neurodiversity Initiative Working Group. If you happened to miss the post by Duke School of Medicine last week, it is certainly worth checking out.

Keep up the great work, Madhav!

 

 

Please Vote in USNWR Best Hospitals for Cardiology & Heart Surgery

USNWR voting for Best Hospitals by specialty is now open in Doximity. If you are board-certified in the U.S. and have claimed your Doximity profile already, please log into your account by March 27 to complete the brief survey: submit your nominations.

New to Doximity? Find and register your profile to vote. Just go to Doximity’s login page, scroll to the bottom and click on “find your profile” – find yours and claim it/register. You can participate in the survey as long as you register on Doximity prior to the survey closing on March 27.

The survey allows you to list up to five hospitals as Best Hospital in the specialty in which you are board-certified. Your ballot counts even if you vote only for one hospital.

As with primaries and national elections, every vote is important!

 

Support Frazier-Mills, Duke Health’s 2024 AHA Woman of Impact!

Please join us in supporting electrophysiologist Camille Frazier-Mills, MD, one of the Triangle American Heart Association’s Women of Impact in her campaign to raise funds to support Go Red for Women.

Camille Frazier-Mills

Frazier-Mills is representing Duke Health as a Woman of Impact in the 2024 campaign and we want to help her reach her campaign goal. By donating, each of us can support her campaign and help ensure more women have equitable access to cardiovascular care and better representation in critically needed medical research.

** Check out Camille Frazier-Mills’ campaign page and please donate by April 4. **

Every year across the country, a select group of individuals are nominated to be a part of Woman of Impact because of their passion and drive to make a difference. This 9-week blind competition is relentlessly focused on women’s heart health. The campaign launched on National Wear Red Day (Feb. 2) and closes on April 4. During this time, the nominees work to build campaign plans, recruit Impact teams, and inspire their networks to support the American Heart Association’s lifesaving mission.

At the end of the campaign, this special group of changemakers will be celebrated for the overall impact they have on the AHA’s mission and the Triangle community. The nominee who makes the greatest impact and raises the most funds locally will be named a local 2024 Woman of Impact Winner.

Additionally, the nominee who makes the greatest impact nationwide will be named the American Heart Association 2024 National Woman of Impact Winner.

Let’s help her reach and exceed her goal – let’s help her WIN! Go, Camille!

 

New CFO announced for DUHS

Lisa M. Goodlett, CPA, MBA, FACHE will join Duke as Senior Vice President, Chief Financial Officer, and Treasurer for Duke University Health System, effective March 4, 2024. Lisa will work closely with leaders across the health system to develop and implement financial, operations, and growth strategies. She joins DUHS from the Medical University of South Carolina where she served as system CFO.

 

Great Catch Brittenham!

Congratulations to Kida Brittenham of Duke Heart’s 7 West team — Kida noticed a sudden change in the amount and character of a patient’s drainage in a negative pressure wound therapy suction canister. She immediately escalated her concern to the provider team and continued to advocate for the patient. The provider discovered an aortic leak, and the patient was taken emergently to the OR and received life-saving care.

Way to go, Kida – thank you for your dedication to safe care for our patients!

 

 

 

 

DUHS Moves to Tier 1 Visitation Status, Tues. March 5

After consulting with Infectious Disease and Infection Prevention experts and closely monitoring respiratory illness in our community, DUHS will move to Tier 1 visitation status on Tuesday, March 5.

Visitation highlights:

  • Hospital visiting hours: 8 a.m. – 9 p.m. daily.
  • Up to four visitors at a time where space permits; switching is allowed.
  • Visitors of all ages are allowed in inpatient, maternity, and ambulatory spaces.
  • Visitors must be 18+ in perioperative/surgical/procedural areas.

Note: Additional visitation and masking precautions may apply to certain patient populations.

Exceptions to visitation restrictions may be granted based on special circumstances.

To keep everyone healthy, please remember to practice safe behaviors, including frequent hand hygiene and the proper use of PPE. Please do not come to work if you are sick. More information is available on Duke Health Now.

 

Adam Silver Elected Chair, Duke University BOT

Duke alumnus and NBA Commissioner Adam Silver will serve as chair of Duke University Board of Trustees for a three-year term starting July 1, succeeding Laurene Sperling. Silver, who currently serves as vice chair, was elected to the post by the Board of Trustees at its recent quarterly meeting.

 

 

 

Reminder: NC Primary/”Super Tuesday” is March 5

The NC Primary is Tuesday, March 5. To find your polling place, you can click here.

Additional information on voting and voter ID requirements can be found on the Duke Votes website.

 

Upcoming Events & Opportunities

  • Friday, March 8 is International Women’s Day
  • March is National Nutrition Month
  • USNWR Best Hospitals Voting is open (through March 27). Please check your Doximity account and vote!

 

Cardiology Grand Rounds

March 5: No CGR today.

March 12: Arrhythmias in Myocardial Infarction: Beyond the Substrate with Ching Zhu, MD. 5 p.m., DN 2002 or via Zoom.

March 19: Beyond the Bump: Navigating the Interplay of Cardiovascular Health and Obstetrics in the Modern Era with Sarah Snow, MD. 5 p.m., DN 2002 or via Zoom.

March 26: Topic TBD with Brittany Zwischenberger, MD. 5 p.m., DN 2002 or via Zoom.

All Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit:

NET ID and password required. Enjoy!

CD Fellows Core Curriculum Conference

March 6: EP Case Presentation with Sara Coles and Jonathan Hanna. Noon. DMP 2W96 (in-person only).

March 8: Pregnancy & Heart Disease with Cary Ward. Noon, DMP 2W96 (in-person only).

Upcoming CME Symposia

March 8: Cardio-Oncology/Amyloid Symposium

The Southeastern Cardio-Oncology Conference, The Future is Now will take place on March 8 at the JB Duke Hotel in Durham, NC. Event registration is open; the registration deadline is March 5.

Duke cardiologists Michel Khouri and Ravi Karra of Duke’s Precision Cardiomyopathy Program will be presenters during the symposium.

Keynote to be provided by Avirup Guha, director of cardio-oncology and assistant professor of medicine at Augusta University’s Georgia Cancer Center.

The symposium is presented by Duke Cancer Network (DCN) in collaboration with Duke Cancer Institute. For more information, please contact Beth Tanner of DCN.

April 12: Duke Sports Cardiology & Sudden Death in Athletes

May 4: Duke Heart Failure Symposium

Registration is not yet open for the April 12 or May 4 symposia, but if you have questions about either event, please reach out to Christy Darnell.

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

Duke Heart in the News:

February 24 — Joseph Turek and the Monroe family

Spectrum News Carolina

North Carolina toddler alive today thanks to a first-of-its-kind procedure

*clip begins @ 15:34:11

February 25 — Taylor Stephenson (lung transplant patient)

WNCN Raleigh

Lifesaving surgery at Duke Hospital gives a young woman a new chance at a better life

*clip begins @ 08:16:30

February 25 — John Reynolds and Taylor Stephenson

WRAL Raleigh

A new lease on life after a woman’s 3rd double-lung transplant

*clip begins @ 06:15:40

February 26 — Carmelo Milano and Krish Dewan

tctMD

Infective Endocarditis in Opioid Users: Care Must Go Beyond the Heart

February 27 — Stephen Greene

Managed Healthcare Executive

Exploring Advances and Challenges in Heart Failure with Stephen Greene of Duke Heart Center

February 28 — Kevin Oeffinger (family medicine & community health)

Diagnostic and Interventional Cardiology

Long-term Survivors of Childhood Cancer at Higher Risk of Death Following Heart Issues; Threshold for Treating Risk Factors Should be Lower

February 28 – Duke University Hospital

Becker’s Hospital Review

43 US hospitals among world’s best: Newsweek

February 29 — Manesh Patel

WRAL

Cardiovascular issues play large role in Black maternal mortality

March 1 — Audrey Blewer (family medicine & community health)

Healio/Cardiology Today

Women with public cardiac arrest less likely than men to receive CPR

March issue — Duke Hospitals (all)

Business North Carolina

North Carolina’s best hospitals 2024

Duke Heart Pulse — February 25, 2024

Highlights of the week:

Heart Team Implants 1500th Durable VAD

Congratulations to our Duke Ventricular Assist Device (VAD) Program for reaching a program milestone: a total of 1500 durable VAD implants have been completed at Duke University Hospital (DUH) as of this past week. The first durable VAD placed at DUH occurred in 1994.

“Achieving 1500 VAD implants is a testament to the unwavering dedication, clinical expertise, and commitment of each member of our multidisciplinary team and the community partners who identify patients that may benefit from this therapy, said Carmelo A. Milano, Joseph W. and Dorothy W. Beard Distinguished Professor of Experimental Surgery and division chief of cardiovascular and thoracic surgery at Duke Health in a statement to team members.

“As one of the first VAD centers certified by The Joint Commission, we are proud of the high standards and quality care provided to each VAD patient at Duke,” Milano adds. “Each implant represents a life impacted and a step forward in delivering comprehensive advanced heart failure care to the patients of our region.”

VADs are durable mechanical circulatory support devices used in patients who have reached end-stage heart failure. They are mechanical pumps that help a patient’s failing heart continue to pump blood through their body. Some patients receive a VAD as a “bridge-to-transplant” therapy while waiting for a heart transplant; others receive VADs as “destination therapy” — long-term placement without receiving a heart transplant. Early VADs were devices that were solely meant to keep people alive in a hospital until a donor heart could be found for them. Now, the devices have improved so much that many patients can not only leave the hospital but potentially live on VAD support for the rest of their lives.

“When this technology became available, we were fully in it from the beginning because we saw a much-needed gap in available treatments,” says Laura Blue, DNP, nurse practitioner and Duke’s lead VAD coordinator since 2003. “We had the resources and the desire to help more patients and it has been awesome to see people get chunks of their life back. To see them have more time to meet their dreams and have their lives improved. Giving people the ability to complete things they want to do and have more time with their families and accomplish goals has been the best part of this process.”

Milano attributes our VAD success to the many people who have been part of the VAD team over the years, especially those who led the way at the very beginning, including thoracic surgeons Peter van Trigt, MD (now at  Moses Cone) and Kevin Landolfo, MD (now at Mayo Jacksonville). The entire current team has great synergy and drive and Milano attributes a lot of that to the two surgeons who are currently driving the VAD program – Jacob Schroder, MD, and Jeffrey Keenan, MD, and cardiology partners including Stu Russell, MD, and lead VAD coordinator Laura Blue, who, he says, has probably put more time into the VAD program than anyone.

VAD technology has evolved from large pulsatile devices to smaller rotary flow pumps over the years and Duke has been a leading site for clinical research in the development of many of the devices. Duke was the leading enroller for the HeartMate II LVAD clinical trial, the HVAD HeartWare clinical trial, and the MOMENTUM HeartMate 3 clinical trials, according to Milano.

“These three devices are probably the most common VADs we’ve used in reaching this 1500th milestone,” said Milano. “And we were leaders in the clinical trials that led to the FDA approval of those devices.”

Stu Russell, MD, Duke’s regional director for advanced heart failure agrees. “If you look back over the years at the kinds of pumps that have been studied, that led us to the ones we’re using today, Duke has been one of the highest enrollers in all of the clinical trials. Our patients have helped pave the way for VADs getting better and better over time.”

Russell says physicians are seeing fewer strokes occurring with VADs and less clotting – that the pumps have gotten better, and smaller, the batteries last longer, and the devices are more reliable than ever.

“Heart failure is the number one discharge diagnosis in most hospitals in America,” Russell says. “It’s everywhere and here in the south, with the rates of hypertension and coronary disease, there is even more of it. There are a ton of people developing and a lot of people dying of heart failure every year. As good as we’ve done and as high a number of VADs as we have implanted — it’s just a drop in the bucket compared to how many more people could probably benefit.”

The team sees reaching this milestone as an accomplishment that goes beyond Duke. They stress the partnerships with referring physicians across the region who choose to send their patients for an evaluation at Duke.

Regionally, the southeast has a very high prevalence of heart failure — higher than anywhere else in the United States,” says Stephanie Barnes, MSN, AGNP, CHFN, clinical director for Advanced Heart Failure at Duke. “Based on our transplant and durable VAD volumes combined, while they’re high and we are leading the way in providing advanced heart failure care to patients, we anticipate there are many patients out there who are not receiving these therapies, simply because they’re not making it to the door of advanced heart failure centers, or they’re making it too late.”

Duke’s durable VAD program has developed alongside its heart failure program, which reached a program milestone of 2000 completed heart transplants in December. The team hit a program and U.S. record of 161 heart transplants completed in 2023.

“Advanced heart failure patients are some of the most severely ill patients we see as cardiologists,” says Chetan Patel, MD, Duke Heart’s Vice Chief for Outreach and Network Development. “Not many heart centers can say they have achieved such a milestone and it’s due to the work of an amazing team over the years.”

We are so proud of this team and the thousands of lives they’ve touched. Congratulations!

 

Support Frazier-Mills, Duke Health’s 2024 AHA Woman of Impact!

Camille Frazier-Mills

Please join us in supporting electrophysiologist Camille Frazier-Mills, MD, one of the Triangle American Heart Association’s Women of Impact in her campaign to raise funds to support Go Red for Women.

Frazier-Mills is representing Duke Health as a Woman of Impact in the 2024 campaign and we want to help her reach her campaign goal. By donating, each of us can support her campaign and help ensure more women have equitable access to cardiovascular care and better representation in critically needed medical research.

Check out Camille Frazier-Mills’ campaign page and please donate by April 4.

Every year across the country, a select group of individuals are nominated to be a part of Woman of Impact because of their passion and drive to make a difference. This 9-week blind competition is relentlessly focused on women’s heart health. The campaign launched on National Wear Red Day (Feb. 2) and closes on April 4. During this time, the nominees work to build campaign plans, recruit Impact teams, and inspire their networks to support the American Heart Association’s lifesaving mission.

At the end of the campaign, this special group of changemakers will be celebrated for the overall impact they have on the AHA’s mission and the Triangle community. The nominee who makes the greatest impact and raises the most funds locally will be named a local 2024 Woman of Impact Winner.

Additionally, the nominee who makes the greatest impact nationwide will be named the American Heart Association 2024 National Woman of Impact Winner.

Let’s help her reach and exceed her goal – let’s help her WIN! Go, Camille!

 

Rymer Accepted to ACC Emerging Faculty Leadership Academy

Jennifer Rymer

Congratulations to Jenn Rymer, MD, assistant professor of medicine in cardiology! We learned this week that she has been accepted into the 2024 American College of Cardiology (ACC) Rick Nishimura, MD, MACC and Patrick T. O’Gara, MD, MACC Emerging Faculty Leadership Academy.

Established in 2005, the ACC Emerging Faculty Leadership Academy supports early-career academic cardiologists who strive to become clinician educators. Participants learn evidence-based teaching strategies and core skills along with other members of their cohort at Heart House in Washington, DC.

Duke cardiologists recently selected for this highly competitive opportunity include Nishant Shah (2023), Tony Gutierrez, MD (2022), and Adam DeVore, MD (2019). 

Congratulations, Jenn! We are so excited for you!

 

USNWR Best Hospitals Voting Now Open

USNWR voting for Best Hospitals by specialty is now open in Doximity. If you are board-certified in the U.S. and have claimed your Doximity profile already, please log into your account by March 27 to complete the brief survey: submit your nominations.

New to Doximity? Find and register your profile to vote. Just go to Doximity’s login page, scroll to the bottom and click on “find your profile” – find yours and claim it/register. You can participate in the survey as long as you register on Doximity prior to the survey closing on March 27.

The survey allows you to list up to five hospitals as Best Hospital in the specialty in which you are board-certified. Your ballot counts even if you vote only for one hospital.

As with primaries and national elections, every vote is important!

Seriously, stop reading and go vote for Duke University Hospital — best of the best for cardiology and heart surgery! We’ll be here when you’re done – there’s more news below!

 

Armed and Dangerous Drills, Feb. 26-29

Jonathan Bae, MD, CPPS, Chief Quality Officer for Duke University Hospital, announced last week that Duke University Hospital will conduct Armed and Dangerous Drills this coming week (Feb. 26th – 29th). The drills will be discussion-based with the goal of reinforcing education and encouraging preparedness conversations with your teams.

Trained facilitators will present a scenario and questions for participants to think through as well as verbalize what they would do. Throughout the week there will be sessions conducted in-person on units at various times. Before each session, facilitators will round and gather any staff who are available. If you are available during a session in one of your work areas, you are welcome to participate in that session.

We understand that participation in on-unit sessions can be challenging for physician teams, so Zoom options are also available. If this works better for your schedule, please register for a time below:

All sessions will last approximately 30 minutes. While we aim to provide accessible opportunities, with a drill of this scale, we will not be able to incorporate everyone. If you are unable to participate we do encourage refreshing your knowledge via the virtual Armed and Dangerous Training available online via LMS Course Number 00073596. 

If you have questions about the drills, please email workplaceviolenceprevention@duke.edu.

Please take some time this week to refresh your preparedness and/or participate in any session for which you’re available.

 

Feb. 27: Before They Were Stars Series – Perspectives from Dean Mary Klotman

We know this is a busy week, but… here’s a great event to consider: the Program for Women in Internal Medicine (PWIM) continues the popular Before They Were Stars series, now open to ALL in the Department of Medicine. This series highlights the career paths of prominent women physicians, capturing the successes, challenges and opportunities facing women in medicine.

This month PWIM is joined by Dean Mary Klotman! Dean Klotman will describe her career journey in academic leadership through her roles as Chair of Medicine and now as Dean of the School of Medicine.

All faculty and trainees are welcome and encouraged to attend. There will be food and beverages provided outside of the meeting venue beginning at 6 p.m. Conversation with Dean Klotman will start promptly at 6:30 p.m. on Tuesday, Feb. 27 in Duke Hospital North 2002.

Please join if your schedule permits. We’d love a great showing from Duke Cardiology if you can stay – this event immediately follows CGR in DN 2002!

 

NC Primary is March 5; Early Voting Ends March 2

Early voting for the March 5 Primary Elections is open through 3 p.m. on Saturday, March 2.

Duke University has an early voting location on campus at Karsh Alumni and Visitors Center. During the early voting period, voters can cast their ballot at any early voting location in the county where they are registered. Other early voting locations across NC can be found here. Voters who missed the registration deadline last week can also register and vote on the same day at early voting locations.

On Election Day, Tuesday, March 5, voters must cast a ballot at their assigned polling location.

Additional information on registering to vote, voting, and voter ID requirements can be found on the Duke Votes website.

 

Upcoming Events & Opportunities

  • February is Heart Month and Black History Month.
  • March is National Nutrition Month
  • March 8 is International Women’s Day
  • USNWR Best Hospitals Voting is open (through March 27). Please check your Doximity account and vote!

 

Cardiology Grand Rounds

Feb. 27: CTEPH…The Challenges We Face with William Auger, MD. 5 p.m., DN 2002 or via Zoom.

March 12: Arrhythmias in Myocardial Infarction: Beyond the Substrate with Ching Zhu, MD. 5 p.m., DN 2002 or via Zoom.

March 19: Beyond the Bump: Navigating the Interplay of Cardiovascular Health and Obstetrics in the Modern Era with Sarah Snow, MD. 5 p.m., DN 2002 or via Zoom.

March 26: Topic TBD with Brittany Zwischenberger, MD. 5 p.m., DN 2002 or via Zoom.

All Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit:

NET ID and password required. Enjoy!

 

CD Fellows Core Curriculum Conference

Feb. 28: HF/Txp Case Presentation with Seamus Hughes. Noon. DMP 2W96 (in-person only).

March 1: EKG Review with Neil Freedman. Noon. Zoom only.

 

Upcoming CME Symposia for Spring, 2024

March 8: Cardio-Oncology/Amyloid Symposium

The Southeastern Cardio-Oncology Conference, The Future is Now will take place on March 8 at the JB Duke Hotel in Durham, NC. Event registration is open; the registration deadline is March 5.

Duke cardiologists Michel Khouri and Ravi Karra of Duke’s Precision Cardiomyopathy Program will be presenters during the symposium.

Keynote to be provided by Avirup Guha, director of cardio-oncology and assistant professor of medicine at Augusta University’s Georgia Cancer Center.

The symposium is presented by Duke Cancer Network (DCN) in collaboration with Duke Cancer Institute. For more information, please contact Beth Tanner of DCN.

 

April 12: Duke Sports Cardiology & Sudden Death in Athletes

May 4: Duke Heart Failure Symposium

Registration is not yet open for the April 12 or May 4 symposia, but if you have questions about either event, please reach out to Christy Darnell.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

 

Duke Heart in the News:

February 16 — Duke University Hospital/Health System

Becker’s Hospital Review

24 most reputable US academic medical centers

February 18 — Carmelo Milano and Jacob Schroder

Innovando News (Italy)*

Fifty million euros for the first Italian artificial heart

*mention is in photo caption

February 19 — Duke Health

Medical Economics

How to keep your patients happy: 6 steps to reduce long wait times and improve patient satisfaction

February 20 — Duke University (biomechanical engineering)

Healthcare-in-Europe.com

Should these pills go together? ML model predicts drug interactions

February 20 — Stephen Greene

Managed Healthcare Executive

Stephen Greene, MD, Gives Insight on the New Heart Failure Drug Sotagliflozin

February 20 — Christopher Granger

The Laurinburg Exchange

Scotland works to increase cardiac arrest survival rates

February 21 — Stephen Greene

HCP Live

Experts’ Perspectives: Top Issue Facing Cardiology in 2024

February 21 — John Reynolds and Taylor Stephenson (lung tx patient)

WRAL (NBC Raleigh)*

Woman recovering after receiving her third double-lung transplant at Duke Health

*carried also by WRAZ (Fox 50) & WILM (Wilmington, NC Channel 10)

February 21 — John Reynolds and Taylor Stephenson

WNCN (CBS17 Raleigh)

‘I don’t want to die yet’: Woman receives life-saving 3rd double lung transplant at Duke Hospital

February 22 — Jacob Klapper and Taylor Stephenson

New York Post

Cystic fibrosis patient, 26, receives 3rd set of lungs after begging doc to take her case: ‘I was always told that two was it’

February 23 — Taylor Stephenson

People.com

Woman, 26, Recovers from 3rd Double Lung Transplant in 8 Years: ‘I Was Getting Another Chance’

Duke Heart Pulse — February 18, 2024

Highlights of the week:

Loring Receives Career Development Award

Zak Loring

Congratulations to Duke electrophysiologist Zak Loring, MD, who has been awarded a Veterans Health Administration (VHA) VISN 6 Career Development Award (CDA) for his study Improving Disparities in Atrial Fibrillation Care Through Development of Machine Learning Risk Models. Loring’s research will implement an ECG-based machine learning model to identify high-risk Veterans in the rural community with atrial fibrillation.

Through early identification and timely delivery of advanced treatment strategies, such as catheter ablation, Loring aims to prevent the development of heart failure. J. Antonio Gutierrez, MD will serve as Loring’s primary mentor for this award.

VISN 6 is the VA’s Mid-Atlantic Health Care Network, one of 23 Veterans Integrated Service Networks of the Veterans Health Administration. VISN 6 is comprised of eight VA Medical Centers (including Durham VAMC) and 15 community-based outpatient clinics.

VA Section Chief, Raj Swaminathan, MD, noted that this project directly builds on work Loring is completing through a VA ADAPT COIN grant award.

Gutierrez also holds a full CDA award, so this represents two CDAs awarded to our faculty in the last three years!

Congrats, Zak!!

 

Pauly Begins as DUH President

Tomorrow, Feb. 19, we welcome Greg Pauly to his new role as president of Duke University Hospital. Pauly will also serve as group president of Acute Care Services for Duke University Health System and as Duke University School of Medicine’s Vice Dean for Clinical and Academic Integration.  

In these roles, Pauly will provide oversight of the strategic direction, fiscal management, and program development for all acute care services across DUHS, including Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital campuses.

Pauly is joining Duke after serving as executive vice president and chief operating officer for Massachusetts General Hospital.

Please give him a warm welcome when you see him!

 

Jessica May Joins Heart Development Team

Please join us in welcoming Jessica Baga May, a major gifts officer for Duke Health Development and Alumni Affairs (DHDAA), to our Duke Heart team! May is now serving as one of our primary team leads focused on increasing and managing philanthropic support of Duke Heart. May joined Duke Health’s development team in 2021; her transition to Duke Heart officially began on February 1.

May’s efforts while at Duke Health have focused on grateful patient fundraising within the Department of Surgery. She will continue to support several of those surgical areas but will expand her focus to include the Heart team.

 May says she is excited to be part of our team and that she hopes to serve as an asset to building philanthropic support for the work we do. We asked her what she’d most like our faculty to know about grateful patient fundraising.

“One of the most important things for faculty to know specifically about grateful patient philanthropy is that it’s a relationship-building process. Part of a development officer’s role is establishing a rapport and a connection with our faculty partners, and identifying if and how each faculty member wants to be involved in the fundraising process.”

May says that her initial goal is to speak with members of the faculty, get to know them, and learn about the experiences they have had with philanthropy. She’ll answer any questions you have about the fundraising process and will look to understand how you prefer to be engaged over time.

“I am here to enable a process for those who want to be engaged with philanthropy, both on the donor side and the faculty side, in a way that is fully respectful of patient care as the top priority. 

Before joining Duke, May served as Senior Development Officer for Leadership Gifts at Wellesley College in Wellesley, MA. She has also served as a major gifts officer at the Massachusetts Institute of Technology in Boston, and Vassar College in Poughkeepsie, NY. Although her professional experience is largely rooted in higher education, her background includes growing up as a child of a cardiologist. She says her father, a now-retired private practice interventionalist, taught her how to work an EKG machine and let her play with pacemaker models as a child.

We are excited to have Jessica working with us in Duke Heart. You can anticipate hearing from her as she starts reaching out to introduce herself to faculty members.

Welcome, Jessica!

 

Thank you, Residents & Fellows!

Duke is celebrating Graduate Medical Education Week from Feb. 18-26, a time to recognize all our residents and fellows and those who work to lead and support these programs, including program directors, associate program directors, program coordinators, and all vice chairs of education. Enjoy the week!

 

Califf Recognized with Duke Centennial ‘Spotlight’

Duke alum and cardiologist Robert Califf, MD was highlighted this week in a ‘centennial spotlight’ as part of Duke University’s Duke 100 Centennial Celebration. To view the current FDA Commissioner’s spotlight and all those who will be recognized throughout the year, please visit the Duke 100 site.

 

Cardiac Surgical Innovations Highlighted in SOM’s Magnify

This week’s feature story in Magnify, Duke School of Medicine’s online magazine, covers recent innovations in pediatric heart surgery for congenital heart defects including partial heart transplantation, “domino” transplants, and the recent heart-thymus co-transplant. Told through a series of interviews with Drs. Joe Turek, Doug Overbey, Louise Markert, and Allan Kirk, Saving More Babies Through Innovation in Pediatric Heart Surgery, looks at lives saved, the challenges of congenital surgery, and hope for the future.

 

ICYMI: Fuller Delivers Sanford Lectureship

Dr. Stephanie Fuller, the Thomas L. Spray Endowed Chair in Pediatric Heart Surgery at Perelman School of Medicine at the University of Pennsylvania delivered the Sanford Lectureship on Wed., February 14th as part of Duke Surgery Grand Rounds. A recording of her lecture, Congenital Heart Surgery: Outcomes, Innovation and Adults can be viewed in Duke Box.

She gave a terrific presentation – the recording is well worth watching.

 

Early Voting Begins for 2024 Primary Elections

Early voting for the March 5 Primary Elections is now open! The early voting period runs through Saturday, March 2. Duke University has an early voting location on campus at Karsh Alumni and Visitors Center. During the early voting period, voters can cast their ballot at any early voting location in the county where they are registered. Other early voting locations across NC can be found here. Voters who missed the registration deadline last week can also register and vote on the same day at early voting locations. On Election Day, voters must cast a ballot at their assigned polling location.

The primary elections in NC include candidates for President, Governor, all 170 members of the state legislature, 14 congressional seats, one NC Supreme Court seat, various judicial positions, and other Council of State positions including Lieutenant Governor, Attorney General, Commissioner of Agriculture, Superintendent of Public Instruction, Commissioner of Labor, Commissioner of Insurance, Secretary of State, State Treasurer, and State Auditor. Registered Democrats, Republicans, or Libertarians must vote their party’s primary ballot, but Unaffiliated voters can choose which party’s ballot to vote.

NC voters are now required to provide photo ID at the polls. A list of acceptable forms of ID can be found on the State Board of Elections website. Duke University students still have the opportunity to request a student voter ID card approved by the State Board of Elections last year. Additional information on registering to vote, voting, and voter ID requirements can be found on the Duke Votes website.

 

Upcoming Events & Opportunities

  • February is Heart Month and Black History Month.
  • It’s GME Week 18-26

Cardiology Grand Rounds

Feb. 20: Closing Arguments on the Management of Atrial Septal Defects with Richard Krasuski. 5 p.m., DN 2002 or via Zoom.

All Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit:

NET ID and password required. Enjoy!

CD Fellows Core Curriculum Conference

Feb. 21: DHP Case Presentation with Eric Xie. Noon. DMP 2W96 (in-person only).

Feb. 23: TBD with TBD. Noon. Zoom only.

Virtual: AHA Hands-Only CPR Demonstration

For team members at Duke who are not required to have BLS certification, please consider participating in the upcoming virtual AHA Triangle Hands-Only CPR demonstration, being held at Noon on Feb. 22. To register please click here. You’ll then receive a confirmation with the Zoom link.

Help us reach 100+ participants from Duke Health!

Office of Faculty — Event with Israni of Stanford Medicine, Feb. 26

Academic Medicine, with all its complexities, naturally includes conflict amongst its crucial collaborators – trainees, faculty, staff, communities and more. 21st century leadership skills require all of us to strategically leverage components of this conflict for constructive change, with intentional and thoughtful actions. This talk will weave together themes from restorative justice and design thinking; and how they can be applied to artificial intelligence and JEDI (justice, equity, diversity, and inclusion), offering a case for new ways of leveraging conflict to advance a culture of connectedness and belonging. The featured speaker will be Sonoo Thadaney Israni of Stanford University’s Presence Center.

February 26: Leveraging Conflict for Constructive Change. 4-5:30 p.m., DN 2002. Presented by the Office for Faculty. Refreshments will follow. To learn more and register: https://duke.is/8/8d7f.  

Upcoming CME Symposia for Spring, 2024

March 8: Cardio-Oncology/Amyloid Symposium

The Southeastern Cardio-Oncology Conference, The Future is Now will take place on March 8 at the JB Duke Hotel in Durham, NC. Event registration is open; the registration deadline is March 5.

Duke cardiologists Michel Khouri and Ravi Karra of Duke’s Precision Cardiomyopathy Program will be presenters during the symposium.

Keynote to be provided by Avirup Guha, director of cardio-oncology and assistant professor of medicine at Augusta University’s Georgia Cancer Center.

The symposium is presented by Duke Cancer Network (DCN) in collaboration with Duke Cancer Institute. For more information, please contact Beth Tanner of DCN.

April 12: Duke Sports Cardiology & Sudden Death in Athletes

May 4: Duke Heart Failure Symposium

Registration is not yet open for the April 12 or May 4 symposia, but if you have questions about either event, please reach out to Christy Darnell.

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

Duke Heart in the News:

February 10 — Duke University

Forbes

Top 20 Universities For NIH Funding; Johns Hopkins Ranks First Again

February 12 — Jen Weber (lung tx patient)

Bonnell Foundation Podcast

All things lung transplant with Jen Weber

February 12 — Elisabetta Politi (Lifestyle & Weight Management Center)

Everyday Health

Using a Salt Substitute Can Slash Risk of Developing High Blood Pressure

February 12 — Marat Fudim

tctMD

More Mortality Reduction Signals With Implantable Hemodynamic Monitors in HFrEF: Meta-analysis

February 13 — Reid Chamberlain

WFMY Greensboro (NC) – CBS News 2

Greensboro 8-year-old becomes first in the world to receive this heart surgery

February 15 — Gerald Bloomfield

NIH News/Fogarty International Center

Finding causes of heart failure in Western Kenya

 

Duke Heart Pulse — February 11, 2024

Highlights of the week:

Happy Lunar New Year!

Yesterday marked the beginning of the Lunar New Year, a 15-day festival marking the beginning of the new year based on the lunar or lunisolar calendar. It is one of the largest holidays in the world and is celebrated across East Asia.

2024 is the Year of the Dragon. To all Duke Heart faculty and staff celebrating the Lunar New Year, we wish you great happiness and prosperity!

New Gift to Support Heart Transplant Patients and Their Families

A $1.5 million legacy gift from an anonymous family will help support Duke Heart transplant patients

The donors know firsthand what it is to have a family member with a failing heart, and what a miracle a heart transplant can be. They also know how arduous the transplant journey is.

“Our experience was really, really good,” a member of the family said. “But one of the things we saw around us was how much the financial stress impacted families. Our belief that ‘to whom much is given, of them much is expected’ meant we wanted to make a meaningful gift, and that it was important to do so in a way that will directly relieve some of the strain on patients and their families.”

For the donors that meant directing their gift to help with the financial challenges families undergoing transplantation face.

“We saw all the challenges that were outside the medical system that insurance doesn’t pay for. And so that really led us to target this gift to help cover those expenses. Families might need transportation, they might need lodging, or something else. And they may not be as fortunate as we are, whether it be to live here or financially be able to take care of those things. We wanted to provide something that would help those families,” another family member added.

Over the last two years, Duke has performed more heart transplants than any other center in the world, helping patients from 10 different states. Duke also accepts high-risk patients who have been turned away from other centers. 

“This gift provides much-needed support to the families being seen at Duke Heart,” said Chet Patel, MD, vice chief for outreach and network development. “Many patients undergoing complex care such as heart transplant sometimes have to make choices between personal recovery and family wellbeing. A lot of these stressors are financial due to costs not covered by health insurance such as living expenses and health-care-related travel. With the help of generous families who have been through these challenges, we can reduce these stressors and allow the patients to focus on healing.”

Duke Heart is one of the world’s premier heart and vascular centers, treating more than 65,000 patients

Manesh Patel

annually. It has the largest heart transplant program in the nation and is recognized both nationally and internationally for its advanced research and treatments. Duke has performed numerous heart transplant ‘firsts’ as well as other breakthrough procedures that have vastly improved outcomes for those with failing hearts.

“Our overriding goal at Duke Heart is to improve and innovate care and deliver those therapies as close to patients in their own communities as possible,” said Manesh Patel, MD, Division Chief of Cardiology and director of Duke Heart. “We are grateful for this family’s gift that will help reduce the barriers to transplant care.”

 

Duke’s Advanced Heart Failure Team Celebrates Recent Milestones

The Duke Heart Advanced Heart Failure Team gathered recently at the Washington Duke Inn to celebrate two significant milestones – the transplantation of 161 hearts in a single year and the transplantation of the 2000th heart at Duke.

The very first heart transplant at Duke was completed in 1985. The volume of heart transplants performed at Duke University Hospital last year was a record not only for Duke but for any U.S.-based program, according to OPTN data.

Congratulations, team – and Happy Heart Failure Awareness Week to all!

 

Kraus to Receive ACSM Citation Award

Duke cardiologist and rehabilitation specialist, William Kraus, MD, has been selected as an American College of Sports Medicine (ACSM) Citation Award winner for 2024. The prestigious Citation Award recognizes distinguished individuals who have made significant contributions to sports medicine and/or to the exercise sciences.

Bill is an outstanding clinician-scientist, mentor, volunteer, and leader in the fields of molecular biology, genetics, integrative human exercise physiology, and metabolism. He joins a highly regarded group of previous winners – many of whom are considered to be the ‘godfathers of exercise physiology’.

Kraus will be honored with the award at the 2024 ACSM Annual Meeting in Boston, May 28-31. He is among six recipients. To see the full list, visit the ACSM award site.

Congratulations, Bill! Well-deserved!

New scientific research will test PREVENT risk calculator among diverse groups

Research teams from Duke University, New York University, and Northwestern University Feinberg School of Medicine will work together to assess the accuracy of the American Heart Association’s (AHA) new PREVENT risk calculator with funding from the AHA’s De-biasing Clinical Care Algorithms project. The de-biasing project is funded by a grant from the Doris Duke Foundation to study the role of race and ethnicity in clinical equations and their impact on equity in disease diagnosis, healthcare delivery, or health outcomes.

Each team received a $150,000 one-year research award to further study how the risk calculator performs among people of various ages, racial and ethnic backgrounds, locations, and socioeconomic levels. The calculator was initially validated using health data from more than 3 million people. The new research intends to test it against even larger datasets.

The AHA PREVENT risk calculator is a new tool for clinicians to help people understand their risk for developing heart disease, stroke, or heart failure. It estimates cardiovascular disease risk based on health factors that assess cardiovascular, kidney, and metabolic health. Unlike the current standard for risk prediction, called the Pooled Cohort Equations (PCEs), a person’s race is not included in PREVENT as a factor in determining cardiovascular risk. Previous equations included race as a surrogate for the health effects of structural and systemic inequities, such as racism, that influence cardiovascular risk. The American Heart Association developed the PREVENT calculator with data on people from diverse races and ethnicities and includes additional health measures as well as a social index to predict risk more accurately.

The research teams will work in collaboration to assess the discrimination and calibration, cost-effectiveness, and accuracy of PREVENT among different sociodemographic groups using health system data from across the U.S. They will also see how it performs compared to the PCEs.

The research projects began January 1, 2024, and include:

  • Evaluation of Cardiovascular Risk Prediction Equations across Diverse Sociodemographic Subgroups – co-led by Michael J. Pencina, PhD, chief data scientist for Duke Health, and Chuan Hong, PhD, an assistant professor of biostatistics and bioinformatics at Duke.
  • Evaluating and Validating Equations Across All Race and Ethnicities – led by Sadiya S. Khan, MD, MSc, a cardiovascular epidemiologist at Northwestern University Feinberg School of Medicine in Chicago.
  • Debiasing Clinical Care Algorithms – CKD-PC Analysis Core – led by Josef Coresh, MD, PhD, founding director of the Optimal Aging Institute and a professor of population health and medicine at the New York University Grossman School of Medicine in New York.

Khan, Coresh, and Pencina were part of the volunteer writing group that developed the PREVENT equations. PREVENT was created based on data from more than 3 million people, and then validated in a different dataset of more than 3 million people to show that it is accurate in people of various ages, ethnicities, and geographic areas. This new collaborative project will further test how risk prediction with PREVENT applies to a diverse sample of adults and examine accuracy across race and ethnicity groups in the U.S.

 

Snider to Receive AmSECT National Award of Excellence

Please join us in congratulating Duke perfusionist Scott Snider! We learned this week that he has been selected as the winner of the 2024 American Society of ExtraCorporeal Technology (AmSECT) Award of Excellence.

This award is presented to a perfusionist who has demonstrated excellent work exemplifying creativity and intellectual originality in extracorporeal technology. The award is presented for excellence in any area such as education, continuing education, research, publication, or leadership, according to AmSECT.

Snider will receive the award during the 62nd AmSECT International Conference which is scheduled for March 20-24 at the Sheraton New Orleans Hotel in New Orleans, LA.

Congratulations, Scott!

 

Duke Kannapolis Community Registry Marks Milestone with Industry License

The Duke Clinical and Translational Science Institute (CTSI) announced last week that Personal Genome Diagnostics is the first company to obtain a license for materials from the MURDOCK Study, a unique community registry and biorepository managed by CTSI and based at Duke’s Kannapolis research site in Kannapolis, NC. The registry and biorepository include samples and associated data from more than 12,000 participants.

Licensing in support of industry research and development, in collaboration with the Duke Office of Translation and Commercialization (OTC), is one of a broad range of uses of the registry available through the Biorepository Transformation Initiative. This initiative makes thousands of biospecimens and associated clinical outcomes data available to researchers both inside and outside of Duke. Duke investigators can easily explore the cohort with just a few clicks using the data exploration tool. The storefronts summarize data and samples at a glance for all interested researchers.

Through the initiative, Duke investigators have recently advanced biomarker research in the areas of heart failure, Alzheimer’s, and diabetes, and the Duke School of Nursing has obtained over 20,000 biological samples and linked data to advance research in health equity and social drivers of health.

Researchers who are interested in accessing samples for academic collaboration or commercial scientific exploration can complete this brief interest form, as a first step in the process.

Congrats, CTSI!

 

Shout-out to Heart Nursing Leaders!

On Tuesday, February 6, several Duke Heart leaders (pictured below) for the Cardiothoracic Step-Down Units attended the Watts College of Nursing Career Fair. They had the opportunity to meet with over 30 potential candidates and establish shadow experiences. They are hoping this will yield new Heart team members!

 

 

Reminder: Tier 2 Status

We are currently in Tier 2 visitation status throughout Duke University Health System. Information is available on Duke Health Now.

 

Upcoming Events & Opportunities 

  • Duke Culture Survey: Jan. 29-Feb.17   
  • February is Heart Month and Black History Month.
  • February 7-14 is Congenital Heart Defect Awareness Week
  • February 11-17 is Heart Failure Awareness Week
  • Wednesday, Feb. 14 is National Donor Day

 

 

 

2024 Lefkowitz Distinguished Lecture

Feb. 13: Immunology of Long COVID with Akiko Iwasaki, PhD of Yale. Noon, Great Hall of Trent Semans Center for Health Education. The event will also be live-streamed.

The Robert J. Lefkowitz, MD Distinguished Lecture aims to celebrate and highlight groundbreaking medical research. This event will be hosted by Dean Mary E. Klotman, Executive Vice President for Health Affairs at Duke University and Dean for Duke University School of Medicine, and Nobel Laureate Robert J. Lefkowitz, MD, James B. Duke Professor of Medicine.

 

Cardiology Grand Rounds

Feb. 13: Breaking Barriers: The future of heart transplantation with Joseph Lerman. 5 p.m., DN 2002 or via Zoom.

All Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit:

NET ID and password are required. Enjoy!

CD Fellows Core Curriculum Conference

Feb. 14: Fellows Forum with Joseph Lerman. Noon. DMP 2W96 (in-person only).

Feb. 16: Radiation Biology and Protection with Robert Reiman. Noon. Zoom only.

Surgery Grand Rounds

Feb. 14: Congenital Heart Surgery: Outcomes, Innovations and Adults with Stephanie Muller. 8 a.m., DN 2002 or via Zoom.

Virtual: AHA Hands-Only CPR Demonstration

For team members at Duke who are not required to have BLS certification, please consider participating in the upcoming virtual AHA Triangle Hands-Only CPR demonstration, being held at Noon on Feb. 22. To register please click here. You’ll then receive a confirmation with the Zoom link. Help us reach 100+ participants from Duke Health!

Office of Faculty — Event with Israni of Stanford Medicine, Feb. 26

Academic Medicine, with all its complexities, naturally includes conflict among its crucial collaborators – trainees, faculty, staff, communities, and more. 21st century leadership skills require all of us to strategically leverage components of this conflict for constructive change, with intentional and thoughtful actions. This talk will weave together themes from restorative justice and design thinking; and how they can be applied to artificial intelligence and JEDI (justice, equity, diversity, and inclusion), offering a case for new ways of leveraging conflict to advance a culture of connectedness and belonging. The featured speaker will be Sonoo Thadaney Israni of Stanford University’s Presence Center.

February 26: Leveraging Conflict for Constructive Change. 4-5:30 p.m., DN 2002. Presented by the Office for Faculty. Refreshments will follow. To learn more and register: https://duke.is/8/8d7f.  

Upcoming CME Symposia for Spring, 2024

March 8: Cardio-Oncology/Amyloid Symposium

The Southeastern Cardio-Oncology Conference, The Future is Now will take place on March 8 at the JB Duke Hotel in Durham, NC. Event registration is open; the registration deadline is March 5.

Duke cardiologists Michel Khouri and Ravi Karra of Duke’s Precision Cardiomyopathy Program will be presenters during the symposium.

Keynote to be provided by Avirup Guha, director of cardio-oncology and assistant professor of medicine at Augusta University’s Georgia Cancer Center.

The symposium is presented by Duke Cancer Network (DCN) in collaboration with Duke Cancer Institute. For more information, please contact Beth Tanner of DCN.

April 12: Duke Sports Cardiology & Sudden Death in Athletes

May 4: Duke Heart Failure Symposium

Registration is not yet open for the April 12 or May 4 symposia, but if you have questions about either event, please reach out to Christy Darnell.

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

Duke Heart in the News:

February 2 — G. Chad Hughes

Medical Dialogues

Even Short Bouts of Hypothermic Circulatory Arrest Tied to Cognitive Deficits After Aortic Arch Surgery

February 2 — Payal Kohli

Verify This

No, slapping the inside of a person’s elbow can’t prevent or treat a heart attack

February 5 — Susan Dent

The ASCO Post

Cardio-Oncology Is a Growing Subspecialty, but Where Are the Oncologists?

February 6 — Jacob Schroder

Medscape

Método prometedor para evaluar corazones donados con criterios ampliados

February 6 — Duke School of Medicine

Diagnostic and Interventional Cardiology

Machine Learning Informs a New Tool to Guide Treatment for Acute Decompensated Heart Failure

February 7 — Adrian Hernandez

Yahoo Noticias (via AHA News)

Más allá de la respiración: cómo el COVID-19 afecta al corazón, al cerebro y otros órganos

(Spanish version of: https://duke.is/z/hd2z)

February 7 — Duke Health/Eric Poon (DPC)

Advisory Board

Ambient AI: A new way to save clinician time

Duke Heart Pulse — February 4, 2024

Highlights of the week:  

February kicked off with several events that were aimed at raising awareness around heart disease and specifically cardiovascular disease in women with GoRed events on Friday February 2nd.  We have several examples below of our heart center community including faculty, fellows, staff and patients engaged in Heart Month awareness events.  We also highlight the ongoing work within the Heart Center around research and patient care. In upcoming weeks we will highlight the recent STS meeting and some our CT surgery and cardiology care and advances in valvular heart disease.  Included below are some pictures from the GoRed – Red Dress event at the Lincoln center in NYC this week that a few of our faculty were able to attend and walk the red carpet.

Voora Appointed Exec Director of VA National Pharmacogenomics Program

Congratulations to Deepak Voora, MD, associate professor of medicine in cardiology! Voora has been appointed Executive Director for the Veterans Affairs National Pharmacogenomics Program.

Since 2019, Voora and his team have designed and implemented an end-to-end system for implementing pharmacogenomics (PGx) into routine clinical care across the VA. This includes access to PGx testing, funding, patient- and provider education, changes to the electronic medical record, clinical decision support systems, population health management tools, pharmacist consultation, and implementation workflows targeting specific patient populations most likely to benefit from PGx testing.

The VA’s National Pharmacogenomics Program currently supports PGx testing and services for the nearly 30,000 U.S. Veterans throughout the Veterans Health Administration (VHA) who are prescribed more than 60 common medications that are impacted by PGx each year. The Veterans Health Administration consists of more than 110 Veterans Affairs Health Care systems.

 

Heart Team Launches Use of Renal Denervation Device; 1st in VAHS & NC

Duke cardiologists Tony Gutierrez, MD, the Durham Veterans Affairs Medical Center (VAMC) Cath Lab Director, and Raj Swaminathan, MD, the Durham VAMC Chief of Cardiology, have performed the first renal denervation procedures for the treatment of hypertension in the Veterans Affairs Healthcare System (VAHS). The team used a recently FDA-approved ultrasound renal denervation device, making it the first commercial use of the device in the entire VAHS and any hospital in NC.

     

Hypertension, also known as ‘high blood pressure,’ puts those who have it at risk for heart disease and stroke — the leading causes of death in the U.S. Nearly half of adult Americans have the condition, but only about one in four have it under control, according to the Centers for Disease Control. The latest guidelines from the American College of Cardiology and the American Heart Association define stage 1 hypertension as a blood pressure at or above 130/80 mmHg and stage 2 hypertension as a blood pressure at or above 140/90 mmHg.

Initial treatments for hypertension are usually lifestyle interventions and medications that can help lower blood pressure. Despite those treatments, more than one-half of individuals do not achieve recommended treatment goals, according to a recent position statement from the Society for Cardiovascular Angiography & Interventions (SCAI). The statement’s team of co-authors, led by Swaminathan, cite the limitations of medical therapy as medication cost, adverse side effects, limited access, and poor adherence.

With the FDA’s approval of two renal denervation devices last year, treatment options are expanding for those with uncontrolled or resistant forms of hypertension, particularly among those at greatest cardiovascular risk.

“The prevalence of hypertension in our Veterans is anywhere from 71 to 87 percent,” Gutierrez says. “The technology that we have now is pretty advanced to go ahead and treat the nerves around the arteries.”

The renal denervation devices are used to disrupt the nerve signals going to the kidneys. The procedure treats high blood pressure and conditions related to high blood pressure, according to Swaminathan. Of the two approved devices, one uses ultrasound technology and the other utilizes radiofrequency ablation.

“Blood pressure control has plateaued over the last decade and existing treatment strategies, including lifestyle changes and medications, are often not enough,” Swaminathan adds. “Renal denervation is a new technology to treat high blood pressure that is safe, durable, and is ‘always on’.”  

The patients treated at the Durham VA both had resistant hypertension and were referred to the team by cardiologist Michelle Kelsey, MD, who has built a robust cardiology prevention clinic at the Durham VAMC. The procedures were performed in December.

The renal denervation approach begins with the cardiologist identifying and targeting appropriate segments of the renal arteries with adjacent renal nerves. A catheter is then threaded carefully through blood vessels toward the renal arteries. Once the catheter reaches its target area, energy (using ultrasound or radiofrequency) is delivered and disrupts nerve signals without damaging the arteries or surrounding tissues. The interrupting of nerve signals is what can help reduce high blood pressure, says Swaminathan.

“The overall objective of renal denervation is to provide long-term reduction in blood pressure, especially to Veterans who may not respond well to medication alone,” Gutierrez adds.

Swaminathan says the Position Statement is currently being used by industry and health systems as a guide to launch renal denervation programs around the country.

Congratulations, Raj, Tony, and Michelle!

 

Duke Celebrates National Wear Red Day!

Thanks to everyone who joined us in wearing red on Friday to celebrate National Wear Red Day! It was terrific to see so many of our teams sporting a bit of red. Check out these pics from teammates throughout Duke University Hospital, Duke Raleigh Hospital and Duke Regional Hospital.

 

This was a great way for our teams to kick off Heart Month!

Next up:

Hands-Only CPR demonstration:

For team members at Duke who are not required to have BLS certification, please consider participating in the upcoming virtual AHA Triangle Hands-Only CPR demonstration, being held at Noon on Feb. 22. To register please click here. You’ll then receive a confirmation with the Zoom link. Help us reach 100+ participants from Duke Health!

 

Duke Heart Team Wins Family-Centered Care Award

Congratulations to Callie Tennyson, John Oliver, Dustin Tart, Karen Jooste, Kelly Kester, and their collaborators — Bradi Granger, Catie Dunn, and Kayla Brooks — for receiving the Society of Critical Care Medicine’s (SCCM) “Family-Centered Care Innovation Award” for Duke University Hospital. The award was formally presented during the SCCM’s 53rd Critical Care Congress held last week in Phoenix, AZ.

The Family-Centered Care Innovation Award is presented annually to a program that demonstrates novel, effective methods of providing care to critically ill and injured patients and their families. The team was recognized for their project, Interprofessional Education for Family Care During Resuscitation.

Way to go!

 

Reminder: Tier 2 Status

We are currently in Tier 2 visitation status throughout Duke University Health System. Information is available on Duke Health Now.

Upcoming Events & Opportunities

  • Duke Culture Survey: Jan. 29-Feb.17
  • February is Heart Month and Black History Month.
  • February 7-14 is Congenital Heart Defect Awareness Week
  • February 11-17 is Heart Failure Awareness Week
  • Wednesday, Feb. 14 is National Donor Day

Cardiology Grand Rounds

Feb. 6: Implementation strategies to address the burden of Heart Failure with Harriette Van Spall of McMaster University. 5 p.m., DN 2002 or via Zoom.

Feb. 13: Breaking Barriers: The future of heart transplantation with Joseph Lerman. 5 p.m., DN 2002 or via Zoom.

All Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit:

NET ID and password are required. Enjoy!

 

CD Fellows Core Curriculum Conference

Feb. 7: HT/Txp Case Presentation with Ivan Nenadic Wood. Noon. DMP 2W96 (in-person only).

Feb. 9: Cardiac PET with Salvadore Borges-Neto. Noon. Zoom only.

 

Office of Faculty — Event with Israni of Stanford Medicine, Feb. 26

Academic Medicine, with all its complexities, naturally includes conflict amongst its crucial collaborators – trainees, faculty, staff, communities and more. 21st century leadership skills require all of us to strategically leverage components of this conflict for constructive change, with intentional and thoughtful actions. This talk will weave together themes from restorative justice and design thinking; and how they can be applied to artificial intelligence and JEDI (justice, equity, diversity, and inclusion), offering a case for new ways of leveraging conflict to advance a culture of connectedness and belonging. The featured speaker will be Sonoo Thadaney Israni of Stanford University’s Presence Center.

February 26: Leveraging Conflict for Constructive Change. 4-5:30 p.m., DN 2002. Presented by the Office for Faculty. Refreshments will follow. To learn more and register: https://duke.is/8/8d7f.  

 

Upcoming CME Symposia for Spring, 2024

Feb 6: Stroke Management of the Future? The Potential Role of Factor XI/XIa Inhibitors in Secondary Stroke Prevention.

This is a DukeHeart/TotalCME event with Manesh Patel, et al. In-person at the Hyatt Regency Phoenix, 2nd floor, Phoenix Ballroom. Virtual: Livestream via MedEd On The Go, 8-9:30 p.m., EST. This evening symposium will be held during the International Stroke Conference 2024 in Phoenix.

Register here

Join experts to explore how factor XI/XIa inhibitors may transform secondary stroke prevention in patients with acute ischemic strokes and transient ischemic attack risk factors. This data-rich symposium reviews currently available therapeutics and how they affect the coagulation cascade, increasing the potential for serious bleeds. Experts outline new and emerging anticoagulation pharmacotherapy that may mitigate bleeding risks. Through interactive presentations, attendees gain a deep understanding of the rapidly evolving stroke prevention landscape, preparing them to implement the latest approaches, improve clinical practice and boost patient outcomes.

Faculty presenters:

  • Valeria Caso, MD, PhD of the University of Perugia
  • Mike Sharma, MD, MSc, FRCPC of McMaster University
  • Manesh R. Patel, MD of Duke Health
  • Ashkan Shoamanesh, MD of McMaster University

Supported by an educational grant from Bayer HealthCare Pharmaceuticals and jointly provided by Duke Heart, MedEd On The Go, and Total CME.

 

March 8: Cardio-Oncology/Amyloid Symposium

The Southeastern Cardio-Oncology Conference, The Future is Now will take place on March 8 at the JB Duke Hotel in Durham, NC. Event registration is open; the registration deadline is March 5.

Duke cardiologists Michel Khouri and Ravi Karra of Duke’s Precision Cardiomyopathy Program will be presenters during the symposium.

Keynote to be provided by Avirup Guha, director of cardio-oncology and assistant professor of medicine at Augusta University’s Georgia Cancer Center.

The symposium is presented by Duke Cancer Network (DCN) in collaboration with Duke Cancer Institute. For more information, please contact Beth Tanner of DCN.

 

April 12: Duke Sports Cardiology & Sudden Death in Athletes

May 4: Duke Heart Failure Symposium

Registration is not yet open for the April 12 or May 4 symposia, but if you have questions about either event, please reach out to Christy Darnell.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

 

Duke Heart in the News:

January 26 — Karen Alexander

Heart.org

What is a heart attack? Cardiologists explain the condition following death of NBA coach

January 26 — Robert Lefkowitz

Business Minds Coffee Chat (podcast)

Episode 123: From Yellow Beret to Nobel Laureate

January 27 — Nenad Bursac and Nicholas Strash

Tech Explorist (IN)

Healing hearts with skin cancer genes

January 29 — Joseph Turek and the Monroe family

The Science Times

World’s First Partial Heart Transplant Completed in Newborn With Truncus Arteriosus; Donor Valve Tissues Grow Along With the Patient’s Body

January 29 — Robert Lefkowitz

Freedom Pact (podcast)

Episode 317: Dr Robert Lefkowitz – Nobel Prize Winner Shares The Secrets To Unlocking Your Genius

January 29 — G. Chad Hughes

Medpage Today

Cooling Technique Frowned Upon in Aortic Arch Surgery

January 30 — Duke University Hospital

Yahoo News/Insider Monkey

30 Best Cardiology Hospitals In the US

February 2 — Manesh Patel

Triangle Business Journal

Their battle: Slow the growth of heart disease

Duke Heart Pulse — January 28, 2024

Highlights of the week:

Schroder Named Surgical Director for Advanced Heart Failure

We are pleased to share that Jacob N. Schroder, MD, assistant professor of surgery, has been named Surgical Director for Advanced Heart Failure of Duke Health’s Heart and Vascular Service line and the Duke Division of Cardiovascular and Thoracic Surgery. The announcement was made Monday by Duke Surgery and Duke Heart leadership.

Jacob Schroder

Dr. Schroder earned his Medical Degree from Georgetown University School of Medicine and completed both his general and cardiothoracic surgery residencies, as well as thoracic transplant surgery fellowship, at Duke University. He then joined the Duke Department of Surgery faculty in the Division of Cardiothoracic Surgery in 2012.

Since then, Dr. Schroder has helped lead transplant growth and innovation within the Duke Heart program while maintaining a deep passion for the care of advanced heart failure patients. In 2017, he accepted the role of surgical director of cardiac transplantation and has led the program to marked volume growth while maintaining outstanding survival outcomes. In 2023, Duke completed 161 heart transplants, which is the greatest annual number at any institution worldwide. In addition, the program has surpassed 2,000 total heart transplants, which has only been achieved by a handful of other programs in the U.S.

In his new role as Surgical Director for Advanced Heart Failure, he will not only oversee heart transplantation but will also oversee the Extracorporeal Membrane Oxygenation (ECMO) program, the Left Ventricular Assist Device (LVAD) program, and the Total Artificial Heart program at Duke. Additionally, Jacob will oversee conventional cardiac surgery procedures in patients with severely reduced left ventricular function. As part of his new role he will assemble a team of surgeons and multidisciplinary team members to deliver these therapies, oversee research efforts throughout these areas, and continue to drive innovation.

Dr. Schroder has been a leader in perfusion storage and was the first surgeon in North America to perform an adult heart transplant utilizing a donation after cardiac death (DCD) donor. He led the U.S. Organ Care System DCD Heart Trial, which was published last year in the New England Journal of Medicine. Importantly, the strategy of utilizing DCD donors has served to expand the donor pool by as much as 30% at adopting centers. He has also reinvigorated the combined heart–lung transplant program and facilitated increased volume in other combined heart-kidney and heart-liver transplant procedures. Jacob has also served as co-director of the 7West  Cardiothoracic  Intensive Care Unit (CTICU), creating an environment of enhanced patient care with collaborative surgical and intensivist oversight. He has led the application of mechanical circulatory support at Duke and performed the first successful CARMAT total artificial heart implant in North America in 2021.

In summary, he has displayed incredible dedication and passion for heart failure care and has worked tirelessly to expand our footprint in the treatment of these patients.

Congratulations, Jacob!

 

St. Jude Children’s Invests $13M in Duke, Columbia, and Stanford Collaboration

St. Jude Children’s Research Hospital has invested nearly $13 million toward a new collaboration with researchers at Duke, Columbia, and Stanford Universities to expand the understanding of G-protein coupled receptors (GPCR), vital proteins that have been linked to more than 100 human diseases and disorders.

The GPCR Collaborative is led by Scott Blanchard, PhD, and M. Madan Babu, PhD, of St. Jude’s. The two are partnering with Jonathan Javitch, MD, PhD, of Columbia University; Georgios Skiniotis, PhD, and Alice Ting, PhD, of Stanford University, and Robert J. Lefkowitz, MD, of Duke University School of Medicine and Duke Cardiovascular Research Center.

Lefkowitz, a cardiologist and biochemist, was awarded the Nobel Prize in Chemistry in 2012 for his studies of G-protein coupled receptors. He received the award with Brian Kobilka, MD, of Stanford.

The multi-institutional GPCR Collaborative team will integrate and improve advanced methodologies including single-molecule imaging, cryo-electron microscopy, data science, and other techniques to study GPCR biology, structure, and pharmacology. Building on insights from these studies, investigators hope to develop new therapies for many pediatric diseases, including cancer and other life-threatening conditions.

“Each group within the collaborative has a very different focus, yet there’s overlap in the methods we use in our laboratories. We each have a distinct emphasis and expertise that is lacking in the other groups,” says Lefkowitz, Chancellor’s Distinguished Professor of Medicine at Duke and member of Duke Cancer Institute. “What my lab brings to the table is, first of all, our very long history in the field. My involvement with the receptors goes back more than 50 years. So we have the long view — the history – of working with GPCRs, but we also bring a pharmacological, biochemical, and clinical perspective to the endeavor.”

The goal of the collaboration is to use the biophysical expertise of the teams to interrogate the receptors in a very deep way to try to assist in developing new strategies to develop drugs, according to Lefkowitz.

“Many of the other investigators in the collaboration bring a deep biophysical and structural orientation to the table. So the hope and expectation are for real synergy to emerge from bringing these different approaches to bear, especially from individuals who have already demonstrated successful collaborations with one another.”

St. Jude’s Children’s Research Hospital has funded six different Research Collaborative projects since 2017, including the GPCR Collaborative, with an investment of more than $80 million. By 2027, St. Jude plans to support even more collaborations focused on unanswered needs in science and medicine which will increase total investment to $160 million.

Congratulations, Bob!

 

Williams Receives TSF Award at STS 2024

Congratulations to cardiothoracic surgeon Adam Williams who has received the Thoracic Surgery Foundation (TSF) Every Heartbeat Matters Award for medical outreach in Honduras via our Duke Heart for Honduras program. The announcement was made during The Society of Thoracic Surgeons (STS) 60th Annual Meeting being held this weekend (Jan. 27-29) in San Antonio, TX.

The TSF, which is the philanthropic arm of the STS, offers grants of up to $35,000 for qualified surgeons who conduct charity surgical outreach work in underserved regions with underserved populations. The grant is designed to provide support for programs that educate, screen, and/or treat underserved populations to reduce the global burden of heart valve disease and other programs that advance healthcare and address underserved populations. The Every Heartbeat Matters Award is made possible through the support of Edwards Lifesciences Foundation.

Duke Heart for Honduras is an international cardiovascular surgical outreach partnership program launched in 2019 between the Division of Cardiovascular and Thoracic Surgery at Duke and the Instituto Nacional Cardiopulmonar (INCP) in Tegucigalpa, Honduras.

The socioeconomic climate of Honduras has made the provision of healthcare to its 9.5 million inhabitants difficult. There is a high rate of poverty, political instability, frequent natural disasters, and very few physicians available to diagnose and treat heart disease, let alone perform surgical cardiac interventions.

There is essentially only one cardiovascular surgeon in all of Honduras – Dr. Hugo Orellana, of the Instituto Nacional Cardiopulmonar (INCP) – with whom the Duke team collaborates. The INCP is a public hospital built roughly 75 years ago to provide specialized care for patients with tuberculosis, pulmonary, and cardiovascular diseases. The hospital has two operating rooms available. When resources permit, cardiac surgery is performed in those spaces.

“This award is key for us to continue these missions to Honduras, because it will essentially help fund all the flights we need to get the team down there,” said Williams. “That’s the biggest expense we have, so we are very excited and grateful to receive this award.”

Williams says the funding will be used to support the team’s next medical mission to Honduras, which is planned for May 11-18, 2024.

Congratulations, Adam — we are thrilled for you and the Duke Heart for Honduras team! Note: We’ll have more coverage from STS next weekend.

 

ICYMI: Latest Duke Publication on Diversity in Cardiology Fellowships

Congratulations to Sarah Snow, Pamela Douglas, and Brooke Alhanti for their latest publication in JAMA Cardiology. Recruiting a Diverse Cardiology Physician Workforce was published online Jan. 24, 2024.

The team reports their findings on changes in the representation of women and underrepresented racial and ethnic populations in cardiovascular disease and cardiovascular subspecialty fellowships. Using data from the Accreditation Council for Graduate Medical Education the team found percentages of women trainees in cardiovascular disease and interventional cardiology fellowships significantly increased from 2008 to 2022. While percentages of Black and Hispanic trainees in these fellowships have increased in recent years, the change is not yet statistically significant, according to the authors.

Great job on an incredibly important topic, Sarah, Pam, and Brooke!

 

Loring, Piccini Appear in Latest Episode of Heart Rhythm TV

Congrats to Zak Loring and Jon Piccini for appearing in a great episode of Heart Rhythm TV. The episode, The Natural History of AF – An Echocardiographic Study was posted to the Heart Rhythm channel on YouTube yesterday.

The two were interviewed by host Roderick Tung about their latest publication, Natural history of echocardiographic changes in atrial fibrillation: A case-controlled study of longitudinal remodeling, appearing in the January 2024 issue of Heart Rhythm Journal.

Nicely done – great interview, Jon and Zak!

 

Jule Named ANM, 6 East

We are excited to share that Annette Jule, BSN, RN, MPH, MSN, has been named the new 6 East assistant nurse manager (ANM), effective Jan. 2, 2024. Annette was born and raised in New York City and obtained her BSN from Long Island University Brooklyn Campus. She has nursing experience in transplant, med/surg, and critical care. She relocated to Florida and while there was promoted to leadership roles in nursing both at Baptist Hospital of Miami and HCA Kendall. During this time she obtained her MPH at George Washington University and MSN in nursing leadership at Nova Southeastern University.

Please join us in congratulating and welcoming Annette in her new role!

 

Kudos to Keenan & CT Surgery Team!

We received a warm note from DUH chief medical officer David Gallagher letting us know about patient feedback on Jeffrey Keenan and members of the CT Surgery team.

“Jeff, we received this nice feedback (from Press Ganey HCAHPS) about the great care you and your team gave to a patient at Duke Hospital. Thank you for the high quality and compassionate care you provide to patients! Jill, thanks to all the heart surgery staff who helped this patient! Great team!” — David Gallagher, MD, chief medical officer

“I can’t say enough on how grateful I am towards my doctor Jeffrey Keenan and all staff that helped me recover from my heart surgery.” — grateful patient, name withheld for privacy

 

Kudos to Parker & CTICU Team!

Kudos to Phillip Parker, nurse manager of the CTICU, and the whole CTICU team for their amazing partnership and floating ICU nurses to the OTC at Duke Hospital last week.

Their teamwork is helping capacity rise to 150 in the next few weeks. Great job!

 

Latest Duke Heart/Med-IQ CME Course Now Available

Managing Mitral Regurgitation Based on the Mechanism of Disease, a Med-IQ CME course with Andrew Wang is now live. To learn more, please click here.

 

Duke Research and Innovation Week

Starting Monday, Jan. 29, Duke is hosting its annual Research and Innovation Week–this time, with a Centennial twist. Join the Office for Research & Innovation for a week of exciting events, panels, and showcases to celebrate the past, present, and future of research and innovation at Duke.

It will include discussions on:

  • Depolarizing Political Toxicity on Social Media
  • Duke and NCCU’s Ongoing Partnerships and Collaboration
  • Race, Ethnicity and Politics Research
  • Many more great topics!

Consider attending the Research Town Hall on Jan. 31 featuring Brian McAdoo, Ross McKinney, Michael Pencina, Geeta Swamy, and Kanecia Zimmerman speaking on Integrity in Scholarship: The Next 100 Years. Or, on Feb. 1, check out the session on Duke Research in 2124 with panelist Muath Bishawi, or Duke and the FDA with Lesley Curtis, Mark McClellan, and Ehsan Samei.

A great week is planned! Learn more here.

 

National Wear Red Day is Friday

On Friday, Feb. 2, please join us in celebrating National Wear Red Day! This annual event is a visible means of showing your support and enthusiasm for working with cardiovascular patients and heart disease survivors. No need to don a completely crimson outfit! Red accessories such as socks, shoes, ties, or earrings are a great way to show you are participating in Wear Red Day! (Note: If your work area at Duke Health requires a uniform of specific color, you must adhere to that dress code policy.)

Kick-off Heart Month by wearing some red on Friday. Another event to consider is:

  • 22 – AHA Triangle Hands-Only CPR demonstration, Noon, via Zoom. To register please click here.

 

Reminder: Tier 2 Status

We are currently in Tier 2 visitation status throughout Duke University Health System. Information is available on Duke Health Now.

 

Upcoming Events & Opportunities

  • Duke Culture Survey: Jan. 29-Feb.17
  • Duke Centennial Research & Innovation Week: Jan. 29-Feb.2
  • National Wear Red Day: 2
  • February is Heart Month and Black History Month.

 

Transplant Grand Rounds

Jan. 30: Partial Heart Transplantation – Emergence of a New Paradigm with Joseph Turek. Noon. DN2003 or via Zoom.

 

Cardiology Grand Rounds

Jan. 30: Unraveling ketone metabolism in the failing heart with Senthil Selvaraj. 5 p.m., DN 2002 or via Zoom.

Feb. 6: Implementation strategies to address the burden of Heart Failure with Harriette Van Spall of McMaster University. 5 p.m., DN 2002 or via Zoom.

All Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit:

Your NET ID and password are required. Enjoy!

Cardiology Grief Debrief Session

Jan. 29. Noon, In-person only: DMP 2W96

CD Fellows Core Curriculum Conference

Jan. 31: HT/Txp Case Presentation with Eric Xie. Noon. DMP 2W96 (in-person only).

Feb. 2: Introduction to SPECT with TBD. Noon. Zoom only.

Office of Faculty — Event with Israni of Stanford Medicine, Feb. 26

Academic Medicine, with all its complexities, naturally includes conflict amongst its crucial collaborators – trainees, faculty, staff, communities and more. 21st century leadership skills require all of us to strategically leverage components of this conflict for constructive change, with intentional and thoughtful actions. This talk will weave together themes from restorative justice and design thinking; and how they can be applied to artificial intelligence and JEDI (justice, equity, diversity, and inclusion), offering a case for new ways of leveraging conflict to advance a culture of connectedness and belonging. The featured speaker will be Sonoo Thadaney Israni of Stanford University’s Presence Center.

February 26: Leveraging Conflict for Constructive Change. 4-5:30 p.m., DN 2002. Presented by the Office for Faculty. Refreshments will follow. To learn more and register: https://duke.is/8/8d7f.  

 

Upcoming CME Symposia for Spring, 2024

Feb 6: Stroke Management of the Future? The Potential Role of Factor XI/XIa Inhibitors in Secondary Stroke Prevention.

This is a DukeHeart/TotalCME event with Manesh Patel, et al. In-person at the Hyatt Regency Phoenix, 2nd floor, Phoenix Ballroom. Virtual: Livestream via MedEd On The Go, 8-9:30 p.m., EST. This evening symposium will be held during the International Stroke Conference 2024 in Phoenix.

Register here

Join experts to explore how factor XI/XIa inhibitors may transform secondary stroke prevention in patients with acute ischemic strokes and transient ischemic attack risk factors. This data-rich symposium reviews currently available therapeutics and how they affect the coagulation cascade, increasing the potential for serious bleeds. Experts outline new and emerging anticoagulation pharmacotherapy that may mitigate bleeding risks. Through interactive presentations, attendees gain a deep understanding of the rapidly evolving stroke prevention landscape, preparing them to implement the latest approaches, improve clinical practice and boost patient outcomes.

Faculty presenters:

  • Valeria Caso, MD, PhD of the University of Perugia
  • Mike Sharma, MD, MSc, FRCPC of McMaster University
  • Manesh R. Patel, MD of Duke Health
  • Ashkan Shoamanesh, MD of McMaster University

Supported by an educational grant from Bayer HealthCare Pharmaceuticals and jointly provided by Duke Heart, MedEd On The Go, and Total CME.

 

March 8: Cardio-Oncology/Amyloid Symposium

The Southeastern Cardio-Oncology Conference, The Future is Now will take place on March 8 at the JB Duke Hotel in Durham, NC. Event registration is open; the registration deadline is March 5.

Duke cardiologists Michel Khouri and Ravi Karra of Duke’s Precision Cardiomyopathy Program will be presenters during the symposium.

Keynote to be provided by Avirup Guha, director of cardio-oncology and assistant professor of medicine at Augusta University’s Georgia Cancer Center.

The symposium is presented by Duke Cancer Network (DCN) in collaboration with Duke Cancer Institute. For more information, please contact Beth Tanner of DCN.

 

April 12: Duke Sports Cardiology & Sudden Death in Athletes

May 4: Duke Heart Failure Symposium

Registration is not yet open for the April 12 or May 4 symposia, but if you have questions about either event, please reach out to Christy Darnell.

 

Angels Among Us Walk & 5K, April 27

Our friends and colleagues at the Preston R. Tisch Brain Tumor Center (BTC) will hold their 31st annual Angels Among Us Walk on April 27 at the corner of Erwin Road and Flowers Drive on the Duke Medical Center campus. The Angels Among Us 5K and Walk of HOPE will begin with a 5K run followed by great entertainment, children’s activities, delicious food, and fun for the entire family.

A ceremony will begin the walk of hope through the Duke Medical Campus and the Sarah Duke Gardens. Proceeds from the event support the Preston Robert Tisch Brain Tumor Center at Duke. Visit www.angelsamongus.org to learn more.

Please consider supporting our Duke BTC colleagues and their annual event!

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

Duke Heart in the News:

January 12 — Nishant Shah

Healthcentral.com

What’s a “Mini” Heart Attack?

January 19 — Robert Lefkowitz

Memphis Business Journal

St. Jude Children’s Research Hospital invests $13M in Duke, Stanford, Columbia University collaboration

January 19 — Jonathan Piccini

Cardiovascular Business

ICE-guided Watchman procedures linked to safety concerns—is TEE better for LAAO or will things improve?

January 19 — Duke Heart study

Woman’s World

Doctors Reveal the Best Sleeping Position to Outsmart Nighttime Leg Pain

*refers to this Duke study

January 20 — Brittany Zwischenberger

The New York Times

The Heart Surgery That Isn’t as Safe for Older Women

January 23 — Stephen Greene

Medscape

Deaths Linked to Substance Use, CVD on the Rise

January 23 — Kristin Newby

Consumer Reports

El mejor chequeo para tu corazón

January 24 — Sarah Snow

Healio/Cardiology Today

Women in CV fellowships on the rise; not so among other underrepresented groups

January 24 — Duke University Hospital

Becker’s ASC Review

The top 317 cardiology facilities for Medicare members, per Aetna

January 24 — Duke Heart study

Today’s Geriatric Medicine

Statins: Reducing Racial Disparities

*references this Duke study.

January 25 — Nenad Bursac

Genetic Engineering & Biotechnology News

Cancer Mutation That Spurs Cell Division Helps Heart Models Run at Full Gallop

January 25 — Nenad Bursac

WPTF/680 News Radio

Mutation in skin cancer may help recovery from heart attacks

*clip begins @ 12:12:48

Duke Heart Pulse — January 21, 2024

Highlights of the week:

Bloomberg Grant Funds Innovative Partnership for Early College High School in Durham

A partnership between Duke Health, Durham Technical Community College, and Durham Public Schools has been awarded a transformative $29.5 million grant from Bloomberg Philanthropies to establish an early college for high school students interested in pursuing healthcare careers upon graduation.

The grant is one of 10 awarded nationally through Bloomberg Philanthropies’ “Student-centered, Market-driven Healthcare Education Initiative.” The initiative’s goal is to address critical healthcare workforce needs while preparing young adults for successful careers in the field.

“For too long, our education system has failed to prepare students for good jobs in high-growth industries,” said Michael R. Bloomberg, founder of Bloomberg Philanthropies and Bloomberg LP and 108th mayor of New York City. “By combining classroom learning with hands-on experience, these specialized healthcare high schools will prepare students for careers with opportunities for growth and advancement. America needs more health care workers, and we need a stronger, larger middle-class – and this is a way to help accomplish both goals.”

The Durham partnership will provide the preparation needed for careers in nursing, allied health, surgical tech, and clinical research. The key elements of the partnership are:

  • Interested Durham Public Schools (DPS) students in grades 9-12 will attend the early college high school and simultaneously earn both a high school diploma and an associate degree or workforce credential for aligned healthcare occupations.
  • The Middle College at Durham Tech will expand to an early college high school and will be housed at Durham Tech (DTCC) in a newly renovated space, with the school opening in the fall of 2025.
  • Upon graduation, students will have an immediate pathway to jobs or research roles at Duke Health.

“This partnership is about much more than an innovative educational approach,” said J.B. Buxton, president of Durham Tech. “It’s about creating a high-quality pathway to some of the most important jobs in our community. It’s about making sure our healthcare workforce looks like the patients it serves. It’s about improving the quality of patient care and the health outcomes for all. It’s about the role of education and health in improving people’s lives.”

The program is expected to open in the fall of 2025 with an initial class of 100 ninth graders, then enroll additional classes of 100 students for each of the next three years.

The Bloomberg Philanthropies grant will allow Durham Public Schools to further increase Durham’s talent pipeline in the healthcare sector. The district currently offers medical career-focused courses and experiences through its City of Medicine Academy.

“This innovative partnership marks a significant milestone in our collective commitment to provide students with unparalleled opportunities and prepare them for successful futures in the dynamic health sciences sector,” said Pascal Mubenga, superintendent of Durham Public Schools. “This will also help us keep qualified talent right here in Durham to strengthen our network of care.”

Students will graduate with one or more credentials required to fill high-demand positions, including certified nursing assistant, emergency medical technician, phlebotomist, and central sterile processing technician.

Duke University Health System (DUHS), which comprises Duke’s hospitals, clinics, and other patient care services, is expected to hire at least 60 students directly after graduation from the early college high school, fulfilling a critical need for a diverse and skilled workforce. To promote retention and career advancement, the health system will provide mentoring, flexible scheduling, and assistance with other support services such as transportation or childcare.

“This exciting new partnership encompasses education, research, patient care, and community enhancement to advance a bold and innovative healthcare education model for Durham,” said Vincent E. Price, president of Duke University. “We are grateful to Bloomberg Philanthropies for supporting this vital work, and thankful for our innovative regional partners as we create compelling new opportunities for Durham students and address critical workforce shortages.”

This initiative reflects Duke’s broad commitment to forging partnerships to support strategic community priorities such as college and career readiness. Through Bloomberg Philanthropy’s generosity, this innovative model of collaboration will provide significant opportunities for young people to be prepared as the next generation of leaders in health care as well as advance the overall well-being of communities.

“Through this collaboration, we will advance economic stability and economic mobility within our communities by expanding educational and career opportunities while addressing critical workforce shortages,” said Craig T. Albanese, chief executive officer of Duke University Health System. “Duke Health’s engagement in this partnership, led by Debra Clark Jones, our associate vice president for Community Health, is one of many DUHS initiatives aimed at improving the overall health, both clinically and socially, of the communities we serve.”

“Duke Health is committed to health equity where everyone in our community has a fair and just opportunity to be their healthiest,” said Debra Clark Jones, associate vice president for Community Health at Duke Health. “Working collaboratively with our community partners to remove barriers to education and good jobs is critical to advancing health equity. I cannot be prouder of leading this important effort on behalf of Duke Health. This initiative is a great example of how we improve overall community health by partnering with intention and leveraging our respective strengths and assets.”

In addition to providing a direct pathway to healthcare jobs, an apprenticeship program through the Duke University School of Medicine will offer a direct route for students to pursue clinical research.

“We are delighted by this opportunity to extend and deepen our work with local education partners,” said Mary E. Klotman, Duke University’s executive vice president for health affairs and dean of Duke University School of Medicine.

“Duke brings strength to this partnership not only as the lead employer for this program but also because we are especially well-positioned to support learners,” Klotman said. “This initiative’s innovative apprenticeship program will offer a more direct pathway for talented young people to enter the profession in clinical research units across Duke. This helps address acute talent shortages while allowing students to gain professional experience in a supportive learning environment.”

The early college high school could help ensure that a significant percentage of new frontline healthcare workers reflect the Durham communities served by DUHS. Because Durham Public Schools is one of the most diverse districts in the region, with approximately 81% non-white students, the graduates of the early college who join DUHS could help improve healthcare access, patient care and engagement, and equity in health outcomes.

“The Bloomberg grant provides a unique opportunity for Durham Public Schools, Duke Health, and Durham Tech to create a transformative educational partnership that will be a “win” for everyone in our community,” said Tara Fikes, Durham Tech Board of Trustees chairwoman. “As a result, DPS students will have a pathway through Durham Tech to well-paying jobs in health care, helping to address the shortage of workers in the field while providing greater access to health care for all residents.”

Administratively, the early college high school will be part of the DPS system, operated jointly by the public school system and Durham Tech. DPS will provide high school teachers, a principal, support staff, student services, and curricular resources. Students will also be dually enrolled at DTCC, which will begin renovating a building on-site to house the new school.

DUHS will also contribute employee time to engage with students in classroom projects, co-teach, and supervise work-based learning opportunities. In addition, the health system will evaluate the program and calculate its overall value and measures of success.

“The plans and aspirations of our partnerships align with the Bloomberg initiative’s vision,” said Bettina Umstead, chair of the Durham Public Schools Board of Education. “Together, we will create innovative education models, prepare young adults for successful career opportunities, and address critical shortages in health care talent, ultimately ensuring our DPS students connect with health care career opportunities in their home, the City of Medicine.”

 

ICYMI: The Heart Surgery That Isn’t as Safe for Older Women

We want to draw your attention to an excellent consumer news article on an important topic published in Saturday’s issue of The New York Times. ‘The Heart Surgery That Isn’t as Safe for Older Women’ features the experiences of several women who underwent coronary artery bypass grafting (CABG) procedures; the piece includes a quote from Duke cardiothoracic surgeon, Brittany Zwischenberger, MD, and references two 2023 publications – one a retrospective cohort study published in JAMA Surgery, the other is the accompanying editorial to that study. Zwischenberger, along with Jennifer Lawton of Hopkins, is a co-author of the editorial. 

A Call to Action to Improve Outcomes in Women Undergoing Surgical Coronary Revascularization, by Zwischenberger and Jennifer S. Lawton, MD.

Operative Outcomes of Women Undergoing Coronary Artery Bypass Surgery in the US, 2011 to 2020, by Mario Gaudino, MD, PhD, MSCE (Weill Cornell Medicine), et al.

 

Duke Culture Survey Launching Jan. 29

In his 2020 Juneteenth address, Duke University president, Vincent E. Price committed to surveying all faculty, students, and staff to assess and inform Duke’s progress in addressing bias and promoting respect, meaningful inclusion, and true equity in our community.

As a result, Duke University staff, faculty, and students were asked to respond to an April 2021 Duke Campus Survey. Nearly 13,000 of us did so. That effort helped identify areas of concern and priorities as we moved forward in our racial equity work. That first survey was an essential step to document where we were.

On Jan. 29, the second Duke Campus Survey will launch — this and all surveys to follow — will ensure we are continuing to move toward equity. The survey will be repeated every three years to track our progress.

If you would like Duke to be a place where everyone has an equal chance to thrive, please take the survey. By sharing your experience, you will help Duke leaders understand our progress as we strive to create a more equitable Duke. The survey is anonymous and will be open between Jan. 29 and Feb. 16.

Keep an eye out on your email for further information. Thank you!

 

Shout-out to Conway

A big shout-out to cardiology clinical pharmacist, Monique Conway!

“Monique is amazing—consistently helping to make sure our patients are on appropriate therapies and teaching the house staff (and sometimes the attendings!) about new studies and evidence. Her support and participation are an essential part of providing excellent care to our inpatients. 

What truly inspired me this week is that she also goes out of her way to care for the patients by making sure they can purchase their medications, and she even helped one of our patients find clothes to wear home on a cold day. We are very grateful to have her as part of our team!”Cary Ward, MD

Nice job, Monique!

 

Kudos to Gaca & Zwischenberger!

We received terrific feedback on Drs. Jeff Gaca and Brittany Zwischenberger via the Patient & Visitor Relations monthly report this week.

“Patient stated that despite the busy unit Dr. Gaca and Dr. John help saved patient’s life.”

“Patient stated that Dr. Brittany Zwischenberger is one of the best doctors he has ever had. She is very knowledgeable and has a good personality. She made him and his wife feel confident.”

Well done, Jeff and Zwisch!

 

Shout-outs to Members of Duke’s Heart Failure Team!

We wanted to share a large group of shout-outs regarding team member efforts in clinical research trial recruitment! Congratulations to Lacey Taylor and Stephen Greene for enrolling the first patient into GOALS-HF and to Kim Biever, Aferdita Spahillari, and Marat Fudim for enrolling a patient into FASTR!

Additional gratitude from Kim Biever: “To Tracy DeWald for approaching the patient for the FASTR trial and filling multiple furosemide syringes over the course of a few days- most impressively, the last one on Sunday evening; to Isha Amin, Shelley Thompson, John Lazzari, Jaime McDermott, Aferdita Spahillari and Stephen Greene for coordination of care, chart documentation and for answering my endless questions about fluid volume; to Marat Fudim for promptly signing what seemed to be at least a hundred orders, and last, but not least, to Ashley Frazier, Laura Dickerson and the nursing staff for ensuring proper staffing levels and for going above and beyond their clinical duties to ensure that our research efforts went smoothly. I appreciate your assistance more than you could ever know! Thank you!

Way to go, team!!!

 

Duke My Chart is Now My Duke Health

Last week, Duke My Chart transitioned to My Duke Health. Neither patients nor staff need to make any changes – login information will remain the same. However, accessing My Duke Health via smartphone or tablet will require downloading the new app which is now available in Google Play and in the Apple App Store, or by visiting MyDukeHealth.org.

 

Reminder: Tier 2 Status

We are currently in Tier 2 visitation status throughout Duke University Health System. Information is available on Duke Health Now.

 

Upcoming Events & Opportunities

  • Duke Culture Survey: Jan. 29-Feb.17
  • National Wear Red Day is Friday, Feb. 2!
  • February is Heart Month

 

Cardiology Grand Rounds

Jan. 23: All you need to know about the new AF guidelines in the new year! with Jonathan Piccini. 5 p.m., DN 2002 or via Zoom.

Jan. 30: Unraveling ketone metabolism in the failing heart with Senthil Selvaraj. 5 p.m., DN 2002 or via Zoom.

Feb. 6: Implementation strategies to address the burden of Heart Failure with Harriette Van Spall of McMaster University. 5 p.m., DN 2002 or via Zoom.

All 2023 Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit: https://duke.is/DukeCGR; NET ID and password required. Enjoy!

 

CD Fellows Core Curriculum Conference

Jan. 24: EP Case Presentation with Andrew Andreae, MD and Damarcus Ingram, MD. Noon. DMP 2W96 (in-person only).

Jan. 26: Cath Lab Math with Thomas Bashore, MD. Noon. Zoom only.

 

Office of Faculty — Event with Israni of Stanford Medicine, Feb. 26

Academic Medicine, with all its complexities, naturally includes conflict amongst its crucial collaborators – trainees, faculty, staff, communities, and more. 21st century leadership skills require all of us to strategically leverage components of this conflict for constructive change, with intentional and thoughtful actions. This talk will weave together themes from restorative justice and design thinking; and how they can be applied to artificial intelligence and JEDI (justice, equity, diversity, and inclusion), offering a case for new ways of leveraging conflict to advance a culture of connectedness and belonging. The featured speaker will be Sonoo Thadaney Israni of Stanford University’s Presence Center.

February 26: Leveraging Conflict for Constructive Change. 4-5:30 p.m., DN 2002. Presented by the Office for Faculty. Refreshments will follow. To learn more and register: https://duke.is/8/8d7f.  

 

Upcoming CME Symposia for Spring, 2024

March 8: Cardio-Oncology/Amyloid Symposium

The Southeastern Cardio-Oncology Conference, The Future is Now will take place on March 8 at the JB Duke Hotel in Durham, NC. Event registration is open; the registration deadline is March 5.

Cardiologists Drs. Michel Khouri and Ravi Karra of Duke’s Precision Cardiomyopathy Program will be presenters during the symposium.

Keynote to be provided by Dr. Avirup Guha, director of cardio-oncology and assistant professor of medicine at Augusta University’s Georgia Cancer Center.

The symposium is presented by Duke Cancer Network (DCN) in collaboration with Duke Cancer Institute. For more information, please contact Beth Tanner of DCN.

 

April 12: Duke Sports Cardiology & Sudden Death in Athletes

May 4: Duke Heart Failure Symposium

Registration is not yet open for the April 12 or May 4 symposia, but if you have questions about either event, please reach out to Christy Darnell.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

 

Duke Heart in the News:

January 12 — Amanda Craig

Cardiovascular Business

Heart transplant recipients face increased risk of maternal complications when giving birth

 

January 12 — Brian Duscha

Healio/Cardiology Today

Each cardiac rehab session attended cuts readmission, death risk by 2%

 

January 12 — Joseph Turek

Univision

Un trasplante parcial de corazón salva la vida de una bebé: te explicamos cómo es este procedimiento

 

January 15 — Kristin Newby

Consumer Reports

Best Checkup for Your Heart

 

January 16 — Joseph Turek and the Monroe family

El Pais

El hito del pequeño Owen: el trozo de corazón trasplantado para curarle un fallo cardíaco crece con él

 

January 16 — Adrian Hernandez

Heart.org

Beyond breathing: How COVID-19 affects your heart, brain and other organs

 

January 16 — Cynthia Shortell

Vascular News

We still have a lot more work to do

 

January 17 — Duke Health

Becker’s Hospital Review

13 major health systems partner with high schools in $250M Bloomberg initiative

 

January 17 — Duke Health

Healthcare Innovation

Bloomberg Workforce Initiative Connects Health Systems, Public Education

 

January 17 — Adrian Hernandez

Associated Press/Sinembargo.mx

La COVID no es “vencer el resfrío” y ya. Deja daños en corazón, cerebro y más órganos

 

January 17 — Pamela Douglas

tctMD

Doctors on Overdrive: Fewer Breaks Equal More Burnout

 

January 17 —  Joseph Turek

La Nacion (Argentina)

“El hito de Owen”. El tejido de corazón trasplantado que crece con el bebé que lo recibió

 

January 17 — Adrian Hernandez

NPR/1A

What’s New With COVID-19?

* carried by WUNC and 480+ affiliated stations nationally

Duke Heart Pulse — January 14, 2024

Highlights of the week:

Shah Named Associate Dean for Translational Research

Svati H. Shah, MD, MS, MHS, has been named associate dean for translational research, effective immediately.  

Svati Shah

In this role, Shah will serve in an expanded capacity from her previous role as associate dean of genomics. She will provide strategic vision, development, and oversight of translational research initiatives within the School of Medicine. Specifically, she will be responsible for overseeing biobanking service centers and the integration of large biologic datasets including storage and computer environments. Her leadership portfolio will also include the OneDukeBio Integrated Biospecimen Network. She will collaborate closely with associate and vice deans in related disciplines to ensure program alignment across the School of Medicine.

Shah has been a member of the Department of Medicine’s cardiology faculty since 2005. Currently, she is Ursula Geller Distinguished Professor of Research in Cardiovascular Disease, professor of bioinformatics and biostatistics, director of the Duke Center for Precision Health within the Duke Clinical and Translational Science Institute (CTSI), director of the Duke School of Medicine Precision Genomics Collaboratory, director of the Adult Cardiovascular Genetics Clinic, and a member of the Duke Molecular Physiology Institute and Duke Clinical Research Institute. She is the founding director of the Duke Center for Precision Health, chair of the research committee for the Board of Directors of the American Health Association, and a member of the Board of Directors of the Sarnoff Foundation.  

Shah is a physician-scientist and practicing cardiologist who sees patients and families with cardiovascular genetic disorders. Upon completing her internal medicine residency at the Brigham and Women’s Hospital, she came to Duke for a cardiology fellowship in 2001, where she also completed a master’s degree in medical genomics and a postdoctoral fellowship in genetic epidemiology. 

Congratulations, Svati!

 

Selvaraj Selected for 2024 ASCI Award

Senthil Selvaraj

We are thrilled to share that Senthil Selvaraj, MD has been selected as a recipient of an American Society for Clinical Investigation (ASCI) 2024 Young Physician-Scientist Award (YPSA). The ASCI award is a significant early-career achievement and highly competitive; there were 172 nominations this year for 52 awards.

Selvaraj, an assistant professor of medicine in cardiology (Advanced Heart Failure and Transplant) at Duke and a faculty member in the Duke Molecular Physiology Institute is a past recipient of ASCI’s inaugural Emerging-Generation Awards in 2022 while he was at the University of Pennsylvania Perelman School of Medicine.

This is the second consecutive year that a faculty member from Duke Heart has earned one of ASCI’s YPSAs. Jennifer Rymer, MD, MBA, received a 2023 ASCI YPSA.

Way to go, Senthil! Congratulations!!

 

Duke Centennial Kick-off Features Easton Sinnamon, Joe Turek of Duke Heart

Duke University’s Centennial Celebration Kickoff was held Tuesday, Jan. 9 in Cameron Indoor Stadium. It was a fantastic event with hosts (and alums!) Ken Jeong, comedian and actor, and Lisa Borders, former president of the Women’s National Basketball Association, along with a special appearance by Mike Krzyzewski. The trio helped highlight the many contributions the faculty, staff, students, and alumni have made over the years. Notable VIPs included Drs. Joseph Turek and Louise Markert who appeared as part of a special segment featuring the story of Easton Sinnamon, the now 3-year-old boy who received the world’s first combination heart transplant-thymus procedure here at Duke in 2021. Sinnamon is doing great, and his story stole the show! 

If you did not get the opportunity to attend in person or to view the livestream, we have links for you! To see an overview and editor selection of key moments, visit https://100.duke.edu/story/start-of-a-centennial/

 

 

 

 

 

To get all the details regarding Duke’s Centennial and associated events, please visit the Centennial web page.

 

Kudos to Cox!

Kudos to Gail Cox for her assistance with a patient of Bill Kraus’ who was having anemia and dyspnea in a post-operative period. The patient and their family, who live in Western Virginia, reached out to whomever they knew at Duke to handle this difficult and frightening situation.

During their emergency, they had pulled their car over on the road after getting someone to take the call at Duke — that amazing person turned out to be Gail Cox. Cox listened to their description of the issue and then arranged for a Duke admission.  

In gratitude, they sent a card to their care team – the card states:

“Dear Gail, We are so appreciative for your help and advocacy. We were struggling to get the help (for patient/name withheld) needed after surgery. You were there to get them the care they needed at Duke. They were able to come home and begin healing. Forever grateful.”

Nicely done, Gail!!!

 

Duke MyChart Transitioning to My Duke Health

On January 17, Duke MyChart will transition to My Duke Health, a sleek new online portal – app and website – with improved functionality and visual appeal.

My Duke Health is expected to provide a tailored, Duke-specific online experience for Duke Health patients, and puts all the convenient features of Duke MyChart into one place. By logging into the portal patients can:

  • Make in-person appointments for provider visits, lab work, imaging, and other tests like screening mammograms and sleep studies.
  • Schedule and attend virtual appointments with primary care providers and specialists.
  • Check-in for appointments up to 5 days ahead of time to save time on the day of an appointment.
  • Communicate with providers, view after-visit notes and test results.
  • Pay bills and view documents

Patients will be able to easily access urgent care virtual visits and view urgent care wait times. There is an option to read Duke Health news and learn about upcoming events, view articles related to the topic of the month, and search through an educational health library. The My Duke Health library contains hundreds of educational materials including short videos and other resources.

Soon, patients will be able to chat with a virtual assistant, view personalized resource pages based on their health needs, and connect with Duke Health Listens, an online community in which patients can offer direct feedback about their healthcare experience, and help us advance better health together.

NOTE: Accessing My Duke Health via smartphone or tablet will require downloading the new app which will be available on Jan. 17 at 10 a.m. in Google Play and in the Apple App Store, or by visiting MyDukeHealth.org.

 

Cardio-Oncology/Amyloid Symposium Announced

The Southeastern Cardio-Oncology Conference, The Future is Now will take place on March 8 at the JB Duke Hotel in Durham, NC. Event registration is open; the registration deadline is March 5.

Duke cardiologists Drs. Michel Khouri and Ravi Karra will be presenters during the symposium. Keynote to be provided by Dr. Avirup Guha, director of cardio-oncology and assistant professor of medicine at Augusta University’s Georgia Cancer Center.

The symposium is presented by Duke Cancer Network (DCN) in collaboration with Duke Cancer Institute. For more information, please contact Beth Tanner of DCN.

 

New Visitor Restrictions In Effect

Duke Health has updated visitation restrictions as of Wednesday, January 3.

  • Visiting hours are from 8 a.m. to 9 p.m.
  • Visitors must check in at the hospital information desk to receive a visitor badge to enter inpatient areas.
  • All visitors must be age 12+. (Visitors in some clinical areas must be age 18+.)
  • Minors are required to be attended by an adult age 18+ at all times.
  • A maximum of two visitors are allowed per patient.
  • Visitors must check out upon departure at a kiosk or with information desk staff.
  • Visitors with fever, cough, or other flu-like symptoms should not visit.

For more details, refer to the Tier 2 visitation standard work document. Updated signage is posted.

Please note: Additional visitation and masking precautions may apply to certain patient populations, including COVID-19/Special Airborne Contact, oncology, end-of-life, and overnight visitors. Please follow all unit guidelines. Exceptions to visitation restrictions may be granted based on special circumstances, including without limitation, to permit Compassionate Care Visitors.

 

Upcoming Events & Opportunities

  • National Wear Red Day is Friday, Feb. 2!
  • February is Heart Month

 

 

 

Cardiology Grand Rounds

Jan. 16: No CGR today.

Jan. 23: All you need to know about the new AF guidelines in the new year! with Jonathan Piccini. 5 p.m., DN 2002 or via Zoom.

Jan. 30: Unraveling ketone metabolism in the failing heart with Senthil Selvaraj. 5 p.m., DN 2002 or via Zoom.

Feb. 6: Implementation strategies to address the burden of Heart Failure with Harriette Van Spall of McMaster University. 5 p.m., DN 2002 or via Zoom.

All 2023 Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit: https://duke.is/DukeCGR; NET ID and password required. Enjoy!

 

CD Fellows Core Curriculum Conference

Jan. 17: DHP Case Presentation with Aarti Thakkar, MD. Noon. DMP 2W96 (in-person only).

Jan. 19: Hypertrophic Cardiomyopathy with Andrew Wang, MD. Noon. Zoom only.

 

Office of Faculty Announces Event with Israni of Stanford Medicine, Feb. 26

Academic Medicine, with all its complexities, naturally includes conflict amongst its crucial collaborators – trainees, faculty, staff, communities and more. 21st century leadership skills require all of us to strategically leverage components of this conflict for constructive change, with intentional and thoughtful actions. This talk will weave together themes from restorative justice and design thinking; and how they can be applied to artificial intelligence and JEDI (justice, equity, diversity, and inclusion), offering a case for new ways of leveraging conflict to advance a culture of connectedness and belonging. The featured speaker will be Sonoo Thadaney Israni of Stanford University’s Presence Center.

February 26: Leveraging Conflict for Constructive Change. 4-5:30 p.m., DN 2002. Presented by the Office for Faculty. Refreshments will follow. To learn more and register: https://duke.is/8/8d7f.  

 

Upcoming CME Symposia for Spring, 2024

Heads up on some CME dates you might want to put on the calendar for next year. Our Duke Sports Cardiology & Sudden Death in Athletes symposium will be held at the Trent Semans Center on Friday, April 12, 2024. And our Duke Heart Failure Symposium will be held at the Durham Hilton on Saturday, May 4, 2024.

Registration won’t be open for a while, but if you have any questions about either event, please reach out to Christy Darnell.

As soon as registration opens, we’ll have that listed here in Pulse.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

 

Duke Heart in the News:

January 4 — Joseph Turek

Le Monde (France)

Le premier nouveau-né ayant bénéficié d’une transplantation cardiaque partielle a aujourd’hui 14 mois

January 4 — Joseph Turek

Scripps News

Baby thriving a year after world’s first partial-heart transplant

January 4 — Joseph Turek

Medical Design & Development

‘World’s First’ Partial Heart Transplant Forms Functioning Valves and Arteries

January 4 — Joseph Turek, Lillian Kang, Douglas Overbey, and Michael Carboni

Nature

A record-setting transplant heals a baby’s broken heart

January 5 — Joseph Turek and Michael Carboni

Healio/Cardiology Today

Valves from world’s first partial heart transplant growing with child recipient

January 5 — Robert Mentz

tctMD

Top Heart Failure News of 2023

January 7 — Harry Severance

KevinMD.com/Medpage Today

Leaders advise us to accept it as a job norm: violence and abuse in the health care workplace

January 8 — Brian Duscha and William Kraus

Knowridge (Australia)

Cardiac rehab is a lifesaving choice for people with heart disease

January 8 — Duke University Hospital

Press Ganey

2023 recipients of the Human Experience Pinnacle of Excellence Award

January 8 — Brian Duscha

WPTF (Raleigh)

Rehab helpful for recovering heart patients

*clip begins @ 15:41:27

January 9 — Carolina Tennyson

U.S. News & World Report

Why Nurse Practitioner Is the No. 1 Job of 2024

January 10 — Joseph Turek

Noticias del Mundo

El corazón trasplantado del bebé Owen crece con él por primera vez en el mundo

 

 

 

Duke Heart Pulse — January 7, 2024

Pulse – January 7, 2024

Highlights of the week:

Study of Duke Heart Attack Patients Finds Definitive Benefit of Cardiac Rehab

The benefits of doing cardiac rehabilitation after a heart attack might seem obvious, but studies have provided surprisingly underwhelming findings.

Now an analysis from Duke Health offers definitive evidence for heart attack patients or those who have had procedures to clear blockages: Cardiac rehab saves lives and keeps people out of the hospital — no matter their age, sex, education level, income level, or race.

Publishing in the Journal of Cardiopulmonary Rehabilitation and Prevention, the researchers showed that fewer than 10 percent of patients with cardiovascular disease who can do so participate in cardiac rehab; and those who do have a 43 percent reduction in either mortality or readmission compared to those who do not. 

“Our study shows that no matter who your patient is, what clinical characteristics they have, what type of intervention they have to clear blockages — if you send them to cardiac rehab, the benefit is far greater than what previous studies have shown,” said lead author Brian Duscha, an exercise physiologist at Duke.

Duscha and colleagues — including senior author William Kraus, MD, professor of cardiology in Duke’s Department of Medicine – said previous studies about the impact of cardiac rehab had limitations that skewed the findings. Notably, studies often included all discharged heart patients, including those with frailties or conditions that required them to live in a facility without access to rehab, or those who lived too far away from an available rehabilitation center that ruled out participation in a rehab program.

The Duke team analyzed the health records of 2,641 patients in Duke Health hospitals with coronary artery disease; all were considered able to do cardiac rehab at the Duke facility given distance or rehab location. Included patients were those with myocardial infarction and/or who had blockages requiring stenting or bypass surgery.

Among those who were ruled out were patients heading to skilled nursing care, those with valve replacements and heart transplant recipients, or those living more than 50 miles from the Duke rehab center. The researchers accounted for demographics, comorbidities, medical therapies, and demographics in their analysis.

“Not controlling for all these factors may explain the inconsistent findings from other studies assessing cardiac rehab’s impact on clinical outcomes,” Duscha said.

The researchers found that only about 8 percent (214) of the eligible discharged patients actually participated in at least one session of cardiac rehab; 93 percent of those who participated, however, attended five or more sessions.

“Importantly, attending even five sessions equated to a 10 percent significantly reduced risk of readmission or mortality,” Duscha said.

Kraus added that for every session attended, the risk of death or rehospitalization declined by 2 percent. 

“Bottom line – cardiac rehabilitation is effective. It keeps people out of the hospital, saving both money and lives. Why wouldn’t you do that?” Kraus said.

In addition to Kraus and Duscha, study authors include Leanna M. Ross, Andrew L. Hoselton, Lucy W. Piner, and Carl F. Pieper.

The study received funding support from Duke research funds and the Johnston Distinguished Professorship.

 

First Barostim Implant Performed at Duke

Duke’s first Barostim implant was performed last month by vascular surgeon Chandler Long, MD, as part of a cross-departmental collaboration. Barostim is an implantable device now being used in heart failure patients with reduced ejection fraction.

Duke is currently offering this to patients referred to the Heart Failure Device Clinic for screening. The providers there, including Leilani Gomez, Todd McVeigh, and Marat Fudim, will screen, follow, and titrate the devices for patients in parallel to their routine care at Duke.

“This therapy will provide an alternative and complementary approach to medications for patients with symptomatic HFrEF (over 35 or less) and NYHA 2-3 symptoms despite GDMT,” according to Fudim.

In the future, the team plans to have providers manage the screening and referrals for implants themselves, but titration of devices will remain with the HF Device Clinic.

 

161 Hearts Transplanted at Duke in 2023

A final count has revealed that our team transplanted 161 hearts in 2023. To celebrate this record,  and for reaching our 2000th heart transplant milestone, our team shared special cookies throughout the units last week.  We will have our final total thoracic support (Transplant  / VAD / Temporary VAD) data in the upcoming weeks.  Again Duke Heart is leading the country in many of these areas

Kudos to all!

 

World’s First Partial Heart Transplant Proves Successful in First Year

The world’s first partial heart transplant has achieved what researchers have spent more than a year hoping for — functioning valves and arteries that grow along with the young patient, as hypothesized by the pioneering team behind the procedure at Duke Health.

The procedure was performed in the spring of 2022, in an infant who needed heart valve replacement. The previous standard of care — using valves that were non-living — would not grow along with the child, requiring frequent replacement, entailing surgical procedures that carry a 50 percent mortality rate.

A study led by Duke Health physicians, appearing online Jan. 2 in the Journal of the American Medical Association, found that the new manner of valve procurement used during the partial heart transplant led to two well-functioning valves and arteries that are growing in concert with the child as if they were native vessels.

“This publication is proof that this technology works, this idea works and can be used to help other children,” said Joseph W. Turek, MD, PhD, first author of the study and Duke’s chief of pediatric cardiac surgery, who led the landmark procedure.

The study also found the procedure requires about a quarter of the amount of immunosuppressant medication than a full heart transplant, potentially saving patients from detrimental side effects that might compound over decades.

Turek said the innovation has paved the way for a domino heart transplant, where one heart can save two lives. During a domino heart transplant, a patient who has healthy valves but needs stronger heart muscle receives a full heart transplant; their healthy valves are then donated to another patient in need, creating a domino effect.

“You could potentially double the number of hearts that are used for the benefit of children with heart disease,” Turek said. “Of all the hearts that are donated, roughly half meet the criteria to go on to be used for full transplant, but we believe there’s an equal number of hearts that could be used for valves.”

“If you introduce the donated hearts that weren’t being put to use into the supply chain and add the valves from domino heart transplants, that can create a substantial change,” Turek said.

The partial heart transplant procedure has been performed 13 times at four centers around the world, including nine at Duke, several of which have been domino heart transplants.

Turek said bringing this innovation to a clinical trial would be the next step to achieving the volume in procedures that would change the availability of hearts by a large amount.

“This innovation adds a lot to the whole donation community,” Turek said, “because it’s treating more kids, while also honoring the wishes of selfless donor parents who’ve given the ultimate gift. It allows them to offer hope to another child in the process.”

Preclinical data was supported by the Brett Boyer Foundation.

In addition to Turek, study authors include Lillian Kang, Douglas Overbey, Michael P. Carboni, and Taufiek K. Rajab.

 

Sports Performance Coach Takes the Lead Against Sarcoidosis Thanks to Expert Care at Duke

In Fall 2019, William Stephens learned he had cardiac sarcoidosis, a rare autoimmune disease that causes inflammation in the heart. A team of Duke doctors helped Stephens continue to work as a sports performance coach for Duke basketball players. Years later, he experienced a life-threatening sarcoidosis “flare” that sent him to the emergency department. Duke sarcoidosis experts stabilized Stephens quickly and established a more aggressive treatment regimen. Today, his sarcoidosis is in full remission, and the 58-year-old is happy to feel better. “This disease will kill you if you don’t get on top of it,” Stephens said. “I’m very blessed.” 

Something’s Not Right

William Stephens prioritized health from a young age. After spending more than a decade in law enforcement, winning a handful of high-profile powerlifting championships, and becoming a certified strength and conditioning specialist, Stephens joined Duke basketball in 1998. He prioritized living a healthy lifestyle at home and work so when he started noticing fatigue and chest pressure in the summer of 2019, he knew something wasn’t right.

Cardiac Sarcoidosis Diagnosis

Stephens’ primary care doctors ordered a battery of tests, which showed his heart rate was dangerously low and inconsistent, and imaging scans showed scarring on his heart. Both signs indicated Stephens could have sarcoidosis. Its cause unknown, sarcoidosis encourages the immune system to form clumps of inflammatory cells that can attack organs including the heart (doctors call this cardiac sarcoidosis). Common sarcoidosis risk factors include age (between 20 and 60 years old) and African American descent, both of which applied to Stephens.

Recognized Sarcoidosis Clinic

Stephens’ doctors referred him to Duke’s Sarcoidosis Clinic, which is recognized by international organizations like the World Association for Sarcoidosis and Other Granulomatous Disorders (WASOG). The clinic’s specially trained providers work together to treat people with sarcoidosis and related complications. Stephens met advanced heart failure specialist Ravi Karra, MD; electrophysiologist James Daubert, MD; and rheumatologist Jayanth Doss, MD.

“Our multidisciplinary providers have expertise in different areas of sarcoidosis, and we work as a team,” Dr. Karra said. He likened it to legendary Duke men’s basketball Coach Mike Krzyzewski’s well-known teamwork analogy: a fist is much more powerful than five individual fingers.

Treatment Plan Includes Heart Device

To address Stephens’ immune response, decreased heart function, and heart rhythm issues, Drs. Karra, Daubert, and Doss recommended medications as well as a combination pacemaker/implantable cardioverter defibrillator (ICD).

“I’ll never forget that phone call when Dr. Daubert told me I had to get a pacemaker. It was a shock,” Stephens said. “Your mind goes a lot of places when someone says, ‘You need something to help your heart do what it’s supposed to do.’ That was hard to digest.”

A Dangerous Flare

Stephens’ pacemaker/ICD was surgically implanted in October 2019. He felt better, returned to work, and had regular check-ups with his doctors. In Spring 2022, Stephens was driving by Duke University Hospital when he felt like someone hit his car from behind. When it happened again, he realized he was being shocked by his ICD. That meant his heart was in a dangerous rhythm. He called his Duke care team, who immediately sent him to the emergency room. “By the time I got to the ER, they took me right back and got everything under control,” Stephens said.

According to Dr. Karra, Stephens was experiencing unstable ventricular tachycardia, a dangerous arrhythmia, or irregular heartbeat that doctors call a “VT storm.” PET scans showed increased inflammation in Stephens’ heart, indicating a sarcoidosis flare — a sudden worsening of an otherwise stable condition. His doctors recommended more aggressive treatment with a different combination of medications. Quick, expert treatment at Duke probably saved his life that day, Stephens said. Four days later, he returned home.

Looking Forward

Since then, follow-up PET scans have shown no evidence of sarcoidosis activity. Stephens is now in his 26th year with Duke athletics and said he’s grateful for how in-tune Duke providers are with their patients.

“We are a very patient-centered program,” Dr. Karra said. “And for Mr. Stephens, we considered things very carefully. What does it mean for him to go back to work? How can he be productive in his role and his job? We want to help people not only prolong their lives but also to enjoy it and have fulfilling experiences.”

Dr. Karra emphasized that Duke can offer the full range of sarcoidosis treatment options, including heart and other organ transplants for the most severe cases. “We can help people at all stages of their disease, including very complex sarcoidosis that’s no longer responding to treatment,” he said. “That’s not true anywhere else in North Carolina.”

Stephens’ story was published last week on DukeHealth.org.

 

Selvaraj Receives FSR Research Grant Award

Congratulations to Senthil Selvaraj!

The Foundation for Sarcoidosis Research (FSR) announced last month that Selvaraj was one of two $50,000 grant award winners in support of research aimed at improving the diagnosis, management, and treatment of cardiac sarcoidosis.

Senthil Selvaraj

Selvaraj, an assistant professor of medicine in the Section of Advanced Heart Failure and Transplant at Duke University Medical Center and faculty member at the Duke Molecular Physiology Institute was selected for his innovative project, “Diagnostic Utility of SGLT2 Inhibition to Facilitate Myocardial Glucose Suppression During Evaluation of Cardiac Inflammation on FDG-PET,”

“We are absolutely delighted to receive this funding support from the FSR,” says Selvaraj. “With this grant, we aim to improve the specificity of cardiac sarcoidosis diagnosis with FDG-PET using a novel strategy incorporating combined SGLT1/2 inhibition with sotagliflozin. Further, we leverage a strong academic collaboration between Duke University and the University of Pennsylvania with co-PI Dr. Paco Bravo.”

“FSR is thrilled to support this extraordinary project through our cardiac sarcoidosis-specific grant,” says Mary McGowan, FSR’s CEO.  “The learnings from this research could be groundbreaking in improving diagnosis, prognosis assessment, and treatment management of not only those living with cardiac sarcoidosis but for many other inflammatory diseases.”

The FSR’s second grant award goes to Daniela Čiháková, MD, PhD, of Johns Hopkins University School of Medicine and Department of Molecular Microbiology and Immunology for her project, “3D Morphological and Spatial Transcriptomic Analysis of Cardiac Sarcoidosis.”

To learn more about FSR’s Research and Grant Programs, please visit www.stopsarcoidosis.org/fsr-grants/.

 

1st DUH BEE Award Recognizes Simpson

We are pleased to share that Danielle Simpson, Health Unit Coordinator for 3100, received the very first BEE Award at Duke University Hospital the week of Dec. 19, 2023. The Being Exceptional Everyday (BEE) award is presented to unlicensed personnel who patients and their loved ones nominate for going above and beyond to make a difference in their or their loved one’s care.

There will be 6 winners announced quarterly across DUH for this award.

Congratulations to Danielle for her exceptional work in caring for our patients and their loved ones!

 

ICYMI: Duke Heart Contributes to Cardiovascular Manual for the Advanced Practice Provider

Congratulations to the following members of the Duke Heart team for their contributions to the recently published Cardiovascular Manual for the Advanced Practice Provider

Allen Stephens, Todd McVeigh, and Cary Ward along with Elisabeth A. Powell (Banner University) and Larry Watts (Atrium Health) co-authored chapter 19 on Infective Endocarditis; Carolina Tennyson author of chapter 21 on Heart Failure with Preserved Ejection Fraction; and Allison Dimsdale who co-authored chapter 30 on Prevention of Cardiometabolic Disease with Christopher Kelly of UNC.

The book was published last month by Springer (eBook ISBN 978-3-031-35819-7, Print ISBN 978-3-031-35818-0).

Great work! Congratulations to all!

 

New Visitor Restrictions In Effect, Jan. 3, 2024

Due to the increase in respiratory illness throughout our communities and after consulting with our Infectious Disease and Infection Prevention experts, Duke has updated visitation restrictions as of Wednesday, January 3.

  • Visiting hours are from 8 a.m. – 9 p.m.
  • Visitors must check in at the hospital information desk to receive a visitor badge to enter inpatient areas.
  • All visitors must be age 12+. (Visitors in some clinical areas must be age 18+.)
  • Minors are required to be attended by an adult age 18+ at all times.
  • A maximum of two visitors are allowed per patient.
  • Visitors must check out upon departure at a kiosk or with information desk staff.
  • Visitors with fever, cough, or other flu-like symptoms should not visit.

For more details, refer to the Tier 2 visitation standard work document. Updated signage is posted.

These changes are being implemented at Duke University Hospital, Duke Regional Hospital, and Duke Raleigh Hospital, as well as Duke Ambulatory Surgery Center, Duke Health Center Arrington, Duke North Pavilion, and the James E. Davis Ambulatory Surgical Center.

We realize that these changes may be challenging to patients, visitors, and team members. We appreciate your support as we continue to implement practices that ensure we provide a safe place for healing.

Please note: Additional visitation and masking precautions may apply to certain patient populations, including without limitation, COVID-19/Special Airborne Contact, oncology, end-of-life, and overnight visitors. Please follow all unit guidelines. Exceptions to visitation restrictions may be granted based on special circumstances, including without limitation, to permit Compassionate Care Visitors.

 

Upcoming Events & Opportunities

  • Happy 100th Birthday, Duke University! 2024 marks the centennial anniversary of the founding of Duke University. The Centennial Celebration Kickoff will take place at 4 p.m. in Cameron Indoor Stadium on Tuesday, Jan. 9, followed by a ‘Winter Chill’ reception outside in K-ville at 5:30 p.m. The Kickoff requires a ticket for entry, but the reception is open to all Duke faculty, staff, students, alumni, and guests. To get all the details, please visit the Centennial web page. Stay tuned for a full year of celebratory events! 

 

Cardiology Grand Rounds

Jan. 9: All you need to know about the new AF guidelines in the new year! with Jonathan Piccini. 5 p.m., DN 2002 or via Zoom.

All 2023 Duke Cardiology Grand Rounds recordings are housed on Warpwire. To access recordings please visit: https://duke.is/DukeCGR; NET ID and password required. Enjoy!

CD Fellows Core Curriculum Conference

Jan. 10: EP Case Presentation with Belal Suleiman, MD, and Aubrie Carroll, MD. Noon. DMP 2W96 (in-person only).

Jan. 12: PAD-Aorta with Jennifer Rymer, MD. Noon. Zoom only.

MDEpiNet: RAPID PASSION CV Virtual Think Tank, Jan. 9

Predictable And SuStainable Implementation Of National CardioVascular Registries: PASSION CVR — Registry-Supported Infrastructure Development for Prospective Trials: Pathways for DEI and “Long, Long” Term Vital Status Use Cases

Tuesday, January 9, 2024, 12:00 p.m. – 4:00 p.m. EST

Meeting Objectives:

  • Pragmatic aspects of CV device research approaches to DEI issues.
  • Pragmatic aspects of developing a streamlined, high quality, “long, long” (> 5 yr) vital status profile that could be predictably and reliably accessed by clinical trial sponsors and sufficient for public health safety assessments going forward.

Click Here to register!

 

Office of Faculty Announces Event with Israni of Stanford Medicine, Feb. 26

Academic Medicine, with all its complexities, naturally includes conflict among its crucial collaborators – trainees, faculty, staff, communities, and more. 21st century leadership skills require all of us to strategically leverage components of this conflict for constructive change, with intentional and thoughtful actions. This talk will weave together themes from restorative justice and design thinking; and how they can be applied to artificial intelligence and JEDI (justice, equity, diversity, and inclusion), offering a case for new ways of leveraging conflict to advance a culture of connectedness and belonging. The featured speaker will be Sonoo Thadaney Israni of Stanford University’s Presence Center.

February 26: Leveraging Conflict for Constructive Change. 4-5:30 p.m., DN 2002. Presented by the Office for Faculty. Refreshments will follow. To learn more and register: https://duke.is/8/8d7f.  

Upcoming CME Symposia for Spring, 2024

Heads up on some CME dates you might want to put on the calendar for next year. Our Duke Sports Cardiology & Sudden Death in Athletes symposium will be held at the Trent Semans Center on Friday, April 12, 2024. And our Duke Heart Failure Symposium will be held at the Durham Hilton on Saturday, May 4, 2024.

Registration won’t be open for a while, but if you have any questions about either event, please reach out to Christy Darnell.

As soon as registration opens, we’ll have that listed here in Pulse.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

Duke Heart in the News:

December 11 — Harry Severance

ACEP Now

More Hospitals are Closing

December 18 — Jonathan Piccini

Medical Dialogues (India)

Cold weather may raise the risk of heart problems, say researchers

December 19 — Harry Severance

Becker’s ASC Review

10 ASC leaders’ thoughts that rocked 2023

December 19 — Manesh Patel

WRAL-TV Raleigh

Family raises awareness about severity of flu in children after death

(*clip begins @ 16:31:08)

December 26 — Manesh Patel

Fox News (national)

New blood pressure procedure is ‘game-changing’ for people with uncontrolled hypertension, say doctors

December 26 — Joseph Turek & the Hobby family

WNCN-TV Raleigh

A NC baby was able to both give and receive the gift of life

(*clip begins @ 18:12:40)

December 27 — Manesh Patel

WRAZ/WRAL-TV Raleigh

Cardiac deaths spike during holidays. Why?

December 27 — Joseph Turek & the Monroe family

Star News (Wilmington, NC)

After receiving the world’s first partial heart transplant, a Leland toddler is thriving

December 27 — Manesh Patel

Arab Times

Innovative procedure offers hope for treatment-resistant blood pressure

December 29 — Manesh Patel

American Talk

‘Game-changing’ procedure could have major impact on heart disease by treating this ‘silent killer’

December 31 — Adrian Hernandez

Medpage Today/Opinion

‘It Is a Horrifying Prospect’: What We Heard This Year

January 2 — Joseph Turek, Nick & Owen Monroe

CNN

Groundbreaking procedure allows heart repairs to grow with children, new study shows

*carried by 35+ CNN affiliates and CNN Panorama Mundial

January 2 — Joseph Turek

Medpage Today

Donated Heart Valves Still Growing a Year After World’s 1st Partial Heart Transplant

January 2 — Joseph Turek

Becker’s Hospital Review

Duke reports success in world’s 1st partial heart transplant

January 2 — Joseph Turek, Lillian Kang, Douglas Overbey, Michael P. Carboni, and Taufiek K. Rajab

WRAL news

Duke breakthrough: Transplanted parts of heart are growing along with child

January 4 — Svati Shah

HFMA.org

Tailoring care to the patient’s needs presents an opportunity for hospitals and physicians.

Duke Heart Pulse — December 17, 2023

Chief’s message:

Happy holidays! This is our final Pulse of 2023 – so, as we close out the calendar year, thank you for all the terrific work you have done this year and for your many good-news submissions to us. We look forward to 2024 where we will continue to focus on the difference we can make in each others lives, our community, and the future leaders of cardiovascular medicine.

We are taking the next two weekends off. We’ll return with the latest news and shout-outs on Sunday, Jan. 7. On behalf of the Duke Heart leadership team, we wish each of you and your loved ones a safe and joyous New Year.

Please find some photos from the Duke Heart Center Holiday Party Photo Booth at the end of the pulse this week.

Highlights of the week:

Heart Team Clears 150 Transplants for 2023; Surpasses 2000 Total

We are thrilled to share that our Heart Transplant team has set a new record! The team has now transplanted more than 150 hearts this year – a feat we believe no other U.S. institution has achieved. They also surpassed a program milestone: transplanting our 2000th recipient one week ago today. The numbers include pediatric and adult transplant cases.

“I am really proud of the work the team did this year,” says advanced heart failure specialist Adam DeVore, MD, medical director of Duke’s Heart Transplant Program. “The volume and the numbers we have reached are a big deal, but when you think about what they represent —  the number of lives we have impacted, it’s pretty amazing. Just think about how many kids went on to grow up, and parents who were able to continue raising their kids, and grandparents who were able to see their families grow. We’ve helped a remarkable number of people and that is what it’s all about.”

Cardiovascular and thoracic surgeon Jeff Keenan, MD, performed Duke’s 2000th heart transplant last weekend. Keenan, who did his surgical residency and training at Duke, recently returned to Duke after two years on the faculty of the University of Washington Medical Center in Seattle.

“I think for our entire team and program, this is a great accomplishment,” says Keenan. “This reflects a great commitment to our patients with advanced heart failure from the institution and the whole team. It reflects a whole lot of hard work from a lot of people over a long period.”

DeVore’s pride in the team is palpable.

“This is a really remarkable achievement, and I am proud to be part of it. I cannot overstate how important this success is overall for Duke Heart Center. This is not a transplant achievement,” says DeVore, “This is a result of the entire Duke Heart team. These patients are cared for within the Heart Center for a long time before they need a heart transplant. Then, even afterward, our patients continue to be touched by all the different areas within Heart services – from cardiac imaging to the cardiac catheterization lab and electrophysiology, and all of the care units – this is a huge testament to what we’re able to do here, together, within Duke Heart.”

Reaching this number of successful transplants goes beyond just a handful of people, DeVore and Keenan both say. The success is due to the efforts of literally hundreds of people contributing over many years.

“Contributions come from across the spectrum. From everyone who takes care of these patients,” Keenan says. “This includes cardiology, our transplant coordinators, the support teams, social workers, our cardiothoracic anesthesiology team, our OR and CTICU support teams, and then all of the staff and support coming through Duke Hospital – and I’m sure there are a lot of people who do things to support us that I have no idea about that make everything ultimately work.”

DeVore notes the energy and dedication of Jacob Schroder, MD, surgical director of the Heart Transplant program. “Jacob has been like the engine for this team. He really has been a driving force and has done so much for the program. We have a great team, we’re doing great work, and love working together.”

Duke’s heart transplant program, established in 1985, has experienced annual growth for nearly a decade, according to DeVore. “It has grown every year since 2015, which is remarkable. Year over year, growth like this is difficult to sustain, but there are no signs of letting up. He says the growth has come through partnering with other great heart failure programs throughout the southeast, and also through innovation and research.

“Any time we’re a part of new discovery, that’s a great thing,” DeVore adds. “But to be able to do it and immediately impact care and see results like this is really, really rewarding and certainly a great thing. Hopefully, we can take this and educate other centers on how to do this so we can keep expanding transplant across the globe, too.”

Congratulations to all for a great year!

 

Ngeno Among Five Recipients of Inaugural Corey Legacy Award

Congratulations to cardiologist Titus Ngeno, MD, MSc-GH, assistant professor of medicine! Ngeno is among five inaugural recipients of the Dr. G. Ralph Corey Legacy Award. The awardees were announced last week by the Hubert-Yeargan Center and Duke Clinical Research Institute, the partnering organizations that created the award and established a research fund to carry on Dr. Corey’s vision of “developing the next generation of globally educated, socially responsible clinician educators and scientists dedicated to improving health equity at home and abroad.”

Ngeno and Neelima Navuluri, MD, MPH, assistant professor of medicine in the division of pulmonary, allergy, and critical care, together were named awardees for their collaborative research project, Validation of Cardiopulmonary Rehabilitation Patient Related Outcome Measures among Adults in Kenya” which will be conducted at Moi Teaching and Referral Hospital in Eldoret, Kenya.

Cardiopulmonary diseases are the leading cause of death globally and exert a disproportionate burden of morbidity in low income regions of the world such as Sub-Saharan Africa. One effective intervention for treatment of cardiopulmonary disease is cardiopulmonary rehabilitation. Such rehabilitation involves a comprehensive set of patient-tailored treatments such as aerobic exercise, endurance training, strength exercises, education, and behavior change designed to improve physical and psychological well-being among patients with chronic cardiac and pulmonary disease. It improves exercise tolerance, functional status, respiratory symptoms, depressive symptoms and quality of life among patients with chronic cardiovascular and respiratory diseases such as heart failure, chronic obstructive lung disease and post-tuberculosis lung disease.

However, cardiopulmonary rehabilitation is not widely available in most of sub-saharan Africa, including in Kenya, according to the team’s project proposal. Thus, there is a critical need for further implementation studies to increase evidence for and availability of rehab programs. 

Ngeno and Navuluri’s co-principal investigators include Neil MacIntyre, professor of medicine in the division of pulmonary, allergy, and critical care; Dr. David Lagat of Moi University School of Medicine, and Dr. Carolyne Lusweti, Moi Teaching and Referral Hospital.

Ngeno and Navuluri’s project aims to assess which cardiopulmonary functional assessment and quality of life measures are most appropriate for the Kenyan setting. The study will enroll 102 participants comprising healthy controls, patients with pulmonary disease (chronic obstructive lung disease, post-tuberculosis lung disease), and patients with cardiac disease (valvular and non-valvular disease, heart failure). Functional capacity and quality of life assessments will be compared across groups. The project findings will yield insight into which metrics would be most appropriate for routine clinical assessments as well as establish reference ranges for future research studies.

Additional inaugural recipients are Hutton Chapman, MD, Sharla Rent, MD, and Sweta Patel, MD. To learn more about the Corey Legacy Award, visit https://duke.is/6/dm83; to read about the other research projects funded this year, please see the lead story in the Hubert-Yeargan Center for Global Health’s latest quarterly newsletter: HYC Happenings – Fall 2023

Congratulations, Titus!

 

Kudos to Melissa Williams!

Congratulations to Duke Heart Center of Excellence team member Melissa Williams! Williams graduated from Duke Management Academy’s year-long program on Wed., Dec. 13. The program, created for mid-level managers, is part of Duke’s commitment to develop leaders at all levels within Duke University and Health System. Williams is clinical manager of our registry team in CV Informatics and Quality Improvement.

Her team (comprised of Williams, Keith Holder, Aris Marton, Katherine Fox, and Danielle Wiggins) received the best presentation and paper award for their project, “Help at Students’ Fingers:  A Mobile App to Navigate Well-being Resources”.

Way to go, Melissa!

 

Duke Heart continuing innovation with Impella RP Flex

Imran and Jeff worked together placing the first RP Flex Impella this week.  Some pictures included.  This is gratifying after our team worked to help with some of the first RP trial patients in the OR and cath labs.  Great work team!

 

New publications from the Duke Heart Team

Congratulations to Bill Kraus, MD and his co-authors on their latest publication!

The Science of Precision Prevention: Research Opportunities and Clinical Applications to Reduce Cardiovascular Health Disparities was published online this week in JACC: Advances.

 

Duke Health Signs Pledge for Ethical, Responsible AI in Health Care

Duke Health is among a leading group of health systems and payers from across the U.S. to sign a pledge advancing ethical and responsible use of Artificial Intelligence technology in health care.

The pledge announced today at the annual conference hosted by the Office of the National Coordinator for Health Information Technology, is a voluntary commitment to the principles of safety, security and trust that are fundamental to the future of AI.

“AI presents unequalled potential for advancing health with new scientific discoveries, improved diagnoses and treatment of diseases and better systems that free our workers to dedicate their expertise to patient care rather than administrative chores,” said Craig T. Albanese, MD, chief executive officer of Duke University Health System. 

“But we recognize that AI also has the potential to be misused,” Albanese said. “By signing this pledge, we are publicly stating our commitment to work toward the better good.”

Mary Klotman, MD, executive vice president for health affairs at Duke University and dean of Duke University School of Medicine, said establishing Duke’s role as a leader in trustworthy AI has been an institutional priority for years and is foundational to advancing better health.

“This pledge actually reflects many years of work that Duke Health has already undertaken to establish the infrastructures we need to pursue AI with integrity,” Klotman said. “It puts us on record with our commitment.”

In addition to signing the pledge, Duke Health has been a founding member of the Coalition for Health AI, or CHAI, established to develop guidelines and guardrails for fair and credible applications of AI in health care.

Duke Health has also built a framework for the governance and evaluation of clinical algorithms used throughout the organization. Duke’s Algorithm-Based Clinical Decision Support framework is designed to foster innovative, safe, equitable, and high-quality patient care. This is achieved with human oversight throughout the use of an AI program to ensure that transparency, quality, and ownership are maintained.

“First and foremost, AI should serve humans,” said Michael Pencina, PhD, Duke Health’s chief data scientist and director of Duke AI Health. “It’s imperative that AI is developed and applied in a trustworthy manner, and we have been engaged in establishing that foundation for the last few years, as evidenced by our role in CHAI and recent publications. We are not catching up on this — it’s something that has been a differentiator in terms of being careful and proactive — and our signature on the pledge is a further confirmation of our commitments.”

 

ICYMI: December Leadership Town Hall

The latest Duke University Health System Leadership Town Hall video from Tuesday, Dec. 12, is now available on Leadership Café. Check it out when you get some time. Leadership Town Hall is held via Zoom on the 4th Tuesday of each month from 12-12:45 p.m.

Upcoming Events & Opportunities

  • Masking is strongly recommended throughout all clinical areas during respiratory virus season, from now through early March. It is currently mandatory in 7E/CICU through 12/21.
  • Lots of holiday fun in-house throughout the holiday season! Be sure to check out Season’s Greetings Bingo; pop-up Cheer Stations (13th-18th); and Tribute Snowflakes: An Act of Remembrance in the corridor from DMP to Duke Central Tower throughout December. Details on the DUH SharePoint site.
  • Everyone working at DUH on Monday, Dec. 25 is invited to enjoy a complementary holiday meal.

Cardiology Grand Rounds

Dec. 19: AHA Recap, part 2 with Manesh Patel and Kristin Newby. 5 p.m., DN 2002 or via Zoom.

All 2023 Duke Cardiology Grand Rounds recordings are housed on Warpwire. The AHA Recap, Part 1 from Dec. 12 has been uploaded. To access recordings please visit: https://duke.is/DukeCGR; NET ID and password required. Enjoy!

CD Fellows Core Curriculum Conference

Dec. 20: EP Case Presentation with Ivan Nenadic Wood and Husam Salah. DMP 2W96 (in-person only).

Dec. 22: No CD Fellows Core Curriculum conference today. Happy holidays!

MDEpiNet: RAPID PASSION CV Virtual Think Tank, Jan. 9

Predictable And SuStainable Implementation Of National CardioVascular Registries: PASSION CVR — Registry-Supported Infrastructure Development for Prospective Trials: Pathways for DEI and “Long, Long” Term Vital Status Use Cases

Tuesday, January 9, 2024, 12:00 p.m. – 4:00 p.m. EST

Meeting Objectives:

  • Pragmatic aspects of CV device research approaches to DEI issues.
  • Pragmatic aspects of developing a streamlined, high quality, “long, long” (> 5 yr) vital status profile that could be predictably and reliably accessed by clinical trial sponsors and sufficient for public health safety assessments going forward.

Click Here to register!

 

Office of Faculty Announces Event with Israni of Stanford Medicine, Feb. 26

Academic Medicine, with all its complexities, naturally includes conflict amongst its crucial collaborators – trainees, faculty, staff, communities and more. 21st century leadership skills require all of us to strategically leverage components of this conflict for constructive change, with intentional and thoughtful actions. This talk will weave together themes from restorative justice and design thinking; and how they can be applied to artificial intelligence and JEDI (justice, equity, diversity, and inclusion), offering a case for new ways of leveraging conflict to advance a culture of connectedness and belonging. The featured speaker will be Sonoo Thadaney Israni of Stanford University’s Presence Center.

February 26: Leveraging Conflict for Constructive Change. 4-5:30 p.m., DN 2002. Presented by the Office for Faculty. Refreshments will follow. To learn more and register: https://duke.is/8/8d7f.  

Call for Abstracts: Duke’s Annual Quality & Safety Conference

Save the date for Duke’s Annual Quality and Safety Conference scheduled for April 11 in the Trent Semans Center. Click here to view Abstract Guidelines. Abstracts are due by 5 p.m. on Dec. 31, 2023. Late submissions will not be accepted. Contact cynthia.gordon@duke.edu or kyle.rehder@duke.edu with any questions. 

Upcoming CME Symposia for Spring, 2024

Heads up on some CME dates you might want to put on the calendar for next year. Our Duke Sports Cardiology & Sudden Death in Athletes symposium will be held at the Trent Semans Center on Friday, April 12, 2024. And our Duke Heart Failure Symposium will be held at the Durham Hilton on Saturday, May 4, 2024.

Registration won’t be open for a while, but if you have any questions about either event, please reach out to Christy Darnell.

As soon as registration opens, we’ll have that listed here in Pulse.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart at tracey.koepke@duke.edu. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.

Duke Heart in the News:

December 5 — Nishant Shah and Neha Pagidipati

Medscape

Meet the Newest Acronym in Primary Care: CKM

December 6 — Stephen Greene

HCP Live

Semaglutide: The Drug of Today and a Steppingstone to Tomorrow

December 7 — Joseph Turek, Paul Martin, and the Nolasco family

Texas Tribune

How one family carved out Medicaid coverage for a rare treatment

December 9 — Jonathan Piccini

The Washington Post

Cold weather may raise the risk of this heart problem

December 11 — Marat Fudim

HealthCentral

The Four Stages of Congestive Heart Failure

December 11 — Svati Shah

American Heart Association Newsroom

Scholars named for research leadership program to increase diversity in clinical trials

December 11 — Jacob Schroder

The Hearty Soul

Doctors Brought Dead Heart ‘back to life’ For Groundbreaking Transplant**

**originally published in Jan. 2020; this is an updated version