1. < Cardiology/Epi

Our faculty are world leaders in many areas and over the next few weeks I will highlight examples of this across many of our missions. This week, read about how members of our department are using research and scholarship to advocate for change, improve outcomes or implement best practices.

I am pleased to begin the new year by shining a spotlight on David Goodman-Meza, MD who serves as the principal investigator of HPTN 094 Los Angeles, a vanguard research study aimed at determining the efficacy of using a mobile health unit to provide integrated health services to people with opioid use disorder who inject drugs, funded by the National Institute on Drug Abuse and conducted through the HIV Prevention Trials Network. In the United States, drug overdose continues to be a leading cause of accidental death. Traditionally, people who use drugs have difficulties accessing care from major health care systems or have had negative experiences when seeking care due to stigma.00

The mobile unit is a welcome sight for the community served. Monday through Thursday, the mobile clinic may be found throughout Los Angeles in areas which experience higher rates of drug use, overdose, and homelessness. The mobile clinic team provides medical care, including treatment and counseling for substance use, HIV treatment and prevention, treatment for STIs and hepatitis C, basic primary care, and harm reduction services like provision of sterile syringes and naloxone. The team also connects patients to resources that address social determinants of health such as food insecurity and housing.

Dr. Goodman-Meza notes a strength of the study includes the integration of peer navigators who have lived through similar experiences as the patient population. Navigators build strong relationships and have a key role in helping study participants access care during and after completing study participation. In addition to the peer navigators, Eliza Samore, Jordan Spoliansky and Usiel Gutierrez, Goodman-Meza recognizes and celebrates the entire teamwhich includes a Mobile Unit Operator Jagroop Chahal, Medical Assistants Esperanza Orozcoand Brigitte Abrego, Study Clinician Shaza Hummel, Community Program Manager Christopher Blades, Research Assistant Brandon Moghanian, Project Regulatory Coordinator Sandra Macnicoll, Project Director Danielle Seiden, Project Administrator Jennifer Baughman, and National Protocol Chair Dr. Steve Shoptaw who are committed to providing high-quality care in challenging and unpredictable environments.

To learn more about this study, and the impact it has had on a recent participant who was diagnosed and undergoing treatment for Hepatitis C through the mobile clinic, check out a recent feature in the LA Times.

Hepatitis C is a slow-moving killer that can be stopped. What's getting in the way?

Michael Mendez said that when learned he had hepatitis C, "I didn't even know what it was." Mendez, 47, had been homeless for years in Los Angeles, and said he hadn't gone to a doctor the entire time he was living on the streets.

latimes.com

We have all experienced pain, but managing chronic pain is an area in which there is the need for progress, particularly in our ability as providers to understand how patients are subjectively responding to what we believe might be suitable therapy. Although there have been major advancements in the development of quality measures in hospice and palliative care, the Center for Medicare and Medicaid Services has noted that there is a scarcity of patient reported measures, particularly in symptom management and communication.

Within this context, Anne M. Walling, MD, PhD, who is the director of palliative care research in the  department of medicine, led a research team in establishing state-of-the-art methods to develop and test patient-reported measures.They recently published their findings in “Patient-Reported Quality Measures for Palliative Care: The Time is Now,” in The Journal of Pain and Symptom Management. Throughout the development and testing process for developing patient-reported measures, researchers used a patient-centered, patient-engaged approach throughout the following four phases:

• Information gathering by conducting a literature review and focus groups to develop measurement concepts.
• Pretesting to refine measurement concepts of palliative care quality, which were informed by the literature review and patient reported survey items sourced during the information gathering phase.
• Testing of the measurement concepts through a two-phase approach that included a three-month pilot study (alpha test) among five palliative care programs, and a 15-month national beta field test among 44 outpatient palliative care programs across 25 states in the US.
• Endorsing the final measures through processes that include the CMS’ Measures Under Consideration and the National Quality Forum Consensus Development Process.

The study developed and tested two patient-reported measures “feeling heard and understood” and “receiving desired help for pain” for patients receiving care in a community-based, out-patient setting. The two measures met the criteria for reliability, had strong face and construct validity which resulted in endorsement from the National Quality Forum, highlighting the importance of incorporating patient voices in palliative care through patient-reported measures.

Heart failure is a major driver of mortality worldwide and progress in adopting new and effective therapies have been slow. In the division of cardiology, Interim Chief Dr. Gregg C. Fonarow, along with colleagues from the United States, Germany, and Scotland, published “Population-Level Implications of Sodium-Glucose Cotransporter-2 Inhibitors for Heart Failure With Preserved Ejection Fraction in the US,” in JAMA Cardiology exploring the population level impact in the US from implementing the use of SGLT-2 inhibitors in people with heart failure (HF) overall and in those with a left ventricular ejection fraction (LVEF) that is higher than 40%. Previous clinical trials such as EMPA-REG OUTCOME (Empagliflozin Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients), DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure), and EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients with Chronic Heart Failure with Reduced Ejection Fraction), demonstrated SGLT-2 inhibitor’s efficacy in reducing HF events among participants. Using a decision analytical model study, Fonarow and colleagues evaluated self-reported heart failure data from 2015-2018 from the National Health and Nutritional Examination Survey, weighted it against the US population and newly eligible LVEF adult patients in the Get With The Guidelines-Heart Failure Registry. The projected population level impact was then estimated using outcome measures from the previous clinical trials measuring the efficacy of SGLT-2 inhibitors.

Study results concluded that increasing the use of SGLT-2 inhibitor use in patients with HF and LVEF with more than 40%, can potentially prevent or postpone approximately 250,000 worsening HF events or cardiovascular deaths, or 630,000 events in HF patients across the LVEF spectrum. Fonarow and colleagues conclude that there is a need for advocacy to initiate SGLT-2 inhibitors for HF in hospital systems and clinic practices given the morbidity benefits and potential reduction in health-related costs for this patient population.

According to Dr. Fonarow, “The projected substantial decreases in HF associated mortality, hospitalizations, and urgent visits that could be achieved at the US population level with optimal use of SGLT2 inhibitors for HF highlight the urgent need to improve access, decrease barriers, and enhance equitable implementation.”

Please join me in congratulating two members of the department, who have achieved national accolades or appointments that reflect their leadership in medicine.

The 22nd International Congress of Nutrition, organized by the International Union of Nutrition Sciences (IUNS), took place in Tokyo, Japan from December 6th–11th, 2022. Zhaoping Li, MD, PhD, director of the Center for Human Nutrition and chief of clinical nutrition at UCLA, was elected as a council member.  As the sole representative of the American Society for Nutrition (ASN), she will be part of the IUNS’s 11-member governance body between 1/1/2023-12/31/2025.

The IUNS was established in London in July 1946 and has been a member of the International Science Council (ISC) since 1968. At present, the IUNS has more than 80 country members and 15 affiliated organizations such as the Federation of African Nutrition Societies (FANUS), the Federation of Asian Nutrition Societies (FANS), and the Federation of European Nutrition Societies (FENS).  IUNS has a special consultative status with the Food and Agriculture Organization (FAO), the World Health Organization (WHO), and the United Nations Children’s Fund (UNICEF).

Each year, the American College of Cardiology recognizes outstanding individuals making contributions to the cardiovascular profession at its Annual Convocation Ceremony. I’m pleased to share that at their upcoming ceremony taking place on March 6, 2023, Karol Watson, MD, PhD  will be awarded the 2023 Bernadine Healy Leadership in Women's CV Disease Award (FACC). Named after the first female director of the National Institutes of Health Dr. Bernadine Healy, this award honors Dr. Watson’s accomplishments in research, teaching, service, and leadership in the field of cardiovascular disease in women.

We are proud of your accomplishments Zhaoping and Karol!

The 2023 DMPG Annual Retreat is quickly approaching with virtual and in-person events taking place between February 6 through the 11. I encourage DMPG faculty to rsvp and attend the retreat to learn about the DMPG's vision, goals for the future, wellness initiatives, and how we can support growth in our clinical practice. DMPG faculty will receive a registration link via email this afternoon. Registration deadline is Wednesday, January 11. 

Dale

P.S.

My new driver’s license arrived this weekend. You may recall that I was required to take a new picture. Well, it worked out. Definitely an upgrade from the first picture from last year. Maybe this might have something to do that we went to the Hollywood DMV this time.

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