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Duke Heart Week Ending March 7th 2021

Highlights of the week:

Heart Highlights: Duke Heart Failure

To continue our celebration of accomplishments made throughout the past year, this week we are pleased to share highlights from the Duke Heart Failure team.

The Duke Heart Failure (HF) team has had a productive year across the clinical, research and educational domains. We wanted to share some important highlights from the overall group as well as the work of specific team members. Like each of the other sections, our team rose to the challenge of caring for our patients during the COVID pandemic. We reached the important milestone of completing 1500 heart transplants since the program’s inception; 104 of those were performed in the past year alone — which is a record for our program. The team also implanted 100 LVADs. Thank you to our LVAD and transplant coordinators, social workers and case managers as well as our world-class surgical team members for all their work this year.

The site-based research team, including Stephanie Newbold, Kim Biever, Lacey Taylor and Gayle Challinor, had an outstanding year of recruitment, retention and high-quality data. With Tracy DeWald as the site PI and Kim Biever as the lead CRC for TRANSFORM-HF, the Duke team is the trial leader for recruitment. The HF research group also leads the country in recruitment for SPIRRIT. The team has enjoyed working with the various site PIs and wanted to highlight Chris Holley’s interesting HAMR trial investigating cell free DNA and additional pathology staining to predict AMR.

Also on the research side, our basic/translational teams (located in the Cardiovascular Research Center) have excelled this year.

  • Sudar Rajagopal’s lab had a productive year including the discovery of a novel paradigm of signaling by GPCRs in a high-impact publication in Science (DOI: 10.1126/science.aay1833).
  • Dennis Abraham was involved with multiple important research efforts and publications this year aimed at investigating pathogenic molecular mechanisms in HFpEF.
  • Chris Holley has had an excellent year leading his basic science lab focused on the role of non-coding RNA (ncRNA) in CV disease, including a fruitful collaboration with Neil Freedman in the atherosclerosis space. Holley has also branched out into translational studies in heart transplantation, including the HAMR study noted above and a project working with Lauren Truby and Svati Shah to study the etiology of primary graft dysfunction.
  • Paul Rosenberg’s research group has continued their focus on a novel calcium-signaling pathway called store operated-calcium entry (SOCE). Notably, work published this year identified how SOCE supports a novel conduction pathway in coronary sinus cardiomyocytes. Elimination of the SOCE pathway in cardiomyocytes predisposes mice to atrial fibrillation (Cell Calcium 2020: 87:102163-9) and (Pflugers Arch. 2021 Feb 27:1-18).
  • Jonathan Stiber’s research continues to focus on the role of the protein Drebrin in smooth muscle phenotype switching and atherosclerosis. He has been instrumental in enhancing the HF presence and clinical care at the Durham VA.
  • Ravi Karra’s research group has made important progress in their research focused on the intersection of regenerative biology with cardiovascular disease. They have recently discovered a myovascular niche that regulates growth and regeneration. In collaboration with the UK Biobank, they have pioneered the application of Mendelian randomization to regenerative biology and have provided the first evidence that regenerative factors can regulate human cardiac growth. Ravi has been instrumental in leading a number of clinical efforts to apply precision medicine to patients with CV disease, such as those with amyloid and sarcoid.

On the clinical research side, a number of faculty have led important clinical trial and outcomes research projects.

  • Adrian Hernandez became the Executive Director of the Duke Clinical Research Institute and led a number of efforts focused on the organization’s strategic vision, innovation and inclusivity. He was on the leadership team for multiple HF trials including the global VICTORIA trial of vericiguat, which recently received FDA labeling.
  • Mike Felker became the leader of the CV Therapeutic Area at DCRI, co-led Transformation Team efforts at DCRI and was on the leadership team for multiple HF trials that reported over the past year including the global GALACTIC-HF trial of omecamtiv mecarbil.
  • Steve Greene and Mike Felker were recently awarded funding from Novartis for an investigator-initiated pilot randomized trial testing whether sacubitril/valsartan can decrease risk of cardiac injury following COVID-19. This exciting trial, named PARACOR-19, aims to kick off in the coming weeks, and will help inform whether entresto may offer cardioprotection for post-COVID patients.
  • Rob Mentz began serving as the HF Section Chief in January where he has worked hard to help improve strategic planning and communication broadly within the group. He has helped lead a number of clinical trials including TRANSFORM, HEART-FID and PARAGLIDE and also became the Editor-in-Chief of the Journal of Cardiac Failure in December.
  • Adam DeVore transitioned into the role of Medical Director of the Cardiac Transplant program with tremendous growth in clinical volumes and research initiatives. He also led multiple large clinical research programs through the DCRI. One notable highlight was serving as PI and completing enrollment for CONNECT-HF, a large-scale, pragmatic, cluster-randomized trial of 161 sites and 5647 patients evaluating heart failure quality improvement initiatives.
  • Richa Agarwal has led a number of clinical and educational efforts that have improved the formal didactic curriculum in HF
    Richa Ajarwal

    and enhanced the trainee experience. She serves as a clinical research mentor for several CV and Advanced HF fellows, and has enjoyed an expanding role with resident education in the Department of Medicine. She is highly supportive of DEI efforts to improve the training environment for all. She will transition into a role as the Advanced HF Fellowship Program Director from Mike Felker on July 1, and looks forward to preserving the Duke tradition of excellence in developing future leaders in HF and Transplant. She is an educational consultant for Abbott, and recently joined the Editorial Board at the Journal of Heart and Lung Transplant. She is site co-PI for the ARIES study in LVAD patients to determine the safety of an antiplatelet-free regimen in the HM3.

In addition to the diverse contributions related to research and clinical activities noted above, the HF faculty have contributed substantially to efforts that have improved patient care throughout the region.

  • Joe Rogers led critical efforts focused on the DUHS COVID-19 response as Duke’s Chief Medical Officer. He has also served as President of the International Society for Heart & Lung Transplantation during this time.
  • Jason Katz has helped lead important efforts for the CICU expansion with enhanced focus on improved patient care and comprehensive educational efforts. He also co-led the important work to improve the clinical care of our LVAD patients.
  • Stu Russell has led remarkable progress to improve collaboration in HF care at Wake Med. This has resulted in 66 patients receiving either LVADs or transplants in the 3 years that he has been at Wake Med. He also co-led quality improvement initiatives to improve the clinical management of our patients with LVADs. He continues to do research with the ARIC and WHI investigators.
  • Chet Patel helped lead efforts that yielded the highest transplant volumes for the program to date with important innovations including use of the Transmedics Organ Care System and Donation after Circulatory Death hearts (Duke became the first U.S. program to transplant a DCD heart in December, 2019). With these advances, in October, the program crossed an important milestone of 1500 heart transplants. Patel is leading a number of initiatives across the Department of Medicine focused on care delivery, quality and practice alignment across divisions and throughout the health system.
  • Mike Blazing is continuing efforts on planning a move to the new clinic space at Arringdon as well as facilitating adaptive strategies to optimize patient interactions with providers with televisits and safety protocols at the clinics. He also continues to meet weekly with the communications center to address scheduling, triage and message handling issues.
  • Michel Khouri has helped lead cardio-oncology efforts to improve cardiovascular risk stratification of cancer patients and enhance the referral and management processes for clinicians. He has helped establish Duke as a regional leader in cardiac amyloidosis care and research.
  • Kishan Parikh has led efforts at Duke Raleigh focused on pulmonary hypertension and heart failure care. More broadly across Duke University Health System, he has led efforts to create an unexplained dyspnea program. He has also helped lead research efforts focused on EHR-based identification of patients with HFpEF, TR, and pulmonary hypertension.

Our nurse leaders in the outpatient clinics have really elevated to the challenges of this year with Karol Harshaw-Ellis and Midge Bowers increasing clinical volumes while leading important patient-centered efforts on HF care outside of the traditional healthcare settings and leading educational efforts locally and on the national stage. Carolyn Lekavich has been busy on the clinical side while also launching a productive research career focused on deep-phenotyping in HFpEF.

Marat Fudim joined the faculty in July and has launched a number of new initiatives. The heart failure group started a new heart failure remote monitoring clinic and as part of Marat’s efforts in the cath lab, we have expanded the hemodynamic investigation of patients with suspected or confirmed heart failure. Marat aims to expand site-based research in the heart failure and cath cluster with a focus on early phase device and diagnostic modalities. In an acknowledgement of his achievements to date he will receive the 2021 Zipes Award from the ACC at this year’s Scientific Sessions.

Steve Greene became a faculty member in July and has joined the Same-Day Access Clinic leadership team where he has helped lead efforts involving a data-driven approach to improved medication titration for guideline-directed medical therapies.  He has also worked to increase utilization of the Same-Day Access clinic by engaging multiple groups within Duke Health, including the hospitalist services and the emergency departments at Duke University and Duke Regional hospitals.

Our nurse clinicians Jennifer Lewis and Martha Anders have gone above and beyond with extraordinary care during the challenges of this past year. Their superb clinical care, attention to detail and stellar communication skills have helped countless patients and remain pivotal to our program’s success. We also welcomed Leilani Gomez to the team who has quickly gotten up to speed to help enhance outpatient HF care. Many other nurse clinician and PA leaders have helped effectively provide exceptional patient care this year including Mike Strub and Kathryn Hord. Kudos to the 2F/2G nursing team as well as the nurse leaders at South Durham and Duke Raleigh.

Notably, Doug Schocken recently retired from Duke with a tremendous legacy of clinical care, education and research. Author or co-author of more than 200 papers, abstracts, books chapters and two books, he is usually quite modest about his contributions. He has been a mentor to trainees and faculty nationwide. When queried about his favorite professional accomplishments, Doug cited his role as Chair of the first AHA Scientific Statement on Prevention of Heart Failure (2008), his service to AHA at many levels of leadership, his term as President of DUCCS (1997-1999), his Presidency of the American Society of Preventive Cardiology (2006-2008), creating the Cardio-Oncology Clinic at Moffitt Cancer Center (1995), and presenting and moderating many sessions at HFSA annual meetings since the inaugural event in Baltimore (1994). In addition to these important achievements, he received the AHA National Scientist/Volunteer of the year in 2002 and the AHA Science Advocate of the year in 2007. He may be ‘retired’ but will continue with activities involving the section and division.

Our APP teammates have been critical to the clinical care, research and educational work this year. Stephanie Barnes has taken on the role as the Clinical Director for Advanced HF Services. She is working closely with the HF team to help led efforts focused on improving the quality of care for our HF patients and focusing on programmatic development for the VAD program. Barnes also served on a committee for AAHFN. Notably, the Cardiology APPs are currently partnering with CEPD to revise the HF educational offerings. Sara Black and Rio Landa have been teaching HF classes for nursing staff. Black revised the HF orientation pathways and education documents for inpatient Cardiology APPs, highlighting important advances in the field and reflecting current research and best practices.

Many inpatient cardiology APPs published HF specific papers or presented HF topics at local or national meetings including Stephanie Barnes, Jaime McDermott, Callie Tennyson, Todd McVeigh and others. In fact, “Sodium–Glucose Cotransporter-2 Inhibitors for Heart Failure: The New Kid on the Block,” by McDermott, Tennyson and Elizabeth Bell-McClure, was just published this weekend in the Journal for Nurse Practitioners. Also on the nursing leadership side, Bradi Granger has helped lead mentorship for nurse trainees performing research and has collaborated with the team on QI efforts.

Mara Watson with the pharmacy team has been working with James Henderson (cardiology pharmacist), Alexis Nanni (PGY1 Pharmacy Transplant Resident), and Adam DeVore on a research project, “Effect of Time-to-Therapeutic (TTT) Tacrolimus Range on Early Rejection and Renal Dysfunction after Heart Transplant.” Cody Carson has been getting involved with more research and QI projects with the HF group. Most notable thus far, she has been assisting with the creation of the Epic Heart Failure Dashboard and providing pharmacy insight for the ongoing QI project aimed at improving HF GDMT prescribing for patients admitted to non-cardiology Services. She is also coordinating the annual Cardiology Pearls Noon Conference CE presentation to educate non-cardiology pharmacists and pharmacy learners on updates in cardiology pharmacotherapy. Kristen Fischer (PGY2 Cardiology Pharmacy Resident) is currently completing a study evaluating warfarin requirements post-discharge in newly implanted LVAD patients, which James Henderson and Cody Carson are precepting.

Finally, we have to thank our three incredible advanced HF fellows this year: Rahul Loungani, Amanda Coniglio and Hirak Shah. They have been exceptional partners. It seems inappropriate to group them all together with a description, but they each have such tremendous knowledge and clinical acumen. They are top notch team players and it has been a true pleasure to work with them. Rahul will join the Piedmont HF team, Hirak will join the University of Kansas, and Amanda will complete her last year of clinical and research training (having been involved with her HF year early). Thank you for your hard work thus far (and through the end of June).

In closing, we thank the entire HF Section for their efforts across the different domains of clinical care, education and research over the past year. Outstanding work!


Kisslo Dissection Course Held

During February, the annual two-part Kisslo cardiac dissection course was held. Joe Kisslo and several sonographers, including Danny Rivera and Alicia Armour, have taught this course 1-2 times per year for more than 20 years! The sessions are attended by cardiac anesthesia, pediatric cardiology, veterinary cardiology (from NC State), occasional UNC cardiology fellows as well as our cardiology fellows and biomedical engineering students. Dr. Kisslo also teaches this course at other institutions in the U.S. and internationally.

In Dr. Kisslo’s words, “These are not just four valves and four chambers, but are in-depth explorations of anatomy and function… and application of these findings to cardiac surgical procedures. Nothing like holding a heart in your hands! Most of all, they are tons of fun.”

Shown here are four of our cardiology fellow attendees, Matt Carlisle, Cara Hoke, Dan Loriaux, and Sarah Snow. On behalf of our cardiology fellows, Dan writes:

“Although it will be impossible to fit an adequate thank you into a single paragraph, we all wanted to take a moment to highlight the tremendous effort that went into making this year’s dissection possible. From Dr. Kisslo’s leadership, Danny’s dissection skills, and all of the preceptors who volunteered their weekends to teach us through Zoom-linked and socially-distanced classrooms, the preparation and planning that went into orchestrating this course in the midst of COVID was truly exceptional. We honestly cannot thank Dr. Kisslo and the full dissection team enough! It was an incredible course. THANK YOU from everyone who was fortunate enough to attend the heart dissection course this year!”

Great work, everyone!


Kudos to Valencia and the Landa’s!

Duke Raleigh offered their first “Pop-Up” Covid-19 vaccine clinic last weekend for the Latinx population in Raleigh. The Duke Raleigh outreach team was in need of Spanish-speaking providers to assist with vaccinations. Diane Sauro put out the SOS to the team and Kelly Valencia from Cardiology and Rio Landa, team lead in Cardiology (as well as Israel Landa, MD, at Duke Regional) answered the call. Although Rio ultimately was unable to join in helping, Kelly and Israel were both able to go on behalf of our team. Both reported enjoying their time helping the community. Big kudos to them as this was 100 percent volunteer driven.

Well done, team!


AHA Triangle Heart Ball, March 19

The American Heart Association’s Triangle Heart Ball will take place virtually on Friday, March 19 at 7:30 p.m. The annual fundraiser features a silent auction and the AHA “Open Your Heart Appeal.” Tickets are free, but registration (secured with a credit card) is required so that you can bid on auction items and/or make an open donation. The silent auction opens Tuesday, March 16 at 8 a.m. and closes Friday, March 19 at 9 p.m.

The Triangle AHA team is providing a curated party box to the first 200 guests who register no later than Wed., March 10. The party box will be delivered to your home. To register, please visit: https://event.gives/triangleheartball and make sure to list Duke Heart as your company. This event is sponsored locally by Duke Heart, UNC Health and LeithCars.com.


Annual Security Awareness Training

Last year, Duke’s Information Technology Security Office developed Annual Security Awareness training, which can be found in the Duke Learning Management System (LMS). It is mandatory for all Duke Health staff and will be required on a yearly basis. The training takes 10 minutes and easily digestible, and helps Duke meet a lot of requirements for our contractual obligations and regulatory compliance. Please encourage your teams to go into the LMS and complete this training as soon as possible. Monthly reminder emails are being sent to staff who have not yet completed the training. Thank you!


Reminder: Best Hospitals Survey Now Open

The U.S. News & World Report Best Hospitals annual survey is open in Doximity. Voting is a great way to celebrate how Duke is leading the way in patient care, education and research, so be sure to log into Doximity by March 26th and VOTE!

Results from the reputation survey are an important component of the scoring U.S. News & World Report uses to rank the nation’s top hospitals, along with all of the work we do to provide the best care for our patients. We hope all survey-eligible team members will consider showing your pride in Duke Heart and voting for all three of Duke’s hospitals as part of your “top 5” for “Best Hospitals for Cardiology and Heart Surgery.”

How to Vote: Voting is open through March 26, 2021. To vote, physicians can visit Doximity.com or the survey page on Doximity.com. The survey will display until the physician votes or the survey closes.

COVID-19 Updates:

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


Upcoming Opportunities/Save the Date:

Cardiology Grand Rounds

Mar.9: Epidemiological Research in Cardio-Oncology – Focus on Atherosclerosis with Avirup Guha of Case Western Reserve University School of Medicine. 7:15 a.m., Webex.

Mar. 16: Advanced Cancer is also Heart Failure Syndrome:  Cardio-Oncology Including and Beyond Cardiotoxicity with Stefan Anker, Professor of (Tissue) Homeostasis in Cardiology & Metabolism at Charite Berlin. 7:15 a.m., Webex.

Mar. 23: If You Build It… (They) Will Come – Advanced Therapies in ACHD with Jonathan Menachem of Vanderbilt University Medical Center. 5 p.m., Webex.

March 30: TBD

April 6: Management of POTS with Camille Frazier-Mills. 5 p.m., Webex.

April 13: Advancing Gender Equity in Global Cardiovascular Health Outcomes with Zainab Samad of Aga Khan University. 7:15 a.m., Webex.

April 20: TBD

April 27: Cardio-Oncology: Moving Forward in 2021 with Daniel J. Lenihan, Director, Cardio-Oncology Center of Excellence, Washington University in St. Louis. 5 p.m., Webex.


Six-Part Mental Health Webinar Series Available Through April

Mar. 17: Understanding Adolescent Alcohol and Substance Use. 4-4:30 p.m. Hosted by the Department of Psychiatry & Behavioral Sciences and led by associate professor David Goldston, PhD. (Link below)

This is the third in a six-part webinar series, “Taking Care of Yourself and Your Loved Ones,” for all Duke University and Duke Health community members and their families. The 30-minute topical webinars provide practical expert advice on topics including emotional wellness, substance misuse, suicide prevention, and mental health for children, adolescents and teens.

The webinar series runs through April 27. Learn more, watch past webinars and join upcoming webinars:  http://bit.ly/DukeMHSeries.


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 1 — Robert Lefkowitz

The Times of Israel

How a Nobel-winning ‘accidental scientist’ changed the world by saving himself




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