Sarah.theheartdoc

Sarah.theheartdoc Mum of 2, wife, heart doctor, enthusiastic optimist. Women in Cardiology Representative & founder of

10/09/2026

Could one of the oldest heart failure medicines also be one of the most overlooked?

Digoxin has been used for more than 200 years, but evidence from three major clinical trials - DIG, DIGIT-HF and DECISION - is encouraging clinicians to look at its role differently.

When considered together, the findings suggest that low-dose digoxin may reduce cardiovascular death or worsening heart failure events by around 15% when added to contemporary treatment.

This doesn’t mean digoxin is suitable for everyone. However, it may still have a valuable role for carefully selected patients, including those who remain symptomatic despite guideline-directed medical therapy, experience recurrent hospital admissions or require additional rate control for atrial fibrillation.

Sometimes progress means discovering a new treatment. Sometimes it means taking another look at a medicine we’ve had all along.

🎧 Hear the full discussion with Professor John Cleland on Beatwise The Podcast.

Always speak to your heart failure team or cardiologist before starting, stopping or changing any medication.

Follow Beatwise for more evidence-based updates from the latest heart failure research. 🫀

ACACIA-HCM trial was a phase 3, double-blind trial involving 517 patients with symptomatic non-obstructive hypertrophic ...
09/09/2026

ACACIA-HCM trial was a phase 3, double-blind trial involving 517 patients with symptomatic non-obstructive hypertrophic cardiomyopathy, randomised to aficamten or placebo.
It was presented at and is published in NEJM

07/09/2026

Are we treating severe tricuspid regurgitation too late?
In TRIC-I-HF, transcatheter tricuspid valve repair produced around 2.4 times more wins than medical therapy alone. At three years, 52% of treated patients were alive without a heart-failure admission, compared with 21% receiving medical therapy alone.
The message: severe symptomatic TR should prompt more than another increase in diuretics. Earlier recognition, optimised heart-failure treatment and timely referral to a specialist Heart Valve Team could change outcomes.
Follow .theheartdoc for more highlights from ESC 2026.
ESCCongress

07/09/2026

ACACIA-HCM was a phase 3, double-blind trial involving 517 patients with symptomatic non-obstructive hypertrophic cardiomyopathy, randomised to aficamten or placebo. At 36 weeks, aficamten significantly improved both primary endpoints—peak exercise capacity and patient-reported health status—with additional improvements in NYHA class and NT-proBNP. However, LVEF fell below 50% in around 10% of patients receiving aficamten versus less than 1% with placebo, although these reductions were generally reversible with treatment interruption or dose adjustment. The trial therefore provides the first strong phase 3 evidence that targeting myocardial hypercontractility may benefit symptomatic non-obstructive HCM, an area with no established disease-specific therapy, but careful cardiac monitoring remains essential.

Study published in NEJM, American College of Cardiology

04/09/2026

Has digoxin been pushed aside too soon in modern heart failure care?

In Episode 54 of Beatwise The Podcast, I’m joined by Prof. John Cleland to take another look at one of heart failure’s oldest treatments and where it might fit alongside modern guideline-directed therapy.

We discuss:

🫀 Why digoxin fell out of favour
🫀 What the original DIG trial actually showed
🫀 Digoxin vs digitoxin
🫀 Its potential role in HFrEF, AF and congestion
🫀 What RATE-AF and DECISION add to the conversation
🫀 Dosing, monitoring and whether we still need a definitive large-scale trial

So, is there still a place for digoxin in modern heart failure care?

🎙️ Episode 54: The Comeback of Digoxin? Rethinking Its Role in Modern Heart Failure Care

Listen now on Beatwise The Podcast - available wherever you get your podcasts.

Comment PODCAST and I’ll send you the link 🔗

CardiologyPodcast BeatwisePodcast

01/09/2026

Actual age: 39. Feels like: 29. ❤️

Another year older, and very grateful for the life I’ve built so far.

Mum to two beautiful children, dog mum to two dogs, cardiologist, researcher and podcast host. Life is busy, often chaotic, and rarely goes entirely to plan - but I wouldn’t change it.

There’s still so much I want to do, but today I’m taking a moment to appreciate how far I’ve come and everything I already have.

Here’s to 39 - even if I’m still convinced I’m 29 🥂

Connecting with hearts around the world
30/08/2026

Connecting with hearts around the world

If healthcare professionals don’t help shape the conversation online, someone else will.Social media has changed how med...
30/08/2026

If healthcare professionals don’t help shape the conversation online, someone else will.

Social media has changed how medical information is discovered, discussed and shared. For doctors, having a visible professional presence is no longer simply about self-promotion—it is an opportunity to translate evidence, challenge misinformation and make specialist knowledge more accessible.

Creating educational content for healthcare professionals allows me to extend those conversations beyond conferences and consulting rooms.

Through Dr. Sarah Birkhoelzer, I’m building a personal brand centred on cardiology, heart failure, amyloidosis, cardiorenal care and clear, evidence-based communication.

Being a medical influencer should never be about popularity. It should be about using professional influence responsibly—and helping credible medicine reach the people who need it.

HealthcareProfessionals PersonalBrand DoctorOnSocialMedia

A new chapter for Heart failure treatment in the NHS.NICE has issued final draft guidance recommending finerenone for a...
25/08/2026

A new chapter for Heart failure treatment in the NHS.

NICE has issued final draft guidance recommending finerenone for adults with chronic heart failure with preserved or mildly reduced ejection fraction — an important step forward for a group of patients where treatment options have historically been limited.

Will Finerenone be in the updated ESC guidance ?

Finerenone is a non-steroidal mineralocorticoid receptor antagonist (MRA), adding another disease-modifying option to our growing HFpEF/HFmrEF toolkit.

Prospective trials to compare nsMRA and MRA have not been conducted.

However we now have more options for more personalised heart failure care. ❤️

ESC Congress 2026 takes place in Munich and online from 28 - 31 August.In the lead-up to the European Society of Cardiol...
25/08/2026

ESC Congress 2026 takes place in Munich and online from 28 - 31 August.

In the lead-up to the European Society of Cardiology’s annual congress, I want to highlight a condition that sits across cardiology and neurology: ATTR amyloidosis.

Patients may receive separate diagnoses for neuropathy, carpal tunnel syndrome, gastrointestinal symptoms and cardiac disease.

Recognising when these features form a wider pattern can help prompt appropriate investigation.

In one cohort of 150 patients with ATTR polyneuropathy, 33% were initially misdiagnosed. Chronic inflammatory demyelinating polyneuropathy (CIDP) and lumbar radiculopathy or spinal stenosis were among the most common initial diagnoses.

None of these symptoms confirms ATTR amyloidosis.

The value of knowing the red flags is recognising when the overall clinical picture warrants further assessment.

Save this as a reminder of the features to look out for.

Speak to your specialist if you have concerns.
[ESCCongress ATTRAmyloidosis Amyloidosis PeripheralNeuropathy CardiacAmyloidosis Cardiology Neurology MedicalEducation]
1️⃣Cortese A, Vegezzi E, Lozza A, et al. Diagnostic challenges in hereditary transthyretin amyloidosis with polyneuropathy: avoiding misdiagnosis of a treatable hereditary neuropathy. J Neurol Neurosurg Psychiatry. 2017;88:457–458.

Join me at European Society of Cardiology. ESC Congress 2026: Munich and Online, 28–31 August 2026. https://www.escardio.org/events/congresses/esc-congress/

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