Sarah.theheartdoc

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

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/

13/08/2026

It’s really easy to get caught up chasing numbers, milestones and the next big thing…

But the older I get, the more I realise that success isn’t measured by what you own or how many people know your name.

It’s measured by the impact you have on other people’s lives, the conversations that change someone’s perspective, the confidence you help someone build, the opportunities you create, and the people who are better off because they crossed paths with you.

That’s the kind of legacy I’m interested in ❤️

12/08/2026

Beatwise Podcast Episode 35: Finerenone
Recorded last year, but even more relevant today: NICE now recommends considering an MRA for HFpEF, while finerenone already has NICE approval for eligible adults with type 2 diabetes and albuminuric CKD.
Listen again for the evidence, practical considerations and what finerenone could mean for cardiorenal care. 🎧
CardiorenalMedicine

09/08/2026

Listen to episode 43 of Beatwise: The Podcast — Advancing Heart Failure Care: New NICE Guidance and Multidisciplinary Team Strategies

I’m joined by Carys Barton, consultant nurse and Chair-Elect of the British Society for Heart Failure, to unpack what the updated NICE chronic heart-failure guidance means for everyday clinical practice.
We discuss:
🫀 The four foundational medicines now recommended for HFrEF
🩺 Earlier diagnosis and intervention
💊 Treatment across HFrEF, HFmrEF and HFpEF
🤝 The expanding role of primary care and multidisciplinary teams
🧑‍⚕️ Personalised prescribing, monitoring and shared decision-making
📚 Helping patients understand and manage their condition
🚧 The practical barriers to delivering guideline-directed care
With almost one million people in the UK living with heart failure, translating guidance into timely, coordinated treatment matters.
Whether you work in cardiology, general practice, nursing, pharmacy or another part of the multidisciplinary team, this conversation offers practical insight into the future of heart-failure care.
🎧 Listen to Episode 43 of Beatwise: The Podcast—available now wherever you get your podcasts.
What do you think will be the greatest challenge in implementing the updated guidance?

What are MRAs—and why do they matter for both the heart and kidneys? 🫀🫘Mineralocorticoid receptor antagonists (MRAs) blo...
09/08/2026

What are MRAs—and why do they matter for both the heart and kidneys? 🫀🫘
Mineralocorticoid receptor antagonists (MRAs) block the effects of aldosterone, a hormone involved in salt retention, fluid balance, blood pressure and tissue fibrosis.
The three commonly discussed MRAs are:
• Spironolactone
• Eplerenone
• Finerenone
They belong to the same drug family, but they are not interchangeable. Their evidence, licensed indications, side effects and costs differ.
Depending on the medicine and the individual patient, MRAs may be used for:
❤️ Heart failure
🩺 Resistant hypertension
🫘 Diabetic chronic kidney disease
💧 Fluid retention or ascites
⚖️ Primary aldosteronism

Key safety message: all MRAs can increase potassium and affect kidney function, so appropriate blood-test monitoring is essential.

This introductory carousel sets the scene. Next, I’ll examine each MRA individually—including the landmark trials, mechanism of action, side effects, hyperkalaemia risk, indications and cost.

For education only—not individual medical advice. Never start, stop or change prescribed medication without speaking to your healthcare professional.


This is an independent post.
COI: funding from AZ,Bayer,Alnylam,Pfizer,BMS.

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