Alex Hajduczok, MD, is an advanced heart failure and pulmonary hypertension specialist at Oklahoma Heart Institute. 

Alex Hajduczok, MD

Rethinking Advanced Heart Failure: Treat the Disease, Not the Symptoms

, host Alex Hajduczok, MD, a cardiologist and heart failure specialist at Oklahoma Heart Institute, sits down with Philip Adamson, MD, MSc, chief medical officer at CVRx, to discuss ongoing paradigm changes in heart failure care and prevention.

Check out the full episode on Adamson’s full cardiology career

The discussion focuses on the evolving understanding of advanced heart failure and the need to move beyond symptom-based treatment paradigms toward earlier, mechanism-driven intervention. The guest argues that current clinical practice often allows left-sided heart failure to "metastasize," with progressive pulmonary vascular disease and right ventricular dysfunction developing long before patients meet conventional definitions of advanced heart failure. He explains that therapies are typically initiated only after patients become overtly symptomatic, despite the underlying pathophysiology having progressed for months or years. To address this gap, he describes the rationale behind the Team HF trial, which is designed to identify physiological markers that can better define the transition to advanced heart failure and determine which patients may benefit from earlier left ventricular offloading before irreversible disease progression occurs.

The speakers discuss the limitations of relying on traditional clinical assessments such as New York Heart Association (NYHA) functional class, noting that congestion and elevated filling pressures may be present regardless of symptom burden. They emphasize that symptoms often poorly reflect the severity of the underlying disease because the body is capable of compensating for substantial physiological disturbances before decompensation becomes clinically apparent. This disconnect, they argue, has led clinicians to justify treatment primarily on the basis of symptom relief rather than targeting the biological processes responsible for disease progression.

Building on this concept, the conversation explores the broader implications of adopting a mechanism-based approach to heart failure management. The guest reflects on his recent work investigating the autonomic nervous system, highlighting its central role in driving the progression of heart failure. Rather than focusing on downstream surrogate markers, he advocates for therapies that directly modify maladaptive autonomic signaling, suggesting that advances in neuromodulation may offer opportunities to fundamentally alter the disease trajectory. He draws parallels to emerging neurotechnology in other fields, arguing that cardiovascular medicine should similarly embrace innovative approaches capable of modifying the underlying mechanisms of disease.

The discussion also examines secondary pulmonary hypertension as a frequently overlooked consequence of left-sided heart failure. The guest cites findings demonstrating that a large proportion of patients with relatively mild, NYHA class II heart failure harbor significant pulmonary hypertension despite appearing clinically stable, underscoring how conventional symptom-based assessment may fail to identify patients at risk for progressive right ventricular dysfunction. Because these patients often would not undergo invasive hemodynamic evaluation in routine practice, important pathological changes may remain undetected until advanced disease develops.

The episode concludes with an overview of emerging therapeutic strategies targeting the pulmonary circulation, including pulmonary artery denervation to reduce maladaptive sympathetic tone. The speakers discuss the potential for these approaches to slow disease progression, attenuate secondary pulmonary hypertension, preserve right ventricular function, and ultimately redefine the treatment of advanced heart failure by intervening earlier in the disease course. Collectively, they emphasize that future advances in heart failure care will depend on identifying physiological mechanisms of progression and developing therapies that address these processes before irreversible clinical deterioration occurs.

Editors’ Note: Hajduczok reports disclosures with CVRx, Edwards Lifesciences, and Impulse Dynamics. Adamson reports employment with CVRx.

Videos

The latest episode of Moving the Needle in Medicine features Philip Adamson, MD, MSc, as he discusses ongoing changes in the way heart failure is treated and prevented.

Can We Stop Heart Failure at Its Source?

In this segment from the latest episode of 

, host Alex Hajduczok, MD, a cardiologist and heart failure specialist at Oklahoma Heart Institute, sits down with Philip Adamson, MD, MSc, chief medical officer at CVRx, to discuss Adamson’s perspective on the recent advancements in heart failure care and the ongoing trials of future treatment techniques.

The conversation begins with a reflection on the evolution of Adamson’s career and the continuity of his scientific focus despite transitioning across different areas of cardiovascular medicine. He explains that, although others have viewed these shifts as changes in specialty, his underlying objective has remained constant: understanding the fundamental mechanisms of disease. Emphasizing the importance of viewing medicine through the lens of pathophysiology rather than rigid sub-specialization, he argues that cardiovascular disorders cannot be fully understood in isolation. Instead, clinicians should recognize the complex interplay between the electrical, mechanical, autonomic, and circulatory systems that collectively influence cardiac function and disease progression.

The discussion then turns to the historical evolution of heart failure management, highlighting the shift from a hemodynamic model of disease to the now well-established neurohormonal hypothesis. Recalling the early 1990s, Adamson describes how the recognition that maladaptive neurohormonal activation drives heart failure progression fundamentally transformed therapeutic strategies. He reflects on the initial skepticism surrounding beta-blocker therapy, noting that many clinicians doubted the failing heart could improve structurally. Subsequent clinical evidence demonstrating reverse ventricular remodeling and improved survival, however, validated the concept that interventions targeting disease mechanisms could modify the natural history of heart failure rather than simply relieve symptoms.

Building on this framework, Adamson explains the physiologic role of the carotid baroreceptors as the body's primary sensors of circulatory status. He describes how reduced cardiac performance leads to diminished baroreceptor signaling, causing the brain to misinterpret heart failure as a state of hypovolemia or hemorrhage. This perceived threat initiates a cascade of maladaptive responses, including sympathetic nervous system activation, renin-angiotensin-aldosterone system stimulation, and inflammatory signaling. While current guideline-directed medical therapies effectively block many of these downstream pathways, he characterizes them as protecting target organs from the consequences of persistent neurohormonal activation rather than addressing its central origin.

The conversation subsequently focuses on baroreceptor activation therapy (BAT) as a novel strategy designed to intervene earlier in this pathophysiologic cascade. By electrically stimulating the carotid sinus nerve, BAT restores afferent signaling to central autonomic control centers, reducing sympathetic outflow, enhancing parasympathetic activity, and attenuating inflammatory responses. Adamson contrasts this approach with conventional pharmacologic therapies, describing it as an opportunity to reduce the neurohormonal "storm" itself rather than simply shielding organs from its downstream effects. He suggests that directly modulating the autonomic nervous system may provide a more comprehensive strategy for slowing heart failure progression.

To conclude the discussion, attention shifts to the ongoing Benefit HF trial, which Adamson notes is expected to enroll approximately 2,500 randomized patients, making it the largest device-based heart failure trial conducted to date. He explains that the study aligns with emerging perspectives reflected in recent heart failure consensus statements, which emphasize defining heart failure according to impaired cardiac function and underlying pathophysiology rather than relying solely on ejection fraction thresholds. By evaluating BAT in patients with ejection fractions below 50%, the trial seeks to determine whether earlier autonomic modulation can improve clinical outcomes across a broader population of patients with heart failure and further redefine the role of device-based therapies within contemporary heart failure management.

The latest episode of Moving the Needle in Medicine features Philip Adamson, MD, MSc, as he discusses upcoming advancements in heart failure care.

Lessons From a Career Dedicated to Transforming Heart Failure Care

, host Alex Hajduczok, MD, a cardiologist and heart failure specialist at Oklahoma Heart Institute, sits down with Philip Adamson, MD, MSc, chief medical officer at CVRx, to discuss Adamson’s path through cardiology and his work with CVRx in heart failure.

Hajduczok and Adamson discuss the transformative potential of baroreflex activation therapy in heart failure, highlighting a patient case from the Oklahoma Heart Institute that demonstrated substantial physiologic improvements following Barostim therapy. They describe marked gains in exercise capacity, with the patient nearly doubling maximal workload during invasive cardiopulmonary exercise testing, alongside a significant reduction in pulmonary capillary wedge pressure. The case is presented as a powerful illustration of the broad physiologic effects of neuromodulation, reinforcing the concept that heart failure is a complex, systemic disease requiring interventions capable of influencing multiple interconnected pathways. Rather than targeting a single aspect of cardiac function, baroreflex activation therapy is described as modifying pulmonary vascular responses, left atrial and ventricular physiology, heart rate regulation, and exercise tolerance simultaneously. The speakers emphasize that understanding these effects requires a strong foundation in cardiovascular pathophysiology and express enthusiasm about completing and publishing the case report to share these findings with the broader heart failure community.

The conversation then shifts from clinical science to professional development, as Adamson reflects on a career spanning academic medicine, clinical research, industry, and innovation. Although his work has evolved over several decades and across different settings, he explains that the central purpose of his career has remained unchanged: finding better ways to improve the lives of patients with heart failure. Adamson notes that each transition provided new opportunities to expand his perspective while remaining focused on advancing patient care. In particular, his experience in industry exposed him to areas beyond traditional clinical practice, including international regulatory processes, reimbursement strategies, medical device development, and the challenges of bringing new technologies from clinical investigation into widespread clinical adoption. He describes these experiences as invaluable, providing a broader understanding of the many factors required to successfully translate innovation into meaningful clinical impact.

The speakers also explore the value of curiosity, resilience, and lifelong learning in both medicine and research. Reflecting on his career, Adamson stresses that failures and missteps should not be viewed as permanent setbacks but rather as opportunities to refine one's thinking and improve future decision-making. He emphasizes the importance of remaining intellectually flexible, acknowledging that long-held hypotheses may ultimately prove incorrect and that unexpected opportunities often emerge for those willing to recognize them. Drawing on the analogy of noticing "red cars" only after intentionally looking for them, he encourages clinicians and investigators to remain attentive to new possibilities rather than becoming constrained by preconceived expectations.

Throughout the discussion, Adamson conveys a deep sense of gratitude for witnessing the remarkable evolution of heart failure care over the past four decades. He recalls entering the field at a time when heart failure was widely regarded as a rapidly progressive and uniformly fatal condition with limited therapeutic options. In contrast, contemporary advances have dramatically improved survival, functional status, and quality of life, with some patients now achieving meaningful recovery. He concludes that these advances have reinforced the purpose that has guided his career from the beginning: continually seeking new ways to help patients live longer, healthier, and more fulfilling lives despite the challenges of heart failure.

The latest episode of Moving the Needle in Medicine features Philip Adamson, MD, MSc, as he walks through his long and successful career in cardiology.

Heart failure management has long been triggered by symptoms, yet the underlying neurohormonal cascade driving disease progression often begins well before congestion or breathlessness appear. Baroreflex activation therapy is drawing renewed attention as a way to intervene upstream, modulating the autonomic signaling the brain uses to interpret a failing heart as a circulatory emergency.

Moving the Needle in Medicine: Innovation, Leadership, and the Future of Heart Failure, With Philip Adamson, MD, MSc

, host Dr. Alex Hajduczok, MD, a cardiologist and heart failure specialist at Oklahoma Heart Institute, sits down with Dr. Philip Adamson, MD, MSc, chief medical officer of CVRx, to explore the personal experiences, mentors, and defining decisions that shaped his career in cardiovascular medicine.

Adamson traces his career from basic science and clinical investigation to device development and implementation science. Reflecting on his early research experiences, Adamson describes how an undergraduate laboratory project sparked a lifelong interest in scientific discovery while emphasizing the importance of intellectual curiosity, resilience, and remaining willing to challenge one’s own hypotheses throughout a research career.

Hajduczok and Adamson then examine the transformation of heart failure care over the past four decades, highlighting the shift from an era with limited therapeutic options to one defined by evidence-based, guideline-directed medical therapy. Adamson recounts the development of dedicated heart failure programs, the early skepticism surrounding subspecialization, and the growing recognition that multidisciplinary disease management is essential for improving long-term outcomes.

A major focus of the conversation centers on the development of implantable pulmonary artery pressure monitoring and the physiological principles underlying remote hemodynamic monitoring. Adamson reviews the lessons learned from early technologies that ultimately informed the creation of CardioMEMS, emphasizing that clinically useful monitoring must reflect meaningful pathophysiology, guide therapeutic intervention, assess treatment response, and provide sufficient lead time to prevent decompensation. Together, Hajduczok and Adamson also discuss implementation challenges, including clinician workflow, data management, and the emerging role of artificial intelligence and machine learning in transforming large volumes of physiologic data into actionable clinical insights.

The conversation also explores patient empowerment through remote monitoring technologies. Hajduczok and Adamson discuss how providing patients with actionable physiologic data may improve engagement, enhance self-management, and reduce heart failure hospitalizations by enabling earlier intervention before symptomatic congestion develops. They describe remote monitoring as an extension of chronic disease management, drawing parallels to continuous glucose monitoring in diabetes and emphasizing its potential to improve the scalability of care for increasingly complex heart failure populations.

Attention then shifts to autonomic modulation and baroreflex physiology, where Adamson reviews decades of work investigating baroreflex sensitivity as a predictor of cardiovascular outcomes and the rationale for neuromodulation therapies. He and Hajduczok discuss the evolution of Barostim therapy and its potential to influence multiple aspects of heart failure pathophysiology, including ventricular function, pulmonary pressures, autonomic balance, exercise capacity, and overall functional status. A recent patient experience serves to illustrate the systemic effects of neuromodulation, reinforcing the concept that heart failure requires therapies targeting interconnected physiologic networks rather than isolated mechanisms.

The episode concludes with reflections on scientific leadership, mentorship, and career development. Adamson encourages early-career investigators to embrace unexpected opportunities, learn from failure, maintain intellectual curiosity, and recognize that meaningful advances arise from continually questioning established knowledge. Together, Hajduczok and Adamson underscore that while research directions and professional roles evolve over time, a sustained commitment to improving the lives of patients with heart failure remains the driving force behind scientific innovation and clinical progress.

Podcasts

Hear Philip Adamson, MD, MSc, discuss his path through heart failure and his work with Abbott and CVRx.

Alex Hajduczok, MD

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