Evelyn Horn

5 Questions With Dr. Evelyn Horn

Advancing comprehensive heart failure care as the ‘Right Heart Doctor’

Evelyn Horn

Over the course of nearly four decades as a cardiologist, Dr. Evelyn Horn has been on the forefront of innovation in heart failure.

In 1992, she helped establish the first heart failure program in the country dedicated to caring for pre-transplant and heart failure patients and advancing clinical heart failure research at NewYork-Presbyterian/Columbia. At various points in her career there, she oversaw clinical services and the heart failure fellowship program, expanded the adult pulmonary hypertension program, and incorporated pulmonary vascular disease into the division. In 2007, she moved to NewYork-Presbyterian/Weill Cornell Medicine to become the Director of Heart Failure and Pulmonary Hypertension at the Perkin Center for Heart Failure. The program she created offers innovative, comprehensive treatment for advanced heart failure and pulmonary hypertension.

Along the way, Dr. Horn earned the moniker of the “Right Heart Doctor” because, as she says, “I was one of the few heart failure doctors who was knowledgeable of not only the left side of the heart but also the right — a direct consequence of having a significant focus on pulmonary hypertension,” she says. This meant colleagues would often seek her expertise on some of the toughest cases that involved right heart failure. “I’ve always tried to provide hope when others couldn’t.”

Dr. Horn spoke with NYP Advances about her early experiences helping build heart failure as a key subspecialty within cardiology and where she sees the field going next.

When did you know that you wanted to specialize in cardiology?

I did look into other specialties before choosing cardiology. At one point I had considered pediatric surgery, and when I applied for residency programs I simultaneously applied to obstetrics and gynecology and internal medicine. But my colleagues in medical school always said I was going to go into cardiology. There was something about the pathophysiology of cardiovascular conditions and my mathematical approach to reasoning that blended well together, so even after exploring other things I came back to cardiology. I was aware that I was picking a field with very few women in it, but I was well-prepared. I went to Stuyvesant High School in New York City the first year it went co-ed. I was one of 13 young women admitted.

I always maintained an interest in high-risk obstetrics throughout my career. During my medical school obstetrics rotation, I helped manage a patient with advanced mitral stenosis through the end of pregnancy and delivery, and I continue to have an interest in the cardiovascular complications of pregnancy and the crossover between hypertensive heart disease, peripartum cardiomyopathy, and preeclampsia.

You have a track record of helping to establish successful heart failure programs, first at Columbia and then at Weill Cornell Medicine. What were your goals for each?

There were two different missions for each of them. Because of Columbia’s transplant program, there was already a population who sought our care, the patients who were being referred for transplant. But there wasn’t a program in place to help with management of their heart failure beforehand, so our goal was to see what we could do to treat the patient’s own heart first before we transitioned to transplant. We were also front and center in developing a left ventricular assist device (LVAD) program from the initial REMATCH study, which was the Columbia clinical trial that helped demonstrate the long-term use of LVADs for heart failure.

The move to Weill Cornell Medicine was a very different mountain to climb. At that time, there wasn’t an existing patient referral population like at Columbia, so building the program meant we had to introduce expertise outside of conventional cardiology to move the needle beyond coronary disease, valvular heart disease, and arrythmias to treat a sicker patient cohort.

One of the beautiful things about NewYork-Presbyterian is the affiliation with both Columbia and Weill Cornell Medicine. I didn’t leave Columbia because I didn’t like what I was doing, I just had an opportunity to start a new program with a new vision at Weill Cornell Medicine and put my stamp of holistic heart failure care on everything from heart failure with preserved ejection fraction to pulmonary hypertension to novel imaging procedure, and more. We also quickly added a bi-campus ventricular assist device (VAD) program where we could present our patients for listing for heart transplant at Columbia. More recently NYP has expanded its heart transplant program to Weill Cornell, so our vision to provide superb heart failure services has only grown.

Looking back on your career so far, what’s the accomplishment that you’re proudest of?

I would say it was being involved in the creation of the Columbia program, which was under the leadership of Dr. Milt Packer, because heart failure programs didn’t exist. I started at Columbia doing some translational research — which is now a big thing but wasn’t necessarily in vogue then — on beta adrenergic receptors in heart failure and transplant patients. Later I got to be involved in some of the newest pharmacological research and device studies of our time.

During this time I also built my expertise in management of the right side of the heart and the afterload it faces. Back then very few people focused on pulmonary hypertension, and certainly not on the unmet challenge of right-heart failure. The more common etiologies for heart failure are hypertensive heart disease and coronary disease, which are all on the left side, so until maybe 15 years ago cardiologists barely even looked at the right side on an echocardiogram. That changed with the use of LVADs, because when you only support the left side, for a variety of reasons, right heart failure will often manifest. People are more focused these days on the right side of the heart than before, but I was happy to be one of the pioneers.

What excites you about the future of the field of heart failure?

It’s an incredibly exciting time to be in this field because of the rapid advances. There are new technologies, discussions about the best use of AI, and new biological assessments; for instance, one of my NIH studies involves the ultimate in precision medicine: analyzing genomics, DNA, RNA, proteomics, and metabolomics to better understand the characteristics of pulmonary vascular disease in different disease processes and patients. This same approach should be more routine in the world of transplant immunology.

"A good physician has to understand from day one who doesn’t fit into that mold and when you need to think outside the box with your approach to treatment."

But now we have to ask ourselves: How do we incorporate these advances with the best clinical judgment? What is the best application of all this for patients? Because the last thing most people want is for decisions to be made by someone just applying an algorithm. It’s truly a privilege to get to know patients and have a special relationship with them. There are times when you can say, “OK, 80% of the population behaves in a certain way, this is where an algorithm can help,” but a good physician understands from day one who doesn’t fit into that mold and when you need to think outside the box with your approach to treatment.

What about NewYork-Presbyterian has kept you here for so long?

I love the people I work with. I was born and raised in Queens so family was certainly high up on the reasons to stay, but at the end of the day, to still enjoy what you do and enjoy the people you’re working with is what makes the biggest difference.

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Dr. Evelyn Horn: Advancing comprehensive heart failure care as the ‘Right Heart Doctor’

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