Duke Heart Pulse — January 7, 2024 – The Pulse

Pulse – January 7, 2024

Highlights of the week:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

First Barostim Implant Performed at Duke

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

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

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

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

161 Hearts Transplanted at Duke in 2023

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

Kudos to all!

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

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

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

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

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

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

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

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

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

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

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

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

Preclinical data was supported by the Brett Boyer Foundation.

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

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

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

Something’s Not Right

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

Cardiac Sarcoidosis Diagnosis

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

Recognized Sarcoidosis Clinic

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

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

Treatment Plan Includes Heart Device

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

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

A Dangerous Flare

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

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

Looking Forward

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

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

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

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

Selvaraj Receives FSR Research Grant Award

Congratulations to Senthil Selvaraj!

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

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

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

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

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

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

1st DUH BEE Award Recognizes Simpson

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

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

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

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

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

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

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

Great work! Congratulations to all!

New Visitor Restrictions In Effect, Jan. 3, 2024

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

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

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

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

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

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

Upcoming Events & Opportunities

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

Cardiology Grand Rounds

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

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

CD Fellows Core Curriculum Conference

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

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

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

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

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

Meeting Objectives:

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

Click Here to register!

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

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

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

Upcoming CME Symposia for Spring, 2024

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

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

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

Have news to share?

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

Duke Heart in the News:

December 11 — Harry Severance

ACEP Now

More Hospitals are Closing

December 18 — Jonathan Piccini

Medical Dialogues (India)

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

December 19 — Harry Severance

Becker’s ASC Review

10 ASC leaders’ thoughts that rocked 2023

December 19 — Manesh Patel

WRAL-TV Raleigh