To Admit or Not to Admit? The Drive to Reduce Heart Failure Readmissions

To Admit or Not to Admit? The Drive to Reduce Heart Failure Readmissions, Scott Feitell, DO, FACC, FHFSA, Director of Heart Failure, Director of Cardiac Intensive Care Unit, Sands Constellation Heart Institute, Rochester Regional Health

Hydroxychloroquine Induced Cardiomyopathy

Hydroxychloroquine (HCQ) is one of the immunomodulatory medications used in treatment of autoimmune diseases. Rarely, HCQ can cause serious complications, such as cardiotoxicity. We present a rare case of HCQ-induced cardiomyopathy. 60-year-old female patient with a medical history of SLE on chronic HCQ therapy for 28 years, preexisting non-ischemic cardiomyopathy and heart failure with reduced ejection fraction for 7 years, and complete heart block status post pacemaker insertion presented with acute chest pain and severe weight loss. Patient underwent coronary angiogram that showed normal coronaries and right-sided heart catheterization that showed acute heart failure. Echocardiogram showed LVEF of 30% with global hypokinesis. Patient was started on dobutamine with an improvement of her symptoms. As HCQ-induced cardiomyopathy was suspected, patient underwent an endomyocardial biopsy that revealed a pathognomonic finding of myocyte vacuolization, consistent with HCQ-induced cardiomyopathy. HCQ was discontinued immediately. However, patient was a poor candidate for heart transplantation and durable mechanical circulatory support due to severe malnutrition secondary to end-stage heart failure. Patient accepted hospice care and passed away peacefully. This case highlights the need for high index of clinical suspicion, careful medication reconciliation for patients with non-ischemic cardiomyopathy, and tissue biopsy with careful histopathological examination to diagnose this rare complication

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

HFPEF, HFPEF and More HFPEF: What to do with the rising prevalence of HFPEF!

HFPEF, HFPEF and More HFPEF: What to do with the rising prevalence of HFPEF!, Scott Feitell, DO, FACC, FHFSA Objectives: Identify and diagnose HFPEF in diverse population Understand diagnostic challenges in diagnosing disease Review and validate literature and guidelines supporting treatment of HFPE

It’s Probably Just a Phage: Novel Treatment Strategies in Multi-Drug Resistant Infections

It’s Probably Just a Phage: Novel Treatment Strategies in Multi-Drug Resistant Infections, Drs. Alexandra Yamshchikov, MD and Scott Feitell, MD Objectives: Understand role of biofilm formation in device associated infections Understand indications for LVAD placement and basic approach to managing LVAD associated infections Review current state of knowledge regarding bacteriophage therapy for treating multi-drug resistant infection

New Updates In Treatment for Heart Failure Patients

New Updates In Treatment for Heart Failure Patients, Mohammed Faisaluddin, MD and Scott Feitell, MD Objectives: Updates on the guideline-based evidence for the care of patients with HFrEF, HFmrEF & HFpE

Cardiac Amyloidosis - The Missed Diagnosis

Cardiac Amyloidosis - The Missed Diagnosis, Drs. Syed Faiz Abbas, Rochester General Hospital Internal Medicine Residency Program, Scott Feitell, Cardiology Objectives: Understand prevalence and impact of cardiac Amyloidosis Differentiate and recognize clinical features of AL amyloid and ATTR Recognize importance of algorithm for evaluation of cardiac amyloidosis Role of non-invasive testing for diagnosis (nuclear scintigraphy) Staging and prognosis of cardiac amyloidosis Treatment options and impact on surviva