Advancing Heart Failure Diagnosis and Management

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Mariell Jessup, MD, FACC, a nationally recognized leader in the field of heart failure diagnosis and management, spoke with Cardiology about her career, research and what the future holds for heart failure patients.

What obstacles did you face as a woman entering the field of cardiology in the 1980s?

There were not many female role models in cardiology in those years, but there were some. Bernadine Healy, MD, FACC, Nanette Wenger, MD, MACC, and Suzanne Knoebel, MD, MACC, to name three. But in the day-to-day life of a cardiology fellow, I often found I was the only woman in the room. Most of the time that meant I overheard a lot of conversations about baseball or football; occasionally the topics turned to more uncomfortable ones. But, that same environment produced two invaluable mentors for me – and some lifelong friends.

Who were some of your mentors who had the most impact on your career?

I will always credit the late Mark Josephson, MD, FACC, for listening to my ideas and encouraging me to follow my clinical passion, which proved to be the burgeoning field of heart failure. It was Karl T. Weber, MD, FACC, who instilled in me some of his many important qualities: the joy of scientific discovery, relentless precision and the appreciation of the volunteer patient. Karl was extrememly generous to me, and helped launch my career in Philadelphia.

Virtually everything we do in 2017 for patients with heart failure was non-existent at the time I began my fellowship in cardiovascuar disease."

When you started as a cardiology fellow at the University of Pennsylvania, heart failure was just beginning to emerge as a field of cardiology. What are some of the key advances you have seen during your career that have changed the prognosis of patients with heart failure?

Virtually everything we do in 2017 for patients with heart failure was non-existent at the time I began my fellowship in cardiovascular disease. The concept of heart failure with preserved ejection fraction, HFpEF, was not even a widespread concept until approximately 1989. The clinical trials of ACE-inhibitors, beta-blockers and other neurohormonal antagonists were just getting off the ground. Heart transplantation was done only in a small handful of centers, and ventricular assist devices were in their infancy. The earliest defibrillators were being implanted during that time – it required general anesthesia and a trip to the operating room and, unfortunately, some operative deaths. All of these therapies have profoundly changed the prognosis of many patients with heart failure. These advances took countless brave patients willing to volunteer for clinical trials, and tireless investigators who supervised the conduct of the trials.

You recently wrote about neprilysin inhibitors as an emerging therapy for heart failure. Where do things stand and what are some of the challenges to implementing this therapy?

I feel that the neprilysin inhibitors are a vitally important breakthrough that came at a critical juncture. The effectiveness of the angiotensin receptor-neprilysin inhibitor compound in the PARADIGM-HF trial reinvigorated scientists and clinicians, many of whom thought we had reached the plateau of discovery in heart failure. But, like any new class of drug, it takes time for clinicians to integrate the drugs into their treatment algorithm. Change is hard, especially for busy practitioners; uptake is increasing, albeit slowly. I am not discouraged. I remember how long it took for physicians to become comfortable with the use of beta-blockers. That took many years, and might still not be optimal.

What is some of the work you are most proud of in terms of service?

There were two events during my year as president of the AHA that were most impactful for me. One was the 50th anniversary of the Surgeon General’s report on tobacco that had initiated our long struggle to make our country tobacco free for future generations. Second was when I was attending the Brazilian Congress of Cardiology. During that meeting, there was a dramatic presentation about that country’s efforts around Go Red for Women – the education and advocacy program to reduce the impact of cardiovascular disease and stroke on women and the people they love. That was an important day to realize this program had spread throughout the world – to Brazil, China and into the Middle East.

"There is great hope for the era of personalized medicine and I think heart failure patients have much to gain from efforts to be more precise in what therapies we give to which patients.

Recently you became the chief scientific officer of Fondation Leducq in Boston. Please tell us about the Foundation and why it prompted you to make this career change.

The Fondation Leducq is the culmination of Jean and Sylviane Leducq’s commitment to improve human health through international efforts to combat cardiovascular and neurovascular disease. The Leducq model of funding is through the Transatlantic Networks of Excellence, initiated in 2003. Since that time, the organization has funded 52 Networks respresenting more than 400 investigators at 130 institutions in 20 countries. The role of chief scientific officer was a new position at the Foundation, and the people, possibilites and the mission of Leducq seemed like a great fit for me, a logical extension of my career so far. I was really lucky to have this opportunity.

What are some of the major advances we will see in the coming decades in the field of heart failure?

There is great hope for the era of personalized medicine and I think heart failure patients have much to gain from efforts to be more precise in what therapies we give to which patients. I think more prognostic phenotyping and diagnostic genotyping will lead to many lifesaving discoveries. I think we will learn how to prevent heart failure in meaningful ways. I hope that mechanical assist devices will continue to improve with respect to technology and outcomes. It will be a very exciting time indeed.

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Jessup completed her medical degree and residency at Hahnemann Medical College and her fellowship in cardiovascular disease at the University of Pennsylvania. In January 2017, she became chief scientific officer of the international grant-making institution Fondation Leducq, leaving her roles as medical director of the Penn Heart and Vascular Center and associate chief of clinical affairs of the cardiovascular division of the University of Pennsylvania School of Medicine. She has served as president of the American Heart Association and been a leader in the development of ACC/AHA Guidelines for the Management of Heart Failure and its updates. She has also served as an important voice in the ACC’s Emerging Strategies for Heart Failure Initiative and was the Kanu and Docey Chatterjee Lecturer at ACC.17 in Washington, DC.

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