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good morning would like to go ahead and get started and welcome everybody to our grand rounds and were delighted to have dr. arvind memorize my heart failure colleague he did his cardiology fellowship at Cook County and completed his advanced heart failure training and Cleveland Clinic really been an integral member of our team for the last several years his 2011 in these champion heart failure disease management which is the most important aspects of our growth and were delighted to get an update today necessary thank you for the introduction Im trying to talk them out of introducing me because I feel but im im part of here and then i know a lot of people that have been lucky to be a faculty with such good people around here ill explain that first slide a little later but as Jerry pointed out Im going to touch upon few related aspects of heart failure really with the team of how we as an institution and really reflecting the rest of the country how to improve inpatient heart fa