1
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Lanfear DE, Njoroge JN, Adams KF, Anand I, Fang JC, Ramires F, Sliwa-Hahnle K, Badat A, Burgess L, Gorodeski EZ, Williams C, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon S, Miao ZM, Claggett BL, Heitner SB, Kupfer S, Malik FI, Teerlink JR. Omecamtiv Mecarbil in Black Patients With Heart Failure and Reduced Ejection Fraction: Insights From GALACTIC-HF. JACC Heart Fail 2023; 11:569-579. [PMID: 36881396 DOI: 10.1016/j.jchf.2022.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Omecamtiv mecarbil improves cardiovascular outcomes in patients with heart failure (HF) with reduced ejection fraction (EF). Consistency of drug benefit across race is a key public health topic. OBJECTIVES The purpose of this study was to evaluate the effect of omecamtiv mecarbil among self-identified Black patients. METHODS In GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) patients with symptomatic HF, elevated natriuretic peptides, and left ventricular ejection fraction (LVEF) ≤35% were randomized to omecamtiv mecarbil or placebo. The primary outcome was a composite of time to first event of HF or cardiovascular death. The authors analyzed treatment effects in Black vs White patients in countries contributing at least 10 Black participants. RESULTS Black patients accounted for 6.8% (n = 562) of overall enrollment and 29% of U.S. enrollment. Most Black patients enrolled in the United States, South Africa, and Brazil (n = 535, 95%). Compared with White patients enrolled from these countries (n = 1,129), Black patients differed in demographics, comorbid conditions, received higher rates of medical therapy and lower rates of device therapies, and experienced higher overall event rates. The effect of omecamtiv mecarbil was consistent in Black vs White patients, with no difference in the primary endpoint (HR = 0.83 vs 0.88, P-interaction = 0.66), similar improvements in heart rate and N-terminal pro-B-type natriuretic peptide, and no significant safety signals. Among endpoints, the only nominally significant treatment-by-race interaction was the placebo-corrected change in blood pressure from baseline in Black vs White patients (+3.4 vs -0.7 mm Hg, P-interaction = 0.02). CONCLUSIONS GALACTIC-HF enrolled more Black patients than other recent HF trials. Black patients treated with omecamtiv mecarbil had similar benefit and safety compared with White counterparts.
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Affiliation(s)
| | - Joyce N Njoroge
- University of California San Francisco, San Francisco, California, USA
| | | | - Inder Anand
- University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | - Felix Ramires
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Aysha Badat
- Wits Clinical Research, Johannesburg, South Africa
| | - Lesley Burgess
- TREAD Research, Cardiology Unit, Department of Internal Medicine, Tygerberg Hospital and Stellenbosch University, Parow, South Africa
| | - Eiran Z Gorodeski
- University Hospitals and Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Rafael Diaz
- Estudios Clínicos Latino América, Rosario, Argentina
| | - Gary M Felker
- Duke University School of Medicine and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, Glasgow, United Kingdom
| | | | - Scott Solomon
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Brian L Claggett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | | - Stuart Kupfer
- Cytokinetics Inc, South San Francisco, California, USA
| | - Fady I Malik
- Cytokinetics Inc, South San Francisco, California, USA
| | - John R Teerlink
- San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, California, USA
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2
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Haynes NA, Johnson M, Lewsey SC, Alexander KM, Anstey DE, Dillenburg T, Njoroge JN, Gordon D, Ofili EO, Yancy CW, Albert MA. Nurturing Diverse Generations of the Medical Workforce for Success With Authenticity: An Association of Black Cardiologists' Roundtable. Circ Cardiovasc Qual Outcomes 2023; 16:e009032. [PMID: 36603043 DOI: 10.1161/circoutcomes.122.009032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The COVID-19 pandemic exposed the consequences of systemic racism in the United States with Black, Hispanic, and other racial and ethnic diverse populations dying at disproportionately higher rates than White Americans. Addressing the social and health disparities amplified by COVID-19 requires in part restructuring of the healthcare system, particularly the diversity of the healthcare workforce to better reflect that of the US population. In January 2021, the Association of Black Cardiologists hosted a virtual roundtable designed to discuss key issues pertaining to medical workforce diversity and to identify strategies aimed at improving racial and ethnic diversity in medical school, graduate medical education, faculty, and leadership positions. The Nurturing Diverse Generations of the Medical Workforce for Success with Authenticity roundtable brought together diverse stakeholders and champions of diversity and inclusion to discuss innovative ideas, solutions, and opportunities to address workforce diversification.
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Affiliation(s)
- Norrisa A Haynes
- Division of Cardiology, Yale University, New Haven CT (N.A.H.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Michelle Johnson
- Division of Cardiology, Memorial Sloan-Kettering Cancer Center, New York NY (M.J.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Sabra C Lewsey
- Division of Cardiology, John Hopkins University, Baltimore MD (S.C.L.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Kevin M Alexander
- Division of Cardiology, Stanford University, CA (K.M.A.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - D Edmund Anstey
- Division of Cardiology, Columbia University, New York NY (D.E.A.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Tierra Dillenburg
- Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Joyce N Njoroge
- Division of Cardiology, University of California, San Francisco (J.N.N., M.A.A.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Debra Gordon
- Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Elizabeth O Ofili
- Department of Medicine, Morehouse School of Medicine, Atlanta, GA (E.O.O.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Clyde W Yancy
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (C.W.Y.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
| | - Michelle A Albert
- Division of Cardiology, University of California, San Francisco (J.N.N., M.A.A.).,Association of Black Cardiologists, Washington, DC (N.A.H., M.J., S.C.L., K.M.A., D.E.A., J.N.N., D.G., E.O.O., C.W.Y., M.A.A., T.D.)
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3
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Njoroge JN, Tressel W, Biggs ML, Matsumoto AM, Smith NL, Rosenberg E, Hirsch CH, Gottdiener JS, Mukamal KJ, Kizer JR. Circulating Androgen Concentrations and Risk of Incident Heart Failure in Older Men: The Cardiovascular Health Study. J Am Heart Assoc 2022; 11:e026953. [PMID: 36285783 PMCID: PMC9673636 DOI: 10.1161/jaha.122.026953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Circulating androgen concentrations in men decline with age and have been linked to diabetes and atherosclerotic cardiovascular disease (ASCVD). A similar relationship has been reported for low total testosterone and incident heart failure (HF) but remains unstudied for free testosterone or the more potent androgen dihydrotestosterone (DHT). We hypothesized that total/free testosterone are inversely related, sex hormone–binding globulin is positively related, and total/free DHT bear a U‐shaped relationship with incident HF. Methods and Results In a sample of men from the CHS (Cardiovascular Health Study) without atherosclerotic cardiovascular disease or HF, serum testosterone and DHT concentrations were measured by liquid chromatography–tandem mass spectrometry, and sex hormone–binding globulin by immunoassay. Free testosterone or DHT was calculated from total testosterone or total DHT, sex hormone–binding globulin, and albumin. We used Cox regression to estimate relative risks of HF after adjustment for potential confounders. In 1061 men (aged 76±5 years) followed for a median of 9.6 years, there were 368 HF events. After adjustment, lower calculated free testosterone was significantly associated with higher risk of HF (hazard ratio [HR], 1.14 [95% CI, 1.01–1.28]). Risk estimates for total testosterone (HR, 1.12 [95% CI, 0.99–1.26]), total DHT (HR, 1.10 [95% CI, 0.97–1.24]), calculated free dihydrotestosterone (HR, 1.09 [95% CI, 0.97–1.23]), and sex hormone–binding globulin (HR, 1.07 [95% CI, 0.95–1.21]) were directionally similar but not statistically significant. Conclusions Calculated free testosterone was inversely associated with incident HF, suggesting a contribution of testosterone deficiency to HF incidence among older men. Additional research is necessary to determine whether testosterone replacement therapy might be an effective strategy to lower HF risk in older men.
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Affiliation(s)
| | | | | | - Alvin M. Matsumoto
- University of Washington Seattle WA
- Veterans Affairs Puget Sound Health Care System Seattle WA
| | | | - Emily Rosenberg
- Brigham and Women’s Hospital Boston MA
- Harvard Medical School Boston MA
| | | | | | - Kenneth J. Mukamal
- Harvard Medical School Boston MA
- Beth Israel Deaconess Medical Center Boston MA
| | - Jorge R. Kizer
- University of California San Francisco San Francisco CA
- San Francisco Veterans Affairs Health Care System San Francisco CA
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4
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Sinha A, Sitlani CM, Doyle MF, Fohner AE, Buzkova P, Floyd JS, Huber SA, Olson NC, Njoroge JN, Kizer JR, Delaney JA, Shah SS, Tracy RP, Psaty B, Feinstein M. Association of immune cell subsets with incident heart failure in two population-based cohorts. ESC Heart Fail 2022; 9:4177-4188. [PMID: 36097332 PMCID: PMC9773780 DOI: 10.1002/ehf2.14140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/16/2022] [Accepted: 08/29/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Circulating inflammatory markers are associated with incident heart failure (HF), but prospective data on associations of immune cell subsets with incident HF are lacking. We determined the associations of immune cell subsets with incident HF as well as HF subtypes [with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF)]. METHODS AND RESULTS Peripheral blood immune cell subsets were measured in adults from the Multi-Ethnic Study of Atherosclerosis (MESA) and Cardiovascular Health Study (CHS). Cox proportional hazard models adjusted for demographics, HF risk factors, and cytomegalovirus serostatus were used to evaluate the association of the immune cell subsets with incident HF. The average age of the MESA cohort at the time of immune cell measurements was 63.0 ± 10.4 years with 51% women, and in the CHS cohort, it was 79.6 ± 4.4 years with 62% women. In the meta-analysis of CHS and MESA, a higher proportion of CD4+ T helper (Th) 1 cells (per one standard deviation) was associated with a lower risk of incident HF [hazard ratio (HR) 0.91, (95% CI 0.83-0.99), P = 0.03]. Specifically, higher proportion of CD4+ Th1 cells was significantly associated with a lower risk of HFrEF [HR 0.73, (95% CI 0.62-0.85), <0.001] after correction for multiple testing. No association was observed with HFpEF. No other cell subsets were associated with incident HF. CONCLUSIONS We observed that higher proportions of CD4+ Th1 cells were associated with a lower risk of incident HFrEF in two distinct population-based cohorts, with similar effect sizes in both cohorts demonstrating replicability. Although unexpected, the consistency of this finding across cohorts merits further investigation.
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Affiliation(s)
- Arjun Sinha
- Department of Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA,Department of Preventive Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Colleen M. Sitlani
- Cardiovascular Health Research Unit, Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Margaret F. Doyle
- Department of Pathology and Laboratory MedicineUniversity of VermontBurlingtonVTUSA
| | | | - Petra Buzkova
- Department of BiostatisticsUniversity of WashingtonSeattleWAUSA
| | - James S. Floyd
- Cardiovascular Health Research Unit, Department of MedicineUniversity of WashingtonSeattleWAUSA,Department of EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Sally A. Huber
- Department of Pathology and Laboratory MedicineUniversity of VermontBurlingtonVTUSA
| | - Nels C. Olson
- Department of Pathology and Laboratory MedicineUniversity of VermontBurlingtonVTUSA
| | - Joyce N. Njoroge
- Department of MedicineUniversity of California at San FranciscoSan FranciscoCAUSA
| | - Jorge R. Kizer
- Cardiology Section, San Francisco Veterans Affairs Health Care System and Departments of Medicine, Epidemiology and BiostatisticsUniversity of California San FranciscoSan FranciscoCAUSA
| | - Joseph A. Delaney
- Department of EpidemiologyUniversity of WashingtonSeattleWAUSA,College of PharmacyUniversity of ManitobaWinnipegManitobaCanada
| | - Sanjiv S. Shah
- Department of Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
| | - Russell P. Tracy
- Department of Pathology and Laboratory MedicineUniversity of VermontBurlingtonVTUSA,Department of Biochemistry, Robert Larner M.D. College of MedicineUniversity of VermontBurlingtonVTUSA
| | - Bruce Psaty
- Cardiovascular Health Research Unit, Department of MedicineUniversity of WashingtonSeattleWAUSA,Department of EpidemiologyUniversity of WashingtonSeattleWAUSA,Department of Health Systems and Population HealthUniversity of WashingtonSeattleWAUSA
| | - Matthew Feinstein
- Department of Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA,Department of Preventive Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoILUSA
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5
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Abstract
PURPOSE OF REVIEW The disease burden of inherited dilated cardiomyopathy (DCM) is large and likely underestimated. This population stands to benefit immensely from therapeutic approaches tailored to the underlying genetic causes. Here, we review recent advances in understanding novel genotype-phenotype relationships and how these can improve the care of patients with inherited DCM. RECENT FINDINGS In the last several years, discovery of novel DCM-associated genes, gene-specific DCM outcomes, and nuanced information about variant-environment interactions have advanced our understanding of inherited DCM. Specifically, novel associations of genes with specific clinical phenotypes can help to assess sudden cardiac death risk and guide counseling around behavioral and environmental exposures that may worsen disease. Important expansions of the current genotype-phenotype profiling include the newly DCM-associated FLNC variant, prognostically significant LMNA, DSP inflammatory cardiomyopathy, and the highly penetrant features of RBM20 variants as well as the role of TTN variants in compounding the effects of environmental factors on toxin-mediated DCM. Future directions to improve diagnostic accuracy and prognostic improvement in DCM will center not just on identification of new genes, but also on understanding the interaction of known and novel variants in known DCM genes with patient genetic background and environment.
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Affiliation(s)
- Joyce N Njoroge
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94103, USA
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Falk CVRB room CV-154, 870 Quarry Road, Stanford, CA, 94305, USA
| | - Jennifer C Mangena
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Falk CVRB room CV-154, 870 Quarry Road, Stanford, CA, 94305, USA
| | - Chiaka Aribeana
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Falk CVRB room CV-154, 870 Quarry Road, Stanford, CA, 94305, USA
| | - Victoria N Parikh
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Falk CVRB room CV-154, 870 Quarry Road, Stanford, CA, 94305, USA.
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6
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Abstract
Acute decompensated heart failure (ADHF) is one of the leading admission diagnoses worldwide, yet it is an entity with incompletely understood pathophysiology and limited therapeutic options. Patients admitted for ADHF have high in-hospital morbidity and mortality, as well as frequent rehospitalizations and subsequent cardiovascular death. This devastating clinical course is partly due to suboptimal medical management of ADHF with persistent congestion upon hospital discharge and inadequate predischarge initiation of life-saving guideline-directed therapies. While new drugs for the treatment of chronic HF continue to be approved, there has been no new therapy approved for ADHF in decades. This review will focus on the current limited understanding of ADHF pathophysiology, possible therapeutic targets, and current limitations in expanding available therapies in light of the unmet need among these high-risk patients.
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Affiliation(s)
- Joyce N. Njoroge
- Division of Cardiology, School of Medicine, University of California San Francisco (J.N.N., J.R.T.), San Francisco, CA
| | - John R. Teerlink
- Division of Cardiology, School of Medicine, University of California San Francisco (J.N.N., J.R.T.), San Francisco, CA
- Section of Cardiology, San Francisco Veterans Affairs Medical Center (J.R.T.), San Francisco, CA
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7
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Bond RM, Gaither K, Nasser SA, Albert MA, Ferdinand KC, Njoroge JN, Parapid B, Hayes SN, Pegus C, Sogade B, Grodzinsky A, Watson KE, McCullough CA, Ofili E. Working Agenda for Black Mothers: A Position Paper From the Association of Black Cardiologists on Solutions to Improving Black Maternal Health. Circ Cardiovasc Qual Outcomes 2021; 14:e007643. [PMID: 33563007 PMCID: PMC7887097 DOI: 10.1161/circoutcomes.120.007643] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Following decades of decline, maternal mortality began to rise in the United States around 1990—a significant departure from the world’s other affluent countries. By 2018, the same could be seen with the maternal mortality rate in the United States at 17.4 maternal deaths per 100 000 live births. When factoring in race/ethnicity, this number was more than double among non-Hispanic Black women who experienced 37.1 maternal deaths per 100 000 live births. More than half of these deaths and near deaths were from preventable causes, with cardiovascular disease being the leading one. In an effort to amplify the magnitude of this epidemic in the United States that disproportionately plagues Black women, on June 13, 2020, the Association of Black Cardiologists hosted the Black Maternal Heart Health Roundtable—a collaborative task force to tackle the maternal health crisis in the Black community. The roundtable brought together diverse stakeholders and champions of maternal health equity to discuss how innovative ideas, solutions and opportunities could be implemented, while exploring additional ways attendees could address maternal health concerns within the health care system. The discussions were intended to lead the charge in reducing maternal morbidity and mortality through advocacy, education, research, and collaborative efforts. The goal of this roundtable was to identify current barriers at the community, patient, and clinician level and expand on the efforts required to coordinate an effective approach to reducing these statistics in the highest risk populations. Collectively, preventable maternal mortality can result from or reflect violations of a variety of human rights—the right to life, the right to freedom from discrimination, and the right to the highest attainable standard of health. This is the first comprehensive statement on this important topic. This position paper will generate further research in disparities of care and promote the interest of others to pursue strategies to mitigate maternal mortality.
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Affiliation(s)
- Rachel M Bond
- Women's Heart Health, Dignity Health, AZ (R.M.B.).,Internal Medicine, Creighton University School of Medicine, Chandler, AZ (R.M.B.)
| | - Kecia Gaither
- Perinatal Services and Maternal-Fetal Medicine, NYC Health + Hospitals/Lincoln, Bronx (K.G.)
| | - Samar A Nasser
- Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G.)
| | - Michelle A Albert
- Medicine, UCSF School of Medicine, Center for the Study of Adversity and Cardiovascular Disease (M.A.A.)
| | | | - Joyce N Njoroge
- Department of Medicine, Division of Cardiology, University of California, San Francisco (J.N.N.)
| | | | | | - Cheryl Pegus
- Cambia Health Solution (C.P.).,Consumer Health Solutions (C.P.)
| | - Bola Sogade
- ObGyne Birth Center for Natural Deliveries (B.S.)
| | - Anna Grodzinsky
- Saint Luke's Mid America Heart Institute, Kansas City, MO (A.G.).,University of Missouri-Kansas City (A.G.)
| | - Karol E Watson
- Medicine/Cardiology, UCLA School of Medicine (K.E.W.).,UCLA Program in Preventive Cardiology (K.E.W.).,UCLA Barbra Streisand Women's Heart Health Program (K.E.W.)
| | | | - Elizabeth Ofili
- Medicine (Cardiology), Morehouse School of Medicine (E.O.).,Morehouse Choice Accountable Care Organization (E.O.)
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8
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Judson GL, Kelemen BW, Njoroge JN, Mahadevan VS. Cardiovascular Implications and Therapeutic Considerations in COVID-19 Infection. Cardiol Ther 2020; 9:293-305. [PMID: 32535752 PMCID: PMC7292941 DOI: 10.1007/s40119-020-00184-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Indexed: 12/15/2022] Open
Abstract
The ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has profoundly impacted all fields of medicine. Infection with SARS-CoV-2 and the resulting coronavirus of 2019 (COVID-19) syndrome has multiorgan effects. The pandemic has united researchers from bench to bedside in attempts to understand the pathophysiology of the disease and define optimal treatment strategies. Cardiovascular disease is highly prevalent and a leading cause of death across gender, race, and ethnic groups. As the pandemic spreads, there is increasing concern about the cardiovascular effects of the viral infection and the interaction of infection with existing cardiovascular disease. Additionally, there are concerns about the cardiac effects of the numerous treatment agents under study. It will be essential for cardiologists to understand the interplay between underlying cardiac comorbidities, acute cardiovascular effects of COVID-19 disease, and adverse effects of new treatments. Here we describe emerging evidence of the epidemiology of SARS-CoV-2 infection and underlying cardiovascular disease, the evidence for direct myocardial injury in SARS-CoV-2 infection, the specific presentations of cardiovascular involvement by SARS-CoV-2, and the cardiac effects of emerging treatments.
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Affiliation(s)
- Gregory L Judson
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Benjamin W Kelemen
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Joyce N Njoroge
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Vaikom S Mahadevan
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA.
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9
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Njoroge JN, Parikh NI. Understanding Health Disparities in Cardiovascular Diseases in Pregnancy Among Black Women: Prevalence, Preventive Care, and Peripartum Support Networks. Curr Cardiovasc Risk Rep 2020. [DOI: 10.1007/s12170-020-00641-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Njoroge JN, Teerlink JR. Systolic time intervals in patients with heart failure: time to teach new dogs old tricks. Eur J Heart Fail 2020; 22:1183-1185. [PMID: 32056362 PMCID: PMC7540403 DOI: 10.1002/ejhf.1725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Joyce N Njoroge
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John R Teerlink
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.,Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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11
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Njoroge JN, Cheema B, Ambrosy AP, Greene SJ, Collins SP, Vaduganathan M, Mebazaa A, Chioncel O, Butler J, Gheorghiade M. Expanded algorithm for managing patients with acute decompensated heart failure. Heart Fail Rev 2019; 23:597-607. [PMID: 29611010 DOI: 10.1007/s10741-018-9697-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Heart failure is a complex disease process, the manifestation of various cardiac and noncardiac abnormalities. General treatment approaches for heart failure have remained the same over the past decades despite the advent of novel therapies and monitoring modalities. In the same vein, the readmission rates for heart failure patients remain high and portend a poor prognosis for morbidity and mortality. In this context, development and implementation of improved algorithms for assessing and treating HF patients during hospitalization remains an unmet need. We propose an expanded algorithm for both monitoring and treating patients admitted for acute decompensated heart failure with the goal to improve post-discharge outcomes and decrease rates of rehospitalizations.
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Affiliation(s)
- Joyce N Njoroge
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Baljash Cheema
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Andrew P Ambrosy
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Stephen J Greene
- Duke Clinical Research Institute and Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | - Sean P Collins
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA, USA
| | - Alexandre Mebazaa
- Department of Anesthesia and Critical Care, Inserm U942, Hôpitaux Universitaires Saint-Louis-Lariboisière, Paris, France.,University Paris Diderot, Paris, France
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular Diseases "Prof C.C.Iliescu", Bucharest, Romania.,University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Javed Butler
- Department of Medicine, University of Mississippi, Oxford, MS, USA
| | - Mihai Gheorghiade
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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