In this special Lifetime Achievement Award Spotlight, we asked this year’s recipient Marvin A. Konstam, MD, FACC. FAHA, FHFSA to share career highlights, opinions on the future of heart failure care, and his professional advice on entering a career in the field of heart failure.
Please share with us some “highlights” from your distinguished academic career that have significantly impacted the field of heart failure.
My academic contributions to the field of heart failure have mainly been in the following areas:
- Understanding right ventricular performance and responsiveness to therapy.
- Ventricular remodeling
- Its natural history
- Its relationship with the clinical progression of the disease and adverse outcomes
- Its role as a surrogate in predicting the impact of a drug or device on mortality. As a result, it is currently an important marker in the early development of heart failure therapies.
- The impact of a variety of therapeutic agents on the remodeling process, including the original demonstration of the benefit of angiotensin converting enzyme inhibitors, in conjunction with reduced mortality.
- Drug and device therapy for heart failure: I played a lead role in clinical investigation of numerous agents many of which are used today in heart failure treatment, including:
- Angiotensin converting enzyme inhibitors
- Angiotensin receptor antagonists
- Mineralocorticoid receptor antagonists
- Neprilysin inhibitors
- Improving quality of care in heart failure
- I was the lead author on the first US clinical practice guideline for heart failure, and a co-author on multiple subsequent US guidelines.
- I developed and published the results of a novel heart failure disease management program, which is in use today by our regional physician network.
- I have published several articles on the impact of the Hospital Readmission Reduction Program of the Affordable Care Act.
I launched Tufts Medical Center’s (Tufts MC’s) Advanced Heart Failure Program, and we performed our first heart transplant in 1985. As Chief Physician Executive of our CardioVascular Center (and previously Chief of Cardiology), together with Dr. James Udelson, our current Chief of Cardiology, we have built and led teams, particularly with recruitment of Dr. David DeNofrio, that have grown Tufts MC into the largest Advanced Heart Failure program in New England, with among the highest heart transplant survival rates in the country. Under direction of Dr. Navin Kapur, we have become one of the largest academic programs in the US performing both preclinical and clinical investigation on acute cardiac and circulatory support devices. Under direction of Dr. Martin Maron, we have become one of the largest (if not the largest) Hypertrophic Cardiomyopathy Centers in the country.
Having trained Heart Failure fellows since the late 1980’s, in 2012, under Dr. DeNofrio’s leadership, we were in the first wave of ACGME approved Advanced Heart Failure and Transplant Cardiology training programs. Training and mentorship – both clinical and academic – have always been major priorities for all of our programs.
In your opinion, what are important next steps in research to improve heart failure care?
I think that the important directions toward improving the care and prevention of heart failure include:
- Continued aggressive research toward developing novel approaches to heart failure therapy. I think we have put to rest the theory that we had reached the ceiling in drug therapy, with the recent demonstration of incremental benefit by new classes of agents. I expect that ongoing basic discovery of drugs and biologics will ultimately meet the numerous remaining unmet needs of patients with heart failure. I anticipate that newer technologies will drive us forward in areas such as therapies for patients with advanced, Stage D heart failure, improved management of arrhythmias, and acute circulatory support.
- Improved access to newer proven treatments. We need to work toward eliminating the numerous obstacles to patient access, including opportunities for improvement in our regulatory processes; disparities in care delivery across our country, in part due to widespread lack of adequate healthcare coverage; and multiple barriers in our payment and delivery systems for drugs and devices.
- Advancement in our systems of care. Heart failure continues to be ripe for system-based improvements in our health delivery machinery. We need to improve provider access to critical information; communication among providers; transitions of care, with continuity and consistency from hospital care to ambulatory care to home-based care; and consistency in utilizing the best practice of care in each care setting. We need to enhance our efforts to monitor and improve upon quality and outcome metrics that focus on our patients’ health (and are developed with patient input).
Over the years, you have served in many key and critical roles within the Heart Failure Society of America. What do you consider to be some of the pivotal activities that you have led within our Society?
First, I was part of the group, led by Dr. Jay Cohn, that founded HFSA, and I served in governance and leadership roles for many years. Whatever I achieved, I did so as part of incredible teams of HFSA members and staff. During my tenure as HFSA president and over the years that followed, I drove, or helped to drive, a number of HFSA successes, particularly:
- Launching the HFSA Research Fellowship program. Working with industry partners, this program has helped to support the early careers of numerous, accomplished clinician-scientists.
- Together with Dr. Clyde Yancy, launching HFSA’s annual symposium for cardiology trainees, which has encouraged and mentored numerous individuals toward a successful career in heart failure. I am pleased that after a several year hiatus, this program has been resurrected.
- Developing relationships with FDA, CMS, and NHLBI and initiated national workshops on regulatory development of devices for heart failure.
- Working to be more inclusive of various health care professionals, particularly nurses.
- Together with Drs. Mariell Jessup and Laura Wexler, developing and implementing a proposal launching the ABIM secondary subspecialty of Advanced Heart Failure and Transplant Cardiology
- Together with Dr. Barry Greenberg, initiating and driving a year-long effort in strategic planning and implementation that culminated in recruiting a new CEO (I chaired the search committee) and relocating the organization from Minnesota to the Washington DC area. With these changes and with new leadership, HFSA was able to launch its advocacy effort, access a large pool of experienced medical organization professionals, and rejuvenate itself in multiple ways, toward expanding HFSA membership, revenues, programs, and influence.
What do you think are new opportunities to grow the Heart Failure Society of America that will enhance its role as a leader amongst professional societies engaged in heart failure education, research, advocacy, etc.?
First, I must say that over the past several years, the member-leaders – presidents, officers, board members, and committee chairs – and the executive team have done an incredible job toward achieving this important goal. In the coming years HFSA leaders and members should redouble their efforts toward 1) adding and continuing to diversify its membership and 2) continuing to enhance the value that HFSA brings to its members.
The Society has done a wonderful job of bringing in many of the important constituencies of those involved in practicing and advancing the prevention and management of heart failure. It must continue this effort and, importantly, work to further involve these constituencies in the leadership and work of the Society. Among the directions for expansion that I know are being considered, is developing a greater international membership.
Areas of value that HFSA might consider initiating or enhancing include:
- Redouble its advocacy for patients, members, and the field, with the aim of becoming the widely recognized “go-to” organization for legislators, regulators, and reporters seeking information or guidance in the area of heart failure.
- As is already being successfully driven by current leadership, improve member access to research opportunities.
- Improve access to education and information for its members, seeking novel approaches, including an even broader role on the internet and social media.
- Develop “turn-key” approaches to be offered to members and their organizations for improving systems of care delivery and for measuring the success of such efforts.
- Catalyze the initiation and development of a patient organization focused on advocacy for improved research, training, and patient-centered care delivery.
What advice do you have for early career professionals who are entering the field?
First and foremost, follow your dream and your heart to guide you during this critical period of your career. Direct yourself toward work that you will love and a mission that you believe in.
Whatever you choose to do, always strive for excellence. Never settle for less because others have told you that nothing better is possible. To quote Dr. Lynne Stevenson – a wonderful mentor – be a “finisher”. Try not to go half way, and try to create, build, or publish, something to look back at proudly. (On the other hand, try to recognize when you need to switch courses to achieve your goals.)
Find terrific mentors – people you admire and emulate, who are accomplished, thoughtful, and caring. Listen to them, but always challenge yourself to be sure that their advice applies to what you want in your career and your life.
Don’t conduct your career as a path to some “ultimate” end. Rather, embrace a general direction, and take jobs and roles that you will love and that will inspire you.
As with parents and parenting, you don’t need to give back to your mentors and teachers. But it’s essential that you “give forward” to the coming generations of individuals in their training and early career. This practice will assure you of an enormous wealth of contributions to continue far into the future.
In clinical practice, spend time listening to your patients. It will help them and you enormously. And never be too prideful. In practice (as in life) never hesitate to ask for advice from someone you respect – whether your senior, your peer, or your junior.
In research it’s useful to have goals that will “pay off” (whatever that means to you) with a short time horizon. But never forget that new knowledge, whether clinical or basic, is always worthwhile. Do not think that you can predict what a discovery will lead to, in a year, or a decade, or a generation.
Don’t pursue your career to the detriment of family. Balance is essential. Strive for fulfillment in every aspect of your life.
Take good care of yourself.
About the HFSA Lifetime Achievement Award
The HFSA Lifetime Achievement Award is presented by the Executive Council of the HFSA. The purpose of this award is to recognize a lifetime body of work by an individual who has made a significant and sustained contributions to the field of heart failure. The 2018 Lifetime Achievement Award has been made possible with the generous support of Cytokinetics.