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Duke Heart Week Ending April 5th 2020

By Manesh Patel, M.D. in Uncategorized on April 5, 2020.

Chief’s Message:

Our faculty, fellows, and staff continue to work to ensure we can deliver and prepare for the ongoing COVID-19 pandemic. Despite the several difficult weeks we have had, there are more coming. It is in these unprecedented times, we are able to see the character of people. We have had people working in remarkable ways to fight the pandemic from managing our clinical practice, organizing research opportunities, to sorting out ways to continue to teach. Perhaps most importantly, I have seen the “all hands on deck” attitude of our entire division across many fronts. Thank you all for your continued effort and commitment to our patients and each other.

Updates of the week:

Melloni Leaving Duke Heart; Heading to IQVIA

After 15 years at Duke, Chiara Melloni, associate professor of medicine, is leaving Duke Heart and the Duke Clinical Research Institute for a new opportunity with IQVIA. Melloni has accepted the role of senior director for IQVIA’s Cardiovascular Center for Excellence. The strategic role will position her to work with sponsors of research clinical trials to understand their needs, help them develop their CV program, work on appropriate site selection, patient selection and help inform clinical trial design.

Melloni says the decision was bittersweet, as she will miss Duke and the people she has come to know so well, but that the opportunity with IQVIA is a terrific one that will allow her to grow professionally and to remain in the Durham area.

“It has been such an honor to be a part of the Duke family for 15 years and I am deeply grateful for the people here who began as colleagues but who have become friends,” Melloni says.

Her experience at Duke has given her great experience in the design and conduct of clinical trials, but she says the new role at IQVIA will give her a lot to learn.

“Through my work with DCRI, I’ve had the opportunity to partner with so many faculty members and this helped me a great deal throughout my fellowship as well as transitioning into becoming a junior faculty member. You find that everyone approaches things just a bit differently and you grow because you’re learning from so many people. I particularly enjoyed working with the international fellows. You make such good friendships through this type of work and get to meet people from all over the world, and we’re all driven by the same ideals around improving patient health.”

She says she has really enjoyed the last few years of working closely with the Duke cardio-oncology team. (To read more about what drove Melloni and her cardio-oncology work, please see: http://dukecancerinstitute.org/donors/your-gifts-at-work/what-does-heart-disease-have-do-cancer)

“Reaching into this area has been an interesting journey, especially working to create a team outside of my therapeutic area; we’ve worked hard to learn how to reduce cardiovascular harms in this patient population. This is one of the areas I think I will miss the most — I really put my heart in every sense into this project. We have done a lot and I’m very proud to have co-chaired the three symposiums we’ve held so far. When you put a lot of work into something and you see it be successful is a great joy.”

Melloni’s last day with us at Duke will be May 10. She hopes to continue collaborating with us in the years to come. Please join us in congratulating and wishing Chiara the very best in her new adventure!

Mobile Cardiac Rehab Program Launched

This week, Duke Heart launched its Mobile Cardiac Rehabilitation program, allowing patients to benefit from a personalized exercise program via mobile app, devices and electronic communication with an exercise physiologist. The need for a remote program was highlighted during the past few weeks as traditional in-person cardiac rehab was no longer possible due to on-site restrictions resulting from the COVID-19 pandemic.

Many patients face barriers to participation in cardiac rehabilitation programs, including transportation and access in their community, as well as overall costs for rehab, which is often prescribed three times a week for up to 12 weeks. Planning for a mobile program at Duke has been underway for nearly a year and a half, as our cardiac rehab team explored ways to make our program more accessible to our patient population. The mobile planning team first met with Pattern Health, a local app development company, in October of 2018.

Our mobile cardiac rehab program will work to address barriers to participation by providing patients the option of completing the majority of the 36 sessions at home. Thanks to a partnership with Duke’s Population Health Management Office (PHMO), our planning team was able to secure 20 sets of devices that will allow patients to monitor and record biometrics including steps, heart rate, blood pressure, weight, glucose levels and ECG rhythm strips.

As of last week, 11 patients are enrolled in the mobile program and a number of patients have downloaded the app and started their tasks. Patients are required to attend an initial in-person session with an exercise physiologist at Duke’s Cardiac Rehabilitation clinic prior to launching their at-home program.

The internal mobile planning team includes individuals from areas across Duke including Duke Heart, PHMO, and the Digital Strategy Office (DSO). A special thanks to the Duke Heart team members who have worked so hard to get this program off the ground: Karen Craig, Beth Summers, Bill Kraus, Brian Duscha, Maria Carroll and Maggie Meyer.

Great job, everyone! This opportunity will be critical to many of our heart patients over the coming weeks and months.

Wang to Serve on AHA COVID-19 Registry Steering Committee

The American Heart Association (AHA) this week announced a new, free COVID-19 cardiovascular disease registry

powered by their Get With The Guidelines (GWTG) quality improvement program. Tracy Wang, associate professor of medicine in cardiology and member of the Duke Clinical Research Institute, will serve on the registry’s steering committee. The DCRI is the analytic center for the GWTG program.

The AHA is creating the multicenter registry to collect biomarkers, clinical data and cardiovascular outcomes in COVID-19 patients. This novel COVID-19 patient data registry is expected to be made available in May to the roughly 2400 hospitals currently participating in a GWTG quality improvement program. To read more about the effort, please visit: https://bit.ly/2UHMk0i

PCORI Commits $50M to DCRI COVID-19 HERO Trial

On Wednesday, the Patient-Centered Outcomes Research Institute (PCORI) announced they will fund up to $50 million to evaluate hydroxychloroquine as a preventive drug for the novel coronavirus that causes COVID-19.

A new rapid-response study called the Healthcare Worker Exposure Response and Outcomes (HERO) research program will be designed and led by the Duke Clinical Research Institute (DCRI); the study seeks to engage healthcare workers across the nation to understand the impact of COVID-19 on their health and to evaluate whether hydroxychloroquine can prevent COVID-19 infections in healthcare workers at high risk of contracting this novel coronavirus.

Adrian Hernandez initiated the program and will serve as the administrative principal investigator.

The HERO program will initially consist of two parts, a national registry and a randomized clinical trial. The registry will be led by DCRI’s Emily O’Brien, assistant professor in Duke’s Department of Population Health Sciences, and will seek to rapidly identify and enroll a large community of healthcare workers at high risk for COVID-19 infection. Recruitment for the registry is expected to begin within the next two weeks. The registry will not only support recruitment into the trial, but will enable future trials as well, and seek to understand the wellbeing of healthcare workers on issues such as workforce stress, burnout, and other outcomes.

The second part, the randomized clinical trial HERO-HCQ, will be led by the DCRI’s Susanna Naggie, associate professor of medicine in infectious diseases at Duke. The trial will launch later in April and will identify approximately 15,000 healthcare workers from the registry to participate. The trial will randomize participants to either one month of hydroxychloroquine or one month of placebo and will examine whether hydroxychloroquine is effective in decreasing the rate of COVID-19 infection. In addition to the benefits and risks of using hydroxychloroquine, the study also will explore how well the drug can prevent healthcare workers from unintentionally spreading the virus to others.

The program will engage the powerful PCORI-funded PCORnet®, the National Patient-Centered Clinical Research Network, which is an established health research network involving more than 850,000 clinicians and hundreds of health systems across the U.S. The study results will be shared widely with the healthcare community.

To learn more, please visit: https://www.pcori.org/news-release/pcori-funds-registry-study-effectiveness-hydroxychloroquine-prevent-covid-19-healthcare-workers and https://dcri.org/hero-pcori-funding-coronavirus/.

Attain Stability Trial Results Published

Congratulations to Kevin Jackson, Susan Gerstl and the entire team on the Attain Stability trial. This study was just published in the Journal of Cardiovascular Electrophysiology; Jackson was first author. We finished in the top 50 percent of enrolling sites and the study was conducted with favorable finances. Advancing knowledge and improving treatment of heart rhythm disorders is among our top priorities within Duke’s EP team, and it is great to see this group make another significant contribution to the field. Congratulations to everyone on this very important accomplishment!

Advance Care Planning for End of Life Care in HF Patients

Harshaw-Ellis, K. 2020. Commentary nursing issues: Using advance care planning for end-of-life care in heart failure improves outcomes. BMJ Evidence-Based Nursing. http://dx.doi.org/10.1136/ebnurs-2019-103249.

Lifelong Learning Statement for Advanced HF & Transplant Cardiology

Clyde W. Yancy, Mark H. Drazner, Samuel Tristram Coffin, William Cornwell III, Shashank Desai, John P. Erwin III, Mahazarin Ginwalla, Karol S. Harshaw-Ellis, Tamara Horwich, Michelle Kittleson, Anuradha Lala, Sabra C. Lewsey, Joseph E. Marine, Cindy M. Martin, Karen Meehan, David A. Morrow, Kelly Schlendorf, Jason W. Smith and Gerin R. Stevens. 2020, March 17. 2020 ACC/HFSA/ISHLT Lifelong learning statement for advanced heart failure and transplant cardiology specialists. JACC. 75(10) 1212-1230:doi: 10.1016/j.jacc.2019.09.030.

Shout-outs to CVRC Labs & Vicky Bryson; Jedrek Wosik & Mike Blazing

Hat tip to Vicky Bryson in the Paul Rosenberg Lab within the Duke Cardiovascular Research Center! After Colin Duckett put out a call within the School of Medicine’s research facilities for PPE supplies that could be donated to Duke University Health System entities, Bryson took the lead on collecting items within the CVRC. Bryson’s efforts yielded many cases of protective gloves in a range of sizes – special thanks to the Rosenberg, Lefkowitz, Shenoy and Stiber labs for their generous donations. Our front-line healthcare workers thank you!!! It’s not too late for CVRC labs to make donations – if you’re interested, send an email to Vicky Bryson or Maria Price Rapoza.

A big shout-out to Jedrek Wosik and Mike Blazing for leading our transition to telehealth visits. You’ve taken on a major project during a stressful time and streamlined it in a way that has been super-palatable to your colleagues – way to go! The Duke Heart team is incredibly grateful and deeply appreciative of the work you’ve done. Many, many thanks!

7 West Partners with Local Restaurant; Helps Others

Amanda Ornell, one of our amazing staff nurses on 7 West, contacted the owners of Travinia, an Italian restaurant and bar in Morrisville that is struggling in the wake of the COVID-19 pandemic, after hearing they wanted to help local healthcare workers. The restaurant has been working to help the community in any way they can, with the food they currently have on hand, so that nothing goes to waste. Ornell and Philip Parker, one of her nurse managers, set up a lunch for the staff on 7 West, with the understanding that the restaurant would take donations so they could continue to pay it forward and support others in the community. According to Parker, the team was able to raise roughly $500 on Friday, March 27^th, which enabled the restaurant owners to provide 250 meals to local nursing home residents. The pictures here show the meals prior to being delivered and Ornell and Parker receiving the lunch provided to 7W staff. Nice job, team!

COVID-19 Updates:

All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:

Self-Care Resources from Your Well-Being Team

Please be good to yourself! Duke Health’s well-being team has developed resources to help all of us deal with anxiety and related issues. Visit the Well-Being Resources page which will be updated each Wednesday with new ideas on how to better care for ourselves and each other.

Remember the basics: Show gratitude for one another. Use huddles and meetings to share ideas on what’s helping your resilience. Take deep breaths and mindful minutes with your team. When you leave work, take a moment to think about three good things that happened in the day, and mentally transition from work to home. A new checklist is available to help you power down, rest and recharge. Many sites are posting this checklist in their work areas. We also encourage everyone (including those working remotely) to print out a copy for themselves, or share via PowerPoint.

If you have well-being ideas or resources that have helped you, or moments of gratitude and awe that you want to share with your colleagues, contact BeWell@Duke.edu.

Upcoming Opportunities/Save the Date:

AHA Announces COVID-19 Grant Funding; Deadline April 6

The American Heart Association (AHA) invites cardiovascular-focused applications that will contribute to understanding the cardiovascular and cerebrovascular pathogenesis, diagnosis, prevention, clinical manifestations, clinical management (including critical care management) and social behaviors which can lead to dissemination, containment, and complications of COVID-19. Because of the urgency of this issue, innovative, highly impactful short-term proposals (9-12 months), which can show progress within the period of this award, are sought.

Grant amounts will be up to $100,000, including up to 10 percent institutional indirect costs. The AHA anticipates funding at least 10 awards and a nationwide Coordinating Center. To learn more, please visit: https://bit.ly/2RcWJyC

Cardiology Grand Rounds

Upcoming Grand Rounds:

Cancelled through April
May 12: Michelle Kittleson, Cedars Sinai
May 19: Mark Newman, University of Kentucky
May 26: Svati Shah

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.

Duke Heart in the News:

March 27 — Mitchell Krucoff

tctMD/the heart beat

Conversations in Cardiology: Uncovered Struts on OCT After 12 Years?

https://www.tctmd.com/news/conversations-cardiology-uncovered-struts-oct-after-12-years

March 28 — W. Schuyler Jones

MedPage Today

Favorable Results for DOAC After Peripheral Intervention

https://www.medpagetoday.com/meetingcoverage/acc/85663

March 29 — E. Magnus Ohman

tctMD/the heart beat

Anatomic Burden, Ischemia Severity, and Outcomes in ISCHEMIA