1/🧵 @SubodhVermaMD @MkosiborodMD and colleagues have published important findings @JACCJournals on inflammation in obesity-related HFpEF from the STEP-HFpEF Program. Let's break it down! #CardioTwitter #HFpEF #ESCCongress jacc.org/doi/10.1016/j.… 2/ The study analyzed data from 1,145 patients with obesity-related HFpEF, looking at the prevalence of inflammation (measured by CRP levels) and its relationship with patient characteristics and outcomes. #ESCCongress @JACCJournals

What we do now is write a paper...& then preprint @medrxivpreprint ...then we take reviews from the journal & the world & work to make the research better. So, Internal tremors & vibrations in long COVID: a cross-sectional study is open for public comment. https://t.co/xh7dXqPcSGmedrxiv.org/content/10.110…
@medrxivpreprint Our objective: 'We compared demographics, socioeconomic characteristics, pre-pandemic comorbidities, & new-onset conditions between people with internal tremors and vibrations as part of their #LongCovid symptoms & people with long COVID but without these symptoms.' #LISTENstudy

We have been doing a series of studies, led by @jeb1426, on sex differences in symptom complexity & phenotypes in acute myocardial infarction (AMI) and their impact on diagnosis & treatment. Some imp findings. #Cardiology #MedTwitter @YaleMed @YaleCardiology @yuan_lu1 @jeb1426 @YaleMed @YaleCardiology @yuan_lu1 In one study, we found 'Women had more variation in unique symptom phenotypes than men' greater symptom complexity & longer door-to-balloon times. Non-chest pain symptoms are more frequent in women, potentially delaying STEMI recognition. @CircOutcomes ahajournals.org/doi/full/10.11…

One of most important articles I’ve done… showing the noise in clinic BP measurement is large & makes it impossible to track Rx effects; almost useless in evaluating change from 2 clinic visits. Let me explain… ahajournals.org/doi/abs/10.116… @YaleMed @YaleCardiology @CircOutcomes @YaleMed @YaleCardiology @CircOutcomes But first, kudos to the team @yuan_lu1 @shiwani_mahajan @rohan_khera @SpatzErica @GCLinderman #yuntianliu @jbmortazavi #chenxihuang - great team that persisted on this challenging project. And thanks @CircOutcomes @bnallamo for your support and reviews.

Why do people have persistent hypertension? Turns out there are many reasons; we developed a taxonomy to classify them so they can be addressed, based on #EHR data. @yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology #bloodpressure @AHAScience ahajournals.org/doi/abs/10.116… @yuan_lu1 @CircOutcomes @SpatzErica @YaleMed @YaleCardiology @AHAScience Several years ago @yuan_lu1 and I introduced the concept of persistent hypertension to describe people with many measures of elevated #bloodpressure; a more encompassing term than resistant hypertension, which was about not responding to drugs. @amjmed sciencedirect.com/science/articl…

Sleep as medicine... On behalf of hospitalized patients, what is we simply stopped ordering routine lab draws before 7am. What is we wrote an order, do not disturb before 7am except for an urgent need. Or an order for 7 hrs of peace and quiet. @FutureDocs nam12.safelinks.protection.outlook.com/?url=https%3A%… @FutureDocs I strongly believe that rest and sleep are essential to recovery from acute illness...and yet everything we do in the hospital seems to ignore the role of sleep in treatment. We need to put people in a position to help their bodies heal and recovery... not make it more difficult.

Is Omicron benign? No. In our @JAMA_current study, led by @jeremyfaust, more all-cause excess mortality occurred in MA during the first 8 wks of Omicron period than during the entire 23-week Delta period. @YaleMed @harvardmed @YaleCardiology @EMRES_MGHBWH jamanetwork.com/journals/jama/… @JAMA_current @jeremyfaust @YaleMed @harvardmed @YaleCardiology @EMRES_MGHBWH We believe excess mortality is the best metric of the burden of the pandemic… how many excess deaths compared with a pre-pandemic steady state period. And so not about labeling deaths… but a broader view of mortality.

Hey #ACC22 presenters, especially late breaking studies of consequence. If you don't have simultaneous peer-reviewed pub, consider #preprint what you presented so it's archived & accessible. Let’s make it normative. @medrxivpreprint @yaleHFdoc #LBCT @EricTopol @CMichaelGibson @medrxivpreprint @yaleHFdoc @EricTopol @CMichaelGibson For all #ACC22 presenters, preprinting is easy; we accept scientific studies, screen rapidly, post quickly. Non-profit. It is of the community-available throughout the world, understood as pre-peer reviewed, and citable. Almost all reputable journals are fine with it, incl @NEJM.

Great piece @FrancesSSellers ...'How #LongCovid is accelerating a revolution in medical research...Patients, who have typically been only subjects in the research process, are becoming partners in it.’ @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI @FrancesSSellers @washingtonpost @limitlessliza @dianaberrent @VirusesImmunity @YaleMed @PCORI “The people who had the wisdom [about #LongCovid were the people experiencing it.” And that Krumholz, said “opened a lot of people’s eyes to a different way of doing research.” [and this approach should become normative…not more subjects in studies, just authentic partners]

Perhaps the most important and most actionable trial #ACC22 is Chronic Hypertension and Pregnancy (CHAP) Trial. Blood pressure control matters in pregnancy. This needs to be put into action. Next in line of great recent BP trials. nejm.org/doi/pdf/10.105… @ACCinTouch @NEJM @ACCinTouch @NEJM In this study @atitapatterns and colleagues randomized 2408 women w/chronic htn to target <140/90 or usual care (unless BP ≥160/105). Outcomes improved substantially with strategy of targeting <140/90. 18% reduction in risk for primary outcome. @nih_nhlbi @NICHD_NIH

Should we put patients w/chronic heart failure on low sodium diets. This international trial indicates it doesn’t decrease risk of CV events or all-cause death. Little reason to promote the approach.
Nice study @JustinEzekowitz and colleagues. #ACC22 thelancet.com/journals/lance… @JustinEzekowitz The #SODIUMHF study had an interesting finding…secondary endpoints of health status modestly improved w/low salt diet. People can try it if they want & see if they feel better. If not, they can stop w/o fear they're increasing their risk. We docs should not push it on them.

Our new piece: #Racism as a Leading Cause of Death in the US. "To address racism, understand its impact on health, & identify remedies, a national set of metrics is needed to galvanise action & promote accountability." bmj.com/content/376/bm… @bmj_latest #HealthEquity @YaleMed @bmj_latest @YaleMed "Black people in the US are more likely to die young—not because there is some intrinsic biological risk, but because of racism… For many racial & ethnic minority groups, particularly for descendants of enslaved Africans, equality in health and longevity remain beyond reach."

Your data, packaged and sold by @IBM. 'Business analysts said the data dump instantly makes Francisco Partners a significant player in the multibillion-dollar business of buying and selling sensitive information about the care of patients.’ @statnews @caseymross @IBM @statnews @caseymross How did IBM get all your sensitive health data to sell? They bought other companies that acquired your sensitive health data. And how did they get it? Mostly from 3rd parties who obtained it from health systems, insurers, & others you trust with your data. #privacy #digitalhealth

Was watching #Dopesick, and I started reflecting on when I first learned IMS (now IQVIA) tracked every prescription by every doc &sold it to pharma so the doctors could be targeted for drug sales… and how inappropriate that seemed to me. And yet I didn’t do anything. I was on a plane and a drug representative was sitting beside me going through the prescriptions written by doctors he covered - and there was so much detail. Data-drive marketing…& we docs had no idea the companies were tracking us in this way… & IMS was making billions on it.

So many questions still about med device regulation. In our @JAMAInternalMed article we take the Class I recall of Penumbra JET7 Reperfusion Catheter to explore oversight of med devices in the US. Led by star med student @ktkadakia jamanetwork.com/journals/jamai… @jsross119 @AdamLBeckman @JAMAInternalMed @ktkadakia @jsross119 @AdamLBeckman "JET 7 device was subjected to class I recall following more than 200 adverse event reports, 14 of which involved patient deaths.” We explore the evidence at authorization that the catheter was safe and effective. The findings were disappointing. @YaleMed @YaleCardiology @US_FDA

Since I drink a lot of tea I really liked this @uk_biobank paper… I am usually skeptical of these types of studies, but this is a good one. “...drinking coffee and tea separately or in combination were associated with lower risk of stroke and dementia.” journals.plos.org/plosmedicine/a… @uk_biobank I was just a little uncertain why people at the top end of coffee and tea consumption tended to have a higher risk… looked a bit like a j-curve.

Glad to be part of an in-depth analysis of aortic valve replacement in US elderly, led by remarkable @mori_md & @aakriti_15 w/interdisciplinary team of cardiologists & cardiac surgeons. Findings highlight key trends in the TAVR era. jacc.org/doi/10.1016/j.… @JACCJournals @YaleMed @mori_md @aakriti_15 @JACCJournals @YaleMed First, the Medicare beneficiaries receiving a new aortic value increased 60% from 2012, with increasing TAVR (percutaneous procedure) and decreasing SAVR (aortic valve surgery). TAVR up 680%; SAVR down 40%. Marked practice change. @YaleCardiology @ArnarGeirssonMD @ajaykirtane

Lots of discussion about science journals…here’s the thing, they do not make it easy on authors. Each journal has their own format, they do not accept each others peer reviewers, they often ask authors to pay for privilege of publishing, and ask authors to donate time to review. There are so many ways to make this easier… be flexible on format until you decide you want the paper… then you can ask authors to format according to your particular preferences.

Great news… @califf001 nomination for @US_FDA seems imminent. And this is a wise choice for someone with the experience, skills and vision to lead at this critical juncture. Sooner we get confirmation, the better. politico.com/news/2021/11/1… @califf001 @US_FDA It is rare to have a Commissioner who has the experience to hit the ground running, and the expertise on the far-reaching responsibilities of the agency, and deeply understands the science. He also knows the potential gamechanging nature of the digital revolution for regulation.

We published today a study on acute hypertension hospitalization trends, led by @yuan_lu1 and news is not good. Over last 20 yrs rates markedly increased even though this can be prevented w/simple & inexpensive strategies. ahajournals.org/doi/10.1161/CI… @YaleMed @YaleCardiology @CircAHA @yuan_lu1 @YaleMed @YaleCardiology @CircAHA And disappointingly but not surprisingly, the highest rates of acute hypertension hospitalizations were among Black patients, who also experienced the steepest increase over last 20 years. The hypertension crisis is also a health equity crisis. @AHAScience

Resistant #hypertension is elevated BP despite the use of 3 antihypertensive drugs. We now introduce persistent hypertension, a broader concept of persistently elevated blood pressure. @amjmed amjmed.com/article/S0002-… @YaleMed @YaleCardiology #BloodPressure @amjmed @YaleMed @YaleCardiology Resistant hypertension focuses attention on those already treated with maximum doses; persistent hypertension is broader, those with persistently elevated blood pressure, for a wide range of reasons - and this is the vast majority who languish at high risk. @yuan_lu1 @amjmed