Circulation on the Run: Come Meet the CardioNerds™

This week's special podcast features the CardioNerds. Join Maryjane Farr, Vanessa Blumer, and M. Trejeeve (Tre) Martyn as they interview Amit Goyal and Daniel Ambinder, who started the Cardio Nerds podcast, website, and learning resources.

Dr. Maryjane Farr:

Welcome, everybody, to Circulation on the Run. My name is Maryjane Farr from UT Southwestern, and here we have an opportunity to take a week from Circulation on the Run and let our social media editors take over and do an interview of their choice. To welcome both two of our social media editors, first, Vanessa Blumer, who is going to be doing her postgraduate year seven in Cleveland Clinic, in advanced heart failure, and Trey Martin, who is a newly-minted faculty member in heart failure and amyloidosis and population health at the Cleveland Clinic. And they've chosen to interview Dan Ambinder and Amit Goyal of CardioNerds.

Dr. M. Trejeeve (Tre) Martyn:

So, thanks to Vanessa and to Dr. Farr for setting this up, and thanks for Amit and Dan for being here. Really excited to talk to you guys. The first thing I want to start off with is to get a little bit of an origin story about CardioNerds. And if you could tell us how you got started and how this all came to be, I think the listeners would be interested to hear that.

Dr. Daniel Ambinder:

Thank you so much, Trey, and it is really great to be here and nice to meet you. This is Dan. So, the origins of CardioNerds actually began early 2019. One of our mentors put us together, Dr. Reza Manesh, who's one of the co-founders of Clinical Problem Solvers, and thought that we should be thinking about potentially starting a podcast. And that definitely lit the spark and is it going to be something that's worthwhile pursuing?

Dr. Daniel Ambinder:

And so, we said to ourselves, at rounds we could teach five people at Noon conference, maybe we could reach out to 20 and to 40 people, but maybe with a podcast, we could reach 500 people at a time and that would be something that would be really worthwhile. So let's just sit down, create a script and start from there. And we created the first episode, aortic stenosis, and we did the recording and we just loved that process. And after that, we said, "This is worth it." So we made a couple more episodes-

Dr. Amit Goyal:

Hey, I'm just going to chime in here real quick. This is Amit. And I'll start off by saying, thank you so much for this invitation and what a joy it is to be doing this with two people who we respect so much, Vanessa and Trey. The process of creating this podcast and education, we learned so much. And it was so much fun that we decided why don't we just give it a shot and trial it by creating maybe three, maybe four episodes and seeing how it goes from there. So that was a backstory.

Dr. M. Trejeeve (Tre) Martyn:

I was curious how you guys thought about initially getting traction. Because that, I think, is the really challenging part and how you thought about getting listenership for your podcast and expanding. And was it focusing on the product, obviously? But I was curious how you, because now you have, you guys have this gravitational pull of prominent faculty and trainees that want to work with you, but how did you get there, and what was the strategy in doing that?

Dr. Amit Goyal:

I'll say that, initially, like Dan said, that we went out with the idea of just giving it a shot, seeing if it fit with our schedules, seeing if we enjoy the process and if there was enough of a need and a desire for this. And so, we said, why don't we create a short number of episodes? And if we could get 500 listeners, that would be the biggest audience that we have individually reached. And before you knew it, the 500 per episode turned into 5,000 per episode.

Dr. Amit Goyal:

And we realized that, even without actively and very deliberately trying to promote this, there was already a need and a desire for this. There was a niche that we were filling that we hadn't realized. The value of asynchronous medical education for people within or people who are interested in the care of patients with cardiovascular illness. So I think that's one. I think that's one takeaway, that there is value for open access, asynchronous education that is high quality.

Dr. Amit Goyal:

I think from there, our next big major pivot was well into COVID-19 when ACGME and the bodies decided that we should have virtual recruitment. This is when, enter Dr. Nosheen Reza, who was the chair of ACC FIT section at the time. And she messaged us on Twitter early afternoon, one day, saying, hey, is there maybe a way we could potentially use social media and the growth that cardio nurses has already had up until that point to maybe help connect residents with programs, ACGME accredited cardiology program, to have their fellows present a case, use one of their experts to provide an editorial expert commentary and then had the program director have a message for the applicants.

Dr. Amit Goyal:

And in discussing the case, the fellows would also talk about the program. And what that did was, I think, internally for us, it helps us realize that this just made it so much, the quality of the content and the breadth of the content, the depth of content just skyrocketed, right? I mean, we had fellows bring us cases of preeclampsia and bicuspid aortic valve, aortic stenosis with pregnancy. I mean, it was just, it was incredible that CardioNerds wasn't just about what we wanted, it was very rapidly turning into a communal entity that other people could take pride of. And so, that became really important to us.

Dr. Daniel Ambinder:

Yes. And I'll just add, again, as Amit's explained is, it happened sequentially. But it was actually a pivotal moment, right before the CardioNerds case report series was launched, where things were feeling stale. We definitely love to teach, there's no doubt about it, and that is a huge part of this. But there was a certain point where we were teaching and we just felt like there needs to be something more.

Dr. Vanessa Blumer:

Thank you so much, Dan and Amit. I mean, I think everything that you do, this is Vanessa. I think everything that you guys do, it's so inspiring for, I think, all generations, right? I think it's inspiring for future generations, but I think you guys inspire people at all levels. When you think about CardioNerds, what is your purpose? What drives you? What is your motivation? What do you think is your ultimate, why?

Dr. Daniel Ambinder:

While we had this passion to educate, that is not necessarily the why. And all of a sudden, as soon as we took off, there was multiple opportunities and multiple things dragging us in different directions. And we immediately sought out our mentor, Dr. Sanjay Desai, who is our program director at the Osler Medical Residency, and he said, "You got to find out your why right away." So, now our why includes to create and disseminate education, promote diversity, equity, inclusion, foster wellness, and humanity in the field of cardiology and in life, and provide mentorship and sponsorship and invigorating a love of cardiovascular medicine and science. Choices were easy. We can just say, "Does this fit the rubric of our mission? Is this an opportunity that we want to pursue? Is this something that's going to enhance this mission?"

Dr. Amit Goyal:

Putting words to a mission was extremely helpful for us. And actually, part of that conversation we're having at that time was around diversity and inclusion, because that's when Sanjay was saying you have to define what your organization stands for and what is a mission, and who are the people that are going to represent these cardiology fellowship training programs, in the eyes of residents who are thinking about a field in cardiology, and how deliberate we want to be about asking program directors to be cognizant about representing diversity in the fellows that they have representing the programs. And so, around these discussions, that's when Sanjay said, okay, there are a lot of things that you can do with CardioNerds, but before you do that, figure out what is your goal and how every action fits into that goal.

Dr. M. Trejeeve (Tre) Martyn:

Thanks, Amit. So, keeping that mission that you described in mind, what do you think is the ultimate goal of CardioNerds? Or, I guess I should say, where do you see CardioNerds being in five to 10 years? I know that's far out and some of the days you're just trying to get through the day you have in front of you. But if you could envision a future and, in the structure or the mission, keeping that in mind, where do you see CardioNerds in five years, let's say?

Dr. Amit Goyal:

Yeah, thanks, Trey. That is such an important question and a very difficult question to answer. I will say that things have evolved so quickly. And so, I think our one challenge that we talk about that we don't know how to resolve just yet is how to build CardioNerds in a way that's scalable, that outlives us. How do we make CardioNerds go beyond us? And that's Dan and I, but also everyone else within CardioNerds, a generation later. How do you maintain CardioNerds?

Dr. Amit Goyal:

And I think the logistic part of that is probably not that hard to figure out, right? You need admin support, you need resources, you need to delegate, you need leadership structure, but how do you grow it and have it outlive you in a way that still continues within the ethos of how you started it, within that mission, within the goals that you set it out to? And I think that's really something that we have to figure out, but that's going to be probably a deliberate way of how we grow it and how people grow into a leadership structure within it, how we design the programs. So I think that that part of the growth depends on the actions and the decisions we make today.

Dr. Daniel Ambinder:

Yeah. I definitely agree with all of that. And just to be brief, I just reiterate, CardioNerds is really for the people and what people want changes. And so, we're always listening and we're getting tons of feedback. And as the network grows, people are coming to us with projects and ideas, and we always try to find people that are just really passionate about what they want to do and give them a space to do it and try to give them as many resources and mentorship and sponsorship as we can, and then get out of the way. And so, that has already been a great recipe for a lot of different outpouchings and outgrowths of CardioNerds that really, again, goes back to the entire mission. And so, it's almost really hard to predict what will happen in five to 10 years, but we are ready and listening and looking to see what we can help the community with and vice versa.

Dr. Vanessa Blumer:

Thank you so much, Dan. And I mean, these answers have been fascinating, honestly. This interview, in general, has just been so enlightening. Dan, I think you touched on the point of democratizing cardiovascular education, which I think is, or should be, one of the highlights of this interview. Can you maybe touch a little bit more on this? And we talked about the why, can you talk about the how and see how you see this moving forward?

Dr. Daniel Ambinder:

Yeah. Thanks so much, Vanessa. We agree, democratization of cardiovascular education, what does that even mean? But what we mean by that is that why should somebody, somewhere off in a distant country, not have the ability to take care of their patients in the most topnotch way, because they may not have had the exposure to a particular part of cardiovascular education? Breaking down some of the formal barriers between levels of trainees, so, for example, CardioNerds' journal club really encompasses that.

Dr. Daniel Ambinder:

Once a month, our CardioNerds Academy, which you haven't talked about, puts on an amazing show. It's really a way where journal club hits Twitter in a traditional format, same process of discussing the article, but in the Twitter format. So it allows for this amazing group of, usually hundreds of people, honestly, to come together and discuss. And what's so amazing is that the scientific community has really gotten on board. So we often have authors of the papers that we're discussing join the actual Twitter club.

Dr. Daniel Ambinder:

And then we have medical students that are asking questions of the authors and this amazing engagement between multi-levels of education coming together. There are certainly ways that some, I wouldn't say the barriers, there are certain ways that these things can be helpful, like traditional learning and formats like that, but sometimes not. And so, we aim to be constructively destructive in terms of that way. And that's what we've done with democratization of cardiovascular education.

Dr. Amit Goyal:

If I might just add, then when we think about democratizing cardiovascular education, it's both for the learner, in terms of making high-quality education available and accessible, but also for the educators, right? I had a conversation with a mentee when he was a resident, and he called me and said, "Amit, I want to be an interventional cardiologist, but I also want to be a medical educator. How does that work?". And the fact that he was asking that is, for me, a problem, right?

Dr. Amit Goyal:

I've had this conversation with Dr. Katie Berlacher, who was also a medical educator, but is a cardiologist. Why does there seem to be strain between becoming a medical educator and becoming a cardiologist, right? That's not there for hospitalist medicine and other fields. So that's part of the reason we really enjoy having all sorts of trainees and faculty come on and teach on the show and be deliberate about how they want to teach on the show.

Dr. M. Trejeeve (Tre) Martyn:

Thanks a lot, Amit and Dan. In some ways, it sounds like you guys have been able to democratize another area other than education, which is clinical trials. And I wanted to get your perspective and hear a little bit more about the CardioNerds Clinical Trials Network. It really seems like an amazing program you guys have set up.

Dr. Amit Goyal:

It all goes back to the mission, but the origins of that is, Dr. Starling, he was a pretty early adopter for CardioNerds. He was a part of our very early heart failure series back in early 2020. And he was such a great supporter and source of encouragement and mentorship for so long. And Trey, I know you understand this, and Vanessa, you too, but he, for one reason or another, he brought up CardioNerds at a meeting about PARAGLIDE-HF. And I think present were Dr. Eugene Braunwald, who's part of the steering committee and Dr. Robert Mentz, who is the lead principal investigator, began recruiting around the time of COVID-19, affecting recruitment for a lot of trials. Lot of challenge there that I think we can all understand at this point.

Dr. Amit Goyal:

And we said, "Okay, well, not sure. We haven't thought about clinical trials, but why don't we think about it and get back to you?" So then, we said, okay, well, what's the core strength of CardioNerds? It's the people, right? After we did the CNCI recruitment series, hosting fellowship training programs, we realized that that worked out really well, because brilliant fellows from all these different programs came and elevated the education. So we established the Healy Honor Roll, after Dr. Bernadine Healy, of training programs who are part of the honor roll by nominating a FIT ambassador, a fellow and training ambassador, who's interested in education.

Dr. Amit Goyal:

We said, okay, well, why don't we just extrapolate that to a clinical trial? Instead of fellowship training programs, it would be trial sites that have training programs affiliated with them. Instead of a program director nominating a FIT ambassador for education, it would be the site PI nominating a FIT trialist for recruitment. But how would that fit as part of the mission? Well, with the Healy Honor Roll, with the academy, with everything else, hosting people on the podcast, it's always been, how do we pair content creation with personal and professional development?

Dr. Amit Goyal:

So, with a clinical trials network, the question was, how do we pair equitable trial enrollment with FIT personal and professional development? How do we meaningfully engage the fellows in the conduct of clinical trials, but also meaningfully help develop their interest in clinical trials and academic careers? How do we equip them with important skills and knowledge in the space? So we created a curriculum that's related to career development and equitable enrollment. And then, also, how do we make sure that they have, and deliberately, they have networking and mentorship as part of this?

Dr. Amit Goyal:

Since then, after we got all the fellows involved, the impact has been absolutely amazing. Because there are two goals here, right? There's equitable recruitment and there's fellow development. And just by having these meetings, by having the curriculum, the fellows are already engaged. So at the very minimum, half the mission is working out really well. But what about the other half, and that's equitable recruitment. So I will say from the time of the first FIT-recruited patient up until June 2nd, okay? So, that's February 8 to June 2nd, we account for 16% of all trial sites, but 49% of patients enrolled.

Dr. Amit Goyal:

Of the patients that we have enrolled, 54% are women compared to 47% for the non-CardioNerds sites. And 80% are BIPOC, or Black, Indigenous and people of color populations, compared to 19% for patients not enrolled by CardioNerds fellows. So, the impact there is, I think it's flooring, honestly. It is earth shattering and we are all amazed by it. And part of the question has been, can this be consistent, right? Is this a fluke? But since, when we had 30 patients enrolled, then we had 35 patients enrolled, we had 40 patients enrolled, these numbers had stayed relatively consistent.

Dr. Amit Goyal:

The question now is why? How is it that we've been so effective in disproportionately recruiting patients who had been historically underrepresented? And that's a very important question that we are really excited to dive deep into the data and try to understand. So our plans with Rob Mentz and the rest of the people who really made this possible is to really look at the numbers in terms of recruitment.

Dr. M. Trejeeve (Tre) Martyn:

That's really amazing, guys. And I have to applaud you on the vision to do that, and then to think about how to meet your mission, and then also to meet an unmet need that is... Because clinical trial enrollment, when you go through it, it's always slower than you hope. And this is such a great way to light that, to one, ignite a new generation into how to do clinical trials on the ground floor, but then also to increase the diversity of enrollment is amazing and you guys should be applauded for that.

Dr. Vanessa Blumer:

I also want to congratulate the both of you. Thank you. You guys are trailblazers and definitely are changing the world for all of us and making it a better place. So, we're so proud of you. We have to wrap up, so maybe just one last question before we go. So, maybe a two-part question, or you can choose to answer one or the other. But what do you guys feel most proud of? And what do you guys think has been the most important lesson that you have learned in the CardioNerds journey so far?

Dr. Daniel Ambinder:

Thanks, Vanessa. It definitely always helps to emphasize this. We really started this right before COVID. We had no idea COVID-19 would hit. And, really, the whole world was lurched into this virtual space. And there was always the hashtag, in real life? Is this even real life? And there was a sense that maybe it wasn't. And when we went to ACC and we met our people in person, and relationships were, not like they were just starting, but they had been ongoing for years. We really, really felt that this is something so real, and that is the lesson of CardioNerds. The lesson of CardioNerds is that the cardiovascular community is a real cohesive, beautiful community, and there's a lot of CardioNerds out there that embrace their nerdom when it comes to cardiology.

Dr. Amit Goyal:

I think in terms of what I'm taking away from this journey and what I'm going to keep relying on, the lessons I'm going to keep relying on, are one, is just find something you love and lean in. Right? I mean, when we first started telling people, "Oh, we're going to make a podcast and, hey, by the way, we're going to call the CardioNerds," the reactions we were getting from people, people we deeply respect and look to for advice and for role models, there were a lot of people who said, "Oh, that's great. It's so nice to have a hobby, but what are you going to do during your research block?" Right. That's great.

Dr. Amit Goyal:

But I think the reason why we've been able to stick with it is because we found something that we genuinely love to do. And so, I think that's really, whatever it is for you, that's really important. I think the second thing that's been extremely important for us is to surround yourself by people who inspire you, who push you, who will advise you, who make you want to be better. And that's people who are senior to you, people who are your peers, people who are junior to you, right? Because you can get as much inspiration from somebody who's 10 years your junior as you can from somebody who's 10 years your senior.

Dr. Amit Goyal:

I know I've taken a lot of inspiration from Vanessa and Trey and have relied on both of you for advice. I remember Vanessa, I think I had a very, a specific conversation about the clinical trials program when it was just a burgeoning idea way back when. And if number two is to take inspiration, take advice, take mentorship, number three is give. To flip that around and try to just give yourself and make yourself available to as many people around you, because that's how you build a community and that's how you give back and thank the people who give to you.

Dr. Maryjane Farr:

Okay, great. So, thank you. Thanks all of you. Four contemporaries who are leading the way into the future of cardiovascular medicine, science, and education. So, on behalf of Circulation on the Run, we have been so delighted and honored for you to spend some time with us, have a podcast about the podcasters. But you're not just podcasters, this is a real and amazing and innovative platform, and we are so excited to see where you go next. Any final, last words from Trey and Vanessa or Amit and Dan?

Dr. Vanessa Blumer:

Thank you so much to Circulation on the Run and Dr. Farr for this opportunity. Amit, Dan, like always, it's such a pleasure. I learn so much from you every single time that I get the opportunity to interact with the both of you and you are an inspiration to all of us. So thank you so much for this platform.

Dr. M. Trejeeve (Tre) Martyn:

Thanks to Dr. Farr for Circulation on the Run, for this platform, Amit and Dan for taking the time out of their evening to be here, Vanessa, for joining me in Cleveland. And I would say that you guys, the CardioNerds founders, you're an inspiration that you don't necessarily have to wait to make an impact.

Dr. Amit Goyal:

Yes. Thank you so much. I don't even know what to say. I'm speechless. I'll say that, for Dan and I, we're still just a couple of nerds. I do my recordings in my attic, Dan's in his home office. I think if you, we're still besides ourselves with disbelief that we are a topic of conversation for a platform like Circulation on the Run. It is absolutely a privilege and an honor for us. And so, I think all I can do is just say thank you so much, and then to Dr. Farr for the invitation to have this conversation for Circulation, and Dr. Hill for giving us this platform. I think this is just such a... Again, we are speechless. Thank you. Thank you so much.

Dr. Daniel Ambinder:

I'm equally as speechless and this podcast, Circ on the Run, really reminds me of my earlier roots, reaching out of my own institution, because it was a Circ social media team that first gave me a great glimpse at what happens outside of the institution that I had been training at for many, many years. And to see how the sausage is made, in terms of how research is vetted and undergoes a strict peer review, was really amazing. And I had the opportunity of meeting Dr. Hill and also being part of the team as COVID was revving up and Circulation had to... We're getting bombarded with all these COVID-related articles. And there was just a very important understanding that what gets published is going to be really, really important.

Dr. Daniel Ambinder:

So, watching that from the sidelines, under the mentorship of Dr. Amit Kara, just seeing how that happened, gave me such an important understanding that what you put out into the world, whether you're Circulation or writing a personal tweet or putting something out on CardioNerds is just really important and treat it as if it's something that's going to be there forever. And I learned so much about collaboration and I also learned so much about podcasting, because of Circ on the Run, it was actually the first podcast I was on and I don't like to listen to that very often. So thank you so much. This is such an honor to bring this full circle and come back and join you all.

Dr. Greg Hundley:

This program is copyright of the American Heart Association, 2022. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.