As part of our “Meet Yale Internal Medicine” series, today we are featuring Daniel Jacoby, MD, associate professor and director of the Cardiomyopathy Program and the Comprehensive Heart Failure Program.
Q: Tell me about your background. What brought you to Yale for medical school?
A: I grew up in Guilford, Connecticut and went to Yale for my undergraduate degree. My father was a veterinary pathologist and a PhD scientist here, and I used to work in his lab during high school. I was excited to be able to attend medical school where my father worked.
After I graduated from medical school, I went to New York to work at Mount Sinai Hospital. It was a great environment. I went to Columbia for my cardiology fellowship, which was fantastic. I did some specialty work in adult congenital heart disease and undertook an echo fellowship. When I came to Yale School of Medicine I continued my work with the Adult Congenital Heart Disease Program, and began working with Forrester Lee, MD, in the Advanced Heart Failure and Transplant Program.
Shortly after I started in 2009, William McKenna, MD, came to campus as part of the Yale UCL Collaborative, and I got connected with him. Cardiology leadership asked me to start an inherited cardiomyopathy program with Bill, modeled after the massive program Professor McKenna had built in London. At the same time, I was doing heart transplant research, helping with the launch of the left ventricular assist device program, and continuing my work with the Adult Congenital Heart Disease Program. Even though the Adult Congenital Heart Disease Program was one of the most excellent and gratifying programs I had worked with, the volume of work coupled with leadership opportunity lead me to engage in the advanced heart failure and inherited cardiomyopathy programs full-time. One aspect of this that I feel particularly proud of is the broadened mission for heart failure care that I was able to promote as the program lead. We began to expand our reach to care not only for the sickest heart failure patients, but to take a serious role in caring for heart failure patients at all stages of illness.
Q: Why did you choose to study cardiovascular medicine?
A: My grandfather had a heart attack which he survived when he was 45 years old. We discovered afterward that familial hypercholesterolemia runs in the family. That became a very important thing for me right around the time that I was making career decisions in my life, so I think that that was probably the influence.
Q: Tell us more about the advanced heart failure program. What are you most proud of?
A: Five years ago, we made a decision to change the name to the Comprehensive Heart Failure Program. We no longer felt that it was appropriate to focus our energy only on patients who failed all therapies and now needed a heart transplant or mechanical support. We wanted to have our program address all the aspects of heart failure and cardiomyopathy — from the patient who has heart failure that requires years of medical management — to the patient who has inherited conditions — to those at the end stage of the disease. The Comprehensive Heart Failure program now includes:
- Heart transplant
- Mechanical circulatory support
- ECMO
- Temporary LVADs
- Cardiogenic shock team
- Amyloid cardiomyopathy
- Genetic forms of heart disease
- Cardiac sarcoidosis, cardio-obstetrics, and
- A robust population health program
Our goal is the right care, for the right patient, at the right time.
Q: What do you see as the future for this program?
A: We see ourselves as leaders in the field. The primary responsibility that we have is to take care of patients, but very closely tied to that is training the next generation of caregivers and advancement of new knowledge. We have a terrific track record and presence in various areas of heart failure. Examples of that would be Jeffrey Testani, MD, MTR, who has an incredible reputation as a translational scientist and heart failure specialist. Tariq Ahmad, MD, is a junior scientist in the field of heart failure and has a national and outstanding publication record. I have an academic presence in hypertrophic and inherited cardiomyopathy, heart failure, and genetic diseases. All the faculty have outstanding clinical and research programs. Probably most importantly we now have Eric Velazquez, MD, as the chief of cardiovascular medicine who brings with him a wealth of experience in translational heart failure research.
Q: If you were speaking to a fellow who was looking at coming to Yale, why should they come here to study under your program?
A: Momentum favors coming here. If I were coming out of training now and looking to do a fellowship in heart failure, I would consider Yale my top choice. The program is rapidly expanding and there are big opportunities. Plus, New Haven is a great place to live with lots of arts, music, and outdoor activities as well as great restaurants.
If you consider what you want out of a fellowship: great clinical experience, an opportunity to produce research, and an environment where you're seeing the field moving forward, Yale is the place for that.
Q: How do you divide your time?
A: I divide my time between my outpatient cardiomyopathy program, administration, clinical work for the advanced heart failure program, translational science, and the fellowship. I have one three-hour block a week where I focus on research. I also do inpatient rotations on the heart failure service at both campuses of Yale New Haven Hospital. Giving talks in the community and outreach is another component of what I do. Historically, I have also organized the annual CME event for heart failure. Dr. Ahmad has taken that over for 2019.
Q: Tell me about your current research priorities?
A: I went to medical school with an entrepreneur named Michael Singer, MD, PhD. About three years ago, Singer donated about $100,000 to start something called The Joshua C. Gibson, M.D., Memorial Fund for Heart Research. Josh Gibson was a medical student with us, and he died from an unrecognized heart condition during his ID fellowship. After what happened to Josh, Dr. Singer gave a gift to this program to study diseases that cause sudden death in the young. We’ve been privileged to hire Nikolaos Papoutsidakis, MD, PhD, to do lots of research though that funding.
For example, we participate actively in the SHaRe Registry which is a collaboration of international experts in sarcomeric cardiomyopathies. We also partner with close colleagues at Yale including Stuart Campbell, PhD, in the Department of Biomedical Engineering and Yibing Qyang, PhD, in the Cardiovascular Research Center (CVRC) stem cell program to develop novel investigations and diagnostics for cardiomyopathic disease.
My colleagues Edward Miller, MD, PhD, Nikolaos Papoutsidakis MD, PhD, and I are also privileged to work with Michael Murray, MD, in the Generations Project to investigate prevalence and treatment of cardiac amyloidosis.
We are currently seeking volunteers for two clinical trials. ATTRIBUTE-CM is a phase 3 randomized clinical trial for patients with symptomatic Transthyretin Amyloid Cardiomyopathy, and GUIDE-HF to test the effectiveness of a medical sensor in patients that have heart failure and are at an increased risk of hospitalization.
Previous clinical trials work was recently published in Annals of Internal Medicine, Mavacamten can reduce LVOT obstruction and improve exercise capacity and symptoms in patients with hypertrophic cardiomyopathy.
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