Featured Publications
Electronic health record alerts for management of heart failure with reduced ejection fraction in hospitalized patients: the PROMPT-AHF trial
Ghazi L, Yamamoto Y, Fuery M, O'Connor K, Sen S, Samsky M, Riello R, Dhar R, Huang J, Olufade T, McDermott J, Inzucchi S, Velazquez E, Wilson F, Desai N, Ahmad T. Electronic health record alerts for management of heart failure with reduced ejection fraction in hospitalized patients: the PROMPT-AHF trial. European Heart Journal 2023, 44: 4233-4242. PMID: 37650264, DOI: 10.1093/eurheartj/ehad512.Peer-Reviewed Original ResearchGuideline-directed medical therapyAcute heart failureMineralocorticoid receptor antagonistsHeart failureElectronic health recordsGDMT prescriptionPrimary outcomeEnzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitorsSodium-glucose cotransporter 2 inhibitorsAngiotensin receptor neprilysin inhibitorElectronic health record alertsEvidence-based regimenProviders of patientsReduced ejection fractionCotransporter 2 inhibitorsRelevant patient characteristicsTime of dischargePre-specified criteriaAHF hospitalizationEligible patientsInpatient initiationPatient characteristicsEjection fractionHospitalized patientsMedian ageElectronic Alerts to Improve Heart Failure Therapy in Outpatient Practice A Cluster Randomized Trial
Ghazi L, Yamamoto Y, Riello RJ, Coronel-Moreno C, Martin M, O'Connor KD, Simonov M, Huang J, Olufade T, McDermott J, Dhar R, Inzucchi SE, Velazquez EJ, Wilson FP, Desai NR, Ahmad T. Electronic Alerts to Improve Heart Failure Therapy in Outpatient Practice A Cluster Randomized Trial. Journal Of The American College Of Cardiology 2022, 79: 2203-2213. PMID: 35385798, DOI: 10.1016/j.jacc.2022.03.338.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyUsual careEjection fractionHeart failureMedical therapyPrimary outcomeCluster-randomized comparative effectiveness trialSodium-glucose cotransporter 2 inhibitorsElectronic health record alertsAldosterone system inhibitorsReduced ejection fractionUsual care armCotransporter 2 inhibitorsMineralocorticoid receptor antagonistsVentricular ejection fractionComparative effectiveness trialNumber of patientsKnowledge of guidelinesLow-cost interventionCare armDays postrandomizationEligible patientsGDMT useFailure therapyPatient characteristicsEmpagliflozin in Heart Failure
Griffin M, Rao VS, Ivey-Miranda J, Fleming J, Mahoney D, Maulion C, Suda N, Siwakoti K, Ahmad T, Jacoby D, Riello R, Bellumkonda L, Cox Z, Collins S, Jeon S, Turner JM, Wilson FP, Butler J, Inzucchi SE, Testani JM. Empagliflozin in Heart Failure. Circulation 2020, 142: 1028-1039. PMID: 32410463, PMCID: PMC7521417, DOI: 10.1161/circulationaha.120.045691.Peer-Reviewed Original ResearchConceptsSodium-glucose cotransporter 2 inhibitorsCotransporter 2 inhibitorsNeurohormonal activationHeart failureRenal dysfunctionBlood volumeHeart failure-related outcomesPlacebo-controlled crossover studyType 2 diabetes mellitusProximal tubular siteHeart failure outcomesStable heart failureUrinary glucose excretionUric acid levelsElectrolyte wastingEmpagliflozin monotherapyOral empagliflozinPlacebo periodStudy drugGlucose excretionNatriuretic effectPotassium wastingTubular sitesDiabetes mellitusFractional excretionSodium glucose cotransporter 2 inhibitors as diuretic adjuvants in acute decompensated heart failure: a case series
Griffin M, Riello R, Rao VS, Ivey-Miranda J, Fleming J, Maulion C, McCallum W, Sarnak M, Collins S, Inzucchi SE, Testani JM. Sodium glucose cotransporter 2 inhibitors as diuretic adjuvants in acute decompensated heart failure: a case series. ESC Heart Failure 2020, 7: 1966-1971. PMID: 32476296, PMCID: PMC7373933, DOI: 10.1002/ehf2.12759.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureSodium-glucose cotransporter 2 inhibitorsGlucose cotransporter 2 inhibitorsDecompensated heart failureCotransporter 2 inhibitorsType 2 diabetesSGLT-2iBlood pressureHeart failureUrine outputYale-New Haven HospitalWeight lossIncidence of hypokalaemiaSGLT-2i initiationSGLT-2i therapyGlucose-lowering medicationsHeart failure outcomesCohort of patientsAverage weight lossDiuretic dosingDiuretic resistanceAdjunctive therapyWorsened survivalDiuretic efficiencyDiuretic monotherapyEffect of Inotropes on Patient-Reported Health Status in End-Stage Heart Failure
Clarke JD, Riello R, Allen LA, Psotka MA, Teerlink JR, Lindenfeld J, Desai NR, Ahmad T. Effect of Inotropes on Patient-Reported Health Status in End-Stage Heart Failure. Circulation Heart Failure 2021, 14: e007759. PMID: 33530705, DOI: 10.1161/circheartfailure.120.007759.Peer-Reviewed Original ResearchConceptsEnd-stage heart failureReduced ejection fractionHealth-related qualityPatient-reported health statusEffect of inotropesHeart failureHealth status domainsEjection fractionHealth statusFunctional statusPositive inotropesStatus domainsAvailable clinical trial dataMorbidity/mortalityPopulation of patientsPatient-centered outcomesHealth status outcomesClinical trial dataFunctional capacity changesQuantity of lifeWeb of ScienceInotrope therapyInotrope useCalcium sensitizerSurvival benefitNatriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure
Rao VS, Ivey-Miranda JB, Cox ZL, Riello R, Griffin M, Fleming J, Soucier R, Sangkachand P, O'Brien M, LoRusso F, D'Ambrosi J, Churchwell K, Mahoney D, Bellumkonda L, Asher JL, Maulion C, Turner JM, Wilson FP, Collins SP, Testani JM. Natriuretic Equation to Predict Loop Diuretic Response in Patients With Heart Failure. Journal Of The American College Of Cardiology 2021, 77: 695-708. PMID: 33573739, PMCID: PMC8114781, DOI: 10.1016/j.jacc.2020.12.022.Peer-Reviewed Original ResearchConceptsLoop diuretic administrationDiuretic therapyNatriuretic responseDiuretic administrationSodium outputAcute decompensated heart failureDecompensated heart failureHeart failure admissionsDaily urine outputSpot urine samplesNet fluid outputNet fluid lossPathway cohortHeart failureLoop diureticsUrine outputDiuretic responseResidual congestionFluid outputTherapyCohortWeight lossAdditional studiesUrine samplesExcellent discriminationRationale, Design, and Patient Characteristics of a Cluster-Randomized Pragmatic Trial to Improve Mineralocorticoid Antagonist Use
Clark K, Victoria-Castro A, Ghazi L, Yamamoto Y, Coronel-Moreno C, Kadhim B, Riello R, O'Connor K, Ahmad T, Wilson F, Desai N. Rationale, Design, and Patient Characteristics of a Cluster-Randomized Pragmatic Trial to Improve Mineralocorticoid Antagonist Use. JACC Heart Failure 2023, 12: 322-332. PMID: 37943221, DOI: 10.1016/j.jchf.2023.08.025.Peer-Reviewed Original ResearchBest practice alertMineralocorticoid receptor antagonistsNovel potassium bindersPotassium bindersEligible patientsUsual careEjection fractionSerum potassiumHistory of hyperkalemiaIncidence of hyperkalemiaStrong guideline recommendationsHeart failure hospitalizationReduced ejection fractionLaboratory test valuesPopulation health outcomesHyperkalemia treatmentMRA prescriptionAntagonist useFailure hospitalizationPatient characteristicsSecondary outcomesHeart failurePrimary outcomeGuideline recommendationsOutpatient visitsContemporary American and European Guidelines for Heart Failure Management JACC: Heart Failure Guideline Comparison
Ostrominski J, DeFilippis E, Bansal K, Riello R, Bozkurt B, Heidenreich P, Vaduganathan M. Contemporary American and European Guidelines for Heart Failure Management JACC: Heart Failure Guideline Comparison. JACC Heart Failure 2024, 12: 810-825. PMID: 38583167, DOI: 10.1016/j.jchf.2024.02.020.Peer-Reviewed Original ResearchConceptsEuropean Society of CardiologySocial determinants of healthDeterminants of healthHealth care disparitiesHeart failureClinical practice recommendationsManagement of heart failureCare disparitiesDevice-based therapiesSocial determinantsEvidence-based pharmacotherapyGroup of patientsHF careSociety of CardiologyClinical careHF preventionPotential downstream implicationsCardiac amyloidosisAmerican CollegeHF risk predictionPractice recommendationsManagement pathwayNoncardiac comorbiditiesRisk predictionHF stagesSequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter?
Hu J, Schwann A, Tan J, Nuqali A, Riello R, Beasley M. Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter? Cardiology Clinics 2023, 41: 511-524. PMID: 37743074, DOI: 10.1016/j.ccl.2023.06.007.Peer-Reviewed Original ResearchConceptsReduced ejection fractionEjection fractionHeart failureChronic kidney diseaseQuadruple therapyTarget dosingTherapy initiationAtrial fibrillationKidney diseaseSpecial populationsMedicationsConventional sequencesTolerabilityBradycardiaPatientsFailureFibrillationDosingTherapyInitiationDiseaseDosesGDMTPragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial
Ghazi L, O'Connor K, Yamamoto Y, Fuery M, Sen S, Samsky M, Riello R, Huang J, Olufade T, McDermott J, Inzucchi S, Velazquez E, Wilson F, Desai N, Ahmad T. Pragmatic trial of messaging to providers about treatment of acute heart failure: The PROMPT-AHF trial. American Heart Journal 2022, 257: 111-119. PMID: 36493842, DOI: 10.1016/j.ahj.2022.12.002.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyAcute heart failureHeart failurePragmatic trialElectronic health recordsSubstantial health care costsBest practice advisoryReduced ejection fractionUsual care armHealth recordsTime of dischargeEvidence-based careHealth care costsClinical decision support systemAHF patientsCare armEligible patientsHF hospitalizationInpatient initiationCardiovascular deathMedication classesEjection fractionMedical therapyPrimary outcomePractice advisoryRationale and design of a cluster-randomized pragmatic trial aimed at improving use of guideline directed medical therapy in outpatients with heart failure: PRagmatic trial of messaging to providers about treatment of heart failure (PROMPT-HF)
Ghazi L, Desai NR, Simonov M, Yamamoto Y, O'Connor KD, Riello RJ, Huang J, Olufade T, McDermott J, Inzucchi SE, Velazquez EJ, Wilson FP, Ahmad T. Rationale and design of a cluster-randomized pragmatic trial aimed at improving use of guideline directed medical therapy in outpatients with heart failure: PRagmatic trial of messaging to providers about treatment of heart failure (PROMPT-HF). American Heart Journal 2021, 244: 107-115. PMID: 34808104, DOI: 10.1016/j.ahj.2021.11.010.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyBest practice alertLeft ventricular ejection fractionHeart failureUsual careMedical therapyPragmatic trialElectronic health recordsEjection fractionCluster-randomized pragmatic trialLarge integrated healthcare systemDays post randomizationAppropriate medical therapyHeart Failure TrialReduced ejection fractionUsual care groupCommon chronic illnessGlomerular filtration rateVentricular ejection fractionRecent blood pressureIntegrated healthcare systemUse of guidelinesLow-cost interventionCreatinine levelsReal-world practiceAdverse drug effects across patients with heart failure: a systematic review.
Butzner M, Riello RJ, Sarocco P, Desai N. Adverse drug effects across patients with heart failure: a systematic review. The American Journal Of Managed Care 2022, 28: e113-e120. PMID: 35404555, DOI: 10.37765/ajmc.2022.88844.Peer-Reviewed Original ResearchConceptsGuideline-directed medical therapyAdverse drug effectsAngiotensin receptor blockersMineralocorticoid receptor antagonistsDrug-related adverse effectsRenal impairmentHeart failureMedical therapyDrug effectsAngiotensin receptor neprilysin inhibitorAdverse effectsReduced ejection fractionAdditional real-world evidenceReal-world evidenceKey search termsSystematic literature reviewReceptor blockersAdult patientsEjection fractionACE inhibitorsReceptor antagonistClinical trialsOvid MEDLINEClinical KeyΒ-blockersA Practical Guide for Cardiologists to the Pharmacological Treatment of Patients with Type 2 Diabetes and Cardiovascular Disease
Ahmad T, Riello RJ, Inzucchi SE. A Practical Guide for Cardiologists to the Pharmacological Treatment of Patients with Type 2 Diabetes and Cardiovascular Disease. European Cardiology Review 2021, 16: e11. PMID: 33897837, PMCID: PMC8054345, DOI: 10.15420/ecr.2020.01.r1.Peer-Reviewed Original ResearchSodium-glucose cotransporter 2 inhibitorsCotransporter 2 inhibitorsType 2 diabetesCardiovascular diseaseHigh-risk type 2 diabetes patientsGlucagon-like peptide-1 receptor agonistsMajor adverse cardiovascular eventsSpecific glucose-lowering agentsPeptide-1 receptor agonistsRecent clinical trial dataType 2 diabetes patientsAdverse cardiovascular eventsHeart failure hospitalizationGlucose-lowering agentsClinical trial dataAnti-diabetes drugsCardiovascular eventsCardiovascular outcomesDiabetes medicationsFailure hospitalizationCardiovascular riskHeart failurePharmacological treatmentSafe prescribingDiabetes patientsReal World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure A U.S. Center’s Experience
Griffin M, Soufer A, Goljo E, Colna M, Rao VS, Jeon S, Raghavendra P, D'Ambrosi J, Riello R, Coca SG, Mahoney D, Jacoby D, Ahmad T, Chen M, Tang WHW, Turner J, Mullens W, Wilson FP, Testani JM. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure A U.S. Center’s Experience. JACC Heart Failure 2020, 8: 199-208. PMID: 32035891, PMCID: PMC7814403, DOI: 10.1016/j.jchf.2019.10.012.Peer-Reviewed Original ResearchConceptsAcute decompensated heart failureHypertonic saline administrationHypertonic saline therapyHypertonic salineSaline administrationSaline therapyDiuretic efficiencyUrine outputSerum sodiumWeight lossAcute decompensated heartDecompensated heart failureCohort of patientsTotal urine outputReal-world safetyU.S. academic medical centersAcademic medical centerLarge U.S. academic medical centerDiuretic doseCenter experienceHeart failureMetabolic derangementsPrimary analytic approachRespiratory statusClinical variablesWhy has positive inotropy failed in chronic heart failure? Lessons from prior inotrope trials
Ahmad T, Miller PE, McCullough M, Desai NR, Riello R, Psotka M, Böhm M, Allen LA, Teerlink JR, Rosano GMC, Lindenfeld J. Why has positive inotropy failed in chronic heart failure? Lessons from prior inotrope trials. European Journal Of Heart Failure 2019, 21: 1064-1078. PMID: 31407860, PMCID: PMC6774302, DOI: 10.1002/ejhf.1557.Peer-Reviewed Reviews, Practice Guidelines, Standards, and Consensus StatementsConceptsHeart failureClinical trialsPositive inotropic therapyChronic heart failureReduced ejection fractionAdvanced heart failureCurrent pharmacological therapiesPopulation of patientsDefinitive clinical trialsVentricular assist deviceQuality of lifePositive cardiac inotropeLong-term useInotropic therapyHeart transplantationSurvival benefitCardiac haemodynamicsEjection fractionPharmacological therapyCardiac outputFuture trialsNeurohormonal systemsFunctional statusPositive inotropesPositive inotropyA Blueprint for the Post Discharge Clinic Visit after an Admission for Heart Failure
Soufer A, Riello RJ, Desai NR, Testani JM, Ahmad T. A Blueprint for the Post Discharge Clinic Visit after an Admission for Heart Failure. Progress In Cardiovascular Diseases 2017, 60: 237-248. PMID: 28826671, DOI: 10.1016/j.pcad.2017.08.004.Commentaries, Editorials and LettersConceptsHeart failureClinic visitsPost-discharge servicesTransitions of carePatient-centered fashionHospital quality measuresHF patientsHF readmissionMulti-disciplinary servicesSymptom burdenDischarge servicesOutpatient settingCare deliveryHealthcare expendituresHospital systemPatientsVisitsCareReadmissionAdmissionFailureInpatientsCliniciansImportant role
2024
Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter?
Hu J, Schwann A, Tan J, Nuqali A, Riello R, Beasley M. Sequencing Quadruple Therapy for Heart Failure with Reduced Ejection Fraction: Does It Really Matter? Heart Failure Clinics 2024, 20: 373-386. PMID: 39216923, DOI: 10.1016/j.hfc.2024.06.004.Peer-Reviewed Original ResearchELECTRONIC ALERTS TO IMPROVE MINERALOCORTICOID RECEPTOR ANTAGONIST USE AND HYPERKALEMIA MANAGEMENT IN AMBULATORY PATIENTS WITH HEART FAILURE: A CLUSTER RANDOMIZED TRIAL
Clark K, Victoria-Castro A, Ghazi, Yamamoto Y, Coronel-Moreno C, Kadhim B, Riello R, O'Connor K, Ahmad T, Wilson F, Desai N. ELECTRONIC ALERTS TO IMPROVE MINERALOCORTICOID RECEPTOR ANTAGONIST USE AND HYPERKALEMIA MANAGEMENT IN AMBULATORY PATIENTS WITH HEART FAILURE: A CLUSTER RANDOMIZED TRIAL. Journal Of The American College Of Cardiology 2024, 83: 2395. DOI: 10.1016/s0735-1097(24)04385-7.Peer-Reviewed Original Research
2020
Safety and Efficacy of an Automated Nurse-Driven Diuretic Titration Protocol: the Yale Diuretic Pathway
Meegan G, Sangkachand P, O'Brien M, Riello R, Soucier R, Jacoby D, Gleason O, Fleming J, Griffin M, Ivey-Miranda J, Cox Z, Rao V, Testani J. Safety and Efficacy of an Automated Nurse-Driven Diuretic Titration Protocol: the Yale Diuretic Pathway. Journal Of Cardiac Failure 2020, 26: s22. DOI: 10.1016/j.cardfail.2020.09.070.Peer-Reviewed Original ResearchAcute decompensated heart failureDiuretic doseLoop diureticsSodium outputBlood pressureEMR orderTitration protocolDecompensated heart failureSystolic blood pressureDaily urine outputSpot urine samplesNet fluid outputDiuretic resistanceFurosemide equivalentsFirst doseMedian doseSodium excretionHeart failureSerum potassiumSubsequent dosesUrine outputClinical outcomesMedian timeSerum magnesiumSame dose
2018
Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure: A U.S. Center's Experience
Goljo E, Soufer A, Colna M, Rao V, D'Ambrosi J, Riello R, Mahoney D, Tang W, Testani J. Real World Use of Hypertonic Saline in Refractory Acute Decompensated Heart Failure: A U.S. Center's Experience. Journal Of Cardiac Failure 2018, 24: s32. DOI: 10.1016/j.cardfail.2018.07.093.Peer-Reviewed Original ResearchAcute decompensated heart failureHypertonic saline solutionDecompensated heart failureHSS administrationHeart failureSerum sodiumHypertonic salineTreatment responseSetting of ADHFHigh-dose loop diureticsMethods Electronic medical recordsLarge urban academic hospitalInotropes/vasopressorsReal-world safetySerum sodium concentrationUrban academic hospitalPotential therapeutic effectsNet fluid outputPositive treatment responseAdditional rigorous studiesElectronic medical recordsImprovement of creatinineADHF patientsFurosemide equivalentsCenter experience