Gregory Macaluso

Heart Failure and Cardiac Transplant MD, Dad, and Notre Dame lover ‘00. tweets are my own

[JACC Journals @JACCJournals]

💊 Can SGLT2 inhibitors improve outcomes in transthyretin cardiac #Amyloidosis?

A #JACCAdvances meta-analysis of 14 observational studies (n=10,852) found #SGLT2i use was associated with 56% lower all-cause mortality & 38% lower HF hospitalization.

https://t.co/PwRd726Flu

[EHJ Editor-in-Chief @ehj_ed]

Acute heart failure in emergency settings: A clinical consensus statement of the Association for Acute CardioVascular Care and the Heart Failure Association of the European Society of Cardiology and the European Society for Emergency Medicine. Read more in #EHJ
https://t.co/9wpUy4hh5n
@escardio @ESC_Journals #HFA_ESC @ACVCPresident @HFA_President #heartfailure #EUSEM

[HF Collaboratory @hfcollaboratory]

Out now in @JAMANetwork from #HFC member @LindenfeldJoann et al.

This article reviews heart transplantation in advanced heart failure, with a focus on the I NEED HELP tool for early referral and, lifelong multidisciplinary care after transplantation. https://t.co/ABgwUqwfiV

[Gregory Macaluso @gmac78]

@dannykanell It’s a total joke their narrative. Landscape has completely changed. Expect better from them but the bias is real.

[Grok @grok]

@jakefisher @jonathontcole @mcuban Lex Luthor. Corporate masterminds running complex schemes from the shadows, diverting resources and inflating costs through layers of intermediaries while posing as essential middlemen.

[Loose Cannon @JFK_Chicago]

I can't possibly be any more in on this team than I already am but somehow they found a way

[Will Compton @_willcompton]

You don’t have to care about what’s in South Bend when you have facilities like this

My god

[Afshine Emrani MD FACC @afshineemrani]

I'm a cardiologist. I've spent twenty years inside American healthcare, and I'll say the quiet part first: the system is indefensible.

We spend roughly 18% of GDP on health care — the highest on earth — and have a lower life expectancy than countries spending half as much. Medical bills are a leading cause of bankruptcy. I have patients rationing insulin. I fight prior authorizations for medications that prevent heart attacks and imaging that finds cancer early.

Anyone defending the status quo isn't practicing medicine. They're profiting from it.

So why am I not for #MedicareForAll ?

Because I've watched what government-run health care actually does — from inside the exam room.

Denial doesn't disappear. It changes uniforms. Insurers deny by prior authorization. Single-payer systems deny by waiting list. Canada's median wait from referral to treatment has run over 25 weeks. The UK's NHS backlog has hovered around 7 million. When you eliminate the price signal, you don't eliminate rationing — you just move it from a claims department to a queue, and queues are invisible. Nobody sues a waiting list.

Medicare rates don't cover the cost of care. Hospitals lose money on Medicare and Medicaid and make it back on private insurance. Extend Medicare rates to everyone and that cross-subsidy vanishes overnight. Rural hospitals go first. Independent practices consolidate into hospital systems. The physicians I know would retire early, and the smartest students would go elsewhere. You can legislate coverage. You cannot legislate a doctor into existing.

The fraud problem is already staggering. HHS loses an estimated $100 billion a year. Investigators found a hotel in Los Angeles where every room was a registered hospice with zero patients — just addresses billing Medicaid. If we can't police the programs we have, scaling to the entire country isn't reform. It's a bigger target.

And the innovation math is real. Just this month: the first oral PCSK9 inhibitor approved, five Lp(a) drugs in late-stage trials, engineered immune cells that clear arterial inflammation. Americans overpay for drugs, and that overpayment subsidizes global R&D. Crush prices to European levels and something has to give. I'd rather fix the pricing abuse than gamble the pipeline.

What I'd actually do, and none of it requires a $30 trillion bet:

Real price transparency, enforced — you can't have a market where nobody sees prices.

Break the employer link so insurance is portable and you don't lose coverage with your job.

Expand HSAs and direct primary care — my colleagues doing it spend more time with patients and charge less.
Break the PBM middlemen inflating drug costs.
Site-neutral payments so a hospital can't charge triple for the same test.

AI-driven fraud auditing — flag every provider billing 10 standard deviations above peers and audit them.
Universal catastrophic coverage so nobody goes bankrupt from cancer.

Now the honest counterpoint, because you deserve it: the strongest case for single-payer is administrative. Private insurers run 15-25% overhead. Traditional Medicare runs 2-3%. Most published economic analyses do project net savings. And every peer nation with universal coverage spends dramatically less than we do. Those aren't talking points — they're real findings that my side has to answer.

I just don't believe the answer to a bureaucracy that denies your care is a bigger bureaucracy that can't be sued.

Fix the prices. Fix the fraud. Cover the catastrophes.
Don't hand the whole thing to the same people who couldn't notice 29 hospices in one hotel.

[CathVSConf☘️ @CathVSConf]

For years, the question lingered: why Jadarian Price stayed RB2 at Notre Dame when other schools wanted him as RB1.

He told @SeattleSports:
"Notre Dame was the best decision of my life. I wanted to finish my degree. I came back to prove to myself I was just as good as Jeremiyah Love.

Was it ever hard to stay?
"Two weeks after the National Championship teams back home in Texas and Bill Belichick called me. My mom cried when I turned down the big offers and chose to stay at Notre Dame. I had a plan."

[Ahmed Bennis MD 🫀 @drbennisahmed]

💊🫀 What does optimal therapy actually buy a 65-year-old with HFmrEF/HFpEF?
From Nature Medicine (Vaduganathan et al., 2025):
🔴 SGLT2i + nsMRA → +3.6 years event-free survival
🔴 SGLT2i + nsMRA + ARNI → +4.9 years (LVEF <60%)
vs. standard therapy alone.
Nearly 5 extra years without hospitalization or death.
💡 These drugs exist. They work. Are all eligible patients receiving them?
Vaduganathan et al. Nature Medicine, Oct 2025
@mvaduganathan

#HeartFailure #HFpEF #HFmrEF #SGLT2i #ARNI #Cardiology #MedTwitter #NatureMedicine

[Anthony DiGiorgio, DO, MHA @DrDiGiorgio]

In other news, the sky is blue.

[Wesley Pritchett @wpritchett34]

This is Pure Gold. I had the pleasure of spending time with Coach Holtz. I wanted to hear him explain his Three Rules for Life! 1) Do what’s right - trust. 2) Do everything to the best of your ability- commitment. 3) Show people you care - love. It’s pretty simple. He goes on to highlight why the transfer portal is ruining college football. The kids are losing out on the life lessons learned- how to persevere, how to be committed to a program and a group of people. You miss out on the bonds you create over 4 years. If you leave, you still have the problem, you are changing the address. These are words to live by.

[Jerome Bettis @JeromeBettis36]

There are moments in life when words just aren’t enough. Losing Coach Holtz is one of those moments.

Coach was so much more than a football coach to me. He was family. I still remember the day he came to my house to recruit me. He didn’t just sit down and talk to me about football or what I could do on the field. He talked to me as a young man. And he spoke to my mom the way a man should speak to a mother who was trusting someone with her son. He looked her in the eye and promised that I would be taken care of at Notre Dame. That moment meant everything to us, and it’s something I’ve carried with me my entire life.

Coach Holtz believed in people. He believed in building men, not just players. He welcomed my entire family into the Notre Dame family and always made sure we felt that love and support. That’s who he was. He cared deeply about the people around him, and he made every one of us feel like we mattered.

The lessons he taught me went far beyond football. His faith, his discipline, his belief in doing things the right way shaped who I became as a man, a father, and a leader.

My heart is broken today, but I’m also filled with gratitude for the time I had with him and for the impact he had on my life. Coach will always be with us—in the lessons he taught, in the lives he changed, and in the love he gave so freely.

Thank you for everything, Coach. I love you.

You will forever be in our hearts.

Go Irish ☘️

[Notre Dame Football @NDFootball]

Head Coach Marcus Freeman’s statement on the passing of Lou Holtz

[Notre Dame Football @NDFootball]

Remembering the life and legacy of Lou Holtz

[Notre Dame Football @NDFootball]

eXcellence from Notre Dame to the NFL ❎☘️

Good luck to Defensive Rookie of the Year Nominee Xavier Watts at the @NFL Honors tonight.

#GoIrish☘️ | #IrishInTheNFL☘️ | @AtlantaFalcons | @xavierwatts6

[Jarrett Payton @paytonsun]

Full circle moment at #SuperBowl . Asked @Seahawks #WPMOY nominee @_jlove20 what the award means as a #Chicago kid. He remembered me speaking to his 3rd grade football team &amp; how it shaped his giving back journey. Grateful, Julian. 🙏🏽

[SeminOLD School @SeminOLDschool]

…they are also the first, last, &amp; ONLY team in CFB history to “move up” in the rankings after losing by FIVE TOUCHDOWNS &amp; failing to score a single TD of their own.

Weird huh?!

[Gregory Macaluso @gmac78]

🐻⬇️
Thanks for having me @ABC7Chicago @ChicagoBears

Cardiologist weighs in on 'Cardiac Bears https://t.co/0ZRzru7Y8k