Jiun-Ruey Hu, MD, MPH, fellow in cardiovascular medicine at the Yale School of Medicine, and Jia Wei Tan, MD, resident in internal medicine at Yale New Haven Health Bridgeport Hospital, were recognized by the American Heart Association (AHA) for their innovative medical education efforts at the intersection of kidney and cardiovascular disease.
Guideline-directed medical therapies (GDMT) are under-utilized in both patients who have heart failure with reduced ejection fraction (HFrEF) and concomitant chronic kidney disease (CKD) or end-stage kidney disease (ESKD).
Interactive GDMT Consult
“Unfortunately, patients with kidney disease and heart failure face triple threats to their prognosis,” Hu noted. “First of all, kidney disease of any stage portends additional risk of death independent of heart failure. Second, patients with kidney disease are excluded from over half of randomized, controlled trials in cardiology. Third, patients with kidney disease are significantly less likely to receive survival-improving heart medications due to clinician uncertainty.”
Together, Hu and Tan constructed an “interactive consult” tool in which clinicians can input a patient’s set of current cardiac medications and clinical parameters, following which their computer algorithm makes recommendations about what GDMT medications can be initiated, uptitrated, discontinued, or switched, based on the patient’s vital signs, laboratory results, demographics, and echocardiographic results.
“We hope that the evidence we have synthesized allows clinicians to prescribe and titrate GDMT with confidence. Of course, we ultimately hope that future trials in cardiology will include more patients with advanced kidney disease,” said Tan.
“The role of cardio–renal interactions is an active area of research. Historically, patients with concurrent HFrEF and kidney disease may not receive optimal treatment. An improved understanding of cardio-renal syndrome can help to minimize future risks,” said F. Perry Wilson, MD, associate professor and director of the Yale Clinical and Translational Research Accelerator (CTRA).
The “interactive consult” by Hu and Tan additionally provides guidance at each stage of kidney disease based on the intersection of current guidelines issued by the AHA, American College of Cardiology (ACC), Kidney Disease Improving Global Outcomes initiative (KDIGO), Heart Failure Society of America (HFSA), and Food and Drug Administration (FDA). Their original tool, entitled “GDMT for Everyone”, is available at www.GDMT.org, and has drawn users from 53 countries.
“Heart failure affects over 6 million U.S. adults and may lead to frequent hospitalizations and increased morbidity that can be significantly reduced by guideline recommended medical therapies. GDMT for Everyone is an invaluable tool,” said Tariq Ahmad, MD, MPH, associate professor and director of the Yale advanced heart failure program.
The AHA’s Council on the Kidney in Cardiovascular Disease, which awarded Hu and Tan a monetary prize of $2,000 after evaluating projects across the country, commented, “This is an impressive project with a lot already accomplished. This project could make a big impact in patient care and education.”
Eric J. Velazquez, MD, Robert W. Berliner Professor of Medicine, and chief of Yale Cardiovascular Medicine, said, “Impressive work – while still in fellowship training Ruey is becoming a widely published and innovative researcher in cardiovascular and kidney disease. We are very proud that he and Dr. Tan are receiving this award.”
“This interactive and educational website highlights the creativity and clinical expertise of our fellows and residents,” said Edward J. Miller, MD, PhD, director of the cardiovascular medicine fellowship program and vice chief of education in the Section of Cardiovascular Medicine.
Hu, who joined Yale in 2021, is also the recipient of a travel award from the AHA Council on Peripheral Vascular Disease. He was recognized last year with the 2021 Dr. Peggy Bia Award for Outstanding Clinical Teaching as selected by Yale medical students and as the 2022 Fellow of the Year by the Department of Internal Medicine residency program.