Episode #52: Cardiac Myosin Inhibitors in Obstructive Hypertrophic Cardiomyopathy

Episode #52: Cardiac Myosin Inhibitors in Obstructive Hypertrophic Cardiomyopathy

In this episode of Beatwise The Podcast, I speak with Dr Brian Halliday about one of the biggest advances in the treatment of obstructive hypertrophic cardiomyopathy (HCM): cardiac myosin inhibitors. For decades, treatment has focused on managing symptoms with medications such as beta blockers, verapamil and disopyramide, alongside septal reduction therapies for selected patients. We explore how cardiac myosin inhibitors represent a different approach by targeting the underlying hypercontractility that drives left ventricular outflow tract obstruction. We discuss the science behind these therapies, how they work at a molecular level, and the evidence from landmark clinical trials including EXPLORER-HCM, VALOR-HCM and SEQUOIA-HCM. Dr Halliday explains what these studies have taught us about symptom improvement, exercise capacity, left ventricular outflow tract gradients and the potential to reduce the need for invasive septal reduction therapy. We also discuss how these treatments are being introduced into clinical practice, including patient selection, specialist referral pathways, echocardiographic monitoring, and what the future may hold for patients with both obstructive and non-obstructive HCM. Key issues addressed: * Traditional treatment options for obstructive HCM * How cardiac myosin inhibitors work * The evidence from EXPLORER-HCM, VALOR-HCM and SEQUOIA-HCM * Myosin inhibitors versus beta blockers * Referral pathways, monitoring and prescribing in the UK * Future directions for HCM treatment Whether you care for patients with HCM or live with the condition yourself, this episode provides an overview of how treatment is evolving and what these new therapies may mean for the future. EPISODE HIGHLIGHTS: 00:00 Welcome and episode focus 01:02 Traditional HCM treatments 02:46 How myosin inhibitors work 06:26 Landmark mavacamten trials 10:23 Aficamten and new evidence 11:45 Beta blockers versus myosin inhibitors 16:19 Referral pathways and monitoring 20:33 NHS prescribing and echocardiographic follow-up 21:42 Future of HCM treatment 23:44 Wrap up 24:35 Final thanks and subscribe If you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content. Don't forget to follow me on social media @sarah.theheartdoc for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community! ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Episode #51: The Shared Pillars of Cardiorenal Care

Heart failure, chronic kidney disease (CKD) and metabolic disease are deeply interconnected, yet healthcare systems have traditionally treated them as separate conditions. In this episode of Beatwise, I’m joined by Dr Andrew Frankel, Consultant Nephrologist at Imperial College Healthcare NHS Trust, to explore why cardiorenal metabolic (CRM) medicine is transforming how we care for patients. We discuss the shared biology linking heart, kidney and metabolic disease, why "creatinine fear" continues to prevent optimal treatment, and how therapies such as SGLT2 inhibitors, finerenone and GLP-1 receptor agonists are reshaping outcomes across multiple specialties. We also explore the future of integrated cardiorenal care, including multidisciplinary services, workforce education, patient-centred CRM hubs and what healthcare systems need to do next to improve outcomes while reducing fragmentation of care. Key topics discussed:  * Why cardiorenal metabolic disease should be viewed as a single disease process rather than separate conditions * The common pathophysiology linking heart failure, CKD and metabolic disease * The problem with "creatinine fear" and premature discontinuation of life-saving therapies * The four pillars of modern cardiorenal metabolic treatment * Practical prescribing tips for SGLT2 inhibitors, including eGFR thresholds and sick day rules * Hyperkalaemia as a barrier to guideline-directed medical therapy and how to overcome it * The role of finerenone and non-steroidal MRAs in cardiorenal care * Why GLP-1 receptor agonists offer benefits far beyond weight loss * How integrated cardiorenal services can improve patient outcomes and reduce healthcare costs * The future of CRM hubs and one-stop multidisciplinary care pathways About my guest: Dr Andrew Frankel is a Consultant Nephrologist at Imperial College Healthcare NHS Trust and a leading advocate for integrated kidney care, cardiorenal medicine and workforce education. He is also co-host of the educational podcast For Kidneys' Sake [https://www.forkidneyssake.com/], which provides practical updates on chronic kidney disease and cardiorenal metabolic care. EPISODE HIGHLIGHTS: 00:00 Welcome and Guest Introduction 01:29 Why Cardiorenal Medicine Matters 03:14 Creatinine Fear and GFR Misconceptions 04:31 The Four Pillars of Cardiorenal Therapy 07:53 Practical Use of SGLT2 Inhibitors 10:58 Hyperkalaemia as a Barrier to Treatment 14:22 Building Integrated Cardiorenal Services 19:04 Specialist Roles and Shared Care 20:40 GLP-1 Receptor Agonists and New Weight-Loss Therapies 23:33 Lifestyle Medicine and CRM Hubs 26:28 Closing Reflections 28:41 Final Thanks and Subscribe If you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content. Don't forget to follow me on social media @sarah.theheartdoc [https://www.instagram.com/sarah.theheartdoc/] for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community! ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Episode #50: Inside the RESOLVE-HCM Trial: A New Approach to Non-Obstructive HCM

In this episode of BeatWise The Podcast, I am joined by Professor Joseph Selvanayagam to explore cardiac metabolism in hypertrophic cardiomyopathy (HCM), the evolving treatment landscape in HCM, and the findings of the RESOLVE-HCM trial investigating perhexiline in non-obstructive disease. We explore the heterogeneity of HCM, including the differences between obstructive and non-obstructive forms of the condition, why symptoms are not always explained by LV outflow tract obstruction alone, and how treatment strategies are beginning to move beyond symptom management toward disease-modifying therapies. We also discuss the role of myocardial energetics and metabolic dysfunction in HCM, how perhexiline works as a CPT1 inhibitor to shift myocardial metabolism toward more oxygen-efficient glucose use, and why this may be particularly relevant in non-obstructive HCM where treatment options remain limited. Professor Selvanayagam takes us inside the design of the randomized, double-blind RESOLVE-HCM trial, including the use of cardiac MRI imaging and maximal LV wall thickness as the primary endpoint over 12 months. We review the trial findings, where several endpoints including diastolic function, NT-proBNP, and quality-of-life measures favored perhexiline, with mental health quality-of-life outcomes reaching statistical significance. We also explore the importance of therapeutic drug monitoring given perhexiline’s narrow therapeutic index, the risks of hepatotoxicity and neurotoxicity, and the future direction of metabolic therapies in cardiomyopathy. Key topics discussed:  * Obstructive vs non-obstructive HCM * What drives symptoms in hypertrophic cardiomyopathy * The evolution of HCM therapies * Cardiac metabolism and myocardial energetics * How perhexiline works * The RESOLVE-HCM trial * Cardiac MRI endpoints in HCM research * Therapeutic drug monitoring and safety * Disease-modifying therapies in cardiomyopathy EPISODE HIGHLIGHTS: 00:00 Welcome to Beatwise 00:27 Why metabolism matters 01:59 Meet Professor Selvanayagam 02:29 HCM types and symptoms 04:29 Treatment landscape update 05:42 Why RESOLVE-HCM 07:20 How perhexiline works 08:44 Trial design and imaging 12:53 RESOLVE-HCM results 14:43 Clinical use and safety 17:15 Future trials and wrap up 18:54 Final takeaways If you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content. Don't forget to follow me on social media @sarah.theheartdoc [https://www.instagram.com/sarah.theheartdoc/] for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community! ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Episode #49: Residual Congestion in Heart Failure: Are We Missing It?

In this episode of Beatwise The Podcast, I speak with Dr Archana Ganapathy about a problem we don’t talk about enough in heart failure: congestion that we can’t properly see. Many patients leave hospital still fluid overloaded at a tissue level - despite looking “better” clinically. And that gap is part of why readmissions and outcomes remain poor. We discuss why current tools - from clinical exam to imaging and biomarkers - often fall short, and why understanding where fluid sits in the body matters just as much as how much is there. We then explore bioimpedance: what it is, how it works at the bedside, and why it may offer a more objective way to guide treatment. Dr Ganapathy also shares early insights from the BioHF trial, including what happens when fluid management is guided by measurement rather than estimation. For further context, Dr Ganapathy’s recent review on congestion assessment in decompensated heart failure is linked here: Advances in Congestion Assessment in Decompensated Heart Failure [https://www.cfrjournal.com/articles/advances-congestion-assessment-decompensated-heart-failure?language_content_entity=en] Key issues addressed:  * Why “hidden” congestion is so common in heart failure * The limitations of weight, BNP, imaging and clinical exam * Why fluid distribution matters * How bioimpedance works in practice * Early findings from the BioHF trial If you care for patients with heart failure - or live with it - this is worth understanding. EPISODE HIGHLIGHTS: 00:00 Hidden congestion problem 02:00 Why assessment falls short 05:05 Fluid location matters 07:02 Promise of bioimpedance 08:54 How bioimpedance works 13:06 BioHF trial design 17:16 Early findings & future impact 22:29 Recruitment & next steps 23:06 Wrap up If you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content. Don't forget to follow me on social media @sarah.theheartdoc [https://www.instagram.com/sarah.theheartdoc/] for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community! Thank you to Maltron International Limited [https://maltronint.com/] for sponsoring this episode. ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.

Episode #48: Why Coding Heart Failure Matters: From Clinic to the NHS

In this episode of Beatwise The Podcast, I speak with Helen Kilminster - Senior Pharmacist ACP and Deputy PCN Clinical Director -  about a part of heart failure care that is often overlooked: coding. We explore a part of heart failure care that is often overlooked: coding. Not as an administrative task - but as something that directly shapes patient outcomes. Because if heart failure isn’t coded accurately, it often isn’t fully visible. Patients are missed, risk isn’t under-recognised, and opportunities for earlier intervention are lost. We discuss how coding underpins everything from diagnosis to commissioning - and why small inconsistencies in how heart failure is recorded can have system-wide consequences. Helen shares how practices are identifying missed patients through NT-proBNP testing and case-finding, how coding supports risk stratification alongside comorbidities, and why clearer communication between cardiology and primary care is essential. We also explore the challenges of inconsistent terminology, and the importance of correctly coding NICE-defined heart failure subtypes - HFrEF, mildly reduced EF, and HFpEF - to ensure patients receive appropriate care. Key issues addressed: * Why heart failure coding directly affects diagnosis and outcomes * How GP coding systems work in practice * The problem of inconsistent terminology across care settings * Why NICE heart failure subtypes need to be clearly coded * Using NT-proBNP and case-finding to identify missed patients * How coding informs funding, commissioning, and service design * Tools to support better coding * The role of communication between primary and secondary care This episode is produced in collaboration with the British Society for Heart Failure. [https://www.bsh.org.uk/] EPISODE HIGHLIGHTS: 00:00 Why coding matters 01:40 How GP coding works 04:33 Finding missed heart failure 06:20 Sharing codes across care 08:27 Contracts and subtypes 11:49 Defining heart failure types 13:48 Tools for better coding 17:35 Funding and commissioning 23:54 NHS reform and teams 28:59 Patient impact and equity 33:23 Practical coding tips 37:05 Final takeaways FURTHER LEARNING: * NICE Guidance [https://www.nice.org.uk/guidance] * OpenPrescribing [https://openprescribing.net/] * OpenCodelists [https://www.opencodelists.org/] * British Society for Heart Failure [https://www.bsh.org.uk/] If you enjoyed this episode, please like, rate, and subscribe to Beatwise The Podcast. Your support helps me reach more listeners and continue providing valuable content. Don't forget to follow me on social media @sarah.theheartdoc [https://www.instagram.com/sarah.theheartdoc/] for the latest updates, behind-the-scenes content, and more engaging discussions. Stay connected and be part of our growing community! ---------------------------------------- Hosted on Acast. See acast.com/privacy [https://acast.com/privacy] for more information.