scientific sessions – Page 3 – The Early Career Voice

Nursing Poster Sessions

November 14, 2017 Leonie Klompstra, MSc, PhD

Next to the great talks, there are also great posters at the American Heart Association. Some of these posters I would like to highlight in this blog.

Muna Hammash presented that interventions such as psychoeducational before and after ICD insertion may improve perceived control and, in turn, quality of life.

Muna Hammash
Dr. Misook Chung had an interesting poster on diet quality in patients with heart failure. She found that diet quality was similar in patients with heart failure regardless of their adherence to sodium restriction diet.

Dr. Missook Chung in front of her poster at Scientific Sessions

Missook Chung poster

Solim Lee presented why patients with heart failure don’t respond to early symptoms.

Solim Lee in front of her poster at Scientific Sessions

Solim Lee conclusion

Dr. Jennifer Miller showed that living in a socio economically austere area imparts greater risk for death or hospitalization for ICD recipients.

Dr. Jennifer Miller in front of he rposter at Scientific Sessions

Hiroko Ishida presented a poster on dyad research. She found that health literacy of patients with heart failure and their caregivers was independently associated with caregivers burden.

Hiroko Ishida in front of her poster at Scientific Sessions

Umama Gorsi had an abstract accepted about cardiac rehabilitation. She found that early outpatient cardiac rehabilitation is associated with reduced total mortality rates after myectomy for treatment of hypertrophic cardiomyopathy.

Umama Gorsi Poster

There were great presentation on self-care in patients with heart failure. Foster Osei Baah found in his research that self-care confidence moderates the relationship between marginalization and self-care maintenance in patients with heart failure.

Foster Osei Baah in front of his poster at Scientific Sessions

In another research on self-care, Miyuki Tsuchihashi-Makeya found that health literacy was associated with poor self-care. Furthermore, she found that perceived control mediated the association between health literacy and self-care behaviors in patients with heart failure.

Miyuki Tsuchihashi-Makeya Poster

I would like to thank all the researchers in this blog for their enthusiasm to discuss their work with me!

Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.

When One Teaches, Two Learn: Core Values Of Mentor/Mentee Relationship

November 14, 2017March 28, 2019 Shayan Mohammadmoradi

laptop, glasses, and paper working late into the night

Whether you are a junior graduate student or an established faculty, there is always something that you can learn. Whether you want to write your very first pre-doctoral fellowship grant or learn how to tweet about your center’s accomplishments, there is always someone that you can count on as your guide. That was the first point that stood up to me when I arrived at the 2017 Scientific Sessions. As the days went by, I started to appreciate the sacred bond that we AHA17 attendees all share: We are all mentees. Despite this mentality, young mentees point of views are often ignored. The ignorance is often derived by cultural differences, generation gaps and unbalanced expectation levels which may exist in the environment that the mentee is growing. To tackle this issue, having core values that helps flourishing the mentor/mentee relationship seems to be crucial. Therefore, as a young mentee and based on what I learned throughout the sessions in the meeting, I propose the following fundamental points to be considered as an infrastructure for establishing a successful mentor/mentee relationship:

Find a synergy between your past experiences and the training opportunities in the new environment.
Clarify your expectations from your mentor/mentee.
Have short-term and long-term plans.
Have self-assessments of your success in accomplishing your goals
Either as the boss or the student, do not expect wins from the other party. Loosing is learning.
Do not hide. Do not be an investigator who is just a name on papers and do not be a student who no one knows.

Having such major core values helps the establishment of relationships that will last for a long time and help both sides to move forward. As Phil Collins beautifully said years ago, “In learning you will teach and in teaching you will learn.” So, no matter which stage you are at, respecting the aforementioned points can help to be both a better learner and a better teacher at the same time.

Shayan is a caffeine dependent PhD Candidate at the Saha Cardiovascular Research Center, University of Kentucky. His research area is focused on vascular biology and lipid metabolism. He tweets @MoradiShayan, blogs at shayanmoradi.com and he is the Winner of World’s Best Husband Award (Category: nagging).

A Gateway To Better Health With Bariatric Surgery

November 14, 2017 Christian Perzanowski, MD

This year’s AHA Scientific Sessions has already provided the medical community with a number of excellent studies. The “GATEWAY” trial addresses the role of bariatric surgery and its effect on hypertension.¹ Patients with morbid obesity are well known to be at risk for a litany of cardiorespiratory complications such as hypertension, obstructive sleep apnea, atrial fibrillation, among others. For many, dietary and lifestyle changes are insufficient measures to lose weight. The past decade has seen the emergence of bariatric surgery as a valid therapeutic approach. In trained hands and with meticulous follow-up, the results can be life-changing.

There already exists published literature regarding the favorable effects on glycemic control and in some cases resolution of type II diabetes in patients followed after Roux-en-Y bypass.²

GATEWAY (Gastric Bypass to Treat Obese Patients With Steady Hypertension) was a randomized trial comparing the effects of surgery to standard medical therapy in patients with morbid obesity (defined as BMI 30-39.9 Kg/m2) with the purpose of achieving control of hypertension. The surgery technique employed is known as a Roux-en-Y gastric bypass; these patients also received medical treatment.

The primary endpoint was reduction of ≥30% of the total number of antihypertensive medications while maintaining systolic and diastolic blood pressure <140 mm/90 mm Hg, respectively, at 12 months. Although the study did not enroll patients with diabetes mellitus, and was limited to 100 patients, the results are intriguing. In fact, the surgical arm was six times more likely to require less antihypertensives with more than half achieving remission of hypertension using the above target value. Encouragingly, the surgical complication rate was low.

This is encouraging data which also leads to additional questions:

Are such results also obtainable with other surgical methods (Laparoscopic adjustable gastric banding; Sleeve gastrectomy;
Duodenal switch with biliopancreatic diversion etc)³?
Are the antihypertensive effects durable?

Larger studies will further validate these findings.

References:

Schiavon CA et al. Effects of Bariatric Surgery in Obese Patients With Hypertension The GATEWAY Randomized Trial (Gastric Bypass to Treat Obese Patients With Steady Hypertension). http://circ.ahajournals.org/content/early/2017/11/10/CIRCULATIONAHA.117.032130
Schauer PR Burguera B, Ikramuddin S, Cottam D, Gourash W, Hamad G, Eid GM, Mattar S, Ramanathan R, Barinas-Mitchel E, Rao RH, Kuller L, Kelley D. Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus. Ann Surg. 2003 Oct;238(4):467-8
Colquitt JL1, Pickett K, Loveman E, Frampton GK. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014 Aug 8;(8):CD00364

Christian Perzanowski is an electrophysiologist in Tampa, FL. His main interests are ablation techniques for atrial fibrillation and device therapy for congestive heart failure.

An Effective Call To Action

November 13, 2017March 28, 2019 Bailey DeBarmore

Population Health Slide

Sitting in the second row at Opening Session on Sunday, surrounded by the 180-degree video experience and bathed in red lights, I was moved most by AHA President Dr. John Warner’s call to action.

In just these first 2 days at AHA 2017 Scientific Sessions, I’ve learned more about who the AHA is, what they do, and why they do it, than I could in any other platform. Through Dr. Warner’s personal story, reflecting on how cardiovascular disease took the older men from his family far too soon, spurring his career in medicine, and his experience championing on behalf of the citizens of Dallas to make the 8th largest city in the United States smoke-free, he summed it up better than I could: “AHA helps you see the health of your community in a different way.”

Moving beyond the wash-rinse-repeat cycle of research, present, publish, impacting public health outside of the lab and the hospital is where the AHA shines.

“The voice of healthcare leaders need to be heard in the community,” Warner said. And the key word is engagement.

Championing quality improvement programs like Get with the Guidelines and Target initiatives at your hospital; lobbying on behalf of affordable health care for your patients; and advocating for more walking and bike paths, and access to healthy foods in your city are key to expanding your impact.

Dr. Donald Lloyd-Jones from Northwestern shared his perspective on the AHA on Saturday at the Early Career Lunch with Legends. He’s realized, over 20 years of volunteering with the AHA, that it’s an organization that has its priorities right.
The AHA reaches beyond competitive lines and knocks down barriers to bring together key partners to benefit communities. Saying yes to AHA is saying yes to your community.

Bailey DeBarmore is a cardiovascular epidemiology PhD student at the University of North Carolina at Chapel Hill. Her research focuses on diabetes, stroke, and heart failure. She tweets @BaileyDeBarmore and blogs at baileydebarmore.com. Find her on LinkedIn and Facebook.

AHA DAY 2: Strengthening The Sisterhood

November 13, 2017 Megan Kamath, MD

Another exhilarating day in sunny Anaheim is over!

Today, I was asked a powerful question, “What is one thing in cardiology that you want to change?” My first thought? I’d like to increase the number of women choosing cardiology as a specialty. I can’t help but think of the brilliant minds that we may be losing out on… the ones who may one day develop the next big clinical trials, the ones who will surely embrace technology and AI implementation in medicine. The ones who will challenge the status quo and become the leaders of the future.

So where do we start? Our approach today was simple, bringing together current women in cardiology, starting from Fellows in Training to Early Career Members to Legends in the field.
It was amazing to hear the diverse stories and backgrounds of everyone who came, unifying our bond as cardiology sisters.

Drs. Minnow Walsh and Malissa Wood gave us advice on actively seeking out leadership roles within our local, regional and national communities. Drs. Sharonne Hayes and Rekha Mankad aptly pointed out that when we all work together and lift each other up, we are at our strongest, while Drs. Laxmi Mehta and Dipti Itchhaporia, noted the importance of taking advantage of resources that are made available. What a treasure trove of pearls!

Dr. Annabelle Volgman even highlighted the networking power of social media, which helped inspire me to join Twitter! Find me now @MeganKamath—- can I reach 1,000 followers before the end of the meeting? Help me get there! #Ilooklikeacardiologist #cardiotwitter #blogger

A personal highlight for me was connecting with some of the people who have helped me in various ways throughout my own cardiology journey: Dr. Elisa Bradley who, during her congenital fellowship, helped me prepare for my own cardiology fellowship interviews; Dr. Nkechi Ijioma who helped connect me with the cardiology blogosphere; and Dr. Sophia Airhart whose advice has been invaluable as I have navigated the transition to advanced heart failure and transplant.

I left our session not only with an expanded reading list to tackle and new social media experimentation to try, but also with my energy once again renewed in the possibility that the women of today can recruit more bright women to continue the field tomorrow.

“She will rise. With a spine of steel and a roar like thunder, she will rise.” – Nicole Lyons

Megan Kamath is a Fellow in Advanced Heart Failure and Transplant Cardiology at the University of California, Los Angeles. Her research interests include outcomes in advanced heart failure, decision making and relational medicine, and utilizing technology in healthcare. She is now tweeting @MeganKamath, so follow her on there!

Anticoagulation In Dialysis Patients: Clear As Mud

November 13, 2017 Wei Ling Lau, MD

End-stage renal disease (ESRD) is a paradox of both increased ischemic and hemorrhagic stroke risk. Atrial fibrillation is prevalent in up to 27% of the ESRD population and further amplifies the stroke risk. However, while the overall ischemic stroke rate is increased 2.5-fold in ESRD as compared to the general population, the rate of hemorrhagic stroke is increased 5-fold due to a complex milieu that includes uremic platelet dysfunction and exaggerated blood pressure fluctuations on hemodialysis.

For over 50 years, warfarin was the only oral anticoagulant available for long-term stroke prevention in atrial fibrillation patients. However, while robust data from randomized controlled trials in the 1980s clearly demonstrated stroke reduction in the general population, we only have observational data in the ESRD population and the evidence here is mixed. Overall, the survival benefit is unclear, and bleeding events are augmented. Warfarin also has the notoriety for increasing the risk of adverse cardiovascular outcomes in the ESRD population. Our group recently published a retrospective analysis of our medical center’s database (spearheaded by medical student extraordinaire Mark Lin) where we noted significantly increased risk of mortality and MI in ESRD patients on warfarin.

Over the past decade we’ve seen the emergence of Direct Oral Anticoagulants (DOACs) that include the direct thrombin inhibitor dabigatran, and the factor Xa inhibitors apixaban, rivaroxaban and edoxaban. Apixaban was approved by the FDA in 2014 for use in ESRD patients, a perplexing move that was based on a single phase 1 study that involved eight hemodialysis patients who were given a single dose of the drug.

At the #AHA17 scientists and colleagues presented trends from the US Renal Data System database that highlights the remarkable spike in apixaban prescriptions for atrial fibrillation among Medicare beneficiaries on chronic dialysis (Nov 12, 2017 Abstract# 17197). About 26,000 patients were included in the final analysis. Utilization of DOACs rose from 0.16% to 29.16% between 2010-2015 with apixaban accounting for the majority of new DOAC prescriptions (see Figure).

anticoagulant graph Photo credit @JCosinSales

Post FDA approval, the observational data has been promising in that apixaban may have lower adverse bleeding rates compared to warfarin. However, a more rigorous pharmacokinetics study published this year in the Journal of the American Society of Nephrology by Mavrakanas et al. raises serious concerns about supratherapeutic blood levels if standard apixaban dosing (5 mg BID) is used in ESRD patients. Until more data is available, the investigators cautioned that apixaban 2.5 mg BID is a more appropriate dosing regimen in dialysis patients.

A randomized clinical trial in ESRD patients with atrial fibrillation is currently ongoing that will directly compare apixaban versus warfarin (RENAL-AF). However, given the lack of a placebo control arm, this trial will not address the fundamental unanswered question: Does anticoagulation, period, decrease stroke risk and improve survival in the ESRD population?

Nephrologists, who manage heparin anticoagulation during hemodialysis treatments and are most attuned to the bleeding risks in ESRD patients, need to be notified when dialysis patients are initiated on anticoagulation. In this complex and high-risk population, ongoing dialogue between the cardiologist, primary care doc and nephrologist is necessary to weigh the risks/benefits of anticoagulation on a case-by-case basis.

Wei Ling Lau MD is Assistant Professor in Nephrology at the University of California-Irvine, where she studies vascular calcification and brain microbleeds in animal models of chronic kidney disease. She is currently funded by an AHA Innovative Research Grant, and has been a speaker for CardioRenal University and the American Society of Nephrology.

Early Career Blog

November 13, 2017 Leonie Klompstra, MSc, PhD

Being at the American Heart Association makes me realize (again) that I have one of the greatest jobs in the world. There are so many inspiring people and talks and I am happy that I can share some of my experience in the Early Career blogging program.

Leonie in front of heart and torch at Scientific Sessions

The first day of the American Heart was all about the early career scientists. Speakers gave great advice on how to find a mentor, the transition to how to succeed in grants, the transition to faculty, how to respond to a rejection letter and how to get your name out there. Tips that were given you can read on the blogs by Bailey DeBarmore and Fawaz Abdulaziz M Alenezi. The second day of the American Heart were for me the day of awards. In this blog, I would like to acknowledge researchers who achieved awards for mentoring, research achievements or are finalists.

Cardiovascular Stroke and Nursing Counsel (CVSN) Kathleen Dracup award

This award highlights the importance of early-career mentoring in cardiovascular and stroke nursing to the CVSN. This year the award was given to Dr. Susan J. Pressler. I would like to congratulate her and thank her for being an example with her gifts and generosity in mentoring Early Career scientists.

Dracup Distinguished Lecture Program

Kathleen A. Lembright Award

This award recognizes and encourages excellence in cardiovascular research by established nurse scientists. This year winner is Dr. Shirley Moore. She gave a great talk about the responsibility of researchers to report on null trials.

Dr. Shirley Moore speaking at the Lembright Award

null trials slide

Martha N. Hill New investigator Award

This award recognizes the outstanding contributions of investigators in understanding, preventing, and treating cardiovascular diseases.

I would like to congratulate the finalists this year: Dr. Margo B Minissian and Dr. Billy Canceres.

Dr. Margo B Minissian conducted research in the association of spontaneous preterm delivery and postpartum vascular function.

Dr. Billy Canceres conducts research in high cardiovascular disease risk in sexual minority women.

Three people at Scientific Sessions
Congratulations to your all!

Leonie Klompstra is a Nurse Scientist at the Linköping University in Sweden. Her primary focus is on heart failure and rehabilitations.

Day 1 Scientific Sessions: Creating Connections And Inspiring Innovation

November 12, 2017 Megan Kamath, MD

Walking down the halls of the Anaheim Convention Center, excitement is in the air. There is anticipation of knowledge to be shared and inspiration for research to be presented. The sense of camaraderie and being a part of a cardiology community committed to advancing clinical, basic, and translational research to benefit patients both now and in the future is pervasive.

Despite its global reach, the atmosphere at AHA makes you feel like you are part of a large family: uniting old colleagues and mentors and forming new relationships that carry well into the future. This was particularly apparent at the Early Career Luncheon with Legends, where current pioneers and trailblazers in both the clinical and research realms mingled with their future counterparts while breaking bread. Simply sitting in the presence of these amazing clinicians and being able to learn about their journey to their present position was invigorating and certainly inspired me to be able to pay it forward like this one day in the future. The willingness of today’s legends to participate speaks volumes about the importance of mentorship and the value that is placed on education for trainees.

While the first part of my day was focused on building connections and gaining advice for building and launching my career, the second part of the day was spent learning about innovative trends and incorporating technology in medicine. The last few years have seen an explosion of healthcare technology innovation ranging from wearable sensors to application development to utilizing smartphones to engage patients in data collections. Though still in its infancy, it became clear to me while listening to these presentations that it is not a matter of if technology and AI will be incorporated into my future practice, but simply how and when it will occur.

I was particularly intrigued to hear about utilization of Fitbit technology to count steps and help better define the progression of neuromuscular disease such as Multiple Sclerosis. At present, there are many pitfalls and obstacles to incorporating this technology into clinical practice (patchy data, no validation of accuracy); I can envision a collaborative system in which clinicians can gain real time data about a larger cohort of patients when fully implemented.

I came out of this session inspired to learn more about advancing technology in advanced heart failure which I think will be of utmost importance in our LVAD population. How will technology affect our sickest most vulnerable patients? How can we use technology to forecast advances and obstacles? How can we become more innovative in our day to day practice to create change on a single patient level or a population level?

With day one down, I am eagerly looking forward to continue being inspired over the next few days.

Mentorship Rests On Communication

November 12, 2017March 28, 2019 Bailey DeBarmore

Filing up on to the stage and taking their seat behind the microphones, the Early Career Day Panel on mentoring literally ‘set the stage’ for the young investigators at AHA Scientific Sessions 2017.

Ranging from junior faculty to seasoned professionals, the speakers introduce themselves and share their top tips for mentoring.

The Highlights

Emelia Benjamin from Boston describes mentoring as a “life course phenomenon” where there is “never a period in your career when you don’t need mentoring”.

Edda Spiekerkoetter from Stanford provides an inspiring example of networking in the digital age, and the role mentors provide in connecting us via email introductions.

Stephen Chan provides a “two-the-point” list, describing two concept of self-awareness and mentor generosity as 2 keys for productive mentoring relationships.

AHA Early Career Mentoring

The Take-Away

Despite different backgrounds, different career paths, and different perspectives, an overarching theme emerges: Communication Communication Communication. Whether you’re searching for a mentor, looking to strengthen your mentor-mentee relationship, or facing challenges with poor mentor-mentee compatibility, communication is key.

Dr. Benjamin closes with a quote from George Bernard Shaw:

“The problem with communication is the illusion that it happened”.

Don’t let that illusion plague your mentor-mentee relationship. Be proactive, know yourself, and learn from every experience.

Tips For Early Career Physicians, AHA 2017- Anaheim, CA

November 12, 2017March 28, 2019 Fawaz Alenezi, MD, MSc 

As an attendee of the 2017 American Heart Association (AHA) Scientific Sessions in Anaheim- California, I have had a chance to attend one of the most comprehensive scientific sessions on tips for early career physicians. This session was very rich and answered some of the questions that we face as early career cardiologists. Particularly, questions on the optimal path of training for trans-catheter valves, and things we don’t learn in residency. Although clinical practice guidelines remain the primary mechanism for offering evidence-based recommendations, these sessions are intended to provide guidance for clinicians in areas where evidence may be limited. I found the topic of this session to be quite interesting, and I hope all derive as much as I did from these tip sessions that the AHA provides.

Trans-catheter aortic valve replacement (TAVR) and trans-catheter mitral valve replacement (MVR) utilize new and transformational technology for severe aortic stenosis (AS) and significant mitral valve regurgitation respectively, in patients for whom surgery is not an option. As we all know, TAVR and MVR have been increasing in volume over the past several years, but this has not really been matched by corresponding data describing the learning curve for this new technology. This session builds on the recommendations in the 2014 AHA/ACC guideline for the management of patients with valvular heart disease and highlighted the optimal path of training as an important step for the best outcome.

Despite the great success of TAVR, close to 25% of TAVR patients die within 1 year of their procedure, and others survive the intervention but remain with poor overall health status. Training programs are one of the important factors that need to be addressed carefully. To summarize, in my opinion, I think there needs to be further development of this subject, particularly in terms of training and developing new trans catheter centers. Currently there’s no real data-driven guidelines in terms of how people become proficient in this technology, nor is there guidance for training methodologies pertaining to TAVR or trans-catheter MVR. Here are some important points that we need to ask ourselves prior to the start any training:

Do self-assessment (what are your interests, strength and weakness).
Have you been taught a problem solving approach?
Do you need to do 10 cases to feel comfortable with a procedure? 100?
Ask for candid assessment from your trainers.
Be careful about taking chances in the first year!
Can introduce new technologies to practice.

In this context, this session highlighted the importance of developing strategies and partnerships that allow initiation of new TAVR and MVR programs that can produce efficacious and safe results that are comparable to existing national benchmarks. It is my hope that other attendees will take full advantage of all the session offerings such as this one. This conference is, without a doubt by far, the most educational and enriching experience!

Dr. Fawaz Abdulaziz M Alenezi is a post-doctorate associate at the Duke University Health Systems. He conducts medical research on the derivation and validation of novel echocardiographic approaches to myocardial deformation and a new echocardiographic technique which assists patients with heart ventricular function.