Stanford IM residency program director, Professor of Medicine, Cardiologist, Specialist in Amyloidosis, Sarcoidosis, Cardio-Oncology, and Advanced heart failure
1/ Thoughts/reflections on the events of the last 24 hours with the vaccine rollout at Stanford... One of the most upsetting 24 hours I have ever experienced.
7/ I was proud to be one of those to take the pledge & cancelled my
#vaccine
spot today, as did so many of my colleagues throughout the
@StanfordDeptMed
, include every member of leadership. Our residents and fellows have started getting vaccinated instead, as it should be.
🚨 MAJOR news in the
#ATTR
#amyloidosis
world! Today the much-anticipated HELIOS-B results were presented
@escardio
& simultaneously published in
@NEJM
. The largest ATTR-CM trial published to date, testing
#vutrisiran
vs. placebo. Bottom line: Huge win for vutrisiran!
Big news in the
#amyloidosis
world with the release of top line results for the Phase 3
#acoramidis
trial, ATTRIBUTE-CM. Main message: It worked! 🍾 A lot of fascinating history behind this story. What else can we learn from the data? Details to follow… (1/14)
🚨(1/9) STOP-CA trial reports positive results at
#ACC23
, showing cardiac protection of atorvastatin for patients treated with anthracyclines. But last year’s similar trial was negative! What to believe?🤔A 🧵…
4/ In an attempt to ensure equity, distribution was via an algorithm. This algorithm was well-intentioned but clearly hopelessly flawed. The lack of a sanity check being done on its output before it was put into action was a shocking and inexcusable error.
2/ The rollout was an absolute mess. Pledges that were made were not followed through on. Housestaff were rightly upset to (for all practical purposes) be completely left out of the first wave. They are our very definition of frontline physicians.
6/ I know there were many efforts across the institution today; I can tell you what we did in the DOM. We came together this morning and decided to ask all faculty except those at highest risk to give up their spots in line until all of our trainees could get vaccinated first.
Congratulations to all of our amazing
@StanfordMedRes
residents on an incredible fellowship match! You make us all proud every day & I can’t wait to see all the great things you continue to do post-residency!!! 🎉🍾🥳
@StanfordDeptMed
@HeartBobH
@StanfordChiefs
9/ I couldn't be prouder of our
@StanfordMedRes
and
@StanfordDeptMed
fellows, who have stepped up all year in the face of this existential health crisis of our time. I more than understand their frustration/anger. I share it.
10/ We had a town hall today for our residents/fellows.
@AJRogers_ICU
gave a particularly passionate/inspiring message about what our trainees have meant for our community.
@HeartBobH
spoke of our Department principles. And so proud of the thoughtful engagement of our housestaff.
5/ The effect on housestaff was just one of the absurdities that occurred. Faculty members who are attending on COVID-only units were not included in Wave A, while others with little exposure were. There are more absurd examples than you can imagine.
(1/10) Today the long-awaited full results from the Phase 3 ATTRibute-CM trial were presented
@escardio
#ESCCongress
. We already knew the topline results from last month: Acoramidis made a (big) difference in outcomes! What more did we learn?🤔Let's dig deeper...
Celebrating the career of the best clinical Cardiologist I have ever known, and from whom I learned SO much — Dr. Michael Fowler, retiring after >40 years at
@StanfordDeptMed
. So much ❤️ in the room today from all of those he trained.
It's finally here -- the
#Amyloidosis
Special Issue from
@JACCJournals
#JACCCardioOnc
! The quality of the manuscripts surpasses anything we could have hoped for. Thank you to all authors & reviewers! Specific highlights below...
8/ I have so much sadness over today. Sadness for the message that it seemed to send to our trainees, even if not deliberate. Sadness to miss out on the joy of celebrating the monumental achievement of the vaccine with the
#IGotTheShot
picture I've been excited about all week.
(1/9) A few thoughts re: today’s topline results for
#acoramidis
(AG10)
@BridgeBioPharma
for
#ATTR
#amyloidosis
. The big takeaway — results are less surprising than first meet the eye, and should not be taken to mean the drug won’t work.
Huge news in AL
#amyloidosis
!
#Daratumumab
shows massive improvements in complete hematologic response (53% vs. 18%!) in upfront treatment when combined w/CyBorD vs CyBorD alone. Awaiting full data, of course, but expect this will be new SOC.
#ANDROMEDA
(1/11) The
@US_FDA
has denied the sNDA for
#patisiran
for an indication for
#ATTR
-CM, based on the APOLLO-B trial. 😮One can respect the process but disagree with the result -- and I think this was a major miss by
@US_FDA
. A brief🧵...
#amyloidosis
(1/9) Exciting news in the
#ATTR
#Amyloidosis
world with the publication of this Phase 1 trial of
#NI006
for amyloid removal. Is this the next big thing? Is it a lot of hype? A 🧵...
Late breaking at
#HeartFailure2023
: In a phase 1 trial, NI006 had a favorable safety profile in patients with transthyretin amyloid cardiomyopathy. At doses of at least 10 mg per kilogram, amyloid-load surrogates appeared to be reduced.
New
#ImpactFactor
release today, and 🤯 WOW!!!
@JACCJournals
#JACC
:CardioOnc up to IF of 11.1 !?!? For a journal not even 4 years old? A testament to the inspired leadership of
#BonnieKy
. So privileged to work w/her & the rest of the editorial team. 🍾🎈🎉
#CardioOnc
Exciting news in the
#amyloidosis
world with the success of APOLLO-B showing the success of a
#silencer
treatment (
#patisiran
) for the first time in a Phase 3 study designed for
#ATTR
-CM. 🍾 Several thoughts to follow…
3/ There will need to be a deep dive into how exactly this happened. I am at least happy to say that I have learned enough over the course of the day to know that this was not malice or a specific intent to exclude the housestaff. (cont.)
Congrats to the investigators on this impressive & important study. Statins do not attenuate doxorubicin-induced LVEF drops in this careful evaluation. More thoughts to follow…
#CardioOnc
@NEJM
Proud to see our latest research on ❤️
#transplant
outcomes in
#amyloidosis
patients published today in
@JACCJournals
JACC:HF. Outcomes in 31 consecutive transplanted patients have been excellent. Key takeaways to follow:
The fondest of farewells to an amazing mentor and friend
@HeartBobH
, finishing his tenure as Chair at
@StanfordDeptMed
. Our Department simply could not have had a better leader. Thank you on behalf of
@StanfordMedRes
& the entire education team!
You attend on an inpatient heart failure service, you often have to put on your ‘Geriatric Hat’ to provide optimal care. So this week’s
#CCU
team kindly surprised me with an actual old-timey geriatric hat. Can I pull it off??? 🤔
@StanfordMedRes
@ecvasti
@AlexiaZagouras
This is FAR too simplistic. Not particularly useful for cardiogenic shock NOS, but can be life-saving for cardiogenic shock due to refractory ischemia, acute MR, or acute VSD. Let’s not throw the baby out with the bath water!
#IABP
#CCU
@HFSA
2) Another nail in the coffin for
#PCI
improving
#heartfailure
outcomes. ABSOLUTELY no difference in death or HF hospitalization (p=0.96) with PCI, even despite viability testing. PCI is for angina & ACS, not heart failure! Now, will it change practice???
Gene editing in
#ATTR
#amyloidosis
: SO exciting. In many ways the “perfect” condition for it - a disease driven by a single protein, with a track record of lowering the protein levels being an effective Rx. The future is now.
#StanfordAmyloidCenter
Truly incredible result for this landmark trial in
#ATTR
#amyloidosis
. I cannot emphasize enough what a home run this is for patients with this not-even-remotely-rare disease. A privilege to take part in this study. More thoughts to follow.
#StanfordAmyloidCenter
#tafamidis
ATTR-ACT: This phase 3 RCT of tafamidis to treat transthyretin amyloid cardiomyopathy reduced, in combination, all-cause mortality and CV-related hospitalizations. It also reduced declines in functional capacity and quality of life.
#ESCCongress
BREAKING NEWS: AMVUTTRA (vutrisiran) approved by FDA for the treatment of hereditary ATTR
#amyloidosis
with polyneuropathy. This approval expands the available treatment options for patients. Congratulations
@Alnylam
A brief thread on the landmark SUCCOUR trial published in this week's
@JACCJournals
... Link to the article & the editorial I had the privilege of coauthoring with
@CardioOncology
below. (1/10)
#CardioOnc
1) Another win for
#SGLT2i
in
#HFpEF
, this time for dapagliflozin. For those who quibble with the HFpEF definition (LVEF>40%), look at the subgroup analysis -- jut as impactful for patients with truly normal LVEFs as those with mild systolic dysfunction.
Congrats to
@StanfordMedRes
Director
@Ron_Witteles
, who received Stanford Graduate Medical Education’s 2020 Program Director of the Year Award. Ron was recognized for his "leadership, advocacy for residents, and his creativity in addressing challenges and devising curricula.”
4)
#ArtificialIntelligence
beats sonographers for LVEF assessment in a well-designed study by
@DavidOuyang
. Really impressive data -- time to integrate into practice?
Dr. Robert Harrington
@HeartBobH
, a cardiologist and Professor of Medicine and chair of the Department of Medicine at Stanford University, will serve as the next Stephen and Suzanne Weiss Dean of
@WeillCornell
Medicine.
3) Very interesting study showing better inpatient decongestion for ADHF patients with addition of
#acetazolamide
to loop diuretics. No change in mortality or HF rehospitalization, but better decongestion at 3 days. Practice changing for ADHF?
Don’t make a catastrophic mistake w/free light chain interpretation! Proud to present this handy guide, in collaboration w/Michaela Liedtke, published in
@CircHF
. One of the most common mistakes in
#ATTR
#amyloidosis
eval. Don’t let this happen to you!
@StanfordDeptMed
@RonglihL
6) Can't be said enough: Each one of these results represents tremendous work by the investigators. Medicine moves forward only with good data, and successfully completing large clinical trials is HARD. Congrats to all. Now let's
#followtheevidence
!
🚨🚨🚨Major issue with
#CABANA
randomization uncovered by
@StanCVFellows
. A randomization finding with a P-value of 5.5 x 10E-6 (!!!) was discovered, and as far as I know, has not been commented on before. Please unroll the thread -- I don't think you'll be disappointed...
A fond farewell to APD-extraordinaire Shri Nallamshetty who is starting a new leadership position at
#PaloAltoVA
. Over the last 8.5 years, Shri’s wisdom & leadership have meant so much to our program and our
@StanfordMedRes
residents. Thank you Shri!
@StanfordDeptMed
@HeartBobH
This week in Boston:
Monday: Incredibly cold
Tuesday: Ridiculously cold
Wednesday: Less ridiculously cold...but wait...
Thursday: A foot of snow with blizzard conditions
Friday: Record setting cold
Saturday: Surface of Mars cold
Sunday: dont-even-think-about-going outside cold
Really big news today in the world of ATTR
#amyloidosis
with the FDA approval of
#Alnylam
-developed medication
#patisiran
. Widely expected of course, but a huge milestone for our field nonetheless. A few thoughts to follow...
And like that,
#GCOS2024
is in the books. Congrats to
@BlaesAnneMD
and the organizing team for an incredible job hosting the meeting. And as always the best part - connecting with friends & colleagues, like members of our
@JACCJournals
#JACC
:CardioOnc editorial team! 🙂
(1/5) We have a new leader in the clubhouse for
#cardiac
#stemcell
hype>>>science. A well-done trial which the investigators deserve great credit for conducting... But the spin & media portrayal of the study results is positively🤯.
Big ego boost this AM. Rounding w/
@YaleCardiology
CCU team who had admitted a patient w/tamponade. They had gone to
@StanfordMed25
website overnight to learn how to measure pulsus paradoxus. 100% coincidence & they couldn’t believe that “the guy from the website” was on rounds!