A Day of Heart Failure at Heart House: The Mid-Atlantic Capital Cardiology Symposium

Jan 19, 2016 | Nisha Gilotra, MD
Chapter Engagement

The Mid-Atlantic Capital Cardiology Symposium took place November 21, 2015 at ACC’s Heart House in Washington, DC. The room was packed this year, with academicians, private practitioners and trainees from Washington, DC, Maryland, Virginia, Delaware and Pennsylvania. The day was filled with exciting educational sessions, research presentations and networking opportunities under the supervision of the director Michael A. Solomon, MD, FACC, chief of cardiology at the National Institutes of Health (NIH).

Learning left from right

This year’s educational focus was on advanced heart failure (HF), an important topic for today’s cardiologist, as the HF population continues to grow to epidemic proportions. There was special attention to the right ventricle and pulmonary circulation. Attendees had the opportunity to hear about the latest in pulmonary arterial hypertension diagnosis and treatment from Anjali Vaidya, MD, FACC, of the University of Pennsylvania, followed by a case-based talk on the management of severe right ventricular failure by Amresh Raina, MD, FACC, of Alleghany General Hospital. The educational sessions culminated with a lecture on advanced left HF by Clyde Yancy, MD, MACC, chief of cardiology at Northwestern University Feinberg School of Medicine. Dr. Yancy discussed the approach to patients at the various stages of HF, including the use of novel drug therapies.

If you don’t try…you won’t succeed

It has been a busy year for HF drug trials and the Symposium focused on some of these novel therapies. Results from the NEAT-HFpEF study, which examined the effects of nitrates on activity level in HF with preserved ejection fraction (HFpEF) patients, were presented during the MACCS Late Breaking Clinical Trials Session, a session in which FITs presented recently released trials. Unfortunately, this trial, along with the FIGHT (effect of GLP-1 receptor agonist, liraglutide, on HF with reduced ejection fraction after hospital discharge), SOCRATES-REDUCED (effect of soluble guanylate cyclase stimulator, vericiguat, on NT-proBNP levels) and BEAT-HF (beta-3 adrenoceptor agonist) trials, which were also presented at the American Heart Association’s Scientific Sessions in Orlando in 2015, were negative.

However, there was some light at the end of the tunnel for cardiomyopathy providers this year. We welcomed the arrival of the combined angiotensin receptor antagonist and neprilysin-inhibitor valsartan/sacubitril (Entresto, Novartis), which, in the PARADIGM-HF study, showed an overwhelming benefit compared to enalapril, bringing the randomized double-blind trial to an early stop. Those in the valsartan/sacubitril group had a 20 percent risk reduction compared with the enalapril group for the primary outcome of cardiovascular death or heart failure hospitalization. As Dr. Yancy pointed out in his presentation on advanced heart failure, optimal patient selection for this new therapy is still being sorted out, with the primary concerns thus far being intolerance due to hypotension, and need for careful monitoring of renal function and potassium. Additionally, the long-term effects of chronic neprilysin inhibition are not yet known. There is some speculation that neprilysin, which also breaks down amyloid-beta peptide, accumulation of which plays a role in development of Alzheimer’s disease, may have untoward effects on the brain or eye. However, this has yet to be shown in any clinical studies. There is an ongoing study, PARAGON-HF, examining the role of valsartan/sacubitril compared with valsartan alone in patients with HFpEF.

Getting involved with your ACC Chapter as a FIT

The meeting was highly attended by FITs, with several opportunities for FITs to feature their accomplishments, including the oral abstract presentations for the Young Investigator Award, poster session, Late Breaking Clinical Trial session and some friendly regional competition with FIT Jeopardy. Three teams, one each from Maryland, Pennsylvania and Virginia, qualified to represent their states in the national ACC FIT Jeopardy competition at ACC’s Annual Meeting in Chicago, IL, April 2 – 4. Trainees had the opportunity to interact with cardiologists from across the region during the poster sessions and throughout the meeting. New this year were labels “looking for a job” and “expanding practice,” that attendees could add to their name badges to help break the ice and facilitate networking.

Don’t forget to visit your ACC chapter websites to find out how to get more involved as a fellow at the local level.

This article was authored by Nisha A. Gilotra, MD, a fellow in training (FIT) in the Division of Cardiology at Johns Hopkins School of Medicine.