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Chief’s message:  Highlights and some updates on the cardiology field

Hope you all had a good week.  This episode of the pulse will welcome a new CT surgery faculty member, we will have a few highlights from the week, and we will be working to get everyone excited for the Triangle Heart Walk with the American Heart Association on October 3^rd.  Register a team, join us for the walk.

The story dominating the cardiology conversation this week continues to be ZEUS: Novo Nordisk’s trial with ziltivekimab (IL-6 ligand inhibitor) that missed its primary endpoint in the phase 3 outcomes trial — HR 0.99 for 3-point MACE in ASCVD/CKD patients with elevated inflammation, despite confirmed target engagement (hs-CRP and free IL-6 both dropped as expected). Given the inflammatory hypothesis – with evident data around relationship – it’s forcing a real reckoning with the inflammatory hypothesis of atherosclerosis less than a year after ACC’s own scientific statement endorsed factoring inflammation into risk assessment. CANTOS gave the hypothesis its first foothold in 2017; ZEUS is arguably the cleanest, largest test of direct IL-6 blockade since, and it came back neutral. Two related trials are still live — HERMES in HFpEF and ARTEMIS post-AMI — both reading out in H1 2027, so this isn’t necessarily the final word on the target in this pathway, but it’s a gut-check moment.  I also think there are some upstream targets that will be important test. We will also in this upcoming week faculty meeting be discussing some prevention and science at the start of the meeting and can discuss with faculty at that time.

Other things crossing the cardiology wire this week for me:

• TAVR at 10 years — JACC published a look-back at long-term TAVR durability data (Aug 14), reopening the durability-vs-SAVR debate for younger, lower-risk patients — relevant given our structural volume.
• Some data that under 30 minutes/day of moderate-vigorous activity may be enough to offset most inactivity-related CV risk — useful soundbite for our prevention/rehab messaging.
• Continued conversations on social media and some pushback on the 2026 AHA/ACC/Multi-society dyslipidemia guideline — worth having our groups think about how we can continue to clarify for our patients.
• Smaller items: a case report on a HYROX competitor’s cardiac arrest prompting sports cardiology warnings about ignoring prodromal symptoms during competition including this high-intensity competition; new data suggesting PREVENT risk equations outperform legacy models in Native American populations; and a study noting LLMs generate inadequate dietary plans for hypertensive patients — the latter is a cautionary note for our teams working on AI management tools and evaluation systems.

Highlights of the week:

Vigneshwar to Join Cardiothoracic Surgery Faculty

Navin G. Vigneshwar, MD, MPH, will join the Duke Department of Surgery faculty as an assistant professor in the Division of Cardiothoracic Surgery in September, following completion of his cardiothoracic surgery fellowship at Duke.

Vigneshwar’s practice will include heart and lung transplantation, mechanical circulatory support — including ventricular assist devices (VAD) and extracorporeal membrane oxygenation (ECMO) — and adult cardiac surgery.

“I’m looking forward to finally practicing cardiac surgery after 10 years of training,” Vigneshwar said. He is also eager to work with Duke residents and pursue opportunities for research collaboration across the university.

Among his early areas of focus will be helping bring a novel donor heart recovery technique to Duke known as Rapid Recovery with Extended Ultra-Oxygenated Preservation (REUP). The technique allows for recovery of hearts donated after circulatory death without reanimation before transplant and has enabled extended ischemic times. Vigneshwar is particularly interested in investigating the mechanisms underlying the approach and its potential applications in transplantation.

For Vigneshwar, remaining at Duke also means beginning his faculty career alongside the colleagues and mentors with whom he has trained.

“The mentorship from senior surgeons as I start a career in heart and lung transplant and adult cardiac surgery is the main reason I chose to stay,” he said. He also pointed to the strength of Duke’s multidisciplinary teams, including colleagues in cardiac anesthesia, heart failure and interventional cardiology, and the OR and ICU.

“I can’t imagine surrounding myself with a better group of colleagues to start my career.”

Vigneshwar earned his undergraduate degree from the University of Virginia and his medical degree from Virginia Commonwealth University School of Medicine. He completed general surgery residency at the University of Colorado, where he also earned an MPH in applied biostatistics, before coming to Duke for cardiothoracic surgery fellowship. His academic interests include heart and lung transplantation, mechanical circulatory support, and organ preservation.

Outside the hospital, Vigneshwar is an avid mountain biker and enjoys playing guitar.

Please join us in congratulating Navin on completing his fellowship and in welcoming him to the Duke Heart & Vascular faculty!

 

Duke Among Top Enrolling Sites for RECHARGE Trial

Duke is among the nation’s leading enrolling sites for a clinical trial designed to address an important evidence gap in coronary revascularization among women and Black and Hispanic patients.

Duke has enrolled 19 participants in the RECHARGE Trial (REvascularization CHoices Among underRepresented Groups Evaluation) and is currently the second-highest enroller among approximately 96 participating sites.

RECHARGE is a Patient-Centered Outcomes Research Institute (PCORI)-funded research program comparing coronary artery bypass grafting (CABG) with multivessel percutaneous coronary intervention (PCI) in two parallel randomized trials: one enrolling women of any race or ethnicity and another enrolling Black or Hispanic patients of any sex. These populations have historically been underrepresented in randomized trials comparing coronary revascularization strategies.

The study is designed to help fill that evidence gap by examining survival and health-related quality of life following CABG or PCI. Participants are followed for a minimum of three years.

At Duke, RECHARGE is led by site co-principal investigators Brittany A. Zwischenberger, MD, MHSc, associate professor in the Division of Cardiothoracic Surgery, and Andres M. Pineda Maldonado, MD, assistant professor of medicine in the Division of Cardiology.

Potential participants must be at least 18 years old and have multivessel or left main coronary artery disease for which revascularization is intended, and the care team determines that either CABG or PCI would be an appropriate treatment option.

The national study is led by Mario Gaudino, MD, of Weill Cornell Medicine, and Gregg Stone, MD, of the Icahn School of Medicine at Mount Sinai. Recruitment is expected to continue for at least two more years or until the study’s overall enrollment goal is reached.

Help Duke keep the momentum going: Clinicians who identify a potentially eligible patient can contact Zwischenberger or Pineda, or reach out to study research coordinator Camryn Black.

 

Join Us at the 2026 Triangle Heart Walk

At Duke Health, nothing unites us like doing good together! It’s what each one of you does each and every day, and for that, we are so grateful.

We want to thank all those who served as Heart Walk coaches and walkers in our 2025 walk. It was a terrific event! Together, we raised more than $123,000 for the American Heart Association, with 1,013 Duke Health team members participating.

We are pleased to share that Duke Health is serving as a lead sponsor of the 2026 Triangle Heart Walk.  On Saturday, October 3, please join us again as we walk alongside our colleagues, family members, friends, and many of our cardiovascular patients to celebrate our community.

We are honored to support this fun, family-friendly event again and look forward to your participation this fall. The Heart Walk is the American Heart Association’s premier fundraising event, drawing communities together from across the U.S. to raise funds and celebrate progress in the fight against heart disease and stroke. This year’s Triangle Heart Walk will unite us in our commitment to living heart-healthy lifestyles and raising lifesaving funds, all while having a fun time together!

This year, we have set a goal for Duke Health to register 250 teams, with 10 people per team, and to raise $170,000. We need your help to accomplish this. Please consider signing up as a team captain to lead a Heart Walk team or simply join one as a walker.

The American Heart Association is one of the largest non-federal funding sources of cardiovascular research in the country. AHA-supported research informs the guidelines, treatments, and prevention efforts our teams use every day, so the dollars we raise come back to our own patients, our colleagues, and our community.

Register for the Heart Walk by Wednesday, Aug. 19, to receive a Duke Health Heart Walk T-shirt. Shirts will be distributed in advance of the Walk through Duke Health team captains.

We hope you’ll join us on Saturday, October 3, at Coastal Credit Union Music Park at Walnut Creek as we walk together in support of healthier hearts and healthier communities.

Let’s make this year the most successful showing for Duke Heart & Vascular yet!

 

Heart Ma’am, AHA Torch Back at Duke This Week

The AHA mascot (“Heart Ma’am”) and the AHA Triangle Torch will be at Duke this week – so be on the lookout! Heart Ma’am will be at Duke North and the Duke Medicine Pavilion on Tuesday, Aug. 18, for visits to Heart & Vascular units. There will be treats, a lot of AHA spirit, and opportunities for photos. The Torch will also arrive Tuesday and spend the week on the 8th floor of the HAFS building.

The visits are part of generating enthusiasm and participation ahead of the 2026 Triangle Heart Walk, set for Saturday, Oct. 3. Register for the Triangle Heart Walk by Aug. 19 to be guaranteed a Duke Heart Walk T-shirt.

Let’s go, team!!!

 

Luggage Donations Needed for Duke Heart for Honduras

The Duke Heart for Honduras team is seeking donations of old or gently used suitcases and luggage to help transport medical supplies and equipment during its upcoming mission trip to Tegucigalpa, Honduras, in September.

Duke Heart for Honduras is a volunteer cardiac surgery mission led by Duke physicians, trainees, and staff in partnership with local healthcare providers. This year, the team plans to perform approximately 15 lifesaving cardiac surgeries at no cost to patients while also providing education and training opportunities for Honduran healthcare colleagues.

Donated luggage will be used to transport needed medical supplies and equipment to Honduras and will remain there for continued use by local healthcare providers and hospitals. Donated luggage will not be returned.

Have a suitcase to spare? Please bring donations to Lauren Parker in CARL Room 250 by Aug. 30. Those for whom CARL is not convenient may contact Lauren at 804-332-4723 or lep52@duke.edu to coordinate an alternate pick-up time and location.

Thank you for helping Duke Heart for Honduras prepare for another important mission!

 

Kudos to Shah, Team for Outstanding Patient Care

Kudos to Nishant Shah, MD, and a multidisciplinary Duke Heart team for their exceptional teamwork and dedication to patient care during a recent unexpected situation.

A patient with stable but sustained ventricular tachycardia (VT) was scheduled for a transesophageal echocardiogram (TEE) and direct-current cardioversion (DCCV), but the procedure could not be completed during regular operating hours. When notified, Shah and team quickly coordinated to perform the procedure after hours, successfully cardioverting the patient.

Janny Sweetow, DNP, recognized the team for their initiative, professionalism, and collaboration, noting that their response exemplified Duke University Hospital’s core values.

Team members recognized include:

• Nishant Shah, MD
• Jordan Franklin, MD, Cardiology fellow
• Hedva Katz, RN
• Emily Luis, RN
• Caroline Burchett, RN
• Jeff Mills, CRNA
• Anne Cherry, MD, Anesthesiology
• Crosby Culp, MD, Anesthesiology
• Danielle McCarthy, Sonography

Thank you to the entire team for going above and beyond to ensure this patient received the care they needed. Great job!

 

Kudos to CVICU Team for Exceptional Care

A heartfelt shout-out to members of our Cardiovascular Intensive Care Unit (CVICU) and Heart teams for the exceptional care they recently provided to a patient and her family during a frightening and uncertain time.

The patient’s family member, who is also a nurse, shared her gratitude for a team that not only provided outstanding clinical care, but also recognized and supported her needs as both a loved one and a healthcare professional.

She particularly recognized Clara, her family member’s primary nurse, who patiently answered questions, talked through assessments and other aspects of care, and understood her need to remain involved.

“She spoke with me as though I was a colleague and a family member,” she shared. “Her allowing me to ask questions and talk with her gave me a sense of purpose and control in a time where I had no control and felt helpless.”

She also recognized Taylor for her confident and compassionate care and for helping make transitions in care feel seamless, and Cheryl, whose “wit and humor” and comforting confidence came at just the right time.

She expressed gratitude to Dr. Etter and team for keeping the family involved in care and decision-making, listening to concerns and making themselves available to answer questions. She also thanked Jason Koontz, MD, and the EP team, as well as the many others who cared for her family member during the hospitalization.

“I cannot thank the team enough,” she wrote.

Thank you to everyone involved for providing this patient and family with skillful, compassionate care — and for demonstrating how much communication, kindness, and inclusion matter during some of our patients’ and families’ most difficult moments.

Way to go!

 

Upcoming CME Events & Opportunities

Cardiology Grand Rounds

Sept. 8: ESC Updates with Christopher Granger, MD. 5 p.m. DN2002 and via Zoom.

Sept. 15: Powering Genomics with Health IT with Jeffrey Balser, MD, PhD, President and CEO, Vanderbilt University Medical Center. 5 p.m. DN2002 and via Zoom.

Sept. 22: Cardiology, Immunology and Rheumatology with Antonio Abbate, MD, PhD, of UVA Health. 5 p.m., DN2002 and via Zoom.

Sept. 23: A Primate Genetic Model Organism for Cardiovascular Disease with Stephen Chang, MD, PhD of Stanford Medicine. 5 p.m. HAFS 7683. This special CGR session will be in person only.

Until then, please enjoy past recordings. All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Registration is now open. Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.
• January 9: Duke EP Symposium. Course director is Jon Piccini. Location: JB Duke Hotel.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

Triangle Heart Walk

The American Heart Association’s 2026 Triangle Heart Walk will take place on Saturday, October 3, 2026, at Coastal Credit Union Music Park at Walnut Creek, 3801 Rock Quarry Road, Raleigh.

The Walk is expected to start around 9:30 a.m., but that may change. Stay tuned for a more formal announcement from the AHA. Meanwhile, registration for team captains and walkers is open!

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

Chief’s message:   Heart walk and impactful science – ongoing story of White Blood Cell Count and Acute MI 

Please see the notes below about the AHA Heart Walk.  We will be setting up teams and sending a note to the broader community tomorrow.  We are really looking forward to a tremendous local Duke Turnout at the Heart walk this year and have some fun competitions and videos coming to engage everyone.

In the science of CV this week – I was interested by a continuing story around immune cell interactions around Acute Myocardial Infarction. 

Worth a read this week: A paper worth your attention is the STEMI neutrophil progenitor work out of the Richter group, published in Nature Cardiovascular Research with a News & Views from Thurston and Mills on August 3rd. The core finding: emergency granulopoiesis after STEMI pushes genuinely immature preneutrophils — not just the usual left-shift neutrophilia we already track — into peripheral blood, and the degree of that mobilization outperforms our established biomarkers for predicting 30-day mortality. Detectable on a standard automated blood counter, this isn’t a research-only assay sitting years from the bedside.

Worth noting: this is really the third act of a story our own institution helped write. Our DCRI teams and  colleagues (Barron, Cannon, and later Chris Granger, Paul Armstrong and others via CARDINAL and APEX-AMI – a trial I was a DCRI Fellow on) established over 20 years ago that elevated WBC count on admission independently predicts in-hospital and 30-day mortality after AMI, and later tied that signal mechanistically to reduced epicardial flow and larger infarct size. That descriptive WBC-mortality association is what motivated our complement-inhibition push with pexelizumab — the hypothesis that blocking C5 activation upstream would blunt the leukocyte-driven reperfusion injury we were seeing in the WBC data. APEX-AMI (we were fortunate to also have the MRI substudy with biomarkers) ultimately didn’t move the needle on clinical outcomes, and Martel/Granger’s substudy gave us the mechanistic postmortem: pexelizumab suppressed C5a but failed to inhibit terminal complement complex (sC5b-9) assembly, which likely explains why downstream leukocyte activation, and mortality, weren’t meaningfully affected. In hindsight, we were looking at the right signal (leukocyte burden as a marker of injury severity) but intervening at the wrong node, and with a drug that didn’t fully hit its target.

The Richter paper essentially picks up where we left off — swapping a crude WBC count for a maturation-stage-resolved readout (preneutrophils specifically) that’s mechanistically closer to the bone marrow stress response itself, which may be why it’s outperforming legacy markers. Given our own history here, I think there’s a natural translational angle for Duke Heart, Precision Health, and DCRI to revisit: could preneutrophil fraction identify the subgroup of STEMI patients who would benefit from a complement- or neutrophil-targeted therapy, in a way unselected enrollment in APEX-AMI couldn’t?

The clinically relevant core finding: emergency granulopoiesis after STEMI pushes genuinely immature preneutrophils — not just the usual left-shift neutrophilia we already track — into peripheral blood, and the degree of that mobilization outperforms our established biomarkers for predicting 30-day mortality – is something that we could both follow, test, and target therapies for today.  I write this with the knowledge that this last week also saw a study in patients with chronic Kidney disease not get benefit from IL-6 inhibiiton (the Zeus) trial.  Lots of reasons for that – that we can discuss.  All of this is for our teams to think about with ESC coming up at the end of the month.

Highlights of the week:

Davis Leads New ASE Guideline on Sonographer Safety

Congratulations to Ashlee Davis, chief technologist for the Cardiac Diagnostic Unit at Duke University Hospital, who served as chair of a new American Society of Echocardiography (ASE) guideline focused on protecting the long-term health of cardiac sonographers.

Guidelines for the Prevention of Work-Related Musculoskeletal Disorders for Cardiac Sonographers: Recommendations from the American Society of Echocardiography provides evidence-based recommendations for addressing a significant occupational health concern: work-related musculoskeletal disorders (WRMSDs) affect up to 90% of cardiovascular sonographers.

The guideline addresses ergonomic equipment and workplace design, safe scanning practices, scheduling strategies, early recognition of symptoms, and emerging technologies that may help reduce injury risk. Importantly, it emphasizes that preventing these injuries is a shared responsibility among sonographers, healthcare organizations and administrators, educators, and equipment manufacturers.

“For too long, musculoskeletal injury has been viewed as an expected part of being a cardiac sonographer,” Davis said. “This guideline challenges that mindset by demonstrating that many of these injuries are preventable through thoughtful design, education and organizational commitment.”

Congratulations to Ashlee on her national leadership in this important work to support the health, safety and longevity of the cardiac sonography workforce. Excellent work!

 

Heart Ma’am Brings Heart Walk Spirit to Duke Heart

Heart Walk season is underway, and a familiar red friend helped spread the word across Duke University Hospital this week!

Heart Ma’am joined Duke Heart team members for visits to 7100, 7200, 7300 and 6300, bringing plenty of Heart Walk spirit — along with opportunities for photos and selfies with teams across the units.

The visits are part of Duke Heart’s efforts to build excitement and participation ahead of the 2026 Triangle Heart Walk, set for Saturday, Oct. 3.

Missed her this time? Heart Ma’am will return to DUH on Tuesday, Aug. 18, for another round of visits with Duke Heart & Vascular units.

Ready to join us? Register for the Triangle Heart Walk by Aug. 19 to be guaranteed a Duke Heart Walk T-shirt!

Let’s go, team!!!

 

DUHS & SOM Updates:

Brandon to Retire as DUHS Chief People Officer

Rhonda Brandon, senior vice president and chief people officer for Duke University Health System, has announced plans to retire at the end of June 2027 after more than a decade of leadership at Duke Health.

Since joining Duke Health in 2016, Brandon has led the transformation of the DUHS Human Resources function, including the development of systemwide approaches to recruitment, performance coaching, employee engagement and HR business partnerships. She also championed affinity groups, Duke Health’s Culture Commitment work and efforts to foster an inclusive workplace centered on the belief that “we are people taking care of people.”

DUHS will launch a national search for its next senior vice president and chief people officer. Additional opportunities to celebrate Brandon and her contributions to Duke Health will be shared in the months ahead.

 

Paulson to Step Down as Chair of Radiology

Erik K. Paulson, MD, Robert J. Reeves Distinguished Professor of Radiology, will step down as chair of the Duke Department of Radiology on March 31, 2027, after 13 years of leadership. He will remain at Duke as a faculty member, continuing to contribute to the School of Medicine’s academic, research and clinical missions.

During Paulson’s tenure, the department experienced significant growth, with the number of clinical faculty more than doubling and imaging services expanding across Duke Health. The department also strengthened its education and research programs and is recognized as an international leader in laboratory and clinical investigation.

A national search for the next chair will be led by Ben Alman, MD, chair of the Department of Orthopaedic Surgery.

 

Meet Our Newest Colleagues: Flobot, R2-DU and Wall-D

This fall, three new team members join Duke University Hospital — though you won’t find them on the schedule. Flobot, R2-DU and Wall-D are autonomous delivery robots, introduced through the Duke Care Innovation Collaborative, that will carry medications and supplies throughout the hospital.

Tasks like these can take up to 30% of nurses’ time each shift. By taking them on, the robots are designed to give frontline teams more time for what matters most: caring for patients.

“Every minute a nurse spends walking across the hospital for supplies is a minute not spent with a patient,” said Chantal Howard, chief nursing and patient care services officer. “Flobot, R2-DU, and Wall-D are here to give that time back, so our teams can focus on what they do best.”

Thank you to everyone who helped name our new colleagues and to the teams preparing to pilot them across DUH.

 

Upcoming CME Events & Opportunities

 

Cardiology Grand Rounds

CGRs have concluded for the summer. We will return in the fall! Meanwhile, please enjoy past recordings.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Registration is now open. Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.
• January 9: Duke EP Symposium. Course director is Jon Piccini. Location: JB Duke Hotel.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

 

Triangle Heart Walk

The American Heart Association’s 2026 Triangle Heart Walk will take place on Saturday, October 3, 2026, at Coastal Credit Union Music Park at Walnut Creek, 3801 Rock Quarry Road, Raleigh.

The Walk is expected to start around 9:30 a.m., but that may change. Stay tuned for a more formal announcement from the AHA. Meanwhile, registration for team captains and walkers is open!

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

Chief’s message:  Improving CV Care in North Carolina

A proud week for Duke Heart. Duke University Hospital and our partners across the state earned the AHA’s 2026 Mission: Lifeline® Systems of Care Regional Award for STEMI care — recognition that means a lot given that our own Chris Granger and Jimmy Jollis and many others built the RACE program here in 2005, the model that became Mission: Lifeline nationally. Two decades later, that collaborative spirit between hospitals and EMS across North Carolina is still delivering results. Duke University Hospital also earned the AHA’s Commitment to Quality Award, one of only 222 hospitals nationwide to hit Silver-level or higher across at least three Get With The Guidelines® programs — a real marker of consistency, not a single good quarter. And we’re sending off Paige Rossman, PA-C, who retired this week after 32 years caring for Duke Heart patients since 1994. Three decades of steady, compassionate care and mentoring the next generation of APPs — that’s a legacy. Congratulations and thank you, Paige.  As is the case every academic year – we have entered August and will be introducing our new fellows and residents to our community.  Finally – that American Heart Association work will be highlighted in coming weeks as we get ready for the local Heart Walk – so get your teams registered and ready for this year.

Highlights of the week:

North Carolina STEMI System Earns Mission: Lifeline Regional Award

Congratulations to Duke University Hospital and its partners across North Carolina on earning the American Heart Association’s (AHA) 2026 Mission: Lifeline® Systems of Care Regional Award.

The recognition honors regional collaboration among hospitals, EMS agencies, and other healthcare partners to deliver high-quality, evidence-based care for patients experiencing ST-elevation myocardial infarction (STEMI), one of the most serious types of heart attacks. The award recognizes the region’s collective achievement in meeting AHA Get With The Guidelines®–Coronary Artery Disease quality standards.

The recognition is especially meaningful for Duke. The AHA’s national Mission: Lifeline initiative grew from the Regional Approach to Cardiovascular Emergencies (RACE) program, developed at Duke in 2005 by cardiologists Christopher Granger, MD, and James Jollis, MD. The pioneering North Carolina program became the model for Mission: Lifeline, transforming how hospitals, EMS agencies, and healthcare systems coordinate heart attack care across the country. Today’s recognition reflects the continued strength of that collaborative approach across North Carolina.

Congratulations to everyone across Duke and our regional partners whose continued commitment to collaboration and quality improvement made this recognition possible. Way to go!

 

Duke University Hospital Earns AHA Commitment to Quality Award

Congratulations to Duke University Hospital for earning the American Heart Association’s (AHA) Commitment to Quality Award, a national recognition introduced just last year to honor hospitals that demonstrate sustained excellence across multiple Get With The Guidelines® quality programs.

To receive the award, hospitals must achieve Silver level recognition or higher in at least three Get With The Guidelines programs. Only 222 hospitals nationwide earned the distinction this year, recognizing Duke’s ongoing commitment to delivering evidence-based, high-quality cardiovascular care.

Congratulations, everyone!

 

Rossman Retires After 32 Years of Caring for Duke Heart Patients

Congratulations to Paige Rossman, PA-C, who retired July 31 after an extraordinary 32-year career at Duke.

After graduating from Duke’s Physician Assistant Program in 1994, Paige began her career at Duke and made the institution her professional home for more than three decades. Throughout her career in cardiology, she provided compassionate care to patients while earning the respect of colleagues and helping educate the next generation of advanced practice providers.

“Her commitment, expertise, and steady presence have touched countless lives and helped shape the practice and culture of our team,” said Diane Sauro, MSN, ANP, NEA-BC, director of advanced practice for the Duke Heart Center. “We are deeply grateful for her many years of service and wish her all the best as she begins this well-deserved new chapter.”

Please join us in thanking Paige for her outstanding contributions to Duke and the Duke Heart Center and congratulating her on a remarkable career. We wish her every happiness in retirement!

 

DUHS Updates:

Duncan Named Sr. Administrative Leader for Musculoskeletal & Rehabilitation

Duke Health leaders announced yesterday that James Duncan, DPT, MBA, has been named senior administrative leader for Duke’s Musculoskeletal & Rehabilitation Service Line and executive administrative leader for the Department of Orthopedic Surgery.

Duncan joins Duke Health from Penn Medicine, where he served as chief operating officer for the Department of Orthopedic Surgery. In his new role, he will partner with physicians and executive leaders to advance the service line’s strategic priorities, strengthen operational excellence, and support Duke’s clinical, research, and educational missions across musculoskeletal care. He will work closely with Tyler S. Pidgeon, MD, who was recently named physician vice president for the Musculoskeletal & Rehabilitation Service Line, to help lead the service line’s continued growth and integration across Duke Health.

Congratulations, James!

 

Pidgeon Named Physician VP for Musculoskeletal & Rehabilitation

Duke Health leaders recently announced that Tyler S. Pidgeon, MD, has been appointed physician vice president for Duke’s Musculoskeletal & Rehabilitation Service Line, effective Aug. 1.

A hand, upper extremity, and microvascular surgeon, Pidgeon joined the Duke faculty in 2018 after completing fellowship training at Duke and has served as clinical associate vice chair for the Department of Orthopedic Surgery since 2024. In his new role, he will provide physician leadership for the Musculoskeletal & Rehabilitation Service Line, partnering with clinical, operational, and executive leaders to advance strategic priorities and strengthen patient care across the service line.

Congratulations, Tyler!

 

Upcoming CME Events & Opportunities

Cardiology Grand Rounds

CGRs have concluded for the summer. We will return in the fall! Meanwhile, please enjoy past recordings.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Registration is now open. Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.
• January 9: Duke EP Symposium. Course director is Jon Piccini. Location: JB Duke Hotel.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

 

Triangle Heart Walk

The American Heart Association’s 2026 Triangle Heart Walk will take place on Saturday, October 3, 2026, at Coastal Credit Union Music Park at Walnut Creek, 3801 Rock Quarry Road, Raleigh.

The Walk is expected to start around 9:30 a.m., but that may change. Stay tuned for a more formal announcement from the AHA. Meanwhile, registration for team captains and walkers is open!

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

Highlights of the week:

Duke Raleigh and Duke Regional Earn Platinum Recognition for MI Care

Duke Raleigh Hospital and Duke Regional Hospital have earned national recognition for delivering exceptional heart attack care, receiving the American College of Cardiology’s (ACC) 2026 National Cardiovascular Data Registry (NCDR) Chest Pain–MI Registry Platinum Performance Achievement Award.

The ACC’s NCDR Chest Pain–MI Registry Platinum Performance Achievement Award recognizes hospitals that consistently meet rigorous clinical standards and demonstrate sustained excellence in the treatment of heart attack patients. Platinum recognition reflects a commitment to following evidence-based clinical guidelines, improving patient outcomes and continuously advancing the quality of cardiovascular care.

“This achievement recognizes the commitment of an exceptional team dedicated to providing excellent care for every patient,” said Julie Yamadi, director of Heart and Procedural Services at Duke Raleigh Hospital. “I’m proud to be part of a team of physicians, advanced practice providers, nurses, cardiovascular invasive specialists and many others who share that commitment every day.”

For Duke Regional Hospital, the award reflects the seamless coordination required across every stage of a patient’s care.

“The Chest Pain–MI Platinum award represents far more than the work of our catheterization laboratory,” said J. Matthew Brennan, MD, MPH, interventional cardiologist at Duke Regional Hospital. “It recognizes the collaboration of EMS, emergency medicine, cardiovascular specialists, intensivists, hospital medicine teams, nurses and many others who work together to deliver outstanding care for patients experiencing heart attacks. We appreciate the recognition of the good work happening at both Duke Regional Hospital and Duke Raleigh Hospital.”

Michael Komada, MD, interventional cardiologist at Duke Regional Hospital, said the recognition is especially meaningful because it reflects the dedication of the people behind the award.

“You could feel the pride across our team when we learned we’d received this recognition,” Komada said. “Everyone works incredibly hard with the shared goal of providing excellent patient care every day, and it’s gratifying to see that commitment recognized nationally. One of our greatest strengths is our people. Many members of our team have worked together for years, creating an experienced, dedicated group that works seamlessly together on behalf of our patients.”

Komada said nationally recognized care across Duke Health’s hospitals reinforces the strength of the health system’s cardiovascular programs and gives patients confidence they will receive exceptional care close to home.

Together, Duke Raleigh Hospital, Duke Regional Hospital and Duke University Hospital have each achieved Platinum status through the ACC NCDR Chest Pain–MI Registry, reflecting Duke Health’s shared commitment to delivering exceptional, evidence-based cardiovascular care across the Triangle. Awards recognize hospitals, but they are earned by people. Behind this recognition are hundreds of dedicated professionals whose expertise, collaboration, and commitment help ensure patients receive exceptional heart attack care whenever and wherever they enter the Duke Health system.

Congratulations, everyone!

 

New NHLBI R01 Supports Research to Regenerate Injured Heart Muscle

A new grant from the National Heart, Lung, and Blood Institute (NHLBI) will support an interdisciplinary research team led by cardiologist Ravi Karra, MD, associate professor of medicine and pathology, to develop new, non-invasive approaches for delivering gene therapies directly to injured areas of the heart, with the long-term goal of helping regenerate damaged heart muscle.

The four-year NHLBI R01 grant (1R01HL178953), Non-invasive approaches for gene therapy to regenerate injured myocardium, brings together investigators from Duke and the University of North Carolina to address one of cardiovascular medicine’s most significant challenges: repairing the heart after injury.

Karra’s laboratory, located within the Duke Cardiovascular Research Center, has spent years investigating the biological mechanisms that enable heart regeneration. The newly funded project builds on that foundation by developing targeted, non-invasive methods to deliver regenerative therapies directly to injured areas of the heart.

The research combines expertise from multiple disciplines and institutions. At Duke, Karra is collaborating with Josh Huang, MD, PhD, Morris N. Broad Distinguished Professor of Neurobiology, whose laboratory developed a platform for conditional RNA therapeutics. At UNC, collaborators Phil Durham, PhD, research assistant professor in the Lampe Joint Department of Biomedical Engineering, and Paul Dayton, PhD, William R. Kenan Jr. Distinguished Professor and chair of the Lampe Joint Department of Biomedical Engineering, contribute expertise in nanobubble technology that may enable more precise delivery of gene therapies.

The project also builds on earlier support from a Duke Science and Technology (DST) seed grant, which enabled Karra’s laboratory to incorporate lipid nanoparticle technology into its research program. That early investment helped lay the foundation for the newly funded NHLBI R01, illustrating how institutional support can catalyze interdisciplinary collaborations that attract major federal research funding.

The NHLBI R01 represents a significant investment in collaborative, translational research aimed at bringing promising regenerative approaches closer to clinical application.

Congratulations, Ravi and team!

 

Michael Sketch, MD, Honored as Distinguished Emeritus Faculty

Congratulations to Michael H. Sketch Jr., MD, who was recently recognized by the Duke University School of Medicine as one of its 2026 Distinguished Emeriti Faculty. The annual honor recognizes faculty members who retired with tenured emeritus status during the previous calendar year, celebrating a lifetime of achievement and enduring contributions to Duke’s missions of patient care, research, education and service.

A nationally recognized leader in interventional cardiology, Sketch devoted more than four decades to advancing cardiovascular medicine through groundbreaking clinical research, exceptional patient care and the education of future physician leaders. During his career at Duke, he directed both the Diagnostic and Interventional Cardiac Catheterization Laboratories and the Interventional Cardiology Fellowship Program for more than 20 years, helping train generations of interventional cardiologists while contributing to advances in coronary intervention and national cardiovascular practice guidelines.

The Distinguished Emeriti Faculty recognition reflects the lasting impact Dr. Sketch has made on Duke Heart, the School of Medicine and the broader field of cardiovascular medicine. We congratulate Mike on this well-deserved honor and thank him for his extraordinary career of leadership, mentorship and service!

 

Kudos to Duke PREEMPT Team for Marking Early Trial Milestones

Congratulations to the Duke PREEMPT study site team within the Duke Heart Center Clinical Research Unit (CRU) for reaching two important early milestones in the PREEMPT clinical trial.

The NHLBI-funded PREEMPT trial is evaluating whether identifying and treating early coronary artery plaque can help slow the progression of atherosclerosis before symptoms develop.

The Duke team was the first site activated for the national clinical trial, and this week enrolled the first participant, marking two important early milestones that reflect exceptional teamwork, preparation, and collaboration.

Special recognition goes to Nishant Shah, MD, associate professor of medicine in cardiology and associate program director of the Duke Cardiology Fellowship; Niki Huffman; and Latasha Phillips for making these milestones possible. The effort was supported by the Duke Heart Center Clinical Research Unit in collaboration with colleagues at the Duke Clinical Research Institute (DCRI).

Shah described the accomplishment as “totally a team effort.”

The achievement also earned praise from Neha Pagidipati, MD, MPH, associate professor of medicine in cardiology and chief of Duke Cardiology’s Prevention Section, who wrote, “We always talk about Duke being first, and Nishant, Niki, Latasha, and the entire site team have proven that it can be done!”

Congratulations to all!

 

Cardiac Sonography Team Volunteers to Teach POCUS Skills to Duke NP Students

Members of Duke Heart & Vascular cardiac sonography team recently volunteered their time to help educate the next generation of advanced practice providers by leading a hands-on point-of-care ultrasound (POCUS) training session for students in the Duke University Nurse Practitioner Program.

During the Saturday workshop, sonographers guided students through scanning techniques, image acquisition, and the fundamentals of cardiac ultrasound views, helping build the skills needed to incorporate bedside ultrasound into future clinical practice.

The session highlights the cardiac sonography team’s expertise as educators and their important role in supporting clinical training across Duke. Special thanks to Rachel O’Brien, Viviana Lujan, Mia Henry, and Jean Woolard for volunteering their Saturday to make this learning opportunity possible.

Way to go, team!

 

Save the Date: Duke EP Symposium Scheduled       

We’re pleased to announce that Duke Heart & Vascular will host the Duke Electrophysiology Symposium on Saturday, January 9, 2027. Jon Piccini, MD, will serve as course director. The event will be held at the JB Duke Hotel. We will have more details to share soon.

 

Upcoming CME Events & Opportunities

Cardiology Grand Rounds

CGRs have concluded for the summer. We will return in the fall! Meanwhile, please enjoy past recordings.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Registration is now open. Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.
• January 9: Duke EP Symposium. Course director is Jon Piccini. Location: JB Duke Hotel.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

 

Triangle Heart Walk Date Announced

The American Heart Association’s 2026 Triangle Heart Walk will take place on Saturday, October 3, 2026, at Coastal Credit Union Music Park at Walnut Creek, 3801 Rock Quarry Road, Raleigh.

The Walk is expected to start around 9:30 a.m., but that may change. Stay tuned for a more formal announcement from the AHA. Meanwhile, registration for team captains and walkers is open!

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

Highlights of the week:

Graduating CTS Residents and Fellows Honored at Annual Finishing Dinner

Duke’s Division of Cardiovascular and Thoracic Surgery celebrated its graduating chief residents and fellows during its annual finishing dinner held on July 11, 2026, at The Cotton Room in Durham. The event marks the completion of training for seven physicians while also honoring a faculty member whose commitment to education reflects Duke’s longstanding tradition of training exceptional cardiothoracic surgeons.

This year’s graduating chief residents include Dathe Benissan-Messan, MD, who will remain at Duke to complete a six-month transplant fellowship; Navin Vigneshwar, MD, who is joining the Duke faculty as a cardiac surgeon; and Oliver Jawitz, MD, who has accepted an academic position at the Medical University of South Carolina in Charleston (MUSC).

The department also recognized four graduating fellows: Lauren Huckaby, MD, who completed the Advanced Aortic and Endovascular Surgery Fellowship and who, along with Jawitz, will join the faculty at MUSC; Papus Keita, MD, who completed the Thoracic Transplant Surgery Fellowship and accepted a position with MedStar Health in Washington, D.C.; Elliot Overman, MD, who completed the Congenital Cardiac Surgery Fellowship and will begin practice in Peoria, Illinois; and Britton Donato, MD, who completed the Thoracic Transplant Surgery Fellowship and has joined Corewell Health in Grand Rapids, Michigan.

 

During the dinner, Jeff Gaca, MD, received the annual Thomas D’Amico Teaching Award, presented each year by the graduating chief residents to recognize a faculty member who has made an exceptional impact on their education. Named for longtime Duke thoracic surgeon and educator Thomas D’Amico, MD, the award recognizes excellence in teaching and mentorship within Duke Cardiothoracic Surgery.

“It means a lot to me,” Gaca said. “We take a lot of pride in our teaching, and it means that I was able to impact the future careers of heart surgeons.”

Gaca said the recognition is especially meaningful because it comes directly from the graduating residents. Much of the technical teaching occurs during complex operations in the operating room. Still, mentorship extends well beyond surgery to include patient care, teamwork, communication, and the transition to independent practice.

“Our residents are extremely talented,” he said. “I try to guide them through these difficult operations and also try to give them pointers on how to practice, how to interact with patients, how to interact with cardiology and referring doctors.”

A Duke-trained cardiac surgeon himself, Gaca said he views teaching as an opportunity to continue the tradition of mentorship that shaped his own career.

“I had the good fortune of training here as well,” he said. “I benefited from the outstanding teachers who taught me, and I just try to keep that going.”

Congratulations to Dathe, Navin, Oliver, Lauren, Papus, Elliot, and Britton on completing their training, and to Dr. Gaca for continuing Duke’s tradition of excellence in educating the next generation of cardiothoracic surgeons!

 

Duke Heart & Vascular Welcomes Incoming Cardiovascular Fellows

We welcomed a new class of physicians to our cardiovascular fellowship programs on July 1, 2026, as trainees began the next stage of their careers. This year’s incoming class includes fellows entering the Cardiovascular Disease Fellowship as well as advanced training programs in Adult Congenital Heart Disease, Advanced Heart Failure and Transplant, Clinical Cardiac Electrophysiology, and Interventional Cardiology.

Some of the incoming fellows are continuing their medical education at Duke after completing residency or fellowship training here, while others are joining the Duke community for the first time from leading academic medical centers across the country. Together, they represent the next generation of cardiovascular specialists who will care for patients, advance discovery, and help shape the future of cardiovascular medicine.

“Welcoming a new class of fellows is one of the highlights of each academic year,” said Manesh Patel, MD, chief of the division of cardiology and physician vice president of Duke Heart and Vascular. “They are joining a community committed to exceptional patient care and scientific discovery, as well as educational excellence. We are excited to welcome them to Duke and look forward to supporting them as they learn, discover, and grow into the next generation of cardiovascular leaders.”

Before beginning clinical responsibilities, the incoming fellows participated in a week-long bootcamp designed to prepare them for fellowship training at Duke. The curriculum included Duke and Durham VAMC orientations, echocardiography bootcamp, a Cardiac Intensive Care Unit bootcamp organized by Robert Harrison, MD, an electrophysiology bootcamp organized by Nishant Shah, MD, and a simulation session led by Shah and Jawan Abdulrahim, MD.

“We are delighted to welcome this outstanding class of cardiovascular disease fellows to Duke and congratulate all of the physicians beginning advanced cardiovascular fellowship training this year,” said Anna Lisa Chamis, MD, program director of Duke’s Cardiovascular Disease Fellowship Program.

Chamis also thanked the many faculty and fellows who organized and participated in bootcamp week, with special recognition to Harrison, Shah, and Abdulrahim for leading key components of the program and helping provide a welcoming, engaging introduction to fellowship training at Duke.

Meet Our Incoming Cardiovascular Fellows

Please join us in welcoming these physicians to the Duke Heart & Vascular community.

Cardiovascular Disease

• Ryan Edwards, MD
• Joshua Ellis, MD, M.M.S.
• Jordan Franklin, MD
• Mark Hieromnimon, MD
• Amanda Jowell, MD
• Christos Kyriakopoulos, MD
• Mathew Padanilam, MD
• Katelyn Rennyson, MD
• Jameson Wilbur, MD
• Dylan Zerjav, MD

Adult Congenital Heart Disease

• Annirudh Balachandran, MD

Advanced Heart Failure & Transplant Cardiology

• Paula Rambarat, MD
• Joshua Rushakoff, MD, M.P.P.
• Seamus Hughes, MD

Clinical Cardiac Electrophysiology

• Jawan Abdulrahim, MD
• Damarcus Ingram, MD
• Eric Xie, MD

Interventional Cardiology

• Medha Biswas, MD
• Jonathan Hanna, MD
• Husam Salah, MD

Congratulations to all and welcome, new fellows!

 

Duke Expands Treatment Options for Patients with Tricuspid Valve Disease

Patients with severe tricuspid regurgitation have more treatment options today than ever before, thanks to advances in minimally invasive valve therapies and the expertise of Duke’s multidisciplinary structural heart team.

Until recently, patients with severe symptomatic tricuspid regurgitation whose symptoms persisted despite medical therapy often had few treatment options beyond surgery, which can carry significant risks and prolonged recovery. Today, Duke physicians offer both transcatheter tricuspid valve repair and transcatheter valve replacement, selecting the approach best suited to each patient’s anatomy and clinical condition.

“The addition of transcatheter tricuspid valve replacement fills an important treatment gap for patients with severe tricuspid valve regurgitation who are at higher surgical risk,” said Andrew Wang, MD, professor of medicine in cardiology. “Having both repair and replacement options allows us to choose the approach that will provide the best outcome for the patient.”

Since launching its transcatheter tricuspid valve replacement program last fall, Duke has completed 11 successful procedures using the FDA-approved EVOQUE Transcatheter Tricuspid Valve Replacement System. Physicians say the team’s early experience has been encouraging, with meaningful improvements in symptoms and quality of life.

Candidates for the procedure are individuals with severe symptomatic tricuspid regurgitation whose fatigue, swelling, and fluid retention continue despite medical therapy. Because not every patient is anatomically suited for transcatheter valve replacement, patients undergo a comprehensive evaluation that includes transesophageal echocardiography (TEE) and cardiac CT imaging. Those studies help the team determine whether transcatheter repair or replacement offers the best approach for that individual patient. 

“Transcatheter tricuspid valve replacement is for patients with severe symptomatic tricuspid regurgitation who remain symptomatic despite medical therapy,” said interventional cardiologist Andres M. Pineda, MD. “We are very excited with the results we have achieved so far. Patients have had significant improvements in their symptoms and quality of life.”

For patients whose anatomy is appropriate, the minimally invasive procedure is performed through a catheter inserted in the groin, allowing patients to recover more quickly than they would following traditional surgery. Recovery continues over the weeks that follow as heart function improves, with physicians monitoring patients closely during the process.

This effort reflects the collaborative approach that defines structural heart care at Duke. Interventional cardiologists partner with specialists in cardiac imaging, heart failure, cardiac surgery, cardiac anesthesia, nursing, and advanced practice to evaluate every patient from multiple perspectives before determining the most appropriate treatment strategy and to optimize procedural outcomes.

“This is not about offering a novel procedure. It is about bringing together the right expertise to identify the right treatment for each patient,” Wang said. “Having both transcatheter repair and replacement options for severe tricuspid regurgitation allows us to personalize care in ways we could not before.”

Our TVRR team includes Wang and Pineda, Zach Wegermann, Adam Williams, Jeff Gaca, Alina Nicora, Katherine Sun, Angela Pollak, Edana Cristy, Chelsea Tinlin, Nicole Garcia, and Mary Beth Alova.

Way to go, team!

 

Duke University Hospital Earns Platinum Recognition for Heart Attack Care

Duke University Hospital has received the 2026 Chest Pain – MI Registry Platinum Performance Achievement Award, the highest level of recognition from the American College of Cardiology’s National Cardiovascular Data Registry (NCDR).

The award recognizes hospitals that consistently meet rigorous performance measures for the treatment of patients experiencing heart attacks, reflecting a sustained commitment to delivering high-quality, guideline-directed cardiovascular care.

This national recognition is made possible through the dedication of physicians, advanced practice providers, nurses, pharmacists, rehabilitation specialists, and the many multidisciplinary team members who work together to provide exceptional care for every patient.

Congratulations and thank you to everyone whose expertise, teamwork, and commitment to excellence made this achievement possible!

 

 

Cardiac MRI Adds Saturday Scans

Cardiac MRI will be performing scans on outpatients, one Saturday per month. Yesterday, July 18, 2026, was their first Saturday! Pictured below with Terri DeMuro, CMRI nurse manager, are Rafael Rojas, Jennifer Angeles, Susan Bender, and Sherilyn Pirela — our MR Technologists and nurse — who worked on the inaugural day. Sreek Vemulapalli, MD, was the attending on service supporting these efforts.

Congratulations to the team!

 

Anyedi Helps Fuel Community Connections

Over the past year, we have mentioned Victor Ayeni, MD, a rising third-year resident in Duke’s Internal Medicine Residency Program, who has been bringing interested parties together across Duke to participate in what he calls “Resi-teering” (residency + volunteering) opportunities.

Ayeni, who has interned with electrophysiologist Camille Frazier-Mills, MD, was recently profiled by Duke School of Medicine, and we wanted to share that piece here with you:

A resident’s mission to serve beyond the clinic fuels community connections

Congratulations, Victor!

 

DUHS updates:

AlertMedia Launches July 20 to Enhance Emergency Communications

Beginning July 20, Duke University Health System will begin using AlertMedia, a new emergency notification platform that delivers faster, more targeted communications during urgent situations.

AlertMedia allows DUHS Operations to send location-specific notifications within seconds through multiple channels, including email, text message, voice call, and the AlertMedia mobile app. The platform was introduced in response to team member feedback requesting fewer unnecessary alerts and more timely, relevant communication.

AlertMedia will be used for severe weather, security incidents, IT disruptions, utility outages, and other time-sensitive operational events.

All DUHS team members are automatically enrolled to receive AlertMedia email notifications. To receive text message alerts, however, team members must log in to dukehealth.alertmedia.com using Duke Single Sign-On (SSO), add a preferred mobile phone number under My Account > Settings, and select their entity location under Preferences. Team members are also encouraged to download the free AlertMedia mobile app for the fastest notification delivery.

AlertMedia complements—but does not replace—Spok Mobile, which will continue to be used for clinical communications such as Code Blue, Rapid Response Team (RRT), and Behavioral Emergency Response Team (BERT) notifications.

Action required: Before July 20, log in to dukehealth.alertmedia.com to add your mobile phone number, verify your contact information, select your entity location, and update your notification preferences to receive emergency text alerts.

Thanks, and let’s stay safe!

 

Upcoming CME Events & Opportunities

Cardiology Grand Rounds

CGRs have concluded for the summer. We will return in the fall! Meanwhile, please enjoy past recordings.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Registration is now open. Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

Triangle Heart Walk Date Announced

The American Heart Association’s 2026 Triangle Heart Walk will take place on Saturday, October 3, 2026, at Coastal Credit Union Music Park at Walnut Creek, 3801 Rock Quarry Road, Raleigh.

The Walk is expected to start around 9:30 a.m., but that may change. Stay tuned for a more formal announcement from the AHA. Meanwhile, registration for team captains and walkers is open!

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

Chief’s message: New Year – Full Steam Ahead

Hope you all are having a fun weekend – able to see some of the world cup, spend time with family and friends, and potentially spend time outdoors if the heat is not too bad.  We are in full transition mode to the new academic year.  We had the CT Surgery finishing dinner this weekend led by Carmelo Milano – recognizing the great residents/fellows and faculty that help train our cardiothoracic surgeons. I have had the privilege of being on Acute MI call some this weekend with our new interventional fellow, and the teams on the wards, ICU, and procedure spaces are working hard and very coordinated to ensure our patients get the care they need.  Please see the stories below as you will see hopefully the continual organization and growth of Duke Heart – with two new sections (Prevention and Congenital and Structural Heart disease), a new recruit for our Anesthesiology/Critical Care group, Heart Failure research and practice improvement with meeting presentations, DukeHeart365 and the innovation jam presentation and future access models, and leading the US in a site based enrollment for a clinical trial.  New academic year – but the same mission to improve the CV health of our region, country, and beyond. 

Highlights of the week:

The Division of Cardiology continues to adapt its organizational structure to support Duke Heart & Vascular’s growing clinical, research, and educational mission. This week, we are pleased to announce two new sections—and the leaders who will guide them into the future.

Duke Cardiology Names Pagidipati First Chief of New Prevention Section

As the way we approach and treat cardiovascular disease continues to evolve, so does the way Duke Cardiology is organized to meet patients’ needs.

This summer, Duke Cardiology will establish a Prevention Section and name Neha Pagidipati, MD, MPH, as its inaugural section chief, giving cardiovascular prevention a formal leadership presence within the division. The move reflects both the growing importance of preventing heart disease before it develops or progresses and Duke’s longstanding leadership in the field. It will also help guide future investments in patient care, research, education, and community health.

While creating the section is an organizational milestone, prevention itself is not new at Duke. The Division of Cardiology has built one of the nation’s longest running cardiometabolic prevention programs, caring for patients while advancing research and innovative approaches to reducing cardiovascular risk.

Duke’s leadership in cardiovascular prevention spans decades—from Fred Cobb‘s pioneering work in preventive cardiology to Bill Kraus‘s landmark STRRIDE trials, which helped define the role of exercise in reducing cardiovascular risk. That legacy has continued through Duke’s multidisciplinary cardiometabolic prevention clinic.

“Our cardiometabolic prevention clinic has been in place for many years—longer than most other cardiometabolic clinics in the country,” Pagidipati said. “What we haven’t had is a formal seat at the table when it comes to thinking about hiring, advocating for prevention efforts and guiding those future investments.”

For Pagidipati, establishing the section is an opportunity to build on that strong foundation while creating something that will benefit Duke for decades to come.

“Our goal is to create a home for prevention that is sustainable with a lasting legacy at Duke, a legacy that will be measured by the impact on our patients and the science,” she said. “Formally creating the section now gives us a stronger foundation to continue expanding our prevention efforts well into the future.”

The section will unite Duke’s prevention efforts under a shared vision, strengthening collaboration across clinical care, research, education, and population health. It will also help expand patient access to prevention services, grow Duke’s research footprint, and develop the next generation of prevention specialists.

“Many other academic medical centers already have formal prevention sections,” Pagidipati said. “Having one at Duke will allow us to attract and retain top faculty and trainees while helping shape how cardiology contributes to broader prevention efforts across the health system.”

As the section begins its work, it represents an investment not only in today’s patients, but in the future of cardiovascular medicine at Duke—strengthening the division’s ability to prevent heart disease through innovation, collaboration, and leadership.

Congratulations to Neha and to the entire preventive cardiology team!

 

New Congenital and Structural Heart Section Joins Growing Areas of Heart Care

The Division of Cardiology is also launching a new Congenital and Structural Heart Disease Section, bringing together Duke Heart’s adult congenital and structural heart programs under a single organizational umbrella.

Cary Ward, MD, will serve as the inaugural section chief. The new section reflects the continued growth of adult congenital and structural heart care at Duke.

“These are two of the major growing areas in cardiology right now,” Ward said. “Bringing them together under one section will allow us to focus on that growth while supporting the outstanding people already doing this work.”

Ward emphasized that combining the programs will help the teams work more closely together, share expertise across disciplines, and advocate more effectively for the resources needed to expand clinical care and research. She also believes the new structure will foster innovation as physicians build on one another’s experience and clinical advances.

For the past decade, Ward has been dedicated to faculty development within the Duke University School of Medicine, supporting physicians in building meaningful and successful careers while fostering high-performing, collaborative teams. She plans to bring that same leadership approach to her new role.

“My hope is to remove barriers so that the team can focus on doing their best work,” Ward said. “We have a tremendous group of faculty; it will be a privilege to support them as they continue advancing patient care, research and education.”

Ward began serving in the role this month as the Division of Cardiology continues to evolve its organizational structure to support Duke Heart’s growing clinical and research programs.

Congratulations, Cary! And congratulations to our ACHD and Structural Heart teams!

 

Bronshteyn Joins Duke Heart & Vascular CTICU Team

The Cardiothoracic Intensive Care Unit (CTICU) will welcome a new faculty member later this month as Yuriy Bronshteyn, MD, joins the Duke Heart & Vascular team.

Bronshteyn earned his medical degree from Vanderbilt University before completing an anesthesiology residency and critical care medicine fellowship at Massachusetts General Hospital. He joined Duke Anesthesiology in 2015 and has since cared for critically ill patients in both the Surgical Intensive Care Unit and the Durham VA Intensive Care Unit.

An associate professor in the Duke University School of Medicine, Bronshteyn is internationally recognized for his expertise in diagnostic point-of-care ultrasound (POCUS). He is board-certified in critical care and transesophageal echocardiography, has authored more than 60 publications, and has served in national educational leadership roles advancing the use of POCUS in critical care.

“I am delighted to introduce Yuriy Bronshteyn, MD, to our CTICU team and broader Duke Cardiothoracic family,” said Mihai Podgoreanu, MD, associate professor of anesthesiology at Duke and chief, Division of Cardiac Anesthesiology.

Bronshteyn will begin rounding in the CTICU later this month. Please join us in welcoming him to the team.

 

Duke Heart Well Represented at National Heart Failure Meeting

Duke Health was well represented at the 2026 American Association of Heart Failure Nurses (AAHFN) Annual Meeting, held June 24–26 in San Diego.

Several Duke Heart team members served as invited faculty and presenters, reflecting the innovation and leadership across our heart failure program. Krystan Coble, DNP; Anna Mall, DNP; Stephanie Barnes, DNP; Steve Greene, MD; and Rob Mentz, MD, served as conference faculty and speakers, sharing their insights with colleagues from across the country.

In addition, Allison Fox and Katherine Adams presented Mobilizing HF Care: The Impact of Leader-Led Mobility Rounds. Their work received the conference’s Quality Improvement Award, which is featured in a separate story in this issue of the Pulse.

Fox also received the Robin J. Trupp Scholarship, an annual AAHFN award that supports nurses pursuing undergraduate, graduate, or doctoral education with a focus on advancing heart failure care.

Thank you to each of you for representing Duke Heart & Vascular so well and for sharing your work with colleagues from across the country. Great job!

 

Duke Heart 365 Earns Duke Health Innovation Accelerator Award

For patients facing a heart condition, timely access to expert cardiovascular care can make all the difference. But navigating specialty care can be complicated, and long waits for appointments often add anxiety to an already stressful time.

A Duke Heart team is working to reimagine that experience.

Their vision—Duke Heart 365—has earned the team a Duke Health Innovation Accelerator Award, recognizing its potential to transform how patients connect with Duke’s cardiovascular specialists.

The awards were presented during Duke Health’s inaugural Innovation Accelerator event on June 29, 2026, at the Trent Semans Center. Duke Heart 365 was one of four projects selected from 12 finalists after a competitive process involving 50 proposals from across the Duke University Health System. The program will provide winning teams with funding and implementation support to help move promising ideas from concept to practice.

“Duke Heart 365 is about creating a more seamless way for patients to engage with Duke Heart for their care,” said Nick Nguyen, MHA, director, finance and administration, for the Division of Cardiology and Duke Heart Center. “Patients want to come to a trusted source like an academic medical center, but they also want that experience to be as frictionless as possible.”

The initiative is designed to help patients quickly connect with a Duke cardiology expert, develop an individualized care plan, and begin the appropriate next steps as quickly as possible. Over time, the platform could bring together virtual care, digital tools, and emerging technologies to extend Duke Heart’s expertise to more patients and communities.

As envisioned, Duke Heart 365 seeks to bring Duke Heart expertise to every community, helping ensure that where a patient resides does not limit access to the specialized cardiovascular care they need nor limit their opportunity for good health outcomes.

“The future of cardiovascular care will not be defined by where care is delivered—it will be defined by how effectively we connect patients with the expertise they need,” said Manesh Patel, MD, Richard Sean Stack, MD, Distinguished Professor at Duke and vice president of Duke’s Heart & Vascular service line. “Duke Heart 365 reflects our commitment to reimagining that connection, expanding access to Duke Heart’s clinical excellence and building a model of care that will better serve patients and communities for years to come.”

The Duke Heart 365 team includes Patel and Nguyen; Camille Frazier-Mills, MD; Sreekanth Vemulapalli, MD; Chet Patel, MD; Jonathan Piccini, MD; Schuyler Jones, MD; Matt Fitzsimmons; and Jill Engel.

Congratulations to all!

 

A Simple Question Leads to Better Patient Care—and National Recognition

When Katherine Adams and Allison Fox looked at why patients on one Duke Heart Center step-down unit weren’t consistently meeting their mobility goals, they didn’t begin by asking what bedside staff were doing wrong.

Instead, they asked a different question: What could nurse leaders do differently to help?

That simple shift in perspective became the foundation of a quality improvement initiative that recently earned Adams, nurse manager, operations, for Duke Hospital 7700, and Fox, clinical nurse specialist for our Heart step-down units, the CDU, and CMRI, the Quality Improvement Podium Presentation Award at the 2026 annual meeting of the American Association of Heart Failure Nurses (AAHFN). Their presentation showcased a leader-led mobility rounding program that has improved patient outcomes by strengthening collaboration among nurse leaders, frontline staff, and patients.

The initiative began in 2024 after the team recognized that many patients were not achieving their prescribed mobility goals. Adams and Fox created weekly leader-led mobility rounds that included reviewing patient charts, talking with nurses and nursing assistants about successes and barriers, and meeting directly with patients to better understand their experiences.

Just as important as the process itself was the culture Adams and Fox wanted to create. Every conversation was designed to foster trust, encourage honest dialogue and better understand the challenges staff faced in helping patients meet their mobility goals.

“I want to make sure there’s a presence of psychological safety in every conversation a staff member has with me,” Adams said. “They should feel safe talking to me.”

That approach created opportunities not only to solve problems, but also to learn from frontline staff and work together to remove barriers that kept patients from staying active during their hospital stay.

The impact was measurable. Compliance with patient mobility goals increased from 49% to 80% among patients included in the intervention. Falls with injury declined, rehabilitation discharges decreased, and average length of stay improved.

Although the national award recognizes Adams and Fox, Adams is quick to credit the entire care team.

“This is really a reflection of our entire unit,” she said. “This is about our nurses, our nursing assistants, and everyone who helped make these outcomes possible.”

The leader-led mobility rounding model has since expanded to additional Heart Center step-down units, demonstrating how curiosity, collaboration, and supportive leadership can improve patient care while empowering the teams who care for them.

 

The award recognizes an innovative approach to improving patient mobility, but Adams hopes its broader lesson will resonate with leaders across Duke Health: sometimes the most meaningful improvements begin with a simple question—and a willingness to listen to the people closest to the work.

“If you’re seeing something that isn’t where it needs to be, leader-led rounding is an excellent way to tackle it,” she said. “We learn from our staff every time we do these rounds.”

Way to go, Katherine and Allison!

 

Kudos to Chelsey Weinbrecht!

Chelsey Weinbrecht is receiving well-deserved recognition for the outstanding support she provides to Duke’s Internal Medicine residents and new team members. We received a note this week from Diane Sauro, MSN, director, Advanced Practice, Duke Heart, sharing a note sent to her by Jenny Van Kirk, associate program director for the Internal Medicine Residency Program:

“I wanted to share that I was in the workroom when Chelsey Weinbrecht gave handoff to one of the interns, and it was FANTASTIC! I was really impressed by her patience, kindness, thorough details, excellent anticipatory guidance, and willingness to teach. In her anticipatory guidance, there was information about not giving amiodarone to someone listed for transplant and about not giving blood to someone listed for transplant (unless symptomatic). The intern asked about this, and she taught graciously. This really struck me as a model that hopefully others could follow!” — Jenny Van Kirk

“Chelsey, Great work, and thank you for being such a team player. We truly appreciate your willingness to support the education and development of our new interns.  Collaborating with the multidisciplinary team is an important part of what we do, and your efforts exemplify the teamwork and commitment that contribute to a positive learning environment and excellent patient care.  Thank you for your dedication and for going above and beyond. We appreciate all that you do.” — Diane Sauro

“Supporting new interns and team members is central to our mission,” added Jill Engel, DNP, service line vice president for Heart & Vascular. “Thank you for being a mentor and leader on the Heart Team.”

Congratulations, Chelsey, and thank you for going above and beyond to support your colleagues and our patients!

 

Shout-Out to Wang and Zakharova!

Congratulations to cardiologist Andrew Wang, MD, site principal investigator, and Oksana Zakharova, lead clinical research coordinator, for leading this week’s U.S. enrollment in the SONATA-HCM clinical trial. As the study enters its final phase of enrollment, Duke was recognized as the highest-enrolling U.S. site in this week’s sponsor update—a testament to the team’s dedication to advancing research for patients with hypertrophic cardiomyopathy.

Krista Camuglia, research practice manager for the Duke Heart Center Clinical Research Unit, recognized the team’s outstanding achievement and thanked Wang and Zakharova for their leadership and commitment to the study.

Wang also praised Zakharova’s exceptional contributions, writing, “We are the leading U.S. enrolling site—quite an achievement and a credit to your diligent screening and contacts with patients. In truth, your name should be listed in place of mine!”

Congratulations, Andrew, Oksana, and the entire study team on this outstanding accomplishment!

 

Upcoming CME Events & Opportunities

Cardiology Grand Rounds

CGRs have concluded for the summer. We will return in the fall! Meanwhile, please enjoy past recordings.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Registration is now open. Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

 

Triangle Heart Walk Date Announced

The American Heart Association’s 2026 Triangle Heart Walk will take place on Saturday, October 3, 2026, at Coastal Credit Union Music Park at Walnut Creek, 3801 Rock Quarry Road, Raleigh. The Walk is expected to start around 9:30 a.m., but that may change. Stay tuned for a more formal announcement from the AHA. Meanwhile, registration for team captains and walkers is open!

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

Chief’s message:  Radical concept and the Arc of Democracy – July 4th 2026

Hope you all stayed cool and had a happy July 4th (250th Anniversary weekend). Want to thank the teams of clinicians and staff that helped care for our patients and starting residents and fellows.  Starting our residents and fellows off in the best way is always an important part of our year.

Our family was lucky enough to get to Philadelphia for the weekend and spend the weekend seeing Independence Hall   (where both the Declaration was finally drafted and signed and Constitutional Convention with the colonies was held), and the several museums and events. It was great to learn some of the history of the complexities the founding fathers faced in both crafting the declaration and setting up the constitution and the government of the United States.  Most impressive was the amount of disruption, the radical thinking, and continuous commitment and courage it took to move our nation forward.  Inspiring to see and to give us some thought as we continue to work to improve the health of our communities, some integral to all in our region, country, and world where cardiovascular disease remains the leading cause of death and disability. 

Revolutionary Guard at Constitution Center, above is Independence hall and table where Jefferson with Virginia delegation.

This last week was a busy one with new trainees, organization for our clinical programs for the upcoming year, ASE echo meeting with great amounts of our echo lab represented, another Nature publication from researchers in the CVRC, and announcement of my work as Volunteer President of the AHA this upcoming year.  We have included my post below describing my excitement from Linkedin and AHA announcement.  Look forward to sharing what I learn this year and the impact we have this upcoming year.  Also excited to have Svati Shah, MD announced as the President-Elect for the AHA, a testament to our cardiovascular group and to her amazing work in precision health.

Highlights of the week:

Manesh Patel Begins One-Year Term as AHA President 

I’m honored and humbled to step into the role of volunteer president of the American Heart Association for 2026-27, and proud to be the first South Asian person to hold this role, a moment that reflects my family’s journey and the values they instilled in me. This opportunity also reflects something larger than any one person. It is a testament to the culture of science and teamwork I have been fortunate to be part of at Duke, from the Duke Clinical Research Institute to Duke Heart and Duke Cardiology, where I have spent nearly 30 years building on a legacy of cardiovascular discovery.

Science saves lives. My focus as president will be making sure the discoveries we make are proven, and that proven therapies reach everyone, everywhere. By 2050, nearly half the world’s population may face some form of cardiovascular disease or its risk factors. That is the scale of the opportunity in front of us. The American Heart Association’s mission and commitment to improving human health is energizing and I look forward to working with the thousands of volunteers, clinicians, and scientists to meet this moment.

I especially want to thank all of our faculty and fellows who have helped me learn and the patients who have allowed me to care for them.  I also want to thank the Heart Center board members and leaders, including our Chair Bob Keegan.  Many of you have invested and believed in our ability to make these types of differences and impact.

Finally, if you’ve been putting off seeing a physician, let this be your sign. Know your numbers. Understand your risk. Most cardiovascular disease is preventable, but you can’t feel it until it affects you.

The link to the AHA announcement is here. The AHA also produced this profile story as part of their announcement: New American Heart Association president aims to close the gap between discovery and care. 

Duke Heart & Vascular Earns Multiple AHA Achievement Awards

Every day, our teams come together across Duke Heart & Vascular to deliver safe, evidence-based care for patients. That commitment has once again been recognized by the American Heart Association (AHA), which awarded Duke University Hospital and Duke Raleigh Hospital multiple 2026 Get With The Guidelines® achievement awards for excellence in heart failure, atrial fibrillation and coronary artery disease care.

The AHA’s Get With The Guidelines® program recognizes hospitals that consistently apply the latest evidence-based treatment guidelines to improve patient care and outcomes. This year’s recognitions reflect the commitment of our teams across DUHS to delivering high-quality, guideline-directed care across the cardiovascular continuum.

“These recognitions are a reflection of our team,” said Manesh Patel, MD, chief of the division of cardiology and vice president of Duke’s Heart and Vascular Service line. “They represent the dedication of each of you across Duke Heart & Vascular who work together every day to provide safe, evidence-based care for our patients. I’m grateful for your commitment to excellence and for the difference you make in the lives of the patients and families we serve.”

Duke University Hospital

• Get With The Guidelines®–Heart Failure Gold Plus with Target: Heart Failure Optimal and Target: Type 2 Diabetes Honor Roll
• Get With The Guidelines®–AFib Gold with Target: Ablation
• Get With The Guidelines®–Coronary Artery Disease STEMI Receiving Center Gold Plus with Target: Type 2 Diabetes Honor Roll
• Get With The Guidelines®–Coronary Artery Disease NSTEMI Gold with Target: Type 2 Diabetes Honor Roll

Duke Raleigh Hospital

• Get With The Guidelines®–Heart Failure Gold Plus with Target: Type 2 Diabetes Honor Roll

Together, these recognitions celebrate the entirety of Duke Heart & Vascular, because your dedication makes our exceptional cardiovascular care possible for every patient, every day.

Congratulations to all!

 

Study Reveals First Drug-like Molecules that Control Key Cellular Signaling Proteins

To function normally, nearly every cell in the human body relies on G-protein coupled receptors (GPCRs) to receive and send signals. That’s why GPCRs are targeted by roughly one-third of all FDA‑approved drugs.  

But the signals from these receptors don’t act alone. Decades ago, Duke University biochemist and cardiologist Robert J. Lefkowitz, MD, and colleagues discovered β-arrestins — proteins that attach to activated GPCRs, dampen their signaling, and pull them inside the cell. In the early 2000s, the lab showed that β-arrestins also launch their own signaling pathways, expanding their role far beyond simply shutting receptors off. 

Now, researchers in the Duke Cardiovascular Research Center’s Lefkowitz lab have identified three powerful, drug-like molecules that directly target β-arrestins. The findings, published June 24 in the journal Nature, provide the first clear way to control these proteins with pharmacological precision. 

In multiple tests, the compounds blocked β-arrestins from interacting with GPCRs and carrying out their normal functions, without interfering with the receptors themselves. Instead of shutting down GPCR activity, the molecules effectively remove β-arrestin control, allowing signaling through G proteins to persist. 

The discovery provides the first chemical tools for studying β-arrestins, opening the door for scientists to better understand how β-arrestins shape cellular responses. And it suggests a path toward more precise therapies for conditions involving metabolism, immune responses, cardiovascular function, and brain signaling. 

The study is the result of more than a decade of work from co-first authors Alem W. Kahsai, PhD, assistant professor of medicine, and postdoctoral researcher Natalia Pakharukova, PhD. 

“Alem could have published a creditable paper about these molecules 10 years ago,” said Lefkowitz, Duke Health Distinguished Professor of Medicine and senior author of the study. “But he’s a perfectionist. He wanted to figure out how they actually work.” 

Kahsai “lived and breathed” these molecules 24 hours a day, drawing in collaborators from Duke and across the country to “describe an extraordinary amount of their biology,” Lefkowitz said. 

The team began with a broad, unbiased search of the National Cancer Institute’s vast compound library to identify molecules that might bind β-arrestins. Then they narrowed the field using tests that showed which compounds physically interacted with the protein and stabilized it. The most promising candidates were studied in engineered human cell systems, where researchers could track real-time GPCR signaling, and later in physiologically relevant immune and heart muscle cells to determine whether their effects extended beyond simplified laboratory models. 

Through this step-by-step process, the researchers identified three compounds that disrupted multiple aspects of β-arrestin function — blocking their recruitment to receptors, preventing receptor desensitization and internalization, and shutting down β-arrestin–specific signaling pathways — while leaving G protein signaling intact. 

“We tested these compounds from every angle we could think of before we were convinced they were bona fide β-arrestin inhibitors,” Kahsai said. 

A pivotal moment came when Pakharukova used Cryo-electron microscopy to visualize one of the compounds, called Cmpd-5, binding to a previously unknown “pocket” on β-arrestin. This visualization showed that the inhibitor works “allosterically” – when it binds to this pocket, it changes the shape of β-arrestin globally and prevents it from fully engaging with GPCRs.  

The team tested the inhibitors with several GPCRs, including the GLP-1 receptor, which is the target of widely used weight-loss drugs Ozempic and Wegovy. Even when the receptor was being stimulated by these drugs, adding the new compounds inhibited β‑arrestin control and allowed G protein signaling to continue longer than usual.  

Such an approach promises to allow researchers to dial specific pathways up or down, potentially improving treatment precision while reducing unwanted side effects. 

Kahsai and Pakharukova’s Duke co-authors are: Henry Y. Kwon, Kunal S. Shah, Caroline T. del Real, Bowie N. Shreiber, Jason G. Liang-Lin, Paul J. Shim, Mason A. Lee, Allison M. Schwalb, Uyen Pham, Anand Chundi, Haoran Jiang, Samuel Liu, Preston C. Nibley, Dana K. Bassford, Cal A. Kunzle, Brittany N. Thomas, Jihee Kim, Jialu Wang, Xingdong Zhang, Jeffrey S. Smith, Lindsay A.M. Rein, Sudha K. Shenoy, Sudarshan Rajagopal, Seungkirl Ahn, Howard A. Rockman, Robert J. Lefkowitz, and Ali Masoudi. 

Funding: Howard Hughes Medical Institute, the National Institutes of Health, the St. Jude Children’s Research Hospital Collaborative Research Consortium on GPCRs, and the Mandel Foundation. 

Congratulations to Alem, Natalia, and their study coauthors!

 

Duke at ASE2026!

Duke was well represented at the American Society of Echocardiography’s 51st Scientific Sessions held June 26 – 28, 2026 at the Gaylord Rockies Resort in Aurora, CO.

Alicia Armour, Practice Administrator, served as co-chair for the meeting and was fortunate to have several Duke faculty members present across several tracks. Contributing to the success of the meeting were: Anita Kelsey, MD, Sreekanth Vemulapalli, MD, Pamela Douglas, MD, Ashlee Davis, Richie Palma, Carissa Bregadze, Melissa LeFevre, Alina Nicoara, MD, Piers Barker, MD, Tracy Ralston, and Anna Lise Brinson.

Award winners included: Emily Lynch (sonographer travel grant), Laura Miller and Chris Dube (Allan D. Waggoner Student Scholarship Award). A big round of thanks for their contribution to the sessions!

Congratulations, Emily, Laura, Chris, and Alicia! Excellent representation across our team!

 

NACE/Cardiology Grand Rounds on Dyslipidemia Guidelines Success

Our first Grand Rounds partnership with the National Association for Continuing Education (NACE) was a resounding success, with more than 1700 people registered as virtual attendees of the hybrid event.  

The continuing education session, 2026 Dyslipidemia Guidelines: Practical Implementation, was led by presenter Nishant Shah, MD, and moderator Manesh Patel, MD. It was held on Monday, June 29, 2026, at the JB Duke Hotel in Durham.

Thank you to everyone who joined us in person and to all those who joined us online. It was an excellent presentation by Dr. Shah with lots of humor throughout, thanks to Dr. Patel. Many thanks to Christy Darnell for her work in making this a successful CME activity.

Congratulations, Nishant, Manesh, and Christy!

 

Shout-out to Thakkar!

We are excited to share that Aetna has updated its policy on lipoprotein A testing, and this comes in large part due to the persistence and dedication of Aarti Thakkar, MD. We received a note this week from Nishant Shah recognizing her work on behalf of the preventive cardiology team:

“I wanted to highlight some great work Aarti Thakkar has led to advocate for insurance coverage for Lp(a) testing. We received this note below from the PRMO showing the success of Aarti’s advocacy and letters she has drafted with Aetna. In addition to Aetna, we now have coverage from many payers in the state of North Carolina that serve Duke Health patients for an Lp(a) test once in a lifetime. Aarti played a big role in helping with the access in order to promote the guideline recommendation of getting an Lp(a) test.” – Nishant Shah, MD 

Note from Jamie Ashmore, Duke PRMO:

“Drs. Pagidipati, Shah, and Thakkar, Good news! With the help and support of your advocacy, Aetna has finally updated their policy on lipoprotein A testing. They will now cover it once per lifetime for patients 19 and over. This would not have happened without your advocacy and the excellent letter you submitted nearly a year ago in support of this effort. Aetna was the last of our major commercial payers who declined to cover this testing, and because they now have the NC State Employees Health Plan, they are a much more significant part of our payer base than in previous years. Thank you so much for your willingness to lend your voices to this effort!”

Way to go, Aarti, Duke PRMO team, Neha, and Nishant! Your advocacy to get patients the care they need, when they need it, is outstanding!

 

Upcoming CME Events & Opportunities

 

Cardiology Grand Rounds

CGRs have concluded for the summer. We will return in the fall! Meanwhile, please enjoy past recordings.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Registration is now open. Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

 

Highlights of the week:

ACHD Fellow Graduation Dinner Held

On June 17, 2026, the Duke Adult Congenital Program celebrated the graduation of its fifth 2-year Thomas Anstrom Fellow in Adult Congenital Heart Disease, Dr. Nina Morgan. Nina will be going to AdventHealth in Orlando where she will serve as the Director of the Adult Congenital Heart Program. The event was held at The Rooftop of The Durham Hotel.

Congratulations, Nina!

 

Interventional Cardiology, Structural Fellows Dinner Held

The annual dinner to celebrate our graduating Interventional Cardiology Fellows and our graduating Structural Heart Disease Fellow was held on Thursday, June 18, 2026, at Hope Valley Country Club in Durham.

Congratulations to the following:

• Nathan Goodwin, MD – joining the faculty at St. Luke’s Hospital.
• Priya Roy, MD – joining the faculty at Mercy Health Hospital and Trauma Center.
• Manasi Tannu, MD – joining the faculty at Northeast Georgia Medical Center.
• Luke Dawson, MD, our Structural Heart Disease fellow

And congratulations to Nathan Goodwin – he was selected as the 2026 recipient of the Warren S. and Gloria R. Newman Fellowship Award!

We wish each of you all the best as you move forward in your careers – please stay in touch!

 

Krasuski Departing Duke Health

Richard Krasuski, MD, professor of medicine in cardiology and director of the Duke Adult Congenital Heart Disease Center, celebrated his final week with Duke Heart & Vascular on Friday, June 26. He is heading to Inova Heart and Vascular Institute, where he will serve as the Schar Family Endowed Chair of Congenital Heart Disease.

“It is with a heavy heart that I leave my terrific friends, colleagues, and mentees at Duke,” said Krasuski. “When you put together the world’s best fellows with the world’s best medical students and residents and surround them with the world’s best staff, you get Duke Cardiology. I thoroughly enjoyed the last 11 years at Duke, and I leave behind one of the best Adult Congenital Heart Programs in the world.”

He added: “I will miss the challenging patients, the camaraderie of pediatric and adult cardiology and cardiovascular surgery, and all the great relationships I have forged with the various medical and pediatric specialties. It takes a village to care for these complex patients, and I am blessed to have been part of that.

I will miss my patients dearly, but know that my former team will continue providing them with excellent care. I look forward to continuing our research collaborations through an adjunct professorship and to maintaining my support for Duke Basketball. I am super excited about building a world-class ACHD program with the fantastic team at Inova. Please keep in touch, and feel free to reach out any time I can be of assistance.”

You will be missed, Rich!

 

Underused Therapy Offers New Hope for Patients with Peripheral Artery Disease

Research has consistently shown that supervised exercise therapy is among the most effective treatments for improving walking ability and quality of life for patients with symptomatic peripheral artery disease (PAD). Yet many eligible patients are never referred for this evidence-based therapy. Duke’s Peripheral Artery Disease Supervised Exercise Therapy (PAD-SET) Program is working to change that.

The three-month program offers individualized, supervised exercise therapy for patients with symptomatic PAD, helping them improve walking ability, reduce symptoms, and lower their risk of future cardiovascular events. Managed by Duke’s cardiovascular team and supported by a multidisciplinary rehabilitation staff, the program combines structured exercise with education on PAD, cardiovascular risk reduction, nutrition, and healthy lifestyle habits.

“Exercise therapy is really a cornerstone of treatment for these patients,” said Sean Lowers, manager of Duke Cardiopulmonary Rehabilitation at Croasdaile. “In many instances, supervised exercise is just as beneficial as other treatment options in improving their symptoms.”

For patients living with PAD, however, the idea of exercising through leg pain can seem counterintuitive. During therapy, participants intentionally walk to the point where symptoms develop—a process that can be uncomfortable but is essential to achieving lasting improvement.

“We have to reach that point to stimulate the anatomical changes that allow new blood vessels to develop,” Lowers said. “We’re looking at the changes that happen over several months—not what’s happening during the first week or two.”

As new blood vessels develop and blood flow improves, patients are often able to walk farther with less discomfort, making everyday activities easier and improving their overall quality of life. The program also helps reduce risk factors for heart attack and stroke, extending the benefits beyond the legs.

The journey isn’t always easy. Participants attend supervised exercise sessions two to three times each week for three months, often while balancing mobility limitations, work schedules, and other life demands. Perhaps the greatest hurdle is asking patients to continue exercising even when it temporarily increases their leg pain.

That’s where Duke’s rehabilitation team is particularly effective.

“Our staff understands that’s not an easy ask,” Lowers said. “They know when to push and when to back off.”

In addition to closely monitoring each patient’s progress, the team uses coaching techniques such as motivational interviewing to help participants stay engaged through the most challenging stages of the program.

“We do this every day,” Lowers said. “Our team understands both the physiology and how to support patients through what can be a challenging process.”

Although supervised exercise therapy has been covered for eligible patients for several years, awareness is still a challenge.

“For a long time, PAD wasn’t a covered diagnosis for cardiac rehabilitation,” Lowers said. “Because of that, supervised exercise may not be the first treatment option providers think about. We want people to remember that this program exists, it’s covered by insurance for many patients, and it can make a real difference.”

For patients with PAD, supervised exercise therapy has the potential to be transformative—but only if they’re referred. By increasing awareness of Duke’s PAD-SET Program, Lowers hopes more patients will gain access to a treatment that helps them walk farther, reduce pain, regain independence, and lower their long-term cardiovascular risk.

Providers can refer eligible patients by searching Epic or MedLink for Ambulatory Referral for PAD Exercise Therapy. Patients must have symptomatic PAD, a face-to-face evaluation with a provider, and education regarding cardiovascular disease and PAD risk-factor reduction before beginning the program.

 

Kudos to Regan

Manesh Patel received a wonderful message this week regarding Jessica Regan, and we wanted to share it with our Pulse readers:

“I am writing to let you know about the incredible work Dr. Jessica Regan has done with the medical school. I am one of the course directors for first-year students. Specifically, I am the clinical correlations director and spend most of my time in the spring teaching our MS1s in team-based learning sessions. 

This spring, we worked together to create a case for our students, and we co-led a case discussion with 125 first-year medical students. The session went amazingly! Many students came up to me afterwards to let me know how much they enjoyed her teaching style. 

Thank you so much, Dr. Regan!” — Nathan Hirshman, MD, Clinical Correlations Director, Duke University School of Medicine; Associate Medical Director of Education, DUH Division of Hospital Medicine

Nicely done, Jessica!

 

Shout-out to Cosiano

We received a terrific note this week regarding incoming Critical Care Medicine fellow (and finishing CD fellow), Michael Cosiano.

“Of his own volition, Mike took a yearlong course on mechanical ventilation this year. It is a challenging course with a standardized curriculum that requires multiple hours of preparation weekly, monthly tests, and culminates in a proctored final exam adjudicated by PCCM program directors as part of a national consortium. The final exam would be reminiscent of oral boards. I am very proud of Mike- he received the highest grade possible, demonstrating not just his proficiency, but fluency, with the subject matter. I know he will be an asset to the CCM program next year as he has been a power player in ours.” – Willard Applefeld, MD

Outstanding, Mike!

 

Great Catch, Trammel!

Morgan Trammel, Clinical Pharmacist, 7E Cardiac ICU, identified an incorrect medication dose following discharge and spoke with the care team to correct it. She also contacted the patient directly to provide clear, updated instructions and ensured follow-through with the pharmacy and providers. 

Great catch, Morgan! Your timely actions ensured the patient received the correct treatment!

 

DUHS Update:

On July 1, Duke University Hospital will open its new Obstetric Emergency Department (OB ED) on the 5th floor of Duke North. Staffed by a team of obstetric specialists, the OB ED will be open 24/7 and offer safe, timely, specialized care for obstetric emergencies.

By transforming what was once the OB triage space into the OB ED, “We’re ensuring that anyone who arrives in a moment of urgency receives immediate access to specialized evaluation and treatment from a team trained for the most complex obstetric situations,” according to Kim Wood, Assistant Vice President of Nursing, Women’s and Newborn Service Line, Duke University Health System.

Information regarding the criteria for receiving care in the OB ED, how to get there, and the basics on billing information is available in a team member guide on SharePoint that you can print and share internally.

 

Upcoming CME Events & Opportunities

 

NACE/Cardiology Grand Rounds: June 29

2026 Dyslipidemia Guidelines: Practical Implementation with Nishant Shah, MD, and Manesh Patel, MD as moderator

JB Duke Hotel, 230 Science Drive, Durham, NC 27708

6-7 p.m.

The in-person event at JB Duke is free (as is parking) but limited to 60 people. Live streaming will be available on the NACE virtual online platform. Creating a NACE account is quick and easy.

Registration is required for both the in-person and the live-stream. NACE will offer CME credit. In-person registration link. Virtual event registration link.

 

Cardiology Grand Rounds

June 30: The Cardiac-Allograft Vasculopathy: Exploring the Enigmatic Enemy of Graft Longevity with Seamus Hughes, MD. 5 p.m., DN 2002 and via Zoom.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

 

Chief’s message:  Happy Fathers Day and Events of the Past week

Hope you all are enjoying this weekend with thoughts and celebrations of the fathers in your life. Many in our community support and recognize the impact of families and fathers — so hopefully for the kids, dads, and granddads – there is time to spend with family.

You will find this week again some updates around our graduating fellows and the amazing work that our faculty continue to do with patient care, education, and research with some key publications and findings highlighted.

Highlights of the week:

CD Fellows Celebrated at Annual Dinner

Our annual dinner to celebrate our graduating Cardiovascular Disease Fellows, Cardiovascular Disease Research Pathway fellows, and Adult Congenital Heart Disease Fellows was held at Parizade on Saturday, June 13, 2026.

Congratulations to the following:

• Michael Cosiano, MD, will join the Duke Critical Care Medicine Fellowship.
• David Elliott, MD, PhD, will join the Duke cardiology faculty later this summer.
• Jonathan Hanna, MD, will join the Duke Interventional Cardiology Fellowship.
• Seamus Hughes, MD, will join the Duke Advanced Heart Failure and Transplant Cardiology Fellowship.
• DaMarcus Ingram, MD, will join the Duke Clinical Cardiac Electrophysiology Fellowship.
• Ivan Nenadic Wood, MD, PhD, will join the Northwestern University Clinical Cardiac Electrophysiology Fellowship.
• Joshua Rushakoff, MD, MPP, will join the Duke Advanced Heart Failure and Transplant Cardiology Fellowship.
• Husam Salah, MD, will join the Duke Interventional Cardiology Fellowship.
• Aarti Thakkar, MD, will join the Duke cardiology faculty later this summer.
• Eric Xie, MD, will join the Duke Clinical Cardiac Electrophysiology Fellowship.
• Anthony Lin, MD, will enter the Duke Clinical Cardiac Electrophysiology Fellowship to finish his 2nd Year.
• Belal Suleiman, MD, will enter the Duke Clinical Cardiac Electrophysiology Fellowship to finish his 2nd Year.
• Paula Rambarat, MD, will join the Duke Advanced Heart Failure and Transplant Cardiology Fellowship.
• Allison Levin, MD, MSc, will join the Columbia University Advanced Heart Failure and Transplant Cardiology Fellowship.
• Nina Morgan, MD, our finishing ACHD fellow, will enter private practice with Advent Health Pediatrics and Adult Congenital Cardiology.

Each year, we recognize outstanding team members during this annual celebration. This year, those award recipients are:

• Michael Cosiano, MD, was presented with the Walter L. Floyd, MD Excellence in Clinical Cardiovascular Medicine
• Bharathi Upadhya, MD, received the Thomas Bashore Teaching Award.
• Willard Applefeld, MD, received the award for Outstanding Mentorship.
• Emily Towery and Clarence Cumming were each presented with a staff award for Outstanding Service.
• Husam Salah, MD, was presented with the Joseph Greenfield Award.
• Joshua Rushakoff, MD, MPP, was presented with the Brandt and Belinda Louie Award.
• DaMarcus Ingram, MD, was presented with the Cassell-Saperstein Award.

Congratulations to all our fellows and award winners!

 

Closing the Cholesterol Gap

One in four Americans has elevated cholesterol — but with better treatment and system-wide action, millions of heart attacks, strokes, and even dementia could be avoided

What keeps Nishant Shah, MD, up at night? Thinking about all the missed opportunities to prevent heart attacks. “Heart disease remains the number one killer across the globe and many of the risk factors, like high cholesterol, are preventable,” said the Duke Health cardiologist.

Cholesterol-lowering drugs can reduce a person’s chances of developing heart attacks and strokes, and vascular dementia, by preventing plaque from building up on the walls of blood vessels.

But too many patients who could benefit aren’t being treated. Shah, an associate professor of medicine at Duke University School of Medicine, recently led a study following almost 2 million patients at 16 academic health centers and found that less than half of patients with known heart disease and high cholesterol were taking medications to lower their cholesterol.

“The study shows a problem across multiple health systems,” he said. “We aren’t controlling cholesterol the way we need to.”

Shah hopes to develop interventions that will help health systems be more effective at controlling cholesterol levels among patients, with the goal of reducing heart attacks across the country.

New Cholesterol Guidelines

The topic is especially timely because new cholesterol guidelines have just been released by the American College of Cardiology and the American Heart Association. The new guidelines recommend aiming for lower levels of LDL, commonly known as “bad” cholesterol.  “There is more and more evidence that the lower your cholesterol is, the better it is for you,” Shah said.

Under the new guidelines, patients at very high risk for heart disease — those with a history of cardiac events and multiple risk factors — should aim for an LDL cholesterol level below 55 mg/dL. High risk patients, including those who’ve had a previous cardiac event, should target less than 70 mg/dL. For everyone else, the goal is below 100 mg/dL.

To determine risk, the guidelines recommend using PREVENT-ASCVD, a calculator that considers factors such as age, blood pressure, blood sugar and body mass index. When a patient’s risk remains unclear, a coronary artery calcium scan can help guide treatment decisions.

The guidelines also recommend screening and treating earlier, because the negative effects of high LDL cholesterol accumulate over time — the more plaque builds up, the narrower arteries become.

Identifying System Level Barriers

Shah is working with Duke Health preventative cardiologist Neha Pagidipati, MD, MPH, to try to understand why so few people with heart disease are taking cholesterol-lowering drugs that could help them.

The investigators are working with six different health systems to identify barriers that prevent more patients with heart disease from having their LDL tested, receiving a prescription, filling the prescription, or taking the medicine. The researchers are also developing strategies to overcome those barriers.

To generate the maximum benefit, the strategies have to be system-wide, scalable, and financially feasible, Shah said. “We’re trying to figure out how to make a health system-wide impact to really move the needle at a population level,” he said.

At Duke, Shah and Pagidipati, an associate professor of medicine, are leading a clinical trial to evaluate the strategy of using a “care champion” to meet with patients while they are hospitalized and stay in touch after discharge. The care champion is responsible for nudging the patient or providers or both in the service of meeting the LDL goal.

To help educate patients and providers at Duke, Shah said, cholesterol reporting has changed in patients’ electronic health records. In the past, LDL was flagged as abnormal only above 190. That’s been changed to 100. There is also guidance at the bottom of the test result about desirable LDL levels, which will be updated according to the new guidelines.

“We’re trying to find ways to maximize awareness at the provider side and the patient side so we get to the common goal of improving everyone’s cardiovascular risk,” he said.

If so few patients with known heart disease are taking cholesterol-lowering drugs, one can imagine uptake is even lower among those who have high cholesterol but haven’t had a heart attack or stroke — yet.

“The problem with high cholesterol is that you don’t feel it,” Shah said. “It’s just circulating in your body until something happens. You want to prevent that something from happening.”

This article, published June 10, 2026, appears in Magnify magazine.

 

New study reveals ‘droplet’ mechanism behind key drug targets

A new study in Nature reveals that one of the body’s most important receptor families signals through liquid-like protein clusters — an unexpected mechanism that could open new avenues for drug development.

Researchers at Duke University School of Medicine found that G protein-coupled receptors (GPCRs) — targets of roughly one-third of FDA-approved drugs — signal through dew-like droplets called biomolecular condensates, formed by β‑arrestin proteins. 

“Our work shows that these receptors that essentially regulate every aspect of physiology signal using a way that we didn’t appreciate before,” said Sudarshan Rajagopal, MD, PhD, associate professor of medicine and senior author of the study. “That’s important because it’s potentially druggable; it suggests that there might be different ways to target GPCR signaling that take advantage of their use of these condensates.”

β‑arrestins have long been known to regulate GPCR activity and are best known for their role in stopping their signaling. But a longstanding puzzle in the field has been how just two β‑arrestin proteins regulate nearly 700 GPCRs in the human body.

For decades, GPCR signaling has largely been understood as a one-to-one interaction: a receptor activates a single β‑arrestin, which then passes the signal along to the next molecule in a linear chain. 

But that tidy model didn’t match what MD‑PhD student Preston Anderson had been seeing under the microscope. At levels normally found inside cells, β‑arrestins are known to form clusters inside cells. During a beach vacation to Kure Beach, as he watched clouds drift and merge across the sky, he began to wonder if β‑arrestins might do the same. What if they weren’t just clustering, but assembling in a way that allowed them to communicate?

That night, he drew a sketch proposing an experiment to test his idea. “When I sent it to Sudar, he basically said it wasn’t going to work. But Sudar is such a great mentor; he never says no. He’ll always let you do the experiment,” Anderson said.

Back in the lab, Anderson attached two halves of a glowing protein to the tail ends of β‑arrestins to see whether they would light up when the proteins come together. When he ran the experiment, they did.

“When I saw it glowing, I thought, ‘We’re onto something,’” he said.

The work began to shift the view of β‑arrestins from individual actors to components of a larger, coordinated system.

“One part of our study shows that the way β-arrestins align and orient with one another influences how effectively they regulate receptor signaling,” Anderson said.

In addition to the split-protein test, over three years of work the team tested the idea with multiple approaches, including: 

• Imaging to visualize β‑arrestin droplets both at baseline and near receptors in cells
• Using chemical and genetic tools to promote and disrupt clustering
• Functional assays which showed how those changes affect receptor signaling and internalization.

Together, these experiments showed that β‑arrestin clustering is not incidental — it directly influences how GPCRs function. When the scientists disrupted the condensates, GPCR signaling was disrupted.

Because condensates organize signaling in specific locations, they may offer new ways to more precisely control GPCR activity. That could ultimately allow drugs to target certain signaling pathways while avoiding others.

“It’s a new model for understanding how this system works,” Rajagopal said. “It suggests we should start thinking about how to selectively target these condensates in the context of specific receptors.”

GPCRs are found throughout the body, and drugs that act on them are used to treat conditions ranging from shock to heart disease and asthma. Anderson said his interest in GPCR biology was shaped by his clinical training during the COVID‑19 pandemic, when he saw patients in shock treated with the same set of GPCR-targeting drugs — such as norepinephrine and vasopressin — that have changed little in decades.

The work builds on Duke’s long legacy in GPCR research, including the discoveries of Robert Lefkowitz, MD, which helped define how these receptors function and earned the 2012 Nobel Prize in Chemistry. The new findings point to a next chapter — one in which the spatial organization of signaling, becomes central to how scientists understand and target these critical systems.

Funding: The American Heart Association, the Mandel Foundation, and the National Institutes of Health.

Other Duke Authors: Adam Kaakati, Juliana Alfonso-DeSouza, Alejandra Patino, Andrew Ahn, Chanpreet Jassal, Samuel Liu, Biswaranjan Pani, Athmika Krishnan, Oscar Chen, Joseph Strawn, and Joshua C. Snyder.

Drs. Rajagopal and Lefkowitz are both principal investigators with the Duke Cardiovascular Research Center.

This article, published online June 1, 2026, was written for Duke University School of Medicine.

 

Shout-out to DeVore

We received a note of praise for Adam DeVore, MD, this week from neurosurgeon Jordan Komisarow. The note reads:

“I am writing to highlight the fantastic care Adam provided on one of my patients. He is a wonderful partner and am grateful to get to work with him.” — Jordan M. Komisarow, MD, vice chair of clinical operations, Department of Neurosurgery.

Way to go, Adam!

 

Upcoming CME Events & Opportunities

June is Pride Month. At Duke Health, we believe everyone deserves to feel safe, seen, and supported, especially when it comes to their health.

 

Cardiology Grand Rounds

June 23: Advancing Contemporary Cardiac Electrophysiology: Innovations in Ablation, Rhythm Control, and Anticoagulation with Belal Suleiman, MD. 5 p.m. DN 2002 and via Zoom.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

Cardiology Grand Rounds: June 29

2026 Dyslipidemia Guidelines: Practical Implementation with Nishant Shah, MD, and Manesh Patel, MD as moderator

JB Duke Hotel, 230 Science Drive, Durham, NC 27708

6-7 p.m.

The in-person event at JB Duke is free (as is parking) but limited to 60 people. Live streaming will be available on the NACE virtual online platform. Creating a NACE account is quick and easy.

Registration is required for both the in-person and the live-stream. NACE will offer CME credit. In-person registration link.

Virtual event registration link.

 

CD Fellows Core Curriculum Conference

June 24: HF/Tx Case Conference with Jonathan Kusner. Noon, DMP 7E39 and via Zoom.

June 26: HF/Tx Case Conference with Harriet Akunor. Noon, Zoom only.

 

MMCVI Grand Rounds

Multi-Modality Cardiovascular Imaging Grand Rounds: A multi-imaging approach to cardiovascular disease cases. Thursdays, Noon to 1 p.m., via Zoom.

June 25: Systemic and Pulmonary Hypertensive Heart Disease with Fawaz Alenezi

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.
• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.

Please save the dates!

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.

 

Highlights of the week:

Graduation Dinners Held for CCE and AHFTC Fellowships

The Clinical Cardiac Electrophysiology fellowship program held its annual graduation dinner on Friday, June 5. The team gathered at The Roof atop The Durham Hotel to celebrate Ilia Shadrin, MD, who is completing the two-year program this month.

• Shadrin is heading into private practice at UNC Rex Hospital.

The Advanced Heart Failure and Transplant Cardiology fellowship program held its graduation dinner on Thursday, June 11, at Hope Valley Country Club in Durham. The program celebrated completing fellows, Aubrie Carroll, MD, Mark Kittipibul, MD; and Merna Hussein, MD.

• Carroll is returning to the Duke Cardiovascular Disease Fellowship program to complete her third year.
• Kittipibul has accepted an academic faculty position with the University of Utah.
• Hussein has accepted an academic faculty position with the Medical University of South Carolina.

Congratulations, Ilia, Aubrie, Mark, and Merna! We wish all of you the very best!

 

DUH Cath Lab 2 Reopens

Duke University Hospital’s cardiac catheterization lab number 2 reopened on Tuesday, June 2, following renovations to the space that began last fall. The renovations now give us the full capability to handle any type of case in that lab. The refreshed space will allow us to pursue renovations to other labs while meeting case load demands – and it provides better flow for team members.

“Overall, this is very exciting for the entire team,” said Rebecca Dial, nurse manager, operations for the adult invasive labs and the CVSSU. “We’re now able to more smoothly support our growing clinical volume. The newly renovated space is laid out well, and I know the staff appreciates that their feedback was taken into consideration prior to starting the renovations. The construction team was thoughtful about organization and details as to what worked well and what did not in the original room. A lot of needs have been met.”

Many thanks to everyone who made this possible: our clinical imaging teams, Matt Hancock and the DUH Clinical Engineering team; Chris Boudreaux and the Facilities team; Joe Kelly, Jill Engel, Mary Lindsay, Schuyler Jones, Manesh Patel, also Jansen Clark, Jordan Goldbach, Razib Khan all from Supply Chain; Randa Romstad, Ayla Presnell, Alyssa Mirante, and Tony (Tritony) Van from the adult cardiac cath labs team, and to everyone else who supported and managed this project. The Duke Heart & Vascular leadership team wishes to send a very special shout-out to Rebecca Dial for her management of this project!

Way to go, team!

 

ICYMI: NEJM Two-Part Double Take Miniseries Features Pagidipati

Preventive cardiologist Dr. Neha Pagidipati and her co-authors on a New England Journal of Medicine Perspective/Double Take are featured in a series of online videos recently produced by the NEJM.

The two-part series includes:

Cardiovascular Risk Factors — Hypertension, published online May 20, 2026, and Cardiovascular Risk Factors — Lifestyle Modifications, published May 27, 2026.

Her co-authors are Holly Biola, MD, and James Davis, MD, of Duke; Sadiya S. Khan, MD, of Northwestern University Feinberg School of Medicine; Donald Lloyd-Jones, MD, of Framingham Center for Population and Prevention Science, Boston University; Willie McDonald and Merodean Moody of NC; and Patrick G. O’Malley, MD, MPH, of the Uniformed Services University of the Health Sciences.

The videos relate back to the article, Global Effect of Cardiovascular Risk Factors on Lifetime Estimates, published last year in NEJM and authored by The Global Cardiovascular Risk Consortium. Yi Zeng, MD, professor of medicine in geriatrics at Duke University School of Medicine, is a member of the Consortium. The videos include b-roll from the 2024 Triangle Heart Walk.

The videos are terrific and well worth watching. Nicely done, Neha!

 

 

HCLC Member Honored by Lee County

Congratulations to Dennis A. Wicker, former lieutenant governor of North Carolina and a current member of the Heart Center Leadership Council! He was recently honored by the commissioners of Lee County, North Carolina. The commissioners voted to name a courtroom in the Lee County Courthouse after Wicker. The dedication of the courtroom and the unveiling of a portrait of Wicker were held on Wednesday, June 3, 2026.

We are thrilled that he has been honored in this way, and we are happy to share this good news more broadly with our Heart & Vascular team members.

“Chet Patel and Carmelo Milano saved my life, and Manesh Patel, through the Heart Board, allows me to pay my gratitude forward,” Wicker said.

Wicker honored with portrait unveiling – Sanford Herald, June 6, 2026.

This is a well-deserved honor. Congratulations, Dennis!

 

Chance Meetup in Bled, Slovenia!

Kristen Norlin, director of academic affairs at the Duke Clinical Research Institute, had a chance to catch up with adjunct professor of medicine, Dr. Tom Povcik, and his family on a recent trip to Bled, Slovenia. They randomly ran into each other at a local cafe.

Gorgeous photos – thanks for sharing them with us, Kristen!

 

Upcoming CME Events & Opportunities

June is Pride Month. At Duke Health, we believe everyone deserves to feel safe, seen, and supported, especially when it comes to their health.

 

Cardiology Grand Rounds

June 16: In-stent Restenosis and the Next Era of PCI with Husam Salah, MD. 5 p.m., DN 2002 and via Zoom.

All Duke CGR Recordings (except for those containing PHI) can be found on Duke Warpwire by year: 2026, 2025, 2024. Questions about recordings? Contact Tracey Koepke.

 

Special Cardiology Grand Rounds: June 29

On Monday, June 29, 2026, the Duke Division of Cardiology will hold a special Cardiology Grand Rounds from 6-7 p.m. at the JB Duke Hotel. Duke Heart is partnering with the National Association for Continuing Education (NACE) to host a live, in-person event, coupled with a live-stream, on dyslipidemia.

Nishant Shah, MD, will present 2026 Dyslipidemia Guidelines: Practical Implementation; Manesh Patel, MD, will moderate.

Learning objectives:

• Perform global cardiovascular risk assessment, adding targeted testing for risk-enhancing factors based on guidelines and recommendations.
• Individualize lipid-lowering therapy based on trial data and guideline-recommendations to achieve LDL-C treatment goals for patients with or at high risk for ASCVD.
• Implement routine monitoring and follow up of patients with or at risk for ASCVD to support clinical decision making for LDL-C add-on therapy.

The event is free, but seating is limited.

Registration is required for both the in-person and the live-stream. NACE will offer CME credit. In-person registration link. NOTE: The in-person event at JB Duke is limited to 60 people. Live streaming will be available on the NACE virtual online platform. Creating a NACE account is quick and free.

June 29: NACE/Duke Heart Cardiology Grand Rounds

2026 Dyslipidemia Guidelines: Practical Implementation with Nishant Shah, MD, and Manesh Patel, MD

JB Duke Hotel, 230 Science Drive, Durham, NC 27708

6-7 p.m.

 

More information is available on the NACE platform, hyperlinked above.

 

CD Fellows Core Curriculum Conference

June 17: Fellowship Review with Anna Lisa Chamis. DMP 7E39 and via Zoom.

June 19: NO CONFERENCE/HOLIDAY

June 24: HF/Tx Case Conference with Jonathan Kusner. Noon, DMP 7E39 and via Zoom.

June 26: HF/Tx Case Conference with Harriet Akunor. Noon, Zoom only.

 

MMCVI Grand Rounds

Multi-Modality Cardiovascular Imaging Grand Rounds: A multi-imaging approach to cardiovascular disease cases. Thursdays, Noon to 1 p.m., via Zoom.

June 18: D-Trans vs L-Trans Congenital Heart Disease with Fawaz Alenezi

June 25: Systemic and Pulmonary Hypertensive Heart Disease with Fawaz Alenezi

 

2026 Symposia

The dates for the following 2026 Duke Heart symposia have been set. We will announce others as they are added.

• September 26: Duke Case-Based Multimodality Imaging Symposium – Course directors are Sreekanth Vemulapalli and Anita Kelsey. Location: Trent Semans Center, Great Hall.

 

• October 30: 18th Annual NC Research Triangle Pulmonary Vascular Symposium – Course directors are Terry Fortin, Sudar Rajagopal, and Jimmy Ford. Location: Durham Convention Center, Durham, NC.

Please save the dates!

 

Hitting with Heart Softball Tournament

The 10^th Annual Hitting with Heart Softball tournament will be held on Saturday, August 22 at Valley Springs Park, 3805 Valley Springs Road, in Durham. The tournament raises funds that will, in part, support the American Heart Association’s 2026 Triangle Heart Walk.

 

Have news to share?

If you have news to share with the Pulse readership, please contact Tracey Koepke, director of communications for Duke Heart & Vascular 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 team. Please call me with any questions: 919-681-2868. Feedback on Pulse is welcome and encouraged. Submissions by Noon on Wednesdays will be considered for weekend inclusion.