Duke Heart Updates – May 30th 2021
Chief’s message: Memorial Day Weekend
It’s a traditional start to the summer, Memorial Day weekend with the Indianapolis 500 and many end of the academic year festivities coming up including graduating medical school students, residents going to fellowships or jobs, and fellows finishing to start their careers as cardiologists. Some of the weekend is also spent remembering the tremendous sacrifices of the women and men in the armed services that allow us the freedoms that we have today. This Memorial Day, we reflect on their sacrifice and the debt we owe our fallen service members and their families.
It would also be hard not to remember our ongoing battle with the COVID-19 pandemic where one year ago today we were trying to keep the COVID related deaths under 100,000 and thinking of ways in which we could continue to safely care for our patients and each other. One year has made a tremendous difference, and we are blessed to have kept our fellows, faculty, and staff healthy with continued focus on serving our local community and the broader missions of academic discovery and training. So, as our health system, faculty, and school are working to determine an aligned way forward in which we can better meet the needs of our community, our clinical and academic missions, I am encouraged by the resiliency and teamwork of all of you at Duke Heart. Together we are stronger and the mission to improve Heart Health remains our true north. You will see in the updates this week that we have kept pushing to develop new ways to educate, innovate, and care for our patients.
Highlights of the week:
Cardiac Ultrasound Certificate Program Receives CAAHEP Accreditation
Congratulations to our Duke Cardiac Ultrasound Certificate Program team led by Richie Palma and Anita Kelsey! They have been granted initial accreditation by the Board of Directors of the Commission on Accreditation of Allied Health Education Programs (CAAHEP). The CAAHEP Board acted upon the accreditation recommendation of the Joint Review Committee on Education in Cardiovascular Technology (JRC-CVT). The decision was made during the CAAHEP board meeting held May 21.
Through the accreditation process, which includes a thorough review of the program, curriculum, resources, faculty and staff, as well as a site visit, the Duke program was determined to be in substantial compliance with the nationally-approved Standards and Guidelines for educational programs. The CAAHEP Standards by which the program was measured has been developed primarily by Cardiovascular Technology professionals, are approved by each profession’s sponsoring organizations, and are intended to reflect required knowledge and skills that a person needs to be able to successfully function within the Cardiovascular Technology profession. CAAHEP Standards focus on quality outcomes, assuring that educational programs are preparing competent Cardiovascular Technology professionals.
CAAHEP accredits more than 2,200 educational programs that prepare health professionals in 32 different disciplines. Accreditation is a critical step in a process that is meant to protect the public and ensure a supply of qualified health care professionals. For more information about CAAHEP and accreditation, visit www.caahep.org.
The Duke Cardiac Ultrasound Certificate Program will graduate its first class in August. The team will be adding a six-month pediatric training program this fall.
Cath Team Performs Duke’s 1st Coronary Angiogram Using Transmedics System
Congratulations to Jennifer Rymer, Angela Lowenstern, Robyn Strong, Meghan Ronn, Michaela Fahn and Shawna Walker (not pictured) – the team completed Duke’s first coronary angiogram using the Transmedics Organ Care System (OCS) to assess the coronary arteries of a donor heart in the catheterization lab.
“We now have one of the largest experiences with the Transmedics OCS in the world, but have not – until this week—had to assess the coronary arteries of the donor heart once it was on the device,” said Chet Patel. “We had discussed the need for doing this on a few occasions in the past, but this was the first time we had to complete one.”
Very few such procedures have been done worldwide among medical centers currently using the Transmedics OCS, according to Patel. Congratulations, team!
Chen Named to JTCVS Editorial Board; Klapper, Andersen Earn Ed Board Awards
Congratulations to Edward P. Chen, chief of the division of Cardiovascular and Thoracic Surgery – he has been named to the editorial board of the Journal of Thoracic and Cardiovascular Surgery (JTCVS). He joins a number of Duke colleagues there, including Tom D’Amico, Nick Andersen, Don Glower, Matt Hartwig, Jacob Klapper, Jerrold Levy, Andrew Lodge, Betty Tong and Joe Turek.
“For me, this is a tremendous honor. JTCVS is arguably the leading CT surgery journal in North America and to be asked to serve in this capacity is a tremendous privilege,” said Chen. “Getting a manuscript accepted into this journal has always been recognized as very difficult and I hope to continue to uphold these high publication standards as a member of the Editorial Board. I am extremely pleased that we have such robust representation of our Duke CT faculty on this Board which is reflective of the emphasis we put on discovery and academic pursuits in our Division.”
Congratulations also to Jacob Klapper and Nick Andersen who were both recognized by the JTCVS with 2021 Editorial Board Awards – which are based on overall average ratings as a reviewer. The average is calculated from the number of papers that reviewers accept for review, the percentage of those completed on time, and the number of reviews that score higher than 70%. “I find reviewing the papers a vital part of continuing to read and assess the medical literature critically as well an opportunity to gain new and valuable insights into my field,” said Klapper.
Excellent work!
Bishawi, Randles Honored with Novim AJN Award
Muath Bishawi, a cardiothoracic surgery resident in our Integrated Thoracic Surgery Residency Program, and Amanda Randles, the Alfred Winborne and Victoria Stover Mordecai Assistant Professor of Biomedical Sciences at Duke, have been honored by Novim with an Alexandra Jane Noble Award. AJN awards are given for innovations contributing to world health, social impact, increasing awareness and new discovery. The awards, now in their fourth year, honor efforts to communicate complex topics in innovative, engaging ways to stimulate higher awareness of scientific issues, particularly in young adults.
Bishawi and Randles were given the 2021 Science Inspiration Award; the colleagues made fundamental contributions to engineering with their split ventilator prototype. With ventilators in high demand during the COVID-19 pandemic, Dr. Randles and Dr. Bishawi created a ventilator splitter and resistor system (VSRS) which enables one ventilator to support two or more patients. A full article about their ventilator system can be found here. Don’t miss this Microsoft Inspire video about the computational models used in development: https://www.youtube.com/watch?v=B55viclEWLc&t=640s
A full listing of all 2021 Novim awardees can be found here. The awards, announced earlier this year, were presented on Wednesday, May 26.
Congratulations, Muath! We are so proud of you!
UPDATE: Risk Capture & HCC Coding: CV Disease
Clinical providers, please review this updated PowerPoint we have sent from Drs. Momen Wahidi and Dev Sangvai on the importance of Risk Adjustment Factor (RAF) documentation. Please take time to review slides 12-18 that highlight documentation tips with patients for the following cardiovascular related conditions: Specified Heart Arrhythmias, Vascular Disease, Angina Pectoris, and Opportunities in Cardiovascular Disease. For additional information, please contact: Momen Wahidi. Thank you!
All Three Duke Hospitals among Top Performing for Treatment of MI
Congratulations to our teams at Duke Raleigh Hospital, Duke University Hospital and Duke Regional Hospital – all three hospitals are recipients of the American College of Cardiology’s NCDR Chest Pain ̶ MI Registry Platinum Performance Achievement Award for 2021. Only 212 hospitals nationwide have received the honor.
To receive the Chest Pain ̶ MI Registry Platinum Performance Achievement Award, hospitals must demonstrate sustained achievement in the Chest Pain ̶ MI Registry for two consecutive years (2019 and 2020), and perform at the highest level for specific performance measures. Full participation in the registry engages hospitals in a robust quality improvement process using data to drive improvements in adherence to guideline recommendations and overall quality of care provided to heart attack patients.
This award is evidence of the hard work and commitment it takes to deliver the highest quality in cardiovascular care to transform heart health. Congratulations to all involved in our Chest Pain – MI Registry!
AACN NTI Poster Presentation
Congratulations to members of the Duke Cardiac Catheterization Lab! They had a poster presentation at the American Association of Critical Care Nurses 2021 National Teaching Institute & Critical Care Exposition. Their poster, Improving Adoption of Evidenced-Based Chlorohexidine Skin Prep Prior to Cardiac Catheterization, authored by Robyn Strong and Cassidy Johnson, demonstrated results of how the cath lab team worked together to improve scrub time, scrub technique and prep dry time to >95% compliance. Great job, everyone!
High Five: Clinic 2F/2G
Our 2F/2G Duke South Clinic team was nominated for a “high five” recently by Carolyn Lekavich. In her nomination, she wrote, “I want to recognize the exceptional team that we have at 2F/2G. I can’t say enough about the exceptional care, compassion, and humanistic style that the entire team provides, every day, for our patients and each other!”
Nicely done, team!
COVID-19 Updates:
All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:
Upcoming Opportunities/Save the Date:
Virtual PMWC: Precision Medicine in the Era of a Pandemic Recovery
June 14-18 – Precision World Medicine Conference. Registration is free and open to all. https://www.pmwcintl.com/covid/
Duke University Chancellor Emeritus Dr. Ralph Snyderman will lead a panel discussion on Personalized, Proactive Value-Based Care: Emerging New Models.
The confluence of the growth of chronic diseases, the impact of COVID, the emergence of new technologies, and the impact of value-based reimbursement are driving major innovations and changes in care delivery. Proactive, personalized, precision, population-based and digitally supported care is emerging and heralding new approaches to health care. This session will capture the elements of these changes and the dynamics of the forces that are driving them. Perspective from care innovators, large providers and payers will be discussed by the following key opinion leaders:
- Patrick Conway, CEO of Care Solutions, Optum
- Jaewon Ryu, President and Chief Executive Officer, Geisinger
- Rodney Hochman, President & CEO, Providence St. Joseph Health
- Marc Harrison, President and CEO, Intermountain Healthcare
HCPLive State of the Science Summit
June 23: — Institutional Perspectives in Cardiology: Cardiovascular Risk Management webinar with Manesh Patel, Schuyler Jones, Tracy Wang and Christopher Granger. 7 to 8:30 p.m. EST. Virtual. Registration is free. They’ll cover:
- CAD/PAD: Identifying Risk & Summary of Recent Clinical Trials
- Extended Thromboprophylaxis: What Do We Know About Scoring, Risk and Contemporary Trials?
- Atrial Fibrillation: What Have We Learned About NOACs in Special Populations?
- Putting This All Together: Treatment Pyramid
To learn more, please visit: HCPLive Institutional Perspectives in Cardiology.
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:
May 18 — Harry Severance, Jr.
ACEPNow.com
Unintended Consequences of Vaccine “Passports”
https://bit.ly/34j3fds
May 21 — Harry Severance, Jr.
CNBC/Travel
Unvaccinated Americans are less worried about traveling than vaccinated Americans are, study says
https://cnb.cx/3ugD95v
May 21 — Sunil Rao
tctMD
Transradial PCI Bests Femoral Access in Complex Cases: COLOR
https://bit.ly/3hXAJ98
May 24 — Manesh Patel
NBCNews.com
CDC looking into possible link between heart problem and Covid vaccines in young people
https://nbcnews.to/3voTsi7
May 25 — W. Schuyler Jones
WebMD
‘Baby’ Aspirin As Effective As High-Dose for Heart
https://wb.md/3fNmcdB
Division of Cardiology Publications Indexed in PubMed May 20-26, 2021
Aktaş MK, Younis A, Zareba W, Kutyifa V, Klein H, Daubert JP, Estes M, McNitt S, Polonsky B, Goldenberg I. Survival After Implantable Cardioverter-Defibrillator Shocks. J Am Coll Cardiol 2021;77(20):2453-2462. PM: 34016257.
Barnett AS, Kiefer T, Kim HW, Mitchell M, Jackson KP, Piccini JP, Koontz JI, Sun AY. Ablation of Ventricular Tachycardia Storm With Coronary Venous Ethanol. JACC Clin Electrophysiol 2021;7(5):682-683. PM: 34016399.
Chiamvimonvat N, Frazier-Mills C, Shen ST, Avari Silva JN, Wan EY. Sex and Race Disparities in Presumed Sudden Cardiac Death: One Size Does Not Fit All. Circ Arrhythm Electrophysiol 2021;14(5):e010053. PM: 33993706.
Chouairi F, Pacor J, Miller PE, Fuery MA, Caraballo C, Sen S, Leifer ES, Felker GM, Fiuzat M, O’Connor CM, Januzzi JL, Friedman DJ, Desai NR, Ahmad T, Freeman JV. Effects of Atrial Fibrillation on Heart Failure Outcomes and NT-proBNP Levels in the GUIDE-IT Trial. Mayo Clin Proc Innov Qual Outcomes 2021;5(2):447-455. PM: 33997640.
Chrispin J, Frazier-Mills C, Sogade F, Wan EY, Clair WK. Pandemic Highlights Disparities in Health Care. Circ Arrhythm Electrophysiol 2021;14(5):e009908. PM: 33993701.
Forrest CB, Xu H, Thomas LE, Webb LE, Cohen LW, Carey TS, Chuang CH, Daraiseh NM, Kaushal R, McClay JC, Modave F, Nauman E, Todd JV, Wallia A, Bruno C, Hernandez AF, O’Brien EC. Impact of the Early Phase of the COVID-19 Pandemic on US Healthcare Workers: Results from the HERO Registry. J Gen Intern Med 2021;36(5):1319-1326. PM: 33694071.
Gargiulo G, Cannon CP, Gibson CM, Lopes RD, Vranckx P, Valgimigli M. The multiplication of loaves and fishes approach: a critic to double anti-thrombotics or to double number of ischaemic events? Eur Heart J Cardiovasc Pharmacother 2021;7(3):e29-e30. PM: 33340322.
Huang HI, Jewell ML, Youssef N, Huang MN, Hauser ER, Fee BE, Rudemiller NP, Privratsky JR, Zhang JJ, Reyes EY, Wang D, Taylor GA, Gunn MD, Ko DC, Cook DN, Chandramohan V, Crowley SD, Hammer GE. Th17 Immunity in the Colon Is Controlled by Two Novel Subsets of Colon-Specific Mononuclear Phagocytes. Front Immunol 2021;12:661290. PM: 33995384.
Lopes RD, Alexander KP, Hochman JS, Maron DJ. Response by Lopes et al to Letter Regarding Article, “Initial Invasive Versus Conservative Management of Stable Ischemic Heart Disease Patients With a History of Heart Failure or Left Ventricular Dysfunction: Insights From the ISCHEMIA Trial”. Circulation 2021;143(20):e961-e962. PM: 33999666.
Mentz RJ, Ambrosy AP, Ezekowitz JA, Lewis GD, Butler J, Wong YW, De Pasquale CG, Troughton RW, O’Meara E, Rockhold FW, Garg J, Samsky MD, Leloudis D, Dugan M, Mundy LM, Hernandez AF. Randomized Placebo-Controlled Trial of Ferric Carboxymaltose in Heart Failure With Iron Deficiency: Rationale and Design. Circ Heart Fail 2021;14(5):e008100. PM: 34003690.
Nelson AJ, Pagidipati NJ, Granger CB. The SAMSON trial: using a placebo to improve medication tolerability. Eur Heart J Cardiovasc Pharmacother 2021;7(3):e13. PM: 33638980.
Ohman EM, Zwischenberger BA, Thiele H. Left Ventricular Support for the Management of Cardiogenic Shock: Sooner May Be Better. JACC Cardiovasc Interv 2021;14(10):1120-1122. PM: 34016409.
Patel PA, Green CL, Lokhnygina Y, Christensen J, Milano CA, Rogers JG, Patel CB, Koweek LM, Daubert MA. Cardiac computed tomography improves the identification of cardiomechanical complications among patients with suspected left ventricular assist device malfunction. J Cardiovasc Comput Tomogr 2021;15(3):260-267. PM: 32891544.
Tai A, Ambrosy AP, Fudim M. Making the case for sacubitril/valsartan in patients with heart failure with a preserved ejection fraction. Eur Heart J Cardiovasc Pharmacother 2021;7(3):e5-e6. PM: 33537712.
Teerlink JR, Felker GM, McMurray JJV. Omecamtiv Mecarbil in Systolic Heart Failure. Reply. N Engl J Med 2021;384(20):1967-1968. PM: 34010541.
Wang L, Balmat TJ, Antonia AL, Constantine FJ, Henao R, Burke TW, Ingham A, McClain MT, Tsalik EL, Ko ER, Ginsburg GS, DeLong MR, Shen X, Woods CW, Hauser ER, Ko DC. An atlas connecting shared genetic architecture of human diseases and molecular phenotypes provides insight into COVID-19 susceptibility. Genome Med 2021;13(1):83. PM: 34001247.
Yoneshiro T, Kataoka N, Walejko JM, Ikeda K, Brown Z, Yoneshiro M, Crown SB, Osawa T, Sakai J, McGarrah RW, White PJ, Nakamura K, Kajimura S. Metabolic flexibility via mitochondrial BCAA carrier SLC25A44 is required for optimal fever. Elife 2021;10:10.7554/eLife.66865. PM: 33944778.
Younis A, Goldberger JJ, Kutyifa V, Zareba W, Polonsky B, Klein H, Aktas MK, Huang D, Daubert J, Estes M, Cannom D, McNitt S, Stein K, Goldenberg I. Predicted benefit of an implantable cardioverter-defibrillator: the MADIT-ICD benefit score. Eur Heart J 2021;42(17):1676-1684. PM: 33417692.
Duke Heart Week ending May 23rd 2021
Highlights of the week:
Duke Highlights, ACC 2021 – part 2!
We closed out ACC.21 earlier this week with lots of great presentations, including:
Melissa Daubert had a poster presentation: Impact of Postpartum BP Screening on Clinical Outcomes in Women with Hypertensive Disorders of Pregnancy
Key findings:
- Early postpartum BP screening was performed in a minority of women with HDP, but was associated with greater detection of CV risk factors and CV disease.
- Over 1/3 of women with HDP developed ≥ 1 new CV risk factor within 5 years of delivery.
- Further study is needed to optimize preventive Figure 2 CV care in high-risk women with HDP.
Adam DeVore presented Effect of a Hospital and Post-discharge Quality Improvement Intervention on Clinical Outcomes and 
Quality of Care for Patients With Heart Failure With Reduced Ejection Fraction on behalf of the CONNECT-HF investigators and committees. Their conclusion: “In this cluster-randomized trial of hospitals treating patients after a hospitalization for HFrEF, a hospital and post-discharge quality improvement intervention that focused on clinician education and audit and feedback of HF quality of care did not meaningfully improve HF outcomes or care above current quality improvement efforts.”
Clinical implications:
- Major gaps in guideline-directed care remain
- Low rates of ACEI/ARB/ARNI, evidence-based beta-blocker, and MRA
- New approaches are needed to improve care above current quality improvement efforts for patients with HFrEF
- HF rehospitalization or death: 39% over 12 months of follow-up
- Fragmented nature of HF care in the US apparent during the study
Renato Lopes presented The Coalition ACTION Trial, a Randomized Clinical Trial To Evaluate a Routine Full Anticoagulation Strategy In Patients With Coronavirus Infection (SARS-CoV-2) Admitted To Hospital. The presentation received a good amount of news coverage (see below). Lopes and colleagues conducted the ACTION trial to determine whether a therapeutic anticoagulation strategy based on rivaroxaban improved outcomes in patients with elevated D-dimer levels hospitalized with COVID-19 compared with a prophylactic anticoagulation strategy.
Neha Pagidipati presented Caring for Women With Familial Hypercholesterolemia Through Pregnancy during the Applying the
Guidelines for Lipid Management in Special Populations session.
Key findings:
- As screening for FH increases, clinicians will increasingly encounter women with FH who become pregnant
- Lipids normally increase in pregnancy; in FH, the absolute increase is greater
- Pregnancy is not associated with risks to mothers with FH, however may be associated with risks to fetus
- Statins are NOT recommended during pregnancy
- Need more studies on what the risks actually are
- Colsevelam is approved during pregnancy, but use is limited by side-effects
- This area is woefully understudied — need more data to drive evidence-based practice for both mothers and their children
J.D. Serfas, a fellow in our Adult Congenital Heart Disease Program, served on the ACC.21 planning committee for the Adult Congenital and Pediatric Cardiology section and primarily designed the section, “Controversies in Interventional and Surgical Management of Congenital Heart Disease.”
Serfas was involved in the planning of several Fellows-in-Training sessions, and helped facilitate the FIT Mix-and-Mingle and Fellows-in-Training Networking Events. He also co-designed and co-moderated the session Art with Heart: Tales of Creativity in Cardiology, a podcast-style session that included conversations with Doug Zipes, Suzie Brown Sacks, Nazanin Moghbeli, and Kedar Sankholkar, all of whom have integrated careers in the arts or entertainment with active cardiology careers.
Serfas presented the case of a patient with d-transposition of the great arteries after atrial switch repair with advanced heart failure requiring LVAD support in the session “Challenges of Transplantation in Congenital Heart Disease Patients: Ethics, Listing Strategy & MCS.”
Additionally, he had a poster presentation: Racial and Ethnic Disparities in Location of Death Among Adult Congenital Heart Disease Patients.
Key findings:
- Minority patients with ACHD are less likely to die at home or with hospice and more likely to die in a hospitalized setting than non-Hispanic White patients, and that structured programs to address these racial disparities in end-of-life care in ACHD are needed.
Olivia Dong, a post-doctoral research fellow working with Deepak Voora, earned first place in the ACC.21 Young Investigator Competition in Outcomes Research. She presented, One-year cost-effectiveness of CYP2C19-guided P2Y12 inhibitors de-escalation and escalation in Veterans undergoing percutaneous coronary intervention.
Key takeaway:
- In Veterans with acute coronary syndromes who have undergone percutaneous coronary intervention, CYP2C19-guided P2Y12 inhibitor selection can improve cardiovascular outcomes and lower costs for the Veterans Health Administration within 12 months of implementation.
“I’m very grateful I had the opportunity to share this research at the ACC.21 conference,” said Dong. “This achievement would not have been possible without the unwavering support from my primary mentor, Dr. Deepak Voora, and my amazing research collaborators– Dr. Kevin Friede (Duke Cardiology Fellow), and Dr. Catherine Chanfreau-Coffinier (Veterans Affairs PHASER Data Core Director).”
Dong is currently completing a post-doctoral T32 NHGRI fellowship in genomic medicine research through the Duke Center for Applied Genomics and Precision Medicine and the Durham VA Health Care System. She will graduate in June. Well done, Olivia – congratulations!
Congratulations to all faculty and fellows who participated in ACC.21 this year – you’re doing remarkable work!
Shout-out to Respiratory Care Services
We were delighted and not at all surprised to learn of the generosity of our Respiratory Care Services team, led by Charlotte Reikofski, in helping support Duke Health by preparing supplies for India. The team gathered resuscitators, oxygen masks, filters and more for shipment to New Delhi – an effort spearheaded by anesthesiologist Madhav Swaminathan, clinical director of CT Anesthesia and Critical Care Medicine.
To read more about the effort, please visit: Duke Health Sends Supplies to India to Assist with Covid-19 Crisis.
Way to go, Respiratory Care team!!!
Moments to Movement – May 25th
Recently, Chancellor Washington shared an update with all Duke Health staff regarding the upcoming anniversary of our Moments to Movement initiative. Locations across Duke Health are planning time for all to stand together in observance of this important day and reflect upon our progress and prepare us for the work to come. Here are a few ways you can participate in the Stand for Peace this week.
Across Duke Health, many of us will take a one-day pause from non-essential meetings to allow our faculty and staff extra space and time to have conversation or to participate in one of the planned observances.
Stand for Peace: 7 a.m. – 9 a.m. and 2 p.m. – 4 p.m.; Duke Medicine Circle (grassy area in front of Duke South Clinics). This event is for all Duke Health faculty, staff and students working on campus; Create individual signs for display; sign the Duke Health Anti-racism Pledge
M2M Virtual Tea for the Soul: 7 a.m., 10 a.m., and 2 p.m., via Zoom. Guided reflection, relaxation for all Duke Health faculty, staff and students; each session will last 15 minutes. Participants are encouraged to bring their own tea. Click here to join. Hosted by Chaplain Services.
Revisiting Black Man in a White Coat: 3:00 p.m. – 3:45 p.m.; Register or read more here. All are invited to join Chancellor A. Eugene Washington and Associate Professor Damon Tweedy for a special conversation as they revisit Black Man In A White Coat — Tweedy’s 2015 bestselling book examining the difficult and often contradictory terrain of race and medicine.
Collective Breath for Justice: 4 p.m. – 4:45 p.m.; via Zoom. The Duke School of Medicine Office of Diversity & Inclusion will lead a virtual event to reflect, connect and share in a collective breath for justice. It will include a nine minute and 29 second silent vigil. Join here.
Senior leadership for Duke University Hospital and DUHS are committed to supporting everyone who wants to participate in one of these events. They ask that you please coordinate with your manager so that as many team members as possible are able to join in these activities while maintaining patient safety.
Thank you for everything you do every day to care for our communities. We are proud of each of you for your commitment to eliminating health disparities and standing against racial inequality and injustice.
COVID-19 Updates:
All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:
Upcoming Opportunities/Save the Date:
Virtual PMWC: Precision Medicine in the Era of a Pandemic Recovery
June 14-18 – Precision World Medicine Conference. Registration is free and open to all. https://www.pmwcintl.com/covid/
Duke University Chancellor Emeritus Dr. Ralph Snyderman will lead a panel discussion on Personalized, Proactive Value-Based Care: Emerging New Models.
The confluence of the growth of chronic diseases, the impact of COVID, the emergence of new technologies, and the impact of value-based reimbursement are driving major innovations and changes in care delivery. Proactive, personalized, precision, population-based and digitally supported care is emerging and heralding new approaches to health care. This session will capture the elements of these changes and the dynamics of the forces that are driving them. Perspective from care innovators, large providers and payers will be discussed by the following key opinion leaders:
- Patrick Conway, CEO of Care Solutions, Optum
- Jaewon Ryu, President and Chief Executive Officer, Geisinger
- Rodney Hochman, President & CEO, Providence St. Joseph Health
- Marc Harrison, President and CEO, Intermountain Healthcare
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:
May 15 — W. Schuyler Jones
Associated Press
Heart study: Low- and regular-dose aspirin safe, effective
https://bit.ly/3bARUtt
*story carried by 425 news outlets
May 15 — W. Schuyler Jones
Medpage Today
Baby Aspirin on Par With Full Dose to Prevent Repeat Heart Events
https://bit.ly/3wgN2BE
May 15 — W. Schuyler Jones
tctMD
High- and Low-Dose Aspirin Equivalent in ASCVD: ADAPTABLE
May 17 — Renato Lopes
tctMD
ACTION: Full-Dose Rivaroxaban Doesn’t Help in Hospitalized COVID-19
https://www.tctmd.com/news/action-full-dose-rivaroxaban-doesnt-help-hospitalized-covid-19
May 17 — W. Schuyler Jones
HealthDay
ACC: 81-mg, 325-mg Aspirin Similarly Effective in ASCVD
https://bit.ly/3yklkFV
May 17 — Renato Lopes
Healio/Cardiology
ACTION: Rivaroxaban-based anticoagulation strategy fails to improve outcomes in COVID-19
https://bit.ly/2S421QC
May 17 — Adam DeVore
Medpage Today
Stubborn Gaps in Heart Failure Persist Despite Clinician Education, Feedback
https://bit.ly/3hBG7yT
May 17 — Adam DeVore
Healio/Cardiology
Hospital, post-discharge quality improvement intervention failed to improve HFrEF outcomes
https://bit.ly/3u3TSbU
May 17 — Manesh Patel and W. Schuyler Jones
HCPLive
VOYAGER PAD with Manesh Patel, MD, and Schuyler Jones, MD
https://bit.ly/3fu7QP9
May 18 — W. Schuyler Jones
WNDU-NBC-16 (South Bend, IN)
Study finds low-dose and regular-dose aspirin perform the same for heart health
https://bit.ly/3eVWTqG
*carried by 17 additional news outlets
May 18 — W. Schuyler Jones and Renato Lopes
Medical Dialogues
Study Cautions Against Use of Oral Anticoagulants in Admitted COVID Patients, ACC 2021
https://bit.ly/3foK86M
May 18 — Adam DeVore
AJMC
Hospital Quality Program for Heart Failure Patients Fails to Improve Outcomes
https://bit.ly/3wgCVg0
May 18 — W. Schuyler Jones
USNews.com
Low- or High-Dose, Aspirin Brings Similar Protection Against Heart Disease: Study
https://bit.ly/3bGIuMT
May 18 — Renato Lopes
HCP Live
Rivaroxaban Linked to Increased Bleeding Among Hospitalized COVID-19 Patients
https://bit.ly/3u6M9tD
May 18 — Manesh Patel
Medium.com
The Extra Extra Life Conversations, Part Two
https://bit.ly/3hDFQLH
Division of Cardiology Publications Indexed in PubMed May 6–19, 2021
Caughey MC, Vaduganathan M, Arora S, Qamar A, Mentz RJ, Chang PP, Yancy CW, Russell SD, Shah SJ, Rosamond WD, Pandey A. Racial Differences and Temporal Obesity Trends in Heart Failure with Preserved Ejection Fraction. J Am Geriatr Soc 2021;69(5):1309-1318. PM: 33401338.
Daubert MA, Yow E, Barnhart HX, Piña IL, Ahmad T, Leifer E, Cooper L, Desvigne-Nickens P, Fiuzat M, Adams K, Ezekowitz J, Whellan DJ, Januzzi JL, O’Connor CM, Felker GM. Differences in NT-proBNP Response and Prognosis in Men and Women With Heart Failure With Reduced Ejection Fraction. J Am Heart Assoc 2021:e019712. PM: 33955231.
Gaeta S, Bahnson TD, Henriquez C. High-Resolution Measurement of Local Activation Time Differences From Bipolar Electrogram Amplitude. Front Physiol 2021;12:653645. PM: 33967825.
Greene SJ, Butler J, Spertus JA, Hellkamp AS, Vaduganathan M, DeVore AD, Albert NM, Duffy CI, Patterson JH, Thomas L, Williams FB, Hernandez AF, Fonarow GC. Comparison of New York Heart Association Class and Patient-Reported Outcomes for Heart Failure With Reduced Ejection Fraction. JAMA Cardiol 2021;6(5):522-531. PM: 33760037.
Greene SJ, Mentz RJ, Limkakeng AT, Irons T, Truong T, Green CL, Nowak C, Blumer V, Pang PS. Comparison of Dyspnea Measurement Instruments in Acute Heart Failure: The DYSPNEA-AHF Pilot Study. J Card Fail 2021;27(5):607-609. PM: 33091609.
Harris Walker G, Gonzalez-Guarda R, Yang Q, Shah S, Prvu Bettger J. Socio-ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study. J Adv Nurs 2021:10.1111/jan.14778. PM: 33650219.
Hurst JH, Liu Y, Maxson PJ, Permar SR, Boulware LE, Goldstein BA. Development of an electronic health records datamart to support clinical and population health research. J Clin Transl Sci 2020;5(1):e13. PM: 33948239.
Kelsey MD, Granger CB. LOW-HARM score predicted mortality in patients hospitalized with COVID-19 in Mexico. Ann Intern Med 2021:10.7326/ACPJ202105180-059. PM: 33939489.
Lala A, Mentz RJ. Reaping from Reciprocity: the Mentor-Mentee Relationship. J Card Fail 2021;27(5):507-508. PM: 33962740.
Lopes RD, Thomas L, Di Fusco M, Keshishian A, Luo X, Li X, Masseria C, Friend K, Mardekian J, Pan X, Yuce H, Jones WS. Clinical and Economic Outcomes Among Nonvalvular Atrial Fibrillation Patients With Coronary Artery Disease and/or Peripheral Artery Disease. Am J Cardiol 2021;148:69-77. PM: 33667438.
Mann DL, Felker GM. Mechanisms and Models in Heart Failure: A Translational Approach. Circ Res 2021;128(10):1435-1450. PM: 33983832.
Parikh PB, Bhatt DL, Bhasin V, Anker SD, Skopicki HA, Claessen BE, Fonarow GC, Hernandez AF, Mehran R, Petrie MC, Butler J. Impact of Percutaneous Coronary Intervention on Outcomes in Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2021;77(19):2432-2447. PM: 33985688.
Peri-Okonny PA, Wang J, Gosch KL, Patel MR, Shishehbor MH, Safley DL, Abbott JD, Aronow HD, Mena-Hurtado C, Jelani QU, Tang Y, Bunte M, Labrosciano C, Beltrame JF, Spertus JA, Smolderen KG. Establishing Thresholds for Minimal Clinically Important Differences for the Peripheral Artery Disease Questionnaire. Circ Cardiovasc Qual Outcomes 2021:120007232. PM: 33947205.
Povsic TJ, Sanz-Ruiz R, Climent AM, Bolli R, Taylor DA, Gersh BJ, Menasché P, Perin EC, Pompilio G, Atsma DE, Badimon L, DeMaria AN, Hare JM, Henry TD, Janssens S, Kastrup J, Torella D, Traverse JH, Willerson JT, Fernández-Avilés F. Reparative cell therapy for the heart: critical internal appraisal of the field in response to recent controversies. ESC Heart Fail 2021;8(3):2306-2309. PM: 33652498.
Prado GM, Mahfoud F, Lopes RD, Moreira DAR, Staico R, Damiani LP, Ukena C, Armaganijan LV. Renal denervation for the treatment of ventricular arrhythmias: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2021;32(5):1430-1439. PM: 33724602.
Rao VN, Kelsey MD, Kelsey AM, Russell SD, Mentz RJ, Patel MR, Fudim M. Acute cardiovascular hospitalizations and illness severity before and during the COVID-19 pandemic. Clin Cardiol 2021;44(5):656-664. PM: 33682157.
Rettmann ME, Holmes Iii DR, Monahan KH, Breen JF, Bahnson TD, Mark D, Poole J, Ellis AM, Silverstein A, Al-Khalidi HR, Lee KL, Robb RA, Packer DL. Treatment-Related Changes in Left Atrial Structure in Atrial Fibrillation: Findings from the CABANA Imaging Substudy. Circ Arrhythm Electrophysiol 2021:10.1161/CIRCEP.120.008540. PM: 33848199.
Sharma G, Douglas PS, Hayes SN, Mehran R, Rzeszut A, Harrington RA, Poppas A, Walsh MN, Singh T, Parekh R, Blumenthal RS, Mehta LS. Global Prevalence and Impact of Hostility, Discrimination, and Harassment in the Cardiology Workplace. J Am Coll Cardiol 2021;77(19):2398-2409. PM: 33985685.
Sun H, Hodgkinson CP, Pratt RE, Dzau VJ. CRISPR/Cas9 Mediated Deletion of the Angiotensinogen Gene Reduces Hypertension: A Potential for Cure? Hypertension 2021;77(6):1990-2000. PM: 33813849.
Duke Heart Week Ending March 16th 2021
Chief’s message: American College of Cardiology Meeting 2021 and Spring Events:
This weekend highlighted the spring virtual American College of Cardiology Presentations. At the time of this email we have had several of our Faculty and fellows present. This year Duke Cardiology, DCRI, and Duke Heart with many of our collaborators will account for 87 presentations at the ACC 2021 meeting, with several late breaking clinical trials, young investigator awards, and overview of hot topics. We also have our heart center leadership council meeting coming up this week and will share updates from that next week. Finally, with some of the CDC and some of the School of Medicine policy changes, we are planning some outdoor graduation events for our wonderful fellows. I was fortunate enough to see some of the ACC and still make it to my daughter’s Indian Dance Performance in Midtown Raleigh and son’s track meet. One of few benefits of virtual conferences is that they have allowed us to balance clinical work, scientific meetings, and family life. Hopefully, you all got some time to enjoy the weekend and potentially catch up on some of the great science being presented.
Highlights of the week:
Duke Highlights, ACC 2021
We are pleased to share information on two late-breaking clinical trials presented this weekend at the American College of Cardiology’s Scientific Sessions. Congratulations to Schuyler Jones and the ADAPTABLE team and Rob Mentz and the REHAB-HF team! Renato Lopes is presenting the ACTION trial evaluating anticoagulation in SARS-COV2 today and we will have information on that in upcoming weeks. Further below, we highlight Marat Fudim and the Doug Zipes Distinguished Young Investigator award… although we have previously reported on this, now that the time has finally arrived, we’re celebrating once again! We will have more ACC.21 coverage next weekend.
ACC.21: Lower- and Higher-dose Aspirin Achieve Similar CVD Protection, Safety
People with cardiovascular disease (CVD) taking aspirin to lower their chances of suffering a heart attack or stroke experienced similar health benefits, including reduced death and hospitalization for heart attack and stroke, whether they took a high or low dose of aspirin, according to a study presented at ACC.21, the American College of Cardiology’s 70th Annual Scientific Session and published in the New England Journal of Medicine.
CVD—and atherosclerosis, in particular, which is a narrowing and hardening of the arteries—is a leading cause of death for men, women, and most racial and ethnic groups in the United States, with estimated direct costs of $214 billion, according to the American Heart Association. Millions of Americans with CVD take recommended aspirin therapy to help reduce their risk of heart attack and stroke, a decades-long practice that has, until now, lacked definitive research studying the doses that work best for patients and minimize potentially serious side effects, such as major bleeding.
“We found that both doses had similar effectiveness and safety, and while there were differences in dose switching between the groups, generally patients with heart disease should take low-dose aspirin given its tolerability and no clear benefit with higher doses of daily aspirin,” said Schuyler Jones, MD, associate professor of medicine in cardiology and the study’s principal investigator at the Duke Clinical Research Institute (DCRI).
The study, called ADAPTABLE, is the first large-scale study of aspirin dosing to be embedded in real-world practice and the first randomized controlled trial to be conducted using PCORnet®, the National Patient-Centered Clinical Research Network. PCORnet is a national resource developed with funding support from the Patient-Centered Outcomes Research Institute (PCORI) to enable more efficient patient-centered clinical research by tapping into real-world health data collected during routine care. PCORI funded ADAPTABLE both to demonstrate the capacities of PCORnet and to fill an important evidence gap regarding cardiovascular care.
Researchers followed 15,076 people with CVD who were identified via electronic health records and randomized to self-administer either 81 mg or 325 mg of daily aspirin for a median of 26.2 months. Participants were engaged at 40 health centers across the nation and a health plan engaged in the PCORnet network. Most follow-up to obtain patient-reported information occurred via a patient portal, with the rest occurring via telephone calls.
While the researchers found no significant difference between the two doses in safety or effectiveness, they noted the higher dose group was much more likely to switch doses during the study. The patients in this group also were slightly more likely to discontinue the use of aspirin, for reasons including tolerability and participant and clinician preferences, among others.
“ADAPTABLE provides useful evidence to inform patients and clinicians who advise them on aspirin dosing decisions,” noted PCORI Executive Director Nakela L. Cook, MD, MPH. “Sometimes health care is based on years of routine practice and when rigorous studies are conducted, we can evolve that practice from common sense to evidence based. That is why PCORI funds studies like ADAPTABLE that aim to enhance decision making with useful evidence.”
Cook added, “ADAPTABLE demonstrated the capacities that PCORnet offers to conduct large-scale patient-centered research more efficiently utilizing a rich data infrastructure and provides valuable lessons learned as the first randomized controlled trial conducted via the network. The generation of real-world evidence to enhance and extend beyond the evidence generated through studies conducted in specialized research settings is so important to improving health outcomes for all populations in all settings around the nation.”
According to the researchers, ADAPTABLE provides a demonstration that randomized trials can leverage electronic health data, direct-to-participant methods and participant-reported outcomes to address important, patient-centered questions.
“ADAPTABLE provides a blueprint for how research can be improved in the future,” added Jones. “The pragmatic structure of the PCORnet network enabled remote follow-up and streamlined processes and made it easier for sites and participants to take part. We also benefited from continuous engagement with patient partners who raised questions at every touchpoint that made us all think how ADAPTABLE and future research could be done differently.”
More information on ADAPTABLE can be found at theaspirinstudy.org, which includes a plain-language summary of the results and a town hall discussion on lessons learned through the study. More information on PCORnet is available at pcornet.org.
ACC.21: Tailored Cardiac Rehab Program Improves Function and Quality of Life in Older Heart Failure Patients
Older patients hospitalized with acute heart failure who participated in a novel 12-week cardiac rehabilitation (rehab) program tailored to address their specific physical impairments had significant gains in physical functioning, quality of life and depression compared with those receiving usual care, regardless of their heart’s squeezing ability (ejection fraction), according to a new study presented at the American College of Cardiology’s 70th Annual Scientific Session. Participation in the program, however, did not significantly reduce rehospitalizations during the six-month follow up.
Heart failure, which happens when the heart can’t pump blood the way it should because it is too weak or stiff, is the leading cause of hospitalizations in people 65 and older. Many of these patients are never able to return to their previous level of functioning—resulting in reduced independence and increased risk of returning to the hospital or dying.
“These patients have persistently poor outcomes with frequent rehospitalizations, poor quality of life, high rates of dying and high health care costs,” said Dalane W. Kitzman, MD, professor of cardiovascular medicine and geriatrics/gerontology at Wake Forest School of Medicine and the study’s lead author. “Despite many efforts to improve outcomes in these patients, most studies testing a wide range of medications, devices and strategies have been negative. This suggested to us that we were overlooking an important factor contributing to these poor outcomes, and we suspected the missing factor might be severe physical dysfunction, which is generally not addressed in heart failure management.”
In an earlier pilot study, Kitzman and colleagues found that older patients admitted to the hospital with acute heart failure had profound deficits in all domains of physical function, including their balance, mobility and strength, not just in endurance, which would have been expected. Nearly all of these patients (97 percent) were considered frail or prefrail.
“Even before they are hospitalized, these patients already have lower physical functioning due to both aging and their chronic heart failure, and when their heart failure worsens, their physical function deteriorates further and this can then be exacerbated by the hospital experience and bed rest,” Kitzman said. “This sequence of events leading to marked impairments in all domains of physical function and its impact on patient outcomes has been largely overlooked.”
With these insights, the REHAB-HF rehabilitation intervention was developed and designed to correct deficits in balance, mobility and strength. REHAB-HF seeks to enhance effectiveness and avoid injuries that can occur when frail older persons undertake traditional cardiac rehab programs that are more focused on endurance. The program was tailored to each patient’s specific needs and adjusted to their ability level as they progressed. Unlike traditional cardiac rehab programs that typically start six weeks after a hospitalization, the REHAB-HF program started early—during the patient’s hospital stay if possible—and transitioned to three outpatient sessions per week for 12 weeks following hospital discharge. The aim of the current REHAB-HF trial was to evaluate whether this novel rehabilitation program could improve physical function (primary outcome) and rehospitalizations (secondary outcome) compared to usual care which could include physician-ordered physical therapy or traditional cardiac rehab.
A total of 349 patients across seven different hospitals, including four community hospitals, were enrolled in the study. Patients ranged in age from 60-99 years; over half were women and 49 percent were from underrepresented racial or ethnic minority groups. Notably, 53 percent had heart failure with preserved ejection fraction (HFpEF). Overall, they had an average of five comorbidities, most commonly high blood pressure, diabetes, obesity, lung disease and kidney disease, which may also contribute to declines in physical function.
At the three-month follow-up, compared with participants randomized to receive usual care, those in the intervention group had notable and significant improvements in physical functioning and quality of life across all the assessments used. For example, the Short Physical Performance Battery, a standard measure of physical function in older adults, improved by 1.6 units—more than twofold greater than the minimum amount that is meaningful to patients. On the six-minute walk test, they were able to walk 34 meters farther, a large improvement compared to very low function at baseline. Participant scores on the Kansas City Cardiomyopathy Questionnaire, which measures the patient’s perception of their health status, and a separate depression survey also showed large improvements. The improvements in physical function in the REHAB-HF intervention group were even greater when compared to the subset of usual care patients who had received traditional physical therapy and/or cardiac rehab as part of their physician’s orders, further supporting the effectiveness of the REHAB-HF intervention.
At six months, 83 percent of patients were still doing their exercises, which Kitzman said bodes well for long-term adherence. However, there were no statistically significant differences in clinical events, including rates of readmission for any reason, with 194 and 213 rehospitalizations occurring in the intervention group and usual care control group, respectively. Heart failure-related hospitalizations were also no different (94 vs. 110) at six months. There were numerically more deaths among people in the rehab group (21 vs. 16), but this was not statistically significant; researchers said this result may have been due to chance.
“The study was not large enough to really look at clinical events. But patient preference surveys show that older patients often value improved function and quality of life independently of rehospitalization and death,” Kitzman said. “By improving quality of life and physical functioning, the patient feels better, which is a positive outcome for patients.”
Kitzman and his collaborators, including David Whellan, Pamela Duncan, Amy Pastva, Robert Mentz, Gordon Reeves, M. Benjamin Nelson, Haiying Chen, Bharathi Upadhya, Shelby Reed, Mark Espeland, LeighAnn Hewston and Christopher O’Connor are now investigating whether certain subgroups of patients (for example, those with HFpEF) saw more benefits, which could inform a subsequent larger trial powered to definitively examine effects on clinical events.
This study was simultaneously published online in the New England Journal of Medicine at the time of presentation. It was funded by the National Institute on Aging.
ACC.21: Fudim Presented with Zipes Award
Marat Fudim received the 2021 Douglas P. Zipes Distinguished Young Scientist Award. He is the first Duke nominee to receive the honor. The Zipes award is presented annually at the ACC Scientific Sessions to recognize a young scientist who has made outstanding contributions to the field of cardiovascular medicine and who has amassed an impressive body of scientific research in either the clinical or basic domain. The pre-recorded award session featured Doug Zipes and JoAnn Lindenfeld; it ran this morning during the Sessions.
Congratulations, Marat!
Samsky CGR presentation
Marc Samsky was our presenter for Cardiology Grand Rounds on Tuesday. Samsky discussed cardiogenic shock and the difficulties in conducting clinical trials for these patients. His research has focused on developing new ways to streamline research on patients with shock, leading to the design of two studies: an AHA Cardiogenic Shock Registry, and the BEST-SHOCK Trial. The trial, which has been submitted as a PCORI grant, would be an RCT to study Impella CP vs vasopressors/IABP. Marc also highlighted the fact that most of the work in cardiogenic shock has focus on patients with AMI and not those with acute on chronic heart failure, so it is difficult or impossible to apply the results from the AMI population to our HF pts.
You can find his recorded presentation here: https://bit.ly/3ybyuFd.
Heart Center Communications Updates
Since the start of COVID, the Heart Center Communications (HCC) volume of communications and the length of calls have increased while staffing has been down, at times, during staff transitions. Additionally, the majority of HCC staff have been working effectively from home in order to maintain social distancing requirements.
Over the last year, the HCC team has experienced employee turnover for a variety of reasons ranging from retirements to the passing of a beloved team member in September. For those familiar with the team, turnover is quite rare – this is a group that has forged close connections and operates more like a family in the way they care for one another.
The HCC now has four new nurses who are actively learning their roles: Kendell Hill, Carroll Enterkin, MJ Chapman and Alicia Snyder. We are very glad to have them on the team!
HCC has two talented financial analysts supporting charge capture processes for DUH cardiology invasive labs: Pat Clarke and Jon Boylan. They truly have a heart for service and continually look for ways to best support patient, provider and clinical staff needs. Heart Center Financial Administration (HCFA) supports DUH cardiac invasive labs by monitoring WQ’s, performing regular audits, reconciliations, financial reporting, charge corrections and communicating with clinical staff and medical providers as needed. By providing financial support, this allows the clinical team to focus more time on patients. The HCFA team has partnered with the cardiology invasive labs at DRH and DRAH, to provide them with this high level of support.
Finally, about a year ago, Duke Heart Center partnered with PRMO to add a dedicated Service Access Manager (SAM) to support Cath/EP, CDU and CMRI. The HCC was able to recruit the highly talented La Chandra Chavis, who role models our Duke Values and demonstrates great leadership. She has been a true asset to the team.
Great work, HCC! Hat tip to Greg Shelton for providing us with this update!
McKinney, NTI Poster Submission
Congratulations to Heather McKinney, MSN, RN, NE-BC! Her poster entitled MenTIR: Mentoring to Improve Retention Study will be exhibited at the National Teaching Institute Conference sponsored by the American Association of Critical Care Nurses, May 24-27, 2021. The poster highlights the successful outcomes, including a reduction in nurse turnover, achieved by implementation of a mentorship program on Duke North Unit 3100.
Way to go, Heather!
Celebrating Nurses!
Congratulations to Missy Sturdevant, RN and Kamie Pedler, NCA of the Duke Heart 3100 Unit in Duke University Hospital who were both nominated during the Department of Medicine’s Celebrate Nursing Campaign! Their nominator(s) had this to say:
“Kamie is one of the hardest working, most compassionate coworkers I have had the honor of working with. She cares deeply about working with patients and exemplifies all of the Duke Values. She deserves all the praise in the world!” – Name withheld
“Missy has been such a dependable, integral and inspiration of a nurse on 3100. She goes above and beyond to share her knowledge and provide the best possible care for her patients. I learned so much from her and hope that Duke realizes how lucky it is to have her caring for our patients.” – Name withheld
Congrats, Missy & Kamie!
Shout-out to Yankey, Loriaux & Flores Rosario!
More great feedback on members of our fellowship program was received this week – in a note to Anna Lisa Crowley, we learned:
“I am writing to recognize three of your outstanding fellows: Dr. George Sipa Yankey, Dr. Daniel Loriaux, and Dr. Karen Flores Rosario. These three fellows volunteered several hours of their time to teach first-year Duke medical students basic cardiac ultrasound. I had the privilege of teaching alongside them, and I was so impressed with their educational skills. The students LOVED learning from them and are still raving about the experience.
We are so lucky to have such gifted educators willing to volunteer their time for our students.” — Julian Hertz, Assistant Professor of Surgery & Global Health, Course Director, Longitudinal Point-of-care Ultrasound Curriculum
Great job, Sipa, Daniel and Karen!
Nursing Gala Held; Celebration of FON Awards
The 32nd Gala Celebration of Excellence, hosted by the Duke Friends of Nursing Board of Advisors was held last night, May 15. The online event honored all Duke nurses and celebrated the nominees and winners of the FON Excellence Awards. A very special congratulations to the following Duke Heart nurses who were recognized: Stephanie Barnes, Allison Dimsdale, Mollie Kettle, Elaine Milton, Brenda Smith, Courtney Stierwalt and Katie Toy. We are so happy for each of you!
Duke Box Update
Good news for those of us who use Box, Duke’s cloud-based storage and collaboration service. Starting Monday, May 17, Box will have new and improved features. The new features include:
- Infinite scroll – Scroll down to view files and folders rather than clicking through pages of content
- Collections – Organize files and folders in ways that make sense to you
You may also notice a slight branding change on the Box interface. This short video provides an overview of the changes: https://warpwire.duke.edu/w/taIFAA/
If you would like to learn more about Box, please visit box.duke.edu.
COVID-19 Updates:
All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:
Upcoming Opportunities/Save the Date:
Proctors Needed: MaryAnn Black Virtual Summer Internship Program
The MaryAnn Black Virtual Summer Internship Program is in need of volunteer proctors to cover about 12 hours during the virtual program. Coverage times are as small as one hour between June 15 and June 30. Proctors will provide active supervision, listen during sessions, and observe to ensure minor participants (ages 15-18) are behaving appropriately. If you’re interested and willing to help out, please contact Darla Wohlfarth.
To learn about the program, please visit: https://community.duke.edu/program/duke-internships/
This year’s program will be completely virtual and will highlight dozens of healthcare careers and healthcare supportive careers. The internship will begin June 7 and end June 30, 2021. The first week will be devoted to structured training and orientation. The remaining weeks will give the student an overview of the many career opportunities that make up the fabric of Duke Health.
Thank you for considering!
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:
May 6 — Cameron Prigge (neurobiology)
AAMC.org
Basic medical research took a hit during the pandemic. It might take years to recover
https://bit.ly/3o9y11F
May 6 — Brigit Carter (Duke SON)
health.usnews.com
Why Representation in Nursing Matters
https://bit.ly/3eFdz5u
May 9 — general interest
The Washington Post
https://wapo.st/3w8QlL7
May 10 — Adrian Hernandez
WRAZ/Fox 50
There’s one side-effect to watch for when children receive the COVID-19 vaccine
https://bit.ly/3y0Pxtv
Note: clip begins at 10:04:10
May 10 — E. Magnus Ohman
Medscape
Patient-Focused Revisit of ISCHEMIA Bolsters Conservative Message in Stable CAD
https://www.medscape.com/viewarticle/950875https://bit.ly/3es0tZr
Duke Heart Week ending May 9th 2021
Chief’s message: Happy Mother’s Day
Hopefully you all got some time to spend celebrating mother’s day either with your mother, or with family remembering your mothers. Springtime in the triangle is notable for a good weather and school graduations, many of which are appropriately on mother’s day weekend. Graduations serve as a reminder of all the hard work and love, compassion, and grace that mothers have in raising and supporting their kids and families. At graduations commencement speakers frequently ask our young colleagues to often look forward and look at the opportunity they will have to shape the world, and it is fitting that doing that with thoughts of the ways in which our mothers helped us all will serve as a continued guiding light.
Highlights of the week:
Celebrating National Nurses Week, May 6-12
It’s National Nurses Week! As we take time to celebrate our nurses, we also pause to consider the sacrifices and losses many nurses and frontline workers have endured due to Covid-19. At Duke Heart and across the Health System, we have seen remarkable dedication and courage from all of our teams over the past year. It hasn’t been easy and there are still challenges ahead. Yet we know that our nurses will continue to help lead the way through their outstanding care for patients and through their commitment to excellence, education, compassion, and to one another. Thank you to all Duke nurses – especially those on each of our Heart units, in each of our clinics and those in the research space and elsewhere. Thanks for all that you do!
Reminder: The Department of Medicine Well-Being Committee is hosting Celebrating Our Nurses. Through May 12, all members of the Department of Medicine can use this link to nominate nurses for their contributions and describe how they emulate the Duke Health values of Excellence, Integrity, Teamwork, Respect, and Innovation.
There is no limit to the number of nurses one person can nominate, and you can nominate a nurse from any location (i.e. clinic, inpatient, research).
This year more than any other, it is important to recognize the inspiring work done by our nursing colleagues and their important role in the care of our patients.
Women in the Heart of Cardiology Symposium Held
The first “Women in the Heart of Cardiology” international symposium was held virtually on Wednesday, May 5th.
The program was organized by the Brazilian Clinical Research Institute (BCRI) in partnership with the Duke Clinical Research Institute and Stanford University with the goal of promoting discussion around gender disparities in cardiology, in cardiovascular health outcomes and quality of care around the world, and strategies to minimize them. The symposium featured discussions on the still low representation of women participating in clinical trials and as well as the paucity of women selected to lead clinical trials.
The symposium featured male and female thought-leaders from across the cardiovascular space. The presentations and discussions were informative, engaging and featured a number of current and former Duke faculty members including Tracy Wang, Renato Lopes, Jennifer Rymer, Adrian Hernandez, Manesh Patel, Robert Harrington, Lesley Curtis and Robert Califf, as well as Duke cardiology fellow, Vanessa Blumer.
To learn more about the event, the topics covered, and to see a full list of all presenters, please visit: https://wihc.online. Congratulations to co-chairs Renato Lopes, Robert Harrington, Tracy Wang and Ariane Macedo for planning a very successful and well-attended event. We hope to see more sessions on these critical topics in the future. Great job!
Swaminathan to Serve as Track Director for SCAI 2022
Rajesh Swaminathan has been appointed the Cath Lab Bootcamp Track Director for the 2022 Society for Cardiovascular Angiography and Interventions (SCAI) Annual Scientific Sessions, which is scheduled for May 19-22, 2022 in Atlanta. SCAI is the only professional medical society in the U.S. dedicated solely to interventional cardiology.
Duke is well represented on the SCAI Sessions planning team. In addition to Raj, former Fellow Connie Hess is part of the planning committee for the Peripheral Track of the meeting and Sunil Rao became President-Elect of SCAI as of April 28; Rao has most recently served as SCAI vice president.
Congrats, Raj!!
D’Amico, Tong Named to AATS Committees
Please join us in congratulating surgeons Tommy D’Amico and Betty Tong for their appointments to the following American Association for Thoracic Surgery (AATS) committees:
- D’Amico has been appointed to the AATS Board of Directors, the governing body of the AATS, in recognition of his dedication and service.
- Tong has been appointed to the IT committee, the group charged with modernizing the AATS digital universe and its online presence.
The AATS, founded in 1917, promotes scholarship, innovation, and leadership in the field of thoracic and cardiovascular surgery; it is an international organization whose members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease.
“These appointments are not only significant individual accomplishments, but also are extremely important for our entire Division as well as our individual faculty and residents,” said Edward P. Chen, chief of the Division of Cardiovascular and Thoracic Surgery. “I am absolutely thrilled for them and ask that you join me in congratulating Tommy and Betty for their achievements.”
Perfusion Services Team Recognized with JECT Award
Congratulations to Travis Siffring, Amy Evans, William Dauch, Greg Smigla and David Kaemmer – all members of the Duke Perfusion Services pediatric specialty team — and to Duke medical student, Neel Prabhu. Their manuscript, Sustained Total All-Region (STAR) Perfusion: An Optimized Perfusion Strategy for Norwood Reconstruction, has been selected for the JECT Technique Article Award for 2021. The Journal of ExtraCorporeal Technology (JECT) is the official publication of the American Society of ExtraCorporeal Technology (AmSECT) and is the longest continuously published periodical in the field of perfusion.
STAR perfusion is a new technique being used at Duke during Norwood reconstruction. It combines continuous coronary perfusion, cerebral perfusion and lower body perfusion at mild hypothermic temperature for the duration of surgery to reconstruct the aorta. Norwood reconstruction is generally performed in the first weeks of life on infants born with a congenital heart defect called hypoplastic left heart syndrome – a condition where the left side of the heart has not fully developed, rendering the heart unable to pump oxygen-rich blood throughout the body.
“Before this technique we had to cool the patients and use hypothermic circulatory arrest with cerebral perfusion only in order to allow the surgeons to perform a big portion of the surgery — creation of the neoaorta,” Siffring said. “Now we can stay closer to normothermia and can perfuse the brain, the heart and the rest of the body while the surgeons are operating on the aorta.”
The perfusion team presented on this technique at the AmSECT 58th International Conference, held in March, 2020. Their manuscript describing the technique was published in the December 2020 issue of JECT.
This award is presented annually to a perfusionist who has published an exceptional technique article in JECT. The award consists of a certificate and a modest honorarium. The JECT Award was presented last weekend during AmSECT’s 59th International Conference, which was held virtually from May 1-4.
ICYMI: Members of our pediatric heart surgery team published recently on the development and use of the STAR perfusion technique during Norwood. A manuscript by surgeons Nick Anderson and Joe Turek with medical student Neel Prabhu, Sustained Total All-Region (STAR) Perfusion for Norwood Reconstruction was published online last May in the journal Operative Techniques in Thoracic and Cardiovascular Surgery; it appears in the autumn 2020 print issue.
Congratulations to all!
Passings: Carl M. Voyles, Jr., MD
We were saddened this week to learn that Dr. Carl M. Voyles, Jr., a Duke cardiology alum, died on Dec. 31, 2020. He was 98. His obituary reads, in part, “Carl was part of an accelerated medical program at Duke University Medical School during the war (WW2). He interned at Johns Hopkins and then was drafted. As part of his military training, he became a flight surgeon. After his military service, Carl returned to Duke and completed advanced medical training in Cardiology/Internal Medicine under the infamous Dr. Eugene Stead. When his specialized medical training was complete, he moved to St. Petersburg, Florida, and opened a cardiology practice with fellow Duke graduate, Dr. Charlie Rast.”
A wonderful tribute to his life can be found here. Our condolences to his wife Joan, their family and friends and his former colleagues. We know he is missed.
Shout-out to CT Surgery Team
We received the following note from Andrew Wang: “I would like to express my gratitude and awe for remarkable collaboration during a high risk TAVR case this past week. During the procedure being performed by Dr. Jeff Gaca and myself, there was a rare, unexpected complication that required rapid problem-solving and eventual conversion to open surgery. In addition to the prompt response from the OR staff, perfusion team and CT anesthesia, both Drs. Jacob Schroder and Ben Bryner quietly appeared and assisted in the emergent surgery which was successfully completed. In observing the many of parts of our heart center team work together at a moment’s notice, running toward the fire, it provided a real-time example that “culture eats strategy for breakfast.” Thanks for everyone’s dedication and help.” – Andrew Wang, Vice Chief for Clinical Affairs, Division of Cardiology.
Nicely done, team!!!
Shout-out to Corley
We’re pleased to share the following message of praise for first year fellow Ali Corley. In a note to Anna Lisa Crowley from Durham VAMC cardiology physician assistant Kim Jones, we learned:
“Ali is the best. I told her today about the snafu with the VA ID badges here so no incoming fellows in July. She asked who would be covering her patients. I told her I would, and she said she would be available to help with any questions I had.
What impressed me was not that she said she’d help with any questions (hopefully all the fellows would) but that her first comment was “who will be taking care of my patients?” … that, priceless.
Her future patients should count themselves lucky!!!” –Kimberly Jones, PA, Durham VAMC Cardiology
We completely agree — Great work, Ali!
Kudos to Tong
In a note from Lisa Clark Pickett, Chief Medical Officer for Duke University Hospital, we learned of warm feedback for Betty Tong and the thoracic care team.
“Every nurse was extremely nice to me and my visitor. Dr. Tong was awesome.” – A grateful patient (name withheld)
Pickett wrote, “Betty, while reading comments on our Patient Satisfaction Survey I was just delighted to read this lovely compliment about you and your team! Thank you for always providing such excellent and compassionate care.”
Photo of the Week: Nafissi Wedding
Congratulations to Duke cardiology fellow Navid Nafissi and his wife, Haley, who were married April 17! The couple, along with their friends and family, celebrated at the Daniel Stowe Botanical Garden in Belmont, NC. It was a beautiful day for a beautiful couple! Congratulations, Navid and Haley!
Newly published!
Congratulations to Carolyn Lekavich and her co-authors, Dennis Abraham, Marat Fudim, Cynthia Green, Robert Mentz, Karol Harshaw-Ellis, Margaret Bowers, Anita Kelsey, Kishan Parikh, Tracy Truong, Debra Barksdale (Virginia Commonwealth University), and William Kraus – their manuscript, Early Identification of Patients At-Risk for Incident Heart Failure with Preserved Ejection Fraction (HFpEF): Novel Approach to Echocardiographic Trends was published online yesterday in the Journal of Cardiac Failure. Great job!
Triangle Go Red Luncheon – Register Now
The American Heart Association’s 2021 Triangle Go Red for Women Luncheon digital celebration will be held on Friday, May 14th from 11:30 a.m. – 1 p.m. Join us as we celebrate the impact of Go Red for Women in the Triangle, learn tips to structure self-care into your day, participate in a series of health and wellness breakout sessions, and hear from inspiring survivors who are “Living Fierce” and not letting cardiovascular disease stand in their way. If interested, please visit https://events.bizzabo.com/301164. Registration is still open for those who would like to join. The event is free and open to all.
Registration Open for Friends of Nursing Gala, May 15
The Duke Friends of Nursing Board of Advisors cordially invites you to attend the 32nd Gala Celebration of Excellence! Hundreds of nurses, friends, supporters and community members attend the Gala each year to honor all Duke Nurses, and to recognize the nominees and winners of the Excellence Awards. While we can’t celebrate in-person this year, we are preparing for a very special virtual celebration. Join us for a virtual program celebrating our spirit of innovation, unwavering compassion, clinical excellence, and significant impact across Duke Health. We hope you will attend. There is no fee for this event. To learn more or to register, please visit: https://www.dukefriendsofnursing.org.
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
May 11: Cardiogenic Shock: An Outlook on the Past, Present, and Future with Marc Samsky. 5 p.m. Webex.
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:
May 1 — Robert Lefkowitz
Endocrine News (April issue)
https://bit.ly/3es0tZr
May 2 — Robert Lefkowitz
Newsweek
‘I’m A Nobel Laureate, But I Still Have Regrets’
https://bit.ly/3eYveUT
Division of Cardiology Publications Indexed in PubMed April 29 – May 5, 2021
Badhwar V, Vemulapalli S, Mack MA, Gillinov AM, Chikwe J, Dearani JA, Grau-Sepulveda MV, Habib R, Rankin JS, Jacobs JP, McCarthy PM, Bloom JP, Kurlansky PA, Wyler von Ballmoos MC, Thourani VH, Edgerton JR, Vassileva CM, Gammie JS, Shahian DM. Volume-Outcome Association of Mitral Valve Surgery in the United States. JAMA Cardiol 2020;5(10):1092-1101. PM: 32609292.
Blumer V, Greene SJ, Wu A, Butler J, Ezekowitz JA, Lindenfeld J, Alhanti B, Hernandez AF, O’Connor CM, Mentz RJ. Sex Differences in Clinical Course and Patient-Reported Outcomes Among Patients Hospitalized for Heart Failure. JACC Heart Fail 2021;9(5):336-345. PM: 33714746.
Breeze CE, Batorsky A, Lee MK, Szeto MD, Xu X, McCartney DL, Jiang R, Patki A, Kramer HJ, Eales JM, Raffield L, Lange L, Lange E, Durda P, Liu Y, Tracy RP, Van Den Berg D, , Evans KL, Kraus WE, Shah S, Tiwari HK, Hou L, Whitsel EA, Jiang X, Charchar FJ. Epigenome-wide association study of kidney function identifies trans-ethnic and ethnic-specific loci. Genome Med 2021;13(1):74. PM: 33931109.
Califf RM, Hernandez AF, Landray M. Weighing the Benefits and Risks of Proliferating Observational Treatment Assessments: Observational Cacophony, Randomized Harmony. JAMA 2020;324(7):625-626. PM: 32735313.
Cavalier JS, Klem I. Using Cardiac Magnetic Resonance Imaging to Evaluate Patients with Chest Pain in the Emergency Department. J Cardiovasc Imaging 2021;29(2):91-107. PM: 33938167.
Dayoub EJ, Eberly LA, Nathan AS, Khatana SAM, Adusumalli S, Navar AM, Giri J, Groeneveld PW. Adoption of PCSK9 Inhibitors Among Patients With Atherosclerotic Disease. J Am Heart Assoc 2021;10(9):e019331. PM: 33904340.
Douglas PS. Functional vs Anatomical Testing for Patients With Stable Chest Pain-Binary or Directional Thinking? JAMA Cardiol 2020;5(8):868-870. PM: 32492103.
Figueroa JF, Wadhera RK, Frakt AB, Fonarow GC, Heidenreich PA, Xu H, Lytle B, DeVore AD, Matsouaka R, Yancy CW, Bhatt DL, Joynt Maddox KE. Quality of Care and Outcomes Among Medicare Advantage vs Fee-for-Service Medicare Patients Hospitalized With Heart Failure. JAMA Cardiol 2020;5(12):1349-1357. PM: 32876650.
Garza MY, Rutherford M, Myneni S, Fenton S, Walden A, Topaloglu U, Eisenstein E, Kumar KR, Zimmerman KO, Rocca M, Gordon GS, Hume S, Wang Z, Zozus M. Evaluating the Coverage of the HL7 FHIR Standard to Support eSource Data Exchange Implementations for use in Multi-Site Clinical Research Studies. AMIA Annu Symp Proc 2021;2020:472-481. PM: 33936420.
Greene SJ, Velazquez EJ, Anstrom KJ, Eisenstein EL, Sapp S, Morgan S, Harding T, Sachdev V, Ketema F, Kim DY, Desvigne-Nickens P, Pitt B, Mentz RJ.Pragmatic Design of Randomized Clinical Trials for Heart Failure: Rationale and Design of the TRANSFORM-HF Trial. JACC Heart Fail 2021;9(5):325-335. PM: 33714745.
Kirtane AJ, Mehran R, Navar AM, Bonow RO. Heroism in the Face of the COVID-19 Pandemic. JAMA Cardiol 2020;5(10):1163-1164. PM: 32558909.
Klein LW, Anderson HV, Rao SV. Performance Metrics to Improve Quality in Contemporary Percutaneous Coronary Intervention Practice. JAMA Cardiol 2020;5(8):859-860. PM: 32374347.
Lowenstern A, Alexander KP, Douglas PS. Should We Simplify Computed Tomography Angiography Reporting as Black or White vs Describing All Shades of Gray?-Reply. JAMA Cardiol 2020;5(12):1450-1451. PM: 32902566.
Malik AO, Spertus JA, Patel MR, Dehmer GJ, Kennedy K, Chan PS. Potential Association of the ISCHEMIA Trial With the Appropriate Use Criteria Ratings for Percutaneous Coronary Intervention in Stable Ischemic Heart Disease. JAMA Intern Med 2020;180(11):1540-1542. PM: 32955575.
Mentz RJ, Rao VN. Worsening Heart Failure Events in HFpEF: Underlying Biology Not Treatment Location. JACC Heart Fail 2021;9(5):383-385. PM: 33839077.
Nanna MG, Chen ST, Nelson AJ, Navar AM, Peterson ED. Representation of Older Adults in Cardiovascular Disease Trials Since the Inclusion Across the Lifespan Policy. JAMA Intern Med 2020;180(11):1531-1533. PM: 32897289.
Okoro PC, Schubert R, Guo X, Johnson WC, Rotter JI, Hoeschele I, Liu Y, Im HK, Luke A, Dugas LR, Wheeler HE. Transcriptome prediction performance across machine learning models and diverse ancestries. HGG Adv 2021;2(2):100019. PM: 33937878.
Pagani FD, Mehra MR, Cowger JA, Horstmanshof DA, Silvestry SC, Atluri P, Cleveland JC, Lindenfeld J, Roberts GJ, Bharmi R, Dalal N, Kormos RL, Rogers JG. Clinical outcomes and healthcare expenditures in the real world with left ventricular assist devices – The CLEAR-LVAD study. J Heart Lung Transplant 2021;40(5):323-333. PM: 33744086.
Roth GA, Emmons-Bell S, Alger HM, Bradley SM, Das SR, de Lemos JA, Gakidou E, Elkind MSV, Hay S, Hall JL, Johnson CO, Morrow DA, Rodriguez F, Rutan C, Shakil S, Sorensen R, Stevens L, Wang TY, Walchok J, Williams J, Murray C. Trends in Patient Characteristics and COVID-19 In-Hospital Mortality in the United States During the COVID-19 Pandemic. JAMA Netw Open 2021;4(5):e218828. PM: 33938933.
Shahid I, Nizam MA, Usman MS, Khan MS, Fudim M, Michos ED. Meta-Analysis Comparing the Safety and Efficacy of Dual Versus Single Antiplatelet Therapy After Transcatheter Aortic Valve Implantation. Am J Cardiovasc Drugs 2021 May;21(3):373-376. PM: 33634434.
Spahillari A, Zhu J, Ferket BS, Hunink MGM, Carr JJ, Terry JG, Nelson C, Mwasongwe S, Mentz RJ, O’Brien EC, Correa A, Shah RV, Murthy VL, Pandya A. Cost-effectiveness of Contemporary Statin Use Guidelines With or Without Coronary Artery Calcium Assessment in African American Individuals. JAMA Cardiol 2020 Aug 1;5(8):871-880. PM: 32401264.
Steinberg BA, Li Z, O’Brien EC, Pritchard J, Chew DS, Bunch TJ, Mark DB, Nabutovsky Y, Greiner MA, Piccini JP. Atrial fibrillation burden and heart failure: Data from 39,710 individuals with cardiac implanted electronic devices. Heart Rhythm 2021 May;18(5):709-716. PM: 33508517.
Stone AT, Carlson KM, Douglas PS, Morris KL, Walsh MN. Assessment of Subspecialty Choices of Men and Women in Internal Medicine From 1991 to 2016. JAMA Intern Med 2020 Jan 1;180(1):140-141. PM: 31545349.
van Diepen S, Hochman JS, Stebbins A, Alviar CL, Alexander JH, Lopes RD. Association Between Delays in Mechanical Ventilation Initiation and Mortality in Patients With Refractory Cardiogenic Shock. JAMA Cardiol 2020 Aug 1;5(8):965-967. PM: 32432650.
Yang S, Starks MA, Hernandez AF, Turner EL, Califf RM, O’Connor CM, Mentz RJ, Choudhury KR. Corrigendum to “Impact of baseline covariate imbalance on bias in treatment effect estimation in cluster randomized trials: Race as an example” [Contemporary Clinical Trials volume 88 (2020) 105775]. Contemp Clin Trials 2021 Apr;103:106298. PM: 33578196.
Duke Heart Week ending May 2nd 2021
Chief’s message: Transitions and Accomplishments
It’s understandable that great institutions produce faculty and fellows that garner national attention and eventually leave to lead and areas of importance in medicine around the world. However, this fact does not make it any less bittersweet when we have one of great colleagues leave to pursue other opportunities. This was the case this week as we had a celebration grand rounds for Joe Rogers, someone who has been a clinician scientist for Duke Heart, and a leader for our institution on many fronts including cardiovascular medicine, the department of medicine, the PDC, and most recently as CMO of the health system. The grand rounds we had reminded me of the times we as faculty and fellows could tell stories, share accomplishments, and most importantly thank each other for the roles that we play in each other’s lives. Hopefully as we move towards more in person interaction, we can have grand rounds and get togethers where some of that can be done again. Joe has certainly played an important role in many lives at Duke Heart will be missed by many.
I wanted to also highlight for all of our faculty, fellows, and friends of Duke Heart that this week we will have the national American College of Cardiology meeting (virtually). We have an enormous number of scientific presentations by our faculty and fellows, and we will ensure that next Sunday that we have a mothers’ day edition of the pulse with updates of all the great science our group is playing a role in developing and discovering.
Highlights of the week:
Rogers Celebrated During Special CGR
A special Cardiology Grand Rounds was held via Zoom on Thursday, April 29 to celebrate Joe Rogers and all he has meant to us in Duke Heart – including his many accomplishments across his 16 year career at Duke. Rogers was celebrated as an extraordinary mentor, leader, clinician, researcher, and as someone who exemplifies the very best of Duke. He was recognized as dedicated to inclusivity – as someone who helped everyone to feel welcome and that their voice mattered. We are truly blessed to have worked with him and he will be deeply missed. Stories and anecdotes from across the years were shared by Carmelo Milano, Jacob Schroder, Chet Patel, Adam DeVore, Bradi Granger, Jennifer Lewis, Mona Fiuzat, Chris O’Connor, Robert Mentz, Marc Samsky, Mike Felker, Adrian Hernandez and several others.
Joe is heading to Texas Heart Institute this month to join their team as President and Chief Executive Officer. We wish him all the best!
Perfusion Team Recognized with AmSECT’s Inaugural Pillar Award
Duke Perfusion Services has been named one of the inaugural recipients of the Pillar Award for Perfusion Excellence by the American Society of Extracorporeal Technology (AmSECT). Awardees are being recognized for their programmatic dedication to excellence as well as professional standards across four categories or “pillars” — quality, community, responsibility, and education.
“We are so fortunate at Duke to have such an outstanding team of perfusionists who support our cardiothoracic faculty at the highest level possible all while embracing the core values encompassing this award,” said Edward P. Chen, MD, Chief of the Division of Cardiovascular and Thoracic Surgery. “It is a true privilege to have them on the Duke Heart Team.”
With thirty-four perfusionists, Duke Heart offers one of the largest and best trained perfusion teams in the U.S. Each member of the team is certified by the American Board of Cardiovascular Perfusion, licensed by the North Carolina Medical Board, and most hold advanced degrees and credentials. In addition to proficiency in cardiopulmonary bypass (operating the heart-lung machine during cardiothoracic surgery), Duke perfusionists specialize in order to support a variety of needs across the hospital. Duke offers a dedicated team of pediatric perfusionists, as well as a team to support heart surgery at Duke Regional Hospital. There is a team that specializes in Extra-Corporeal Life Support (ECLS) assisting with cannulating and retrieving patients from referring hospitals; there is a team that provides apheresis in the OR, and a team trained in use of the Transmedics Organ Care System, increasing the donor pool for Duke’s Heart Transplant program.
“Perfusionists have a distinct role,” says Desiree Bonadonna, chief of Perfusion Services at Duke. “I don’t think many people are aware of the full scope of our practice. In the operating room we run cardiopulmonary bypass which is quite complex and responsible for the patient’s circulation, respiratory function, and anesthesia and drug delivery while the surgeon is operating on the heart or lung. We have expertise in ventricular assist devices, extracorporeal membrane oxygenation (ECMO), really anything that involves pumping blood or perfusing organs, such as specialized chemo delivery systems used in surgical oncology cases. We are invested in education, research and quality improvement work and we are doing it in the high volume, high performance space of Duke Heart. We are very excited to be one of the first programs recognized with a Pillar award.”
Members of the Duke Perfusion team are regularly invited to present at national conferences, and a number of perfusion schools send their students here to learn from the Duke team.
“On behalf of the Cardiothoracic Anesthesiology and Critical Care faculty, I would like to extend a big round of applause and heartfelt congratulations to our Duke Perfusion family on their receipt of the inaugural 2021 AmSECT Pillar Award, said Mihai V. Podgoreanu, MD, chief of Cardiothoracic Anesthesiology. “Founded on a tradition of excellence, this program has continued to expand and perform outstandingly in supporting the ever-increasing clinical needs of extracorporeal technology both in the operating rooms and intensive care units. Through leadership, patient-centeredness, innovation, ownership, meticulous attention to quality improvement and collaboration, this talented and passionate group of professionals is contributing 24/7 to life-changing procedures, shaping the next generations of perfusionists and cardiovascular physician trainees through education and simulation, and generating new research knowledge. Bravo!”
Criteria for the award included demonstration of a clear management structure; well-developed protocols and procedures; an onboarding and orientation process; quality assurance standards and processes, and a professional commitment to the field. At Duke, each member of the perfusion team is also a member of a professional organization or society for the advancement of the field of perfusion – this way they are always learning and contributing.
“The value of our perfusion team to patient care at Duke cannot be underestimated or overstated,” adds Andrew J. Lodge, MD, Medical Director of Quality and Safety for Children’s Surgery. “I have been saying for years that the Duke Perfusion team is consistently the best group of individuals with whom I have had the pleasure to work. Their various sections have been characterized by excellent leadership and outstanding clinical skills.
“To a person, the perfusionists with whom I’ve worked, particularly on the pediatric and ECMO teams, have been exemplary colleagues. Additional words I would use to describe them are compassionate, dedicated, professional, driven, and ambitious. Not only are they great educators, they are always striving to learn themselves. They are on the cutting edge of technology, and allow us to offer the best available treatments for our patients. They are tireless workers and always up for a challenge. It comes as no surprise to me that the Duke Perfusion team has received a national award for excellence. It is surely well-deserved.”
Please join us in congratulating our entire team of perfusionists on their Pillar Award for Perfusion Excellence, particularly since today launches National Perfusion Appreciation Week (May 2-8). Congratulations and keep up the great work!
Coniglio to Serve as Chief Cardiology Fellow, 2021-2022
Amanda Coniglio has been elected by her peers to serve as Duke’s chief cardiology fellow for 2021-2022. The announcement was made Friday evening by Anna Lisa Crowley, program director for the cardiology fellowship program.
As some of you may know, Amanda grew up in Richmond, Virginia before moving to upstate New York for high school. She attended Elon University here in North Carolina for her undergraduate degree. She returned to New York for medical school at the University of Rochester. There, she met her now husband, Andrew, and they couples-matched at the University of North Carolina Chapel Hill for residency. After completing residency, we were fortunate that Amanda switched to the darker blue for her cardiovascular disease fellowship training at Duke. She is completing advanced heart failure and transplant fellowship training this year before rejoining cardiovascular disease fellowship for a year of research in July. She is interested in familial cardiomyopathy and is planning to spend her research year working with Svati Shah and learning clinical genetics. Amanda is very honored to be elected as the chief fellow and is excited to work with all the fellows!
Please join us in congratulating and welcoming Amanda to this new role!
Shout-out to Friede!
The following message from Anna Lisa Crowley was shared with the fellows and faculty on Friday evening:
“As Amanda Coniglio transitions to her new role as chief cardiology fellow during May, I want to take an opportunity to give a big THANK YOU to Kevin Friede who has been spectacular this year during unprecedented challenges. Kevin helped us implement new virtual lectures, end of year fellows’ banquet, recruitment, and a holiday talent show! In addition, Kevin was a clear and calm voice for the fellows. He helped us re-imagine the CICU fellow experience, arranged COVID and overnight coverage, and many other things I have not listed here.
He navigated all these new challenges while working in the lab, studying and passing the ever-shifting CV ABIM exam, and welcoming a new daughter, Celia, to his family.
We are fortunate that Kevin will stay on at Duke next year as an interventional fellow.
Please join me in thanking Kevin for his dedication to the fellowship! Attached is a photo of Kevin, his wife, Dr. Schell Bressler, and daughters Elizabeth and Celia, taken after Celia was born last fall.”
Well done, Kevin!
Kudos to Harrison, Hughes & Glower
In a note from Lisa Clark Pickett, Chief Medical Officer for Duke University Hospital, we learned of recent patient compliments for three of our faculty members. The compliments were submitted to Duke via recent Patient Satisfaction Surveys.
“I thank God for Dr. Glower— he saved my life. Everything about my stay was excellent. Everyone had my best interests at heart.” – Grateful patient, name withheld
“Excellent facility & hospital – best decision to use Duke. Doctors were great and very thankful for them*.” – Grateful patient, name withheld (*Dr. Robert Harrison & *Dr. Chad Hughes)
Pickett added, “You and your team clearly made an impact on this person. Thank you for your dedication to excellence!”
Medicine Grand Rounds with Lefkowitz
For anyone who missed Bob Lefkowitz’s terrific presentation “A Tale of Two Callings” during last week’s Medicine Grand Rounds, you can view a recording of the event here: https://warpwire.duke.edu/w/tasFAA/.
Picture of the Week – Mike Sketch’s pen found in the Duke Cath lab
I was in the Duke Cath Lab on Friday and found this pen in the duke cath lab. On inquiring, I learned it was Mike Sketch’s unicorn to-do list pen. It’s a pretty cool pen and we have it kept for Mike in the lost and found.
Celebrating Our Nurses: Nominations Are Open!
In recognition of National Nurses Week (May 6-12) the Department of Medicine Well-Being Committee hosts “Celebrating Our Nurses.” From today until May 12, all members of the Department of Medicine can use this link to nominate nurses for their contributions and describe how they emulate the Duke Health values of Excellence, Integrity, Teamwork, Respect, and Innovation.
The Committee will communicate each nomination to the individual nurse and their manager, display nominations on a virtual bulletin board, and feature the campaign on the Department of Medicine Twitter feed. There is no limit to the number of nurses one person can nominate, and you can nominate a nurse from any location (i.e. clinic, inpatient, research).
This year more than any other, it is important to recognize the inspiring work done by our nursing colleagues and their important role in the care of our patients.
Registration Open for Friends of Nursing Gala, May 15
The Duke Friends of Nursing Board of Advisors cordially invites you to attend the 32nd Gala Celebration of Excellence! Hundreds of nurses, friends, supporters and community members attend the Gala each year to honor all Duke Nurses, and to recognize the nominees and winners of the Excellence Awards. While we can’t celebrate in-person this year, we are preparing for a very special virtual celebration. Join us for a virtual program celebrating our spirit of innovation, unwavering compassion, clinical excellence, and significant impact across Duke Health. We hope you will attend. There is no fee for this event. To learn more or to register, please visit: https://www.dukefriendsofnursing.org.
COVID-19 Updates:
All the latest official DUHS information regarding coronavirus/COVID-19 response at the following locations:
Upcoming Opportunities/Save the Date:
Virtual Town Hall
Do you have questions regarding the new clinical practice model that is being formed by the PDC, SOM, and DUHS? Join us for a virtual town hall for all members of the Duke Health community on May 3, from 5 to 6 p.m. Leaders will answer your questions about the planning process for this new clinical practice model. Panelists will include Ted Pappas, Tom Owens, and John Sampson who will share their perspectives on why change is needed now and their expectations for the path forward.
Monday, May 3rd from 5 to 6 p.m. Join the Zoom here
The Zoom link is one-click entry, however if prompted to enter a passcode it is 505478. Access to the webinar series requires authenticated access with your NetID and password. If prompted to sign in, please select to ‘Sign in with SSO’ and enter ‘duke’ when prompted for the company domain. You will be directed to log in with your NetID and password.
Submit questions in advance to DukeFP@duke.edu. A recording of the town hall will be posted on the website the next day.
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:
April 22 – Rob Califf
Club Industry
COVID-19 Patients Could Develop Chronic Health Conditions, Causing Possible Onslaught For U.S.
https://bit.ly/3gP52i5
April 27 — Duke University Hospital
WRAL
Colorful mural captures contributions of health care heroes at Duke Hospital
https://bit.ly/3vrpEkh
April 27 — Yuichiro Yano (Family Medicine)
Medpage Today
USPSTF Prioritizes Office Measurements in Hypertension Screening
https://bit.ly/3sZjMNB
April 30 — Duke Hospitals are mentioned
News & Observer
Which Triangle hospitals are the safest? Watchdog group releases latest report cards
https://bit.ly/3gQ1c86
April 30 — W. Schuyler Jones
Healio/Endocrinology
Predictive model identifies risk factors for major adverse limb events in diabetes
https://bit.ly/3xBicF3
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