Reposted by Harriette Van Spall MD MPH 🇨🇦Donovan Blake @donovanwrites.bsky.social · 17/02/2026Important work.. recognizing oral diuretic intensification as a meaningful worsening HF event could really improve how trials capture real-world risk and patient outcomes. 001
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 25/01/2026evidence.nejm.org/doi/full/10.... Worsening #HF requiring oral #diuretic intensification is clinically relevant, associated w ⬆️ ☠️ Here we review #RCT data, propose a standard definition for ODI, argue for its inclusion in primary outcome of HF RCTs, & show how this will ⬆️ trial efficiencyevidence.nejm.orgOral Diuretic Intensification as a Worsening Heart Failure Event in the Primary Outcome of Clinical TrialsAlthough evidence-based therapies for patients with heart failure (HF) have decreased all-cause mortality, the residual risk of other clinically relevant outcomes — such as worsening HF — remains h... 120
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 22/01/2026Among patients with acute #HF in the #CLOROTIC #RCT 💠 #Diuretic resistance -> worse outcomes 💠 #Hydrochlorthiazide effect on weight loss was consistent across categories of diuretic resistance Trial led by JC Trullàs, subanalysis by A Pandey onlinelibrary.wiley.com/doi/10.1002/... 010
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 22/01/20262026 #HeartDisease & #Stroke #Statistics: Report of US & Global Data From American Heart Association is here‼️ Did you know that the leading causes of #heartfailure are preventable? CAD (20%) HTN (20%) tobacco (14%) obesity (12%) diabetes (12%) www.ahajournals.org/doi/10.1161/... 010
Reposted by Harriette Van Spall MD MPH 🇨🇦NEJM.org @nejm.org · 31/12/2025Worsening heart failure is commonly managed w/oral diuretic intensification (ODI). In a new NEJM Evidence article, learn how the inclusion of ODI into trial endpoints could yield consistent treatment effect estimates & improve statistical efficiency. eviden.cc/48zIwEp @hvanspall.bsky.social 073
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 17/09/2025#Medtronic press release on our pivotal #ELEVATE-HFpEF RCT which will test the efficacy & safety of a personalized elevated #pacing rate (based on LVEF & height) in #HFpEF 75 countries 2 patients enrolled already (AUS & US) Methods to be presented at #HFSA25 news.medtronic.com/2025-09-15-M... 130
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 16/08/2025FDA announces approval for #semaglutide 2.4 mg sc weekly for #MASLD based on results of the #ESSENCE #RCT. Did you know that #CVD is the leading cause of death in patients with #MASLD? Common mechanisms & now, common treatments for #CKLM diseases www.novonordisk.com/news-and-med... 061
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 14/06/2025I love my outdoor #office, where work and play are fully intertwined! What does your #Saturday morning look like? #HappySeason #HomeSweetHome #JoyInWork 360
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 09/06/2025It’s impossible to uncouple #health from #economic policy Healthiest countries have fair economic policies that allow upward mobility & access to healthier lifestyles Focusing on individual interventions alone: inadequate www.thelancet.com/journals/lan...thelancet.comChildhood obesity: prioritising a healthy startRecent data from National Health Service (NHS) weight clinics in England show that a disproportionate number of referrals originate from the most deprived areas, with some children having BMIs over 40... 000
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 09/06/2025Phase 3 Trial of #Semaglutide in #Metabolic Dysfunction–Associated #Steatohepatitis In patients with #MASH and moderate or advanced #liver #fibrosis, once-weekly semaglutide at a dose of 2.4 mg improved liver steatohepatitis & fibrosis at 72 weeks t.co/vfcgItgXpbt.cohttps://www.nejm.org/doi/full/10.1056/NEJMoa2413258 000
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 08/06/2025Regional disparities in participant #enrolment in RCTs are related to regional #disparities in site recruitment relative to 🌎disease distribution We propose estimating site representation index during trial planning to ensure globally (or nationally) representative #RCT popn doi.org/10.1002/ejhf... 010
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 08/06/2025#NUDGECKD #ERA25 LBT #KristofferSkaar & #TorBiering SimPub #Circulation Pragmatic 2x2 factorial #implementation RCT Randomization at cluster + individual level E-letters re #GDMT to 1540 GPs & 22617 patients w #CKD did not ⬆️ uptake of #RASi or #SGLT2i www.ahajournals.org/doi/10.1161/... 032
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 08/06/2025The #sun rose and put on a show just for me! #LifeOnTheLake #Sunrise #LakeMuskoka 020
Reposted by Harriette Van Spall MD MPH 🇨🇦Swapnil Hiremath 🍁🇨🇦 @hswapnil.medsky.social · 07/06/2025Huge Danish trial of nudges Patient level (N 22,000) + practice level (1500 practice cluster with N 28,000 pts) To increase RASination & Flozination www.ahajournals.org/doi/abs/10.1... in @ahajournals.bsky.social at #ERA25 Absolutely null effect - is the baseline too high to improve upon? 4158
Reposted by Harriette Van Spall MD MPH 🇨🇦Carolyn Thomas 🇨🇦 @heart-sisters.bsky.social · 06/06/2025Pill splitting guide for patients who take a lot of pills... Which ones are safe to divide? myheartsisters.org/2016/12/04/p...myheartsisters.orgPill splitting: which ones are safe to divide?Don’t split your pills with a knife. Always use a pill-splitter. Don’t split them in advance – and other very sound tips for people like me who have been (until now!) using a kitchen kn… 011
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 07/06/2025#Happy season is here! #LifeOnTheLake #LakeMuskoka #Sunsets 120
Reposted by Harriette Van Spall MD MPH 🇨🇦Women As One @womenasone.bsky.social · 03/06/2025🚨 Missed early registration? No problem. You can still sign up for RISE @ ESC Congress 2025, the essential event for women in cardiology. 📍 Madrid | 🗓️ Aug 28 🎯 Leadership on the Global Stage Register now 👉 rise.womenasone.org #LetsRISE2025 #ESCCongress #WCCardio #CardioSky #WIC 013
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 01/06/2025Ship of #tolerance, created by 2000 school children in our town and displayed in #OakvilleGalleries #GairlochGardens Such a collaborative, moving art display, with ideas communicated in a way that only kids can do. 020
Reposted by Harriette Van Spall MD MPH 🇨🇦Citizens’ Climate Lobby Canada @citizenslobbyca.bsky.social · 27/05/2025“The true north is indeed, strong and free” A balanced and appropriate speech from the throne on this historical day. Climate change and biodiversity were woven into this speech alongside, not mentioning by name he who shall not be named. m.youtube.com/watch?v=FCzk...m.youtube.comLIVE: King Charles presents the speech from the throne in Ottawa | CTV News Special CoverageYouTube video by CTV News 041
Reposted by Harriette Van Spall MD MPH 🇨🇦Parham Eshtehardi MD @cardioobdoc.bsky.social · 15/05/2025Interplay of CKD & Effects of #Tirzepatide in Patients With #HFpEF & Obesity: SUMMIT Trial #CardioSky #NephroSky #JACC www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social @dlbhattmd.bsky.social @hmkyale.bsky.social @chriskramermd.bsky.social @psatishmd.bsky.social @drmonalidesai.bsky.socialjacc.orgInterplay of Chronic Kidney Disease and the Effects of Tirzepatide in Patients With Heart Failure, Preserved Ejection Fraction, and Obesity: The SUMMIT Trial 053
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 11/05/2025The sweetest word in the world, the one I’m most grateful to hear each day, is #mum. #MothersDay2025 020
Reposted by Harriette Van Spall MD MPH 🇨🇦Parham Eshtehardi MD @cardioobdoc.bsky.social · 09/05/2025Is #Aficamten Plus #Disopyramide More Effective Than Aficamten Alone in obstructive HCM? #CardioSky #JACCHF www.jacc.org/doi/10.1016/... @jaccjournals.bsky.social @jimjanuzzi.bsky.social @robmentz.bsky.social @hvanspall.bsky.social @vietheartpa.bsky.social @load-dependent.bsky.social 035
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 09/05/2025While #health systems across🌎 are designed around #acute illnesses, 86% of yrs lived w disability & 71% yrs of life lost are from #chronic diseases Burden of chronic dz ⬆️ in higher income countries & w age How to move needle? See our analysis @Nature.bsky.social rdcu.be/ek1MH 142
Reposted by Harriette Van Spall MD MPH 🇨🇦Dr Anastasia S Mihailidou PhD FAHA FCSANZ FESC @anastasiasmihaili.bsky.social · 05/05/2025📢 #CardioSky #MedSky #NephSky join us👇for our @ahascience.bsky.social #HTNImpact webinar! 🌟Faculty @jordybc.bsky.social @daichishimbo.bsky.social + more provide insights on #BP Timely @amjhypertension.bsky.social State of Art Review #AI to improve #BP Control academic.oup.com/ajh/article-ab… 056
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 29/04/2025Today, we voted to protect our #sovereignty, freedom, environment, economy, people, We voted for knowledge, alliances, respect, strength, unity We voted to care about those with less so that every kid has a chance to build #CanadaStrong #ViveLeCanada #April2025 130
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 28/04/2025Canadians go to #polls today Counting on us to elect a strategic, steady leader who will protect #Canada’s - sovereignty - environment - economy - education - healthcare - global alliances Counting on us to reject politics of anger, fear, division #TrueNorth #CanadaStrong 000
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 24/04/2025Happy #AdministrativeProfessionalsDay, dear Robin Thank you making magic happen in my professional life & in our program every day Thank you for being a caring friend in the truest sense of the word Thank you for being incredibly kind to our patients I’m so #grateful for you 010
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 23/04/2025#ClimateChange threatens health and livelihood, commonly displacing people. Children are among the most vulnerable. www.unicef.org/stories/3-wa...unicef.org3 ways climate change threatens children's livesClimate change poses significant risks to children’s health and well-being 010
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 21/04/2025I voted on #EasterSunday for - A builder of #bridges, not walls - A strong #economy - Strategic international #partnerships - Environmental #sustainability - Data-informed #policy - #Education & #healthcare for all - #Respect for all Did you #vote?🇨🇦 #CanadaStrong #CanadaElection2025 030
Reposted by Harriette Van Spall MD MPH 🇨🇦Brendon Neuen @brendonneuen.bsky.social · 21/04/2025New in CJASN: Our meta-analysis of 66 CKD trials shows both acute & chronic GFR slope independently predict clinical outcomes Findings support 3-year total slope as the optimal surrogate endpoint for CKD trials @asnpublications.bsky.social: doi.org/10.2215/CJN.... 0217
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 20/04/2025#Light over darkness #Hope over despair #Faith over fear #HappyEaster #Easter2025 000
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 19/04/2025“Let everything you do be done with love.” - 1 Corinthians Happy Easter from my home to yours! #Easter2025 130
Reposted by Harriette Van Spall MD MPH 🇨🇦Max Kozlov @maxkozlov.bsky.social · 18/04/2025Per source, NIH has been instructed to hold off from issuing ALL awards to Harvard, Cornell, Columbia, Brown, and Northwestern (including med schools) Agency staff have also been instructed to not speak about this funding freeze to grantees and applicants 761793939
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 18/04/2025Was honoured to talk to Dr Joseph Hill, EIC of Circulation @ahajournals.bsky.social about his career path, our era of medical disinformation, & power of effective scientific #communication. Brilliant, accomplished, honest, humble, he’s among the best of the best! #Publishing tinyurl.com/2sdsuk7h 020
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 17/04/2025The #TarteAuChocolat was delicious, but the note was even sweeter! I never take our privilege for granted. #Cardiology #Medicine #Chocolate 020
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 16/04/2025New 2025 #CONSORT guidelines for #RCT #reporting standards The 30 checklist items ensure transparent reporting, but adherence is suboptimal & only required by some journals (onlinelibrary.wiley.com/doi/10.1002/ej…) Essential for trialists + editorial/review teams!www.bmj.com/content/389/...23 000
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 14/04/2025“The administration’s prescription goes beyond the power of the federal government. It violates #FirstAmendment rights and exceeds the statutory limits of the government’s #authority under Title VI.” www.harvard.edu/president/ne...harvard.eduThe Promise of American Higher EducationNo government—regardless of which party is in power—should dictate what private universities can teach, whom they can admit and hire, and which areas of study and inquiry they can pursue 012
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 13/04/2025Is there a better time of day? (Featuring my favourite cup from grad school days) #5AM #SundayMorning 020
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 13/04/2025#Nudges are behavioral interventions that influence decisions without restricting choices or giving incentives This 2x2 factorial #RCT will evaluate effect of 🇩🇰 nationwide electronic letter nudges delivered to people with #CKD, their GPs, or both on #GDMT www.sciencedirect.com/science/arti... 010
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 12/04/2025Canadian #researchers w US federal funding must now confirm that research does not 📌include climate / environmental justice component 📌contain diversity, equity & inclusion elements 📌ascribe to “gender ideology” Some knees bend to money Others wont www.globenewswire.com/news-release...globenewswire.comTrump administration threatening Canadian researchersOTTAWA, Ontario, March 18, 2025 (GLOBE NEWSWIRE) -- The Canadian Association of University Teachers (CAUT) is warning that the Trump administration is... 000
Reposted by Harriette Van Spall MD MPH 🇨🇦JACC Journals @jaccjournals.bsky.social · 11/04/2025📢 Call for Papers: #JACCAdvances seeks submissions for a focus issue on Implementation Science & CV Learning Health Systems. Submissions may include pragmatic trials, digital infrastructure, & more. 📅 Deadline: April 15 🔗 bit.ly/43QfNcu 034
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 10/04/2025Is anyone aware of any #RCT that demonstrated the efficacy of any intervention in any CVD on the primary #endpoint of “days alive and out of the hospital”? If so, please share. (And what #breakfast are you having to fuel the clinical workday?) #DAOH #TrialDesign 010
Reposted by Harriette Van Spall MD MPH 🇨🇦Henry Han @hancardiomd.bsky.social · 10/04/2025This State-of-the-Art Review addresses the current understanding on the pathophysiological link between #CVD and #CKD, clinical implications and challenges academic.oup.com/eurheartj/ad... #CardioSky @escardio.bsky.social @cardioobdoc.bsky.social @hvanspall.bsky.social @novitham.bsky.social 046
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 10/04/2025📌E.g. of #Coanda effect: jet passing through an orifice that abuts a curved surface will deviate from ipath & adhere to surface 📌Due to entrainment of fluid from downstream chamber into jet, creating low P area around jet margin (towards which jet moves) #EchoFirst #MR #Flail 020
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 09/04/2025When you take a break from hospital clinical services to meet @vkittipibul who is visiting @PHRIresearch as part of @DCRIFellows exchange program.. 020
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 09/04/2025Wonder what makes #healthcare systems successful? Read this #GlobalRounds 📑 on #Denmark led by Tor Biering-Sorensen in #Circulation @AHAjournals.bsky.social Economically just society Universal healthcare Strong primary care for every person Enviable clinical & research infrastructure #Cardiosky 033
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 08/04/2025Troubling evidence that inadequate exploration of reversible #suffering – lack of access to medical services, poverty, loneliness, and feelings of being a burden – have driven some Canadians to choose #MAiD, now provided with same-day service. macdonaldlaurier.ca/rushing-to-d...macdonaldlaurier.caRushing to death in Canada’s MAiD regime: Ramona Coelho for Inside Policy | Macdonald-Laurier InstituteNew reports from Ontario’s MAiD Death Review Committee (MDRC) raise questions about whether proper assessments, thorough exploration of suffering, and informed consent were consistently practised by M... 010
Harriette Van Spall MD MPH 🇨🇦 @hvanspall.bsky.social · 07/04/2025A 💫 finding of run-in phase of #ADVANCE-HTN Ph2b #RCT: 64% ppl with “uncontrolled” #hypertension got BP control in 3 wks through standard genericTx #Aldosterone synthase blocker #lorundrostat 50 mg ⬇️BP at 8wks (w ⬆️K). 100mg: no evidence of added benefit #ACC25 www.radcliffecvrm.com/video-index/... 153