It is a busy time of year for all of our teams at Duke Heart. This week there are faculty and fellows working on Capital Hill to discuss the importance of supporting Heart Health. One of our fellows NKiru Osude was a member of the American College of Cardiology group (representing North Carolina) who met with members of congress to discuss the impact of health care disparities, access to care, and the importance of covering services and care for people with heart disease or people as risk for heart disease. She is seen here taking a selfie with the whole group.
As you will see in the stories below, members of Duke Heart continue to work hard to perform research to identify ways to have our community and patients have health, from first responders in cardiac arrest research, the genetics of cardiac arrest, helping with a national cardiogenic shock registry, to studying treatments for COVID, and holding symposiums on pulmonary hypertension. The research and clinical care work at Duke Heart remain vibrant.
This time of year also has our community in full swing for a variety of fall celebrations and traditions. Halloween for the kids will be next week, we had the NC state fair this week (you can see – still some work to be done for our community’s food choices), and the upcoming American Heart Association Scientific Sessions in early November where we will have several scientific presentations from Faculty and Fellows.
For some of us this weekend also was important as the start of the celebration of Diwali. Diwali is traditionally held on the darkest night of the new moon in Autumn, and celebrates the victory of light over darkness, knowledge over ignorance, good over evil, hope over despair. In many homes it is marked by cleaning and setting up decorations, symbols, and of course many lights. Kids and families celebrate with songs, dances, and all sorts of treats. My daughter was able to perform in a traditional dance at the local temple, and we were fortunate enough to have her grandparents present. After several years of challenges to our communities, health care systems, and scientific communities, we hope whether you celebrate Diwali or not, you have some time over the fall to spend with family and loved ones. You will see in this version of the Pulse there is much to be thankful for, and many who are working to spread light, knowledge, and health in our Duke Heart Community.
Highlights of the week:
Duke Heart Teams with NC First Responders on Cardiac Arrest Trial
Duke Heart researchers are teaming up with North Carolina emergency care personnel—EMS, fire, police, 911 dispatch and community members—across the state in a pragmatic cluster-randomized trial that will test community interventions to improve survival for out of hospital cardiac arrest (OHCA), a leading cause of death in the U.S.
There are more than 400,000 out of hospital cardiac arrests a year in the U.S. with a survival rate of less than 10%. Despite 30 years of efforts by health care professionals, there is scant evidence that cardiac arrest survival odds have substantially improved. Duke researchers are focused on changing that.
The RAndomized Cluster Evaluation of Cardiac ARrest Systems (RACE-CARS) trial covers a geographic area of 62 counties involving eight million residents and expects to enroll 20,000 cardiac arrest patients over a four-year period. It is one of the first U.S. registry-based trials, such that all eligible patients are included and data are efficiently collected in routine care, an approach that has been used with great success in large, efficient clinical trials in Europe. The trial is being conducted by Duke Clinical Research Institute (DCRI) with a $15 million grant from the National Institutes of Health (NIH).
“We’ve leveraged a highly efficient clinical trial design methodology to be able to address a major public health concern in an ambitious project to test community interventions to improve survival from cardiac arrest,” says the trial’s principal investigator, Christopher Granger, MD, professor of medicine in cardiology and director of the Cardiac Care Unit at Duke. “If we’re successful, this will provide compelling evidence to guide how care is provided around the country and around the world to improve survival from cardiac arrest.”
For the trial, 62 counties were randomly assigned to intervention or control groups. Interventions are focused on community CPR and AED treatment, 911 dispatch performance, and first responder treatment for OHCA. The goal is to have more patients with cardiac arrest treated with bystander CPR and early defibrillation. Intervention counties are working closely with the trial team to carry out and evaluate trial interventions while the control groups will continue to provide their usual care.
The data collection phase began in July for the trial, which runs from July 1, 2020 through June 30, 2027, and uses the pre-existing Cardiac Arrest Registry to Enhance Survival (CARES) registry for patient enrollment, a platform previously implemented in North Carolina by the RACE CARS team. CARES collects data from 911 dispatch centers, EMS agencies, and hospitals and links that information in a single record.
In laying the trial groundwork, researchers in the last two years have surveyed current practices at the counties, reviewed care metrics in each county, created site actions plans and held in-person site visits to provide improved outcome guidance, focusing on activities that will shorten the treatment time to CPR and defibrillation during the first 10 minutes of the cardiac arrest. Each county randomized to the intervention strategy has worked with RACE-CARS investigators to develop a customized intervention strategy that is tailored to each individual agency’s unique needs and resources, and customized training plans for each level of the prehospital chain of survival. (Story continues here)
In addition to Granger, the RACE-CARS team includes Dan Mark, Lisa Monk, Monique Starks, Sana Al-Khatib, Hayden Bosworth, Hussein Al-Khalidi, Kimberly Ward, Steve Vendeventer and James Jollis. Congratulations to all on this important work!
Determining Genetic Causes for Sudden Cardiac Death
People commonly associate heart attacks with clogged arteries, fatty diets, high cholesterol, and plaque buildup in the heart. And while all those things can cause sudden cardiac death, they are not the only culprit; gene mutations can also be to blame.
Certain genetic variants can cause irregular heart rhythms, called arrhythmias, and can affect how well the heart is able to pump
blood to the rest of the body. Otherwise healthy individuals with these genetic variants can fall victim to arrhythmias that are often fatal.
Duke researchers investigated 55 genes responsible for various arrhythmia-related disorders to understand how common these
variants are and the risks they pose. Results were published in Circulation: Genomics and Precision Medicine on September 22.
The team, led by Svati Shah, MD, professor of medicine in cardiology, integrated electronic health records with whole exome sequencing data collected from 8,574 people in the Catheterization Genetics (CATHGEN) cohort, a group that had undergone cardiac catheterization at Duke University Medical Center from 2001 through 2011.
“We took an in-depth look at the entire diagnostic spectrum, from electrocardiograms to cardiac MRIs, as well as medical charts for history of syncope, arrhythmias, and all the other ways these types of conditions could manifest,” said Navid Nafissi, MD, lead author and a Duke cardiac electrophysiology fellow.
The researchers wanted to know whether patients’ symptoms met diagnostic criteria for these conditions and if there was any evidence of sub-diagnoses that might have been missed because they did not meet full diagnostic criteria.
One in 108 people in this cohort carried a pathogenic or likely pathogenic variant in arrhythmia-related genes, which means these variants may be more common in the general population than researchers initially thought.
How severe the genetic variants are, though, varies greatly. The likelihood that a particular variant might cause health problems can range from zero to as high as 83%. Issues might include dilated cardiomyopathy, which causes the heart’s ventricles to thin, stretch out, and grow larger; or hypertrophic cardiomyopathy, which causes the heart muscle to gather scar tissue and thicken. Both these disorders make it harder for the heart to pump blood to the rest of the body. Variants can also cause disorders like long QT syndrome and Brugada syndrome that cause fast, chaotic heartbeats. All of these disorders can lead to sudden death in otherwise healthy people.
“These are people who just die suddenly — without any warning signs,” Nafissi said. “Sometimes there’s no clear manifestations of cardiac disease, even in autopsy.” The heart might look completely healthy: no cholesterol build up, and sometimes no signs of scar tissue from hypertrophic cardiomyopathy or thinning ventricles from dilated cardiomyopathy.
When there is no clear reason as to why a person had a sudden cardiac death, genetic testing can help determine what happened. “Sometimes you can find a causative genetic variant in these cases,” Nafissi said, “which can allow for tailored management and cascade screening of family members.”
Current standards of care still take a reactive approach to this problem. If someone goes into sudden cardiac arrest, health care and emergency workers address the crisis and try to save the patient — but what if there was a better, more proactive approach?
Nafissi hopes this research takes researchers one step closer to utilizing genetic testing earlier to identify those who have genetic variants that could put them at increased risk of sudden cardiac arrest. But, Nafissi clarifies, “Not everyone who carries a variant will go on to have a cardiac event.”
The trick will be identifying those at highest risk and determining the appropriate preventive interventions, such as an implantable cardioverter-defibrillator or something less invasive, like lifestyle modifications or medications. “There are multiple ways that this research could lead to saving lives,” Nafissi said.
Duke Team to help Co-Lead Newly Established Cardiogenic Shock Registry
The American Heart Association (AHA) has established the world’s first professional society shock registry as part of the Get With The Guidelines registries network. Mitch Krucoff, MD, professor of medicine in cardiology at Duke will serve as co-chair of the registry along with Dr. David Morrow, director of the Levine Cardiac Intensive Care Unit at Brigham and Women’s Hospital and professor of medicine at Harvard.
Cardiogenic shock—a life threatening condition when a person’s heart can’t pump enough blood to meet the needs of the body—is most often caused by serious heart attack or advanced heart failure. Historically, data related to cardiogenic shock have been limited, inconsistent and challenging to interpret. As a result, varying treatment recommendations exist around best practices.
The new registry will help researchers, clinicians and regulators to better understand the clinical symptoms of shock types, treatment patterns and outcomes. The registry will provide a foundation for working toward improving the quality and consistency of care in patients in U.S. hospitals with cardiogenic shock symptoms. This effort has had many of our current and past Duke Faculty and fellows involved including Mark Samsky, Magnus Ohman, Joseph Rogers, and Sunil Rao.
“To understand how to improve care for cardiogenic shock patients, we first need a clearer view of the landscape of existing treatment practices for cardiogenic shock in U.S.-based acute care settings,” said Krucoff. “No organization is better positioned to advance this critical public health question than the AHA, with already established networks of sites entering data on heart failure, acute cardiac syndromes, cardiac arrest and COVID—all of which involve patients at risk of progressing to cardiogenic shock.”
The Cardiogenic Shock Registry builds on more than 20 years of quality improvement and registry experience rooted in the AHA’s Get With The Guidelines platform. Data from the registry will help inform the larger medical community on how best to treat cardiogenic shock.
“The new Cardiogenic Shock Registry will leverage the unparalleled reach of the AHA in a unique collaboration between academic clinicians and researchers, federal agencies and funding supporters’ experts to provide high-quality evidence and promote best practices for the treatment of patients with cardiogenic shock,” said Morrow.
Krucoff and Morrow both serve as volunteer experts for the AHA. The AHA’s Precision Medicine Platform, a secure cloud-computing platform, will be used to facilitate the research.
ICYMI: Boulware Named Dean of WFU School of Medicine
Ebony Boulware, MD, MPH, Director of the Duke Clinical and Translational Science Institute (CTSI), Vice Dean for Translational Science in the School of Medicine, and Associate Vice Chancellor for Translational Research at Duke University, has accepted the role of Dean of the Wake Forest University School of Medicine. She will begin her new role in January 2023. Dr. Boulware will also serve as the Vice Chief Academic Officer and Chief Science Officer at Atrium Health. She will step down from her positions at Duke on December 31, 2022, as she makes her transition to this exciting leadership opportunity.
The announcement was made on Monday by Kathleen Cooney, MD, chair of the Duke Department of Medicine and Mary E. Klotman, MD, Dean, Duke University School of Medicine.
Boulware, the Nanaline H. Duke University Distinguished Professor in the Department of Medicine, joined the Duke faculty in 2013 as Chief of the Division of General Internal Medicine in the Department of Medicine and has served as Director of CTSI and Vice Dean for Translational Science since 2016. She has spent most of her academic career investigating how to improve health care and health outcomes for individuals and populations with chronic kidney disease, hypertension, and other chronic diseases, particularly focusing on minoritized populations. In her roles at Duke, she has been instrumental in accelerating the translation of research to clinical care, and she is a national leader in addressing the causes and effects of racial and ethnic health and health care inequities.
The SOM and DOM will work with the Division of General Internal Medicine to create a transitional leadership plan as they prepare to launch a national search for a new Division Chief.
“Dr. Boulware has been a dedicated and innovative leader, and we want to thank her for her service and commitment to the School of Medicine,” said Cooney and Klotman in their statement. “She made significant contributions to the Department of Medicine in her role as Division Chief and generously mentored many faculty members within and outside of the Division. Her passion for addressing health inequities and improving our approach to diversity, equity, and inclusion has profoundly strengthened our department. We know you will join us in congratulating Dr. Boulware.”
Personally, Ebony has been a leader across so many areas a Duke – she will be missed. We are excited for her and will look forward to continuing to collaborate on making NC a healthier state! Congratulations – Ebony!
Nicholls, Chen Join Duke Heart APP Team
Please join us in welcoming two new APPs to our Duke Heart team!
First, we are welcoming Stephanie Nicholls, a nurse practitioner, back to our team. She will be working at South Durham Clinic with Michael Blazing, and at Duke Cardiology Arringdon. Nicholls is originally from a small town in Maine and moved to NC in 2013 to work at Duke. She was initially in the CTICU and then went on to serve as a heart transplant coordinator. She met her husband at Duke and they now have two children — Emma, 3, and Luke, 1. She lives in Durham and can typically be found chasing children around The Museum of Life and Science. She enjoys the great restaurant scene in Durham and going to the beach. She has always enjoyed being a part of the vibrant Duke community and is excited to join her new team.
Karina Chen, a physician assistant, will be at Duke Cardiology Arringdon working with Cary Ward and the DHP group. Chen grew up in southeastern Michigan and attended Fordham University for her bachelor’s degree in biology. She spent some time working as an EMT and CNA before moving to Boston for PA school at Massachusetts College of Pharmacy and Health Science. After graduating, she worked at Brigham and Women’s Hospital in Pulmonary Vascular Medicine with a focus on caring for patients with pulmonary hypertension. She and her husband moved to NC in order to escape the freezing Boston winters, as well as to be closer to her parents who are now living in SC. They are enjoying trying new restaurants in the Triangle area and exploring hiking trails with their corgi, Gimli. She is excited to join the Duke Heart team.
Please welcome Stephanie and Karina to our team!
Shout-out to CT OR Team
Our cardiothoracic team managed a particularly difficult surgical case on Wednesday — a big shout-out to our incredible and dedicated multidisciplinary team! Together, they rallied, showed incredible teamwork, and the patient is doing well.
“I especially want to express my gratitude for Reeni, who scrubbed in and stayed way late to see this through to completion.” – Jacob Schroder
Congrats to all. Well done!
Duke Heart Construction Update
Construction on Cardiac Catheterization Lab 1 is due for completion by Nov. 7 with inspections taking place Nov. 7-11. The team plans to conduct their first case in Cath 1 on the afternoon of Nov. 14. A team from Philips will be present for support as well as training from Nov. 14-17. If you have any questions please contact Elizabeth Watts.
Arges Focused on Raising Vital Funds for MSA
Many of you know that Kristine Arges, RN, BSN, CCRC, left Duke Heart earlier this year after 31 years on the team. Arges is on disability leave after receiving a diagnosis of Multiple Systems Atrophy-Cerebellar (MSA), a rare, incurable neurodegenerative disease that can rapidly progress.
Due to elusive symptoms that appeared over time and seemed unrelated to each other, she went several years before being diagnosed. The disease has progressed fast, and she is now walker- and wheelchair-dependent. After her diagnosis, she began reading up on MSA and says she was shocked to find there are few treatment options and little research being done. She reached out to Mayo Clinic after learning about the work of Dr. Wolfgang Singer, an associate professor of neurology who has completed phase-one research showing that disease progression of MSA could be slowed through the infusion of autologous mesenchymal stem cells. The research looks promising. Arges qualified for the study and enrolled; she is three months in and has completed two infusions of either stem cells or placebo, 2:1.
Having grown up in Manhattan, she earned her BSN at Columbia School of Nursing and quickly found work in a neuro-surgical stepdown at Columbia-Presbyterian. Two years later, she was ready to leave New York City behind her and chose Durham, NC as her next home.
Arges applied at Duke Hospital where there was a need for nurses on 3200; she started on the unit in 1991. Once she made the switch to cardiology care she never looked back. Arges says she developed her sea legs in the ACU and then joined the heart failure research group under Chris O’Connor, MD. There, she eventually coordinated the PRAISE 1 & 2 studies, noting that O’Connor always inspired a healthy sense of competition – and that he and she, ‘Chris and Kris,’ were always vying to be the top enrollers. Kris went on to coordinate many trials in the HF group such as BEST, OPTIME, and CHARM to name just a few.
Pictured here with longtime friend Stephanie Kerr, RN, MSN, at a party celebrating the successful conclusion of the PRAISE 1 trial.
She joined Duke’s Cardiac Diagnostic Unit in 2003 and conducted imaging trials with many of ‘the greats’ in Duke Cardiology, including Jamie Jollis, Joe Kisslo, Zainab Samad, Jerry Bloomfield, Pam Douglas, Eric Velazquez, Michel Khouri, Sreek Vemulapalli and, of course, Fawaz Alenezi. Kris became a “lifer” in the CDU and spent the remainder of her career there. She wore many hats in the CDU – as a stress-nurse one day per week, and as an intermediary for study coordinators in various disciplines who needed tests done on their research patients.
In the “old days,” she says, there wasn’t a system in place to help sonographers know which images to acquire. With the trend in clinical trials to monitor cardiac safety, more and more studies required echocardiograms on study patients. In addition to organizing a system of imaging instructions for what came to be more than 100 research clinical trials, she coordinated contrast perfusion studies in ultrasound; helped manage core lab work at the Duke Clinical Research Institute; and in the lab, she coordinated amyloid studies – including the ATTRACT trial (which became Tafamidis), served as the REMIT nurse working with Wei Jiang, MD for several years, and coordinated a number of studies with the Biomedical Engineering group.
In her last ten years at Duke, she served as lead CRC of Cardiac Imaging. She shared this role with Michele Parker in MRI. Kris’s research group was multi-disciplinary — a microcosm of life in the CDU– consisting of exercise physiologists, sonographers, nurses, clerical assistants, and students.
“Perhaps the thing I loved most about my job was the ever-present variety of people, patients, and disciplines,” said Arges. “Never was there ever a dull moment. The CDU was the place to be.”
Arges and others are working to raise funds to ensure that all 70 patients currently enrolled in the clinical trial can receive compassionate use of stem cells upon completion of Phase 2. All patients involved “have everything to lose if funds are not raised to buy them time until a new treatment or cure is found,” Arges says.
Saddened to have left her role at Duke, Arges is resolved to keep fighting as long as she can. She thinks fondly of her time at Duke Heart, misses her former co-workers, and wishes all of us a belated and fond farewell.
Arges is open about her life with MSA and wants to raise awareness of this poorly recognized disease. She has created a ‘legacy page’ which lives on the Defeat MSA Alliance website where you can learn more about MSA as well as donate. Kris says that she would be honored if you considered supporting her and others with this condition.
Kris is shown here with members of her Duke research group. L-R are: Alicia Armour, Melissa LeFevre, Arges, Jennifer Tomfohr and Danielle Wilson).
You are missed, Kris!
Early Voting in NC, on Duke Campus: 2022 Election
The one-stop early voting period in North Carolina opened on Thursday, Oct. 20, and runs through Saturday, Nov. 5. During early voting, voters may cast a ballot at any early voting site in their county and would-be voters may same-day register and vote. Durham residents have the opportunity to vote at Duke University’s early voting site on campus in Karsh Alumni Center (2080 Duke University Rd, Durham, NC 27708). Multiple early voting sites are available in Durham, Wake, Orange, Person, and Alamance counties. Early voting locations in each county can be found on the NC State Board of Elections website.
Voters who choose to vote by mail may request an absentee ballot until Tuesday, Nov. 1 at 5 p.m. All absentee ballots must be postmarked by 5 p.m. on Election Day and received by Nov. 14 at 5 p.m. Voters who have already requested an absentee ballot may drop it off at any early voting site in-person, either for themselves or a close relative. Absentee ballots may also be returned to the local board of elections office or a designated drop-off site by 5 p.m. on Election Day. Voters can make sure their absentee ballot was received by using Ballottrax, an absentee ballot tracking site operated by the State Board of Elections.
- October 23-29 is Respiratory Care Week. Please send some love their way this week!
- DukeALERT testing was performed this week. Please make sure you’re familiar with the several ways in which you would be informed in the event of an emergency. You can find great information on the Duke Emergency Management Website as well as the DUHS Preparedness and Response Center.
- October is Medical Ultrasound Awareness Month – thank a sonographer!
- Open Enrollment is now open through Oct. 28. This is your opportunity to review your medical, dental, vision, and reimbursement account benefit elections and make any changes necessary to ensure your choices continue to meet your needs. You should have received a copy of the annual Open Enrollment Guide in the mail from Duke HR.
- The DUHS annual flu vaccination campaign is underway. The deadline for staff vaccinations is Tuesday, Nov. 15 at 10 a.m. Vaccination sites for faculty and staff can be found here: https://flu.duke.edu/vaccination/employees/
Upcoming Events & Opportunities
Cardiology Grand Rounds
October 25: No CGR this week.
CME & Other Events
October 17-28: Open Enrollment period for 2023 for all Duke faculty and staff.
October 28: Duke Caregiver Community Event, in-person conference. Details here: https://duke.is/nzbcp.
November 4: 14th Annual NC Research Triangle Pulmonary Hypertension Symposium. 7 a.m.-4 p.m. This will be an in-person event at the Durham Convention Center. Registration required. To learn more and register, visit: https://duke.is/jag2b
November 14: Prostate Cancer & CVD Symposium, Webinar 4. Final of a four-part webinar series. Collaboration between the International Cardio-Oncology Society & Duke Heart. Noon, Eastern. Free. To register visit https://duke.is/ptjbs.
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 email@example.com. We would love to hear about your latest accomplishments, professional news, cool happenings, and any events or opportunities that may be of interest to our Duke Heart family. Please call with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon, Wednesdays, to be considered for weekend inclusion.
Duke Heart in the News:
October 14 — Mark Sendak (DIHI)
The Medical Futurist
October 17 — Joseph Turek and the Sinnamon family
WAFF TV-48 (Huntsville, AL)
*clip begins @ 12:24:34
October 18 — Duke Health
Becker’s Hospital Review
October 19 — Shahzeb Khan, G. Michael Felker & Marat Fudim
October 19 — Adrian Hernandez & Susanna Naggie
CBS-17 WNCN/cbs17.com (Raleigh)
October 20 — Adrian Hernandez & Susanna Naggie
HealthDay News/U.S. News & World Report