Like many translational research questions, the one Matthew Yuyun, MD, PhD, is chasing down came straight from his clinical work.

Yuyun was frustrated by the lack of options for a certain subset of his cardiology patients: those with heart failure with preserved ejection fraction (HFPEF), in which the heart pumps normally but is too stiff to fill properly. The condition, which accounts for about 50% of all heart failure and is steadily increasing worldwide, is a significant precursor to cardiac death. Yet, no one knows whether or to what degree abnormal cardiac rhythms might be to blame.

A clinical cardiac electrophysiologist and assistant professor of medicine at VA Boston Healthcare System, Yuyun aims to change that. He is using protected research time as a Harvard Catalyst-funded faculty fellow through Harvard Medical School’s Office for Diversity Inclusion & Community Partnership office (DICP) to tease out the role of arrythmias in heart failure of this type and increase options for patients like the ones that sparked his research.

We caught up with him a few months into his fellowship.

Your two-year DICP Faculty Fellowship investigates how arrhythmias impact heart failure. What got you interested in this?

My training is in epidemiology, so when I see patients in the clinic, my mindset is to figure out whether there’s something I can do or not. It’s usually easy to see areas where there’s a lack of research or clinical uncertainty. You’re always looking for something that has not been answered.

We now classify heart failure as either heart failure with preserved ejection fraction (HFPEF), with mildly reduced ejection fraction, or with reduced ejection fraction, based on how the heart pumps. Clinical research suggests that about 25% of people who present with HFPEF go on to die suddenly, and we don’t know why. Are they dying from arrhythmic deaths or other causes? Nobody knows.

“Clinical research suggests that about 25% of people who present with HFPEF go on to die suddenly, and we don’t know why.”

We know that most people who have heart failure with significantly reduced ejection fraction will die because they go into a ventricular tachycardia or some other dangerous rhythm. But we don’t know whether that is true for people who have heart failure with preserved ejection fraction. We don’t even know the burden of arrhythmias in this population. We don’t know how many people in this group have true atrial fibrillation, dangerously slow heart rates (bradycardia), or ventricular arrhythmias.

I’m hoping we may be able to answer some of these questions using existing data the Veterans Administration (VA) has been collecting since 2006. It’s a large, rich database that encompasses a diverse population. Among other variables, we’ll be analyzing whether ethnicity or gender impacts arrhythmia events.

Then, within the sub-population of people with HFPEF who went on to die suddenly, we will try to tease out the driving mechanism of death. Is it arrhythmic or non-arrhythmic?

How has your clinical work affected your research?

In my clinical cardiology work, patients often come onto the ward with terrible heart failure but preserved ejection fraction, and there’s not a lot to do for them. Recently we have had some breakthrough drugs to apply to some cases, but prior to that it was diuretics and nothing else. Meanwhile, many therapeutic options exist for people with reduced ejection fraction.

So this question kept coming up around arrhythmias: What if these patients who die suddenly do so because of an arrythmia? I reviewed the literature and found that we know very little about malignant arrhythmias in these patients. So I talked to my mentors, because in this world of research, you cannot do things solo; you could pigeonhole yourself into a narrow area only to find that it’s already been knocked off. But instead I learned that the absence of knowledge was real.

What might be the clinical impact of this study in the long term?

The goal of our study is to see if we can reduce the risk of sudden cardiac death in this population. Once we know this group’s burden and distribution of arrhythmias, we can ask how we might prevent them.

But the most important thing is to identify potential treatments, because we don’t have many therapeutic interventions for heart failure with preserved ejection fraction. We anticipate uncovering opportunities for further research into therapeutic interventions.

If we do find that arrhythmias are driving sudden cardiac deaths, then we are going to try to develop a risk score to stratify patients with HFPEF and begin to identify who would most likely benefit from therapeutic interventions.

You work full time at the VA clinic and pursue this research. How does the faculty fellowship fit into your career and research goals?

The fellowship provides not only financial assistance but, most importantly for me, 25% protected time for research. The importance of this cannot be stated enough.

“Having this protected time allows me to pursue the research question raised by my patients’ needs.”

My long-term plan is to continue carrying out clinical research alongside clinical practice. It can be really hard as a full-time clinician to squeeze out time for research if it is not officially allocated. The difficulty starts with obtaining funding, because most funding bodies want you to allocate 50 to 75% of your time to research. If you have clinical duties, like myself, you have to also allocate enough time for your interventional procedures or you might lose those skills.

I have enormous respect for clinician scientists who are able to balance the two and do this kind of translational research, because I think seeing patients informs where one’s evidence may be lacking. Then they can spearhead research into specific areas of concern. Having this protected time allows me to pursue the research question raised by my patients’ needs.

How do you find work/life balance in all of this?

The fellowship also gives me the opportunity to have some good work/life balance.

I’m a husband and a father of three: two daughters and a son.  Sometimes I have done my research late into the evenings after having done clinical work in the day and some weekends. That cannot be done without stealing valuable time from family and friends.

Having that 25%  in protected time means that some days I can go home after five o’clock and just be with family instead of being at work.