Jay Vance

Cardiology fellow by way of med/peds

[Jay Vance @jaycvance]

Though unsurprising, it's unsettling to see a direct dose-response relationship between the number of meals a Novartis rep bought for a general cardiologist and the number of sac/val prescriptions they wrote.

[Jay Vance @jaycvance]

The year is 2032. SpaceX has opened a residential colony on the moon and is now handing out free lattes at the center of the vendor fair at ACC32. This recommendation appears in the new HF guidelines based on a recent JAMA Cardiology research letter.

[NNE Chapter, ACC @NNewEnglandACC]

Congrats to Team Vermont for winning this year's @NNewEnglandACC FIT Jeopardy Tournament! They will represent the Chapter at ACC.25 in Chicago. Way to go @uvmcards competitors!!!

[Jay Vance @jaycvance]

5/ I wish he discussion and/or editorial had framed the findings more objectively: In 60-something yo pts who initially tolerated a maximum dose of sac-val for at least 6 weeks and then later developed hypotension…

[Jay Vance @jaycvance]

1/ This is an elegant post-hoc analysis of prognostic associations of hypotension in PARADIGM-HF, but I disagree with the conclusion that the benefits of sac/val were “enhanced” in patients experiencing hypotension.

https://t.co/e1f8p2wFY2

[Jay Vance @jaycvance]

4/ I have no idea how to interpret/apply these results in light of PARADIGM-HF’s pre-randomization double drug run in period, during which >1100 pts were excluded for adverse events, the majority of which I’m willing to bet were hypotension-related.

[Jay Vance @jaycvance]

Small Gerbode defect seen on CMR.

(Illustration from a great review by Saker et al., PMID: 28983172)

[Jay Vance @jaycvance]

Canakinumab lowers risk of MACE, yet we can't use it due to higher rates of fatal infection (despite no difference in ACM).

Rilonacept and anakinra reduce pericarditis recurrence, and we can use them without studies powered to detect difference in fatal infection rates.

Why?

[Jay Vance @jaycvance]

Tragic. A CHOP chief resident and future pediatric oncologist killed while bike commuting. The infrastructure for and attitude towards human-powered transport in the US is egregious.

https://t.co/a7IgvJ4Gi7

[Jay Vance @jaycvance]

I’m J.C. Vance and an alumnus of the Ohio State University. This is… inconvenient.

[Jay Vance @jaycvance]

9/ Questions: Is the outcome data (pVO2/6MWT improvement, HHF reduction) clinically meaningful? Is FCM cost effective? Is it reasonable to use FCM in hospitalized patients or use IV iron formulations other than FCM? Input very much welcome!

[Jay Vance @jaycvance]

2/ The AHA and ESC HF guidelines define ID w/ FAIR-HF criteria (ferritin <100 or 100-299 w/ TSAT <20%). A third of pts w/ that criteria don’t truly have deficient bone marrow iron stores (PMID: 29382661). TSAT <19.8% or iron <13 (regardless of ferritin) might be better biomarkers

[Jay Vance @jaycvance]

8/ Summary: FCM is probably reasonable in carefully selected ambulatory HFrEF patients who don’t mind attending outpatient infusions for a small chance of benefit, especially if TSAT <19.8% or iron <13.

[Jay Vance @jaycvance]

1/ Really nice review published in JACC this week on the topic of iron deficiency (ID) in HFrEF. Here are my takeaways and what I continue to grapple with: