Melissa Walton-Shirley

Disclosures

November 18, 2013

Nancy Brown, CEO of the American Heart Association, opened today's sessions Texas-style after a taped welcome message from the popular TV characters "Bobby and Sue Ellen Ewing." This played well, as it followed a bigger-than-life orchestral rendition of the theme song to the nostalgically popular television show that shares its name with the iconic city of Dallas. The intro was completed with aerial shots from around the state. "Sue Ellen and Bobby" still look fantastic. They were a staple of my Friday-night date nights starting way back in 1978. It was entertaining just to see them again on screen.

Dr Mariell Jessup (University of Pennsylvania School of Medicine, Philadelphia), this year's president of the American Heart Association, began by saying that "Texas is a huge state and famous for so many things: hospitality, graciousness, oil, and of course the TV show Dallas! I welcome you with the big heart of Texas, and thanks for being here." What followed was a touching and poignant presentation on the advances in heart failure, two fascinating case reports, and a surprise appearance by two very special patients.

After an in-depth review of the history of pharmacologic and device management of chronic heart failure, Dr Jessup related the first story of one of her most notable patients. "Tony" was diagnosed with a cardiomyopathy in his mid-40s. His EF was just 25%. His left ventricular ejection fraction, his symptoms, and his quality of life have all been bolstered by the advent of nearly every class of drugs and devices available in the era of the pharmacologic and device treatment of heart failure. He was her first chronic heart failure patient to receive beta- blockers, a move that left her terrified. "I felt I was about to sail off the edge of the flat earth," but the instincts of her mentor Dr Karl Weber, who suggested she use beta-blockade, were correct, and Tony's symptoms of tachycardia and shortness of breath were improved. "I have continued to follow him more than 30 years altogether," she said. "He's inquisitive by nature and was subsequently randomized to an ACE-inhibitor trial. After that, his exercise tolerance became almost normal."

Then he volunteered to take part in SCD-HEFT and had a CRT pacemaker implanted. His most recent EF was 55%, up from 30% before implantation. "He's now 87 and always questions me about what's new in heart failure. Tony and his wife Joyce had their 60th wedding anniversary. We should all remember what unsung heroes these volunteers are," she beamed. The audience "aahed" with admiration when a picture of a dapper gentleman and his beautiful wife flashed on the big screen.

Then Dr Jessup told the story of a young mother, Elaine, who lost her battle with presumed peripartum cardiomyopathy. Some years later, a young woman with a low EF was referred to her, and in hearing her family history, she recognized that "Jess" had been the newborn baby of Elaine that Mariell had so desperately tried to save. "It was an inherited cycle of familial heart failure before my eyes. There must be an inherited genetic mutation," she reasoned. "Jess is thriving—recently married, completed nursing school, exercises vigorously, and volunteers for the AHA."

It was a treat to see Dr Jessup's special patients "Tony and Jess" walk across the stage to join her. The simple fact they are alive is miraculous. Their ability to thrive is both a testament to their good fortune of having been born in an era of heart-failure pharmacology but also to having one of the foremost practitioners in the world of heart failure as their physician.

Then another one of the world's outstanding heart-failure physicians took the stage to accept the chairperson's award.

I've known Dr Ileana Piña (Case Western Reserve University, Cleveland, OH)for several years now in our affiliation with theheart.org on Medscape. She's a forthright, hard-working, dedicated professional who has never been at a loss for meaningful words when I interview her. Her "brown-bag clinic approach" to postdischarge heart-failure management is legendary, and her smile radiant. Today, we all had an opportunity to know her better. "When I was nine years old, my father dropped me off at school. That was at 8:30 am. At 3:30 pm he was gone," she said, her voice transformed by the emotion of a nine-year-old schoolgirl who had seen her father alive for the last time. Because "he didn't have the opportunity to benefit from the many advances" that are a product of the efforts of the American Heart Association, she accepted her award in his honor. I believe it was her daughter who sat beside me beaming with pride.

So we saw the interface of discovery and action, love and loss, and tragedy and victory in the realm of cardiovascular science in the opening session of the American Heart Association. Its members have a lot to be proud of. Our dedication to the reduction of death and dying from stroke and heart attack is what motivates several thousand of us to travel each year, and it is what brought us to Dallas in 2013. It is at these meetings and others like it that we encourage, comfort, congratulate, and speculate on what the future might bring.

I hope that's a Texas-size future for the good of all humankind.

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