EP 109: Navigating Volume Status in Heart Failure Patients with Dr Andrew Darlington

Dr Ankur Kalra’s guest this week is Dr Saraschandra Vallabhajosyula, Interventional and Critical Care Cardiologist, Assistant Professor of Medicine at the Warren Alpert Medical School of Brown University and the Director of the Cardiac Intensive Care Unit at Rhode Island Hospital, the Miriam Hospital and Lifespan Cardiovascular Institute. In this episode of Parallax, they delve into the latest insights from ACC.24 through the lens of five pivotal late-breaking trials. Dr Vallabhajosyula offers a deep dive into the nuances of each study. Together, Dr Kalra and Dr Vallabhajosyula distil the complexities of these trials into key messages for practice, grounded in their own clinical experiences. In the spotlight are five key trials: 1. DanGer Shock: Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock 2. RELIEVE-HF: Safety and effectiveness of the V-Wave® Ventura® Interatrial Shunt for the treatment of heart failure (HF) 3. PREVENT: Preventive PCI or medical therapy alone for vulnerable atherosclerotic coronary plaque 4. REDUCE AMI: Decreased usage of beta-blockers after acute myocardial infarction 5. ORBITA-COSMIC: Coronary sinus reducer for the treatment of refractory angina Dr Kalra and Dr Vallabhajosyula dissect the practical implications of these trials, answering pressing questions and addressing emerging dilemmas. What are the key takeaways from ACC.24? How do these findings shape contemporary clinical practice?

In this week’s episode of Parallax, Dr Ankur Kalra welcomes Dr Shashank Sinha. Dr Sinha is an Advanced Heart Failure, Mechanical Circulatory Support, and Transplant Cardiologist at Inova Fairfax Medical Campus, where he serves as Co-Medical Director of the Cardiac Intensive Care Unit and Director of the Cardiovascular Critical Care Research Program. Additionally, he holds the position of Assistant Professor of Medical Education at the University of Virginia School of Medicine. In this episode, Dr Sinha shares his insights on leadership after participating in the prestigious Presidential Leadership Scholars Programme. This programme, designed for mid-career professionals with 10+ years of experience, aims to foster bipartisan, action-oriented leaders. Dr Sinha discusses what motivated him to apply for the programme and guides us through the practical details of the process. Ankur asks him about his modules and the lessons he derived from this multidisciplinary programme. Dr Sinha and Dr Kalra discuss civic duty and the values that can be nurtured to make a difference on a larger scale. Dr Kalra also asks about Dr Sinha's approach to conflict management and combating inherent bias. What is the Presidential Leadership Programme? What qualities constitute a good leader? How can individuals foster their leadership skills?

In this informative episode of Parallax, Dr Ankur Kalra is joined by Dr Andrew Darlington, an Advanced Heart Failure Cardiologist at Piedmont Heart Institute in Georgia. Together, Dr Kalra and Dr Darlington delve into the significance of assessing volume status in patients with heart failure, highlighting its continued relevance in 2024, including the availability of new diagnostic tools, including the Heart Failure Management System (HFMS). Dr Darlington shares his approach to taking a patient’s medical history and some of the cues he looks for during a physical exam and the art of assessing neck veins. Together, they explore diagnostic tools and technologies available to measure fluid volume, including HFMS and strategies for effectively communicating about the utility of this technology to patients with worsening heart failure. Dr Darlington gives a comprehensive overview of the recent clinical data presented at ACC 2023 on the BMAD trial and how he uses HFMS in his own clinical practice. This series is supported by ZOLL and is intended for Health Care Professionals.

In this week's Parallax episode, Dr Ankur Kalra welcomes Dr Haider Warraich, a cardiologist at Brigham and Women's Hospital. Dr Warraich is not only a Senior Advisor for Chronic Disease to the FDA Commissioner but also a prolific author, having written three books, including "Song of Our Scars: The Untold Story of Pain." He is a regular contributor to publications like the New York Times and the Washington Post. During the conversation, we learn more about Dr Warraich's journey into medicine and his current role at the FDA, along with his passion for writing. Dr Kalra asks about how Dr Warraich manages his busy schedule and what it takes to write a book. Dr Warraich openly shares his personal experience grappling with chronic pain, a pivotal event that not only influenced his career trajectory but also inspired his book "Song of Our Scars." Moreover, he discusses his role as a Senior Advisor to Dr Robert M Califf, offering insights into his day-to-day responsibilities within the FDA. The conversation also touches upon the agency's perspective on emerging technologies like artificial intelligence (AI). How does writing complement Dr Warraich’s work as a physician? How did he become a senior advisor to Dr Robert M Califf at the FDA? What is his message to our listeners?

Join Dr Ankur Kalra on Parallax this week as he welcomes Dr Candice K Silversides, the first Editor-in-Chief of JACC: Advances. Dr Silversides, a cardiologist and professor at the University of Toronto, wears many hats. She leads the Obstetric Medicine program and directs the Cardio-Obstetric clinic at Mount Sinai Hospital, while simultaneously steering JACC: Advances in its exciting early stages. Dive into the unique synergy between her clinical practice and editorial leadership as Dr Silversides shares her vision for the journal. Learn how she navigates diverse responsibilities, manages peer reviews, and ensures fair evaluation of the submitted manuscripts. Get insights into launching a journal, from adapting to the needs of the readership and editorial board selection to time management. Dr Silversides joins Dr Kalra in exploring the evolving landscape of academic publishing, discussing the challenges and opportunities presented by AI and other advancements. What does the future of academic publishing look like? What is the role of AI? What are the day-to-day tasks of an Editor-in-chief?

In the season 6 premiere of Parallax, Dr Ankur Kalra welcomes Dr Alex Carter, a Senior Lecturer at the London School of Economics and Political Science (LSE) Department of Health Policy. As the course director for the executive MSc in Health Economics, Policy & Management, Dr Carter delves into the origins and evolution of LSE's health economics program, showcasing its transformation in response to the challenges facing health systems in 2024. The podcast embarks on an exploration of the program's three fundamental pillars: health economics, outcomes measurement, and management. Dr. Carter underscores the importance of efficiently allocating scarce resources, evaluating health system performance through population outcomes, and translating theoretical knowledge into practical application through leadership. Dr Kalra asks Dr Carter about his work with the HyperMarker project, an EU-funded initiative that leverages big data analytics to optimize the prescription of antihypertensives and generate personalized treatment recommendations for patients with hypertension. What do we gain by understanding health economics? How was one of the first health economics programs created? What is Dr Carter’s message to our listeners?

In this week's Parallax, Dr Ankur Kalra welcomes back Dr Sukhjinder Nijjer for their much-anticipated annual review of advancements in cardiovascular medicine that defined the year 2023. Dr Nijjer, a Consultant Cardiologist in the UK, serves as the President of the Royal Society of Medicine and is an Honorary Senior Clinical Lecturer at Imperial College London. Drs Kalra and Nijjer share their perspectives and experiences, offering valuable insights, practical tips and considerations when interpreting this year’s most impactful trials: • ORBITA-2 (AHA Scientific Sessions): PCI for stable angina • FIRE (ESC Congress): Functional versus culprit-only revascularization in elderly patients with myocardial infarction and multivessel disease • DAPA-MI (AHA Scientific Sessions): SGLT2i in MI without diabetes or heart failure • ILUMIEN IV (ESC Congress): OCT vs angiography-guided PCI • OCTOBER (ESC Congress): OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions • ARTESIA (ESC Congress): Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation • SELECT (AHA Scientific Sessions): Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes What are the most impactful cardiovascular trials of 2023? How do Dr Kalra and Dr Nijjer integrate the latest information into their daily practices?

In this thought-provoking episode, Dr Ankur Kalra is joined by Dr Anuradha Lala, assistant professor of medicine at the Zena and Michael A Wiener Cardiovascular Institute and in the Department of Population Health Science and Statistics at Icahn School of Mount Sinai and Mount Sinai Hospital. Dr Lala is also the Deputy Editor of the Journal of Cardiac Failure. Dr Kalra and Dr Lala delve into the critical topic of disparities in care within the healthcare system from a cardiologist's point of view and explore actionable steps towards a more inclusive and fair healthcare landscape. Dr Lala advocates for an approach focused on the patient, valuing the unique needs and preferences of each individual as crucial elements in creating a personalised treatment strategy. In this podcast, she provides insight to her study on 'Acute Heart Failure Presentation to the Emergency Department: National Trends by Race and Ethnicity 2007-2019' and how it shows there are differences based on race and ethnicity in terms of wait time and the demographic of patients presenting. The fundamental principle that healthcare is a basic human right is emphasised, setting the stage for a deeper exploration of the disparities prevalent within the system. Through candid discussions, the episode highlights the differences in healthcare access and quality and examines methods to prevent and mitigate these discrepancies. Addressing the 'why' behind these disparities is a central theme, exploring the presence of subconscious biases within healthcare. The conversation isn’t just theoretical, Dr Kalra and Dr Lala present real-life scenarios and personal stories, offering a refreshingly honest and open perspective. Key questions are explored, such as identifying the top places where disparities in care exist and strategies to address these issues. This series is supported by ZOLL and is intended for Health Care Professionals.

On October 28th, 2023, the Canadian Cardiovascular Society (CCS) released a new classification system for acute atherothrombotic myocardial infarction (MI) based on stages of tissue injury severity (CCS-AMI). This expert consensus is the result of decades of data on acute MI with reperfusion therapy. Dr Ankur Kalra is joined this week on Parallax by Dr Andreas Kumar, Chairperson of the Writing Group of the Expert Consensus Statement, Associate Professor of Medicine at the Northern Ontario School of Medicine, Cardiologist at Health Sciences North, and President of the Canadian Society of Cardiovascular MRI. In this informative episode, Dr Kumar shares what led his team and the CCS to introduce a new classification scheme for acute MI. He discusses how research from the past 15 years highlighted the need to incorporate tissue changes resulting from acute myocardial infarction (MI) into clinical practice. Dr Kumar outlines the four stages of CCS-AMI, and we gain insight into how this novel classification scheme could impact bedside medicine. Dr Kalra asks about treatment optimization based on stages of tissue injury severity. Dr Kumar delves into the risks associated with the four stages, with a particular focus on CCS Stage 4, MI with reperfusion haemorrhage. Finally, Dr Kumar highlights how the use of the classification system can lay the foundation for future research studies and bring us closer to finding answers and identifying agents suitable for different stages of acute MI. What are the key messages from CCS-AMI? What are the data behind the new scheme? How might the new classification scheme impact the development of new treatment options? Resources: Kumar A, et al. The Canadian Cardiovascular Society Classification of Acute Atherothrombotic Myocardial Infarction Based on Stages of Tissue Injury Severity: An Expert Consensus Statement. CJC 2023. https://doi.org/10.1016/j.cjca.2023.09.020 Gaba P & Bhatt DL. Promise of a Novel Classification System for Acute Myocardial Infarction. CJC 202. https://doi.org/10.1016/j.cjca.2023.10.011 Questions and comments can be sent to “[email protected]” and may be answered by Ankur in the next episode. Guest: @AndreasKumarMD Host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

In this week's episode of Parallax, Dr Ankur Kalra's guest is Dr Craig R Smith, Cardiac Surgeon and Chairman of the Department of Surgery at Columbia Presbyterian Hospital. In 2020, The Wall Street Journal called Dr Smith the pandemic's most powerful writer. Each day throughout the COVID-19 crisis, Dr Smith provided the faculty and staff with updates on pandemic response and priorities, offering both vital information and unwavering support. This month, Dr Smith released his book, 'Nobility in Small Things: A Surgeon's Path’. In this inspiring episode, Dr Smith delves into the story behind his book and the motivating circumstances that led him to become an author. Dr Kalra asks Dr Smith about his experience as a leader during the pandemic as a surgeon. Dr Smith shares the story of his unconventional journey into medicine, emphasizing how hard physical labor built his resilience and prepared him for his residency. Dr Kalra also asks about Dr Smith's experience as a surgeon for President Bill Clinton in 2004. We learn more about some of the highlights of Dr Smith's book and his advice for listeners aspiring to become writers. Nobility in Small Things is available for purchase here: https://us.macmillan.com/books/9781250278531/nobilityinsmallthings Questions and comments can be sent to “[email protected]” and may be answered by Ankur in the next episode. Guest: Dr Craig R SmithHost: @AnkurKalraMD and produced by: @RadcliffeCARDIO.