Ileana L. Piña, MD, MPH

Disclosures

April 05, 2012

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Hi. I'm Ileana Piña and this is my blog. I'm from Montefiore Einstein Medical Center in the Bronx, and I'm talking to you today from the American College of Cardiology (ACC) Annual Scientific Session in Chicago. There is a lot of excitement, and I'm very thrilled to see a very high attendance this year and to talk to you a bit about what's going on in the sessions.

Hospital-to-Home Initiative: Thinking Outside the Box

The hospital-to home (H2H) initiative of the ACC, which I have talked about before to this audience, is trying to reduce the staggering 30-day readmission rate that we have all been facing, and where there probably will be payment cuts. We have talked about initiatives that are different, that are thinking outside of the box. At a session here, 4 or 5 of us are going to bring one of our fellows, nurses, or other associates to talk about what we actually are doing in our own centers.

In my own place, we are doing a "brown bag clinic," where we ask patients to empty out their medicine cabinet, put all their medications in a brown bag, and bring them in. This clinic is run by pharmacists who are really excellent teachers. They will go over the patients' medications, but they also have the ability to uptitrate. Very often, patients are sent home on low doses of drugs, and until they see their provider again, the medications are never uptitrated. So, this is an example of thinking outside of the box [at one clinic], and we will be hearing about others.

Galectin-3: A New Biomarker

Another interesting talk at the meeting concerns biomarkers. Galectin-3, a new emerging biomarker, has been recently approved by the FDA, based on data from the HF-Action trials,[1] where we had saved blood samples. Galectin-3, in fact, was associated with worse outcomes, which is the basis of much of the work that has been surrounding galectin-3, including its association with fibrosis. One of the questions that we are asking is, should we be testing large cohorts?

Daniel Levy's group from Framingham presented an abstract about the levels of galectin-3 in the second Framingham cohort. This consists of the offspring of the initial Framingham cohort with a mean age of about 59 years and with a very strong association with incident heart failure -- in other words, new heart failure diagnosis. Keep your eyes open, because I'm sure that the publication following that abstract will be coming out very soon.

From HF-Action

We also have a couple of papers from HF-Action, including one about a very common comorbidity: chronic obstructive lung disease and how important it is that a cardiopulmonary test be well done so that it can help a clinician differentiate shortness of breath due to the heart from that due to the lungs. Of note, when minute ventilation is successive and encroaches upon patients' maximum ventilation, patients are likely to be limited by their lungs and not by their heart.

We hope that you can tune in to others of these sessions. I will be doing several other blogs to keep the audience abreast of what's going on. I want to thank you for the attention today and say goodbye to you from Chicago and ACC sessions.

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