Gregg Fonarow MD

[Henry Han @HanCardiomd]

LBB Area Pacing vs RV Pacing for AV Block and Preserved Left Ventricular Function:
The #LEAP-Block Trial

📍499 patients with #LVEF ≥50% randomized to LBBAP vs #RVP across 14 Chinese hospitals.

📍 Primary endpoint: 2.4% vs 12.5% favoring #LBBAP (P=0.003).

📍 HF events: 3.4% vs 11.3% with LBBAP vs RVP.

📍 LBBAP ⬇️ the 24-month primary endpoint risk (HR 0.37, 95% CI 0.19–0.73), with no significant differences in mortality or device complications.

#LEAPBlock #Cardiology #HeartFailure #Pacing

https://t.co/WYk6J8JIny

@JAMACardio #JAMA

[Gregg Fonarow MD @gcfmd]

@docwarsi @hvanspall @SJGreene_md @JavedButler1 @AndrewJSauer @ankeetbhatt @FudimMarat @robmentz @HeartDocSadiya @boback @ATSandhu Management of Patients With Heart Failure at Home After Hospital Discharge (STRONG@HOME)

Sponsor University 🏨, Akershus

https://t.co/ijuxZ5YygY

•Arms:

◦Digital follow-up at home: video consultations + telemonitoring

◦In-person follow-up at an HF outpatient clinic

[Gregg Fonarow MD @gcfmd]

@docwarsi 📲 Remote vs in-person #GDMT titration in HFrEF:

✅ 86% vs 48% reached optimal dose (pilot RCT)

⏱️ 11 vs 19 wks to optimal

🏥 54% fewer clinic visits

📈 Navigator-led: BB use 77→92%

🏠 Home titration: 0 vs 26 HF hosps (obs)

⚠️ Small studies; bigger RCTs ongoing

[Circ: PHO @CircOutcomes]

What actually drives quality of life(QoL) in #HFrEF?Analysis of 2 HFrEF registries finds low KCCQ-QoL score is driven by symptoms &social limitations(effect size 0.48-0.60)less by physical limitations alone(effect size=0.34) Findings held across age & sex
https://t.co/vqPCdpKTzA

[Gregg Fonarow MD @gcfmd]

@docwarsi @dranulala @MinnowWalsh @DCRINews @CaliforniaACC @Drroxmehran @robmentz @DLBHATTMD @HFSA @NMHheartdoc @MKIttlesonMD Potentially can assist with identifying eligibility, contraindications, prior intolerance beyond simple yes/no queries

Potentially can assist with digital/remote initiation, titration, monitoring, including labs and patient education (with less need for in person clinic slots)

[Gregg Fonarow MD @gcfmd]

🫀 Full quadruple GDMT for US HFrEF:

💊 4 generic pills, ~$25/month ➡️

❤️ ~114K lives saved/year

🏥 ~864K hospitalizations avoided

💰 $16.3Billion net savings

⚠️ Only 18% get all 4

💻 One of the best opportunities in healthcare for AI to improve care, outcomes & cost?

[Ahmed Bennis MD 🫀 @drbennisahmed]

Practical Implementation of Steroidal and Nonsteroidal Mineralocorticoid Receptor Antagonists in the Management of Heart Failure

Guideline-directed medical therapy is often underutilized in patients with HF.

Consider simultaneous or rapid sequence initiation of a combination therapy for patients with HF with mildly reduced or preserved ejection fraction
@mvaduganathan @gcfmd @CMichaelGibson @SJGreene_md @DrMarthaGulati @HFA_President @GianluSava
https://t.co/vRIJDqvMoY

[JACC Journals @JACCJournals]

MRAs are effective for #CHF across the entire LVEF spectrum. Guidelines, label indications, & patient comorbidities must be considered when selecting an MRA for GDMT combination therapy regimens. Read the state-of-the-art review in #JACCAdvances!

@GCFMD

https://t.co/agnzGUxYqt

[Journal of Cardiac Failure @JCardFail]

💰 The broader annual cost burden of Heart Failure (HF) is projected to reach $858 billion by 2050. Yet, we hold an extraordinarily cost-effective solution in our hands today. See below for more + click here for more insights from our HF STATS 2026 report https://t.co/LmsKyqs781

[Gregg Fonarow MD @gcfmd]

@GlidingOverAll @rblument1 @kewatson @DrMarthaGulati @boback @CBallantyneMD @AnnMarieNavar @HeartDocSadiya @ATSandhu @ericpetersonMD @pnatarajanmd Less expensive full-dose options:

Lerochol at $199/mo (monthly by design)

Praluent at $225/mo

Lipfendra (oral): if you have commercial insurance, Merck's copay card may get it down to $15

Also can try an insurance appeal with risk documentation

[Gregg Fonarow MD @gcfmd]

💊 PCSK9 inhibitors in the US, Oct 2026:

💉 Repatha: ~60%↓LDL | CVOT ✅ | $239/mo

💉 Praluent: ~45–60% | CVOT ✅ | $225/mo

🩺 Leqvio: ~50% | CVOT ⏳ | no DTC

💉 Lerochol: ~56–60% | CVOT ❌ | $199/mo

💊 Lipfendra (oral!): ~56–59% | CVOT ⏳ | $315 list

 #Lipids

[Gregg Fonarow MD @gcfmd]

@GlidingOverAll @rblument1 @kewatson @DrMarthaGulati @boback @CBallantyneMD @AnnMarieNavar @HeartDocSadiya @ATSandhu @ericpetersonMD @pnatarajanmd Discuss w/ your MD

One 140 mg pen a month: in single-dose data, LDL-C fell about 70% by day 15, and about 38% of that drop remained at day 29

It's off-label with no outcomes data, and on a statin it may fade faster

Check lipids right before the next dose to see true trough

[Gregg Fonarow MD @gcfmd]

@LipidLover1030 @DrLuizSilva1 @rblument1 @kewatson @DrMarthaGulati @boback @CBallantyneMD @AnnMarieNavar @HeartDocSadiya @ATSandhu @ericpetersonMD @pnatarajanmd There remains a substantial opportunity to improve care and outcomes for those with and at risk for ASCVD

[Gregg Fonarow MD @gcfmd]

💊Is evolocumab cost-effective before a first MI or stroke?

📊 VESALIUS-CV lifetime model at $3,107/yr

❤️ −0.24 MACE/person

✅ ICER $71,162/QALY; scenarios $20K–$51K

🎯 All below the $120K AHA/ACC threshold

⚠️ Preprint

🔗 https://t.co/7LTpH7kvKx

[Gregg Fonarow MD @gcfmd]

@evipedia_ai @rblument1 @kewatson @DrMarthaGulati @boback @CBallantyneMD @AnnMarieNavar @HeartDocSadiya @ATSandhu @ericpetersonMD @pnatarajanmd

[Gregg Fonarow MD @gcfmd]

@TheLancet “Meanwhile, observational or real-world data are increasingly available for retrospective evaluations, but face inherent, unmeasurable, systematic errors from confounding and selection biases.”

[Gregg Fonarow MD @gcfmd]

@orion7710 @boback @kewatson @HeartDocSadiya @rblument1 @DrMarthaGulati @texhern @HeartBobH Low vitamin D is associated with many diseases in observational studies

Does supplementing help?

RCTs say:

🧠 Dementia — no
🔬 Colon polyps — no
☀️ Melanoma — no
🦠 Severe COVID — no

🦴 Bone/fractures — YES, but only in the truly deficient + calcium

[Gregg Fonarow MD @gcfmd]

Trial after trial, vitamin D supplements keep coming up empty:

💊 VITAL (25,871): no CV benefit

🧬 83,000 across 21 RCTs: null

💀 80 RCTs: no CV benefit

🩺 SIMPLIFIED (2026, dialysis): no ☠️ benefit, HR 0.94

Billions spent on RCTs

Still nothing

Low D is a marker

[Gregg Fonarow MD @gcfmd]

@ACCinTouch @MedAxiom What is the @ACCinTouch doing to help address this issue?

The 2027 @CMSGov HF ASM quality measures beta-blockers and RASi 💊, but not ARNI, MRA or SGLT2i

Those 3 could prevent:

~88K deaths 💔 a year

~746K 🏥 a year

Saving $14.1B 💰, at $227/year per patient