Heart Matters

Host: Alfred Bove, MD Guest: Howard Eisen, MD There are many potential options for treating left ventricular dysfunction, from medical to device therapies. Dr. Howard Eisen, Thomas J. Vischer Professor of Medicine and chief of the division of cardiology at Drexel University College of Medicine and Hahnemann University Hospital, in Philadelphia, Pennsylvania, outlines the roles of bypass surgery, p...

Host: Alfred Bove, MD Guest: Jeffrey Olin, DO Fibromuscular dysplasia, most commonly found in the renal or carotid arteries, often goes undiagnosed, even though the condition may affect three- to five-percent of the U.S. patient population. What are symptoms of FMD, and in what patients should physicians screen for FMD, despite the absence of symptom presentation? Dr. Jeffrey Olin, professor of ca...

Host: Alfred Bove, MD Guest: William Dec, MD Correcting anemia or iron deficiency in patients with heart failure has been shown to improve mortality and quality of life. Among patients with heart failure, how common are anemia and iron deficiency? What type of iron supplementation therapy is most effective? Dr. William Dec, chief of the cardiology division, co-director of the Massachusetts General...

Host: Alfred Bove, MD Guest: Charles Love, MD Defibrillator and pacemaker leads can be challenging to remove or replace, even when the procedure is performed by an experienced cardiologist. Infection, manufacturer recall and device malfunction are all reasons a lead might require extraction. How can we balance the risks of the procedure with the potential harms of leaving a lead implanted? Dr. Cha...

Host: Jack Lewin, MD Guest: Christopher Cannon, MD Previous trials, including the ENHANCE trial , have raised doubts about the clinical benefits of adding ezetimibe to high-dose statin therapy. The ARBITER 6-HALTS trial added further weight to the results of ENHANCE, wherein the ARBITER trial demonstrated that extended-release niacin was superior to ezetimibe as adjunctive therapy to high-dose sta...

Host: Jack Lewin, MD Guest: George Halvorson How does an integrated cardiac care model work, and how difficult a process is such a model to implement? What are the various components of the program, and what have the results been? George Halvorson, chairman and chief executive officer of Kaiser Permanente and author of the book Healthcare Will Not Reform Itself , joins host Dr. Jack Lewin to discu...

Host: Janet Wright, MD Guest: David Morrow, MD, MPH Standard troponin assays can be a crucial tool in diagnosing myocardial infarction, but have also been criticized for their low specificity at the time of presentation. Will newer, more sensitive troponin assays improve early detection and diagnostic accuracy for MI? Even with use of the newer assays, Dr. David Morrow, associate professor of medi...

Host: Janet Wright, MD Guest: Judith Hochman, MD What are the 2009 recommendations for best managing ST-segment-elevation myocardial infarction, or STEMI, and the need for percutaneous coronary intervention, or PCI? Dr. Judith Hochman, the Harold Snyder Family Professor of Cardiology and clinical chief of cardiology at the New York University (NYU)-New York City Health and Hospitals Corporation (H...

Host: Janet Wright, MD Guest: Arthur Moss, MD Although cardiac resynchronization therapy (CRT) is recommended for patients with moderate to severe heart failure and a prolonged QRS interval, is it ever recommended for patients with mild cardiac symptoms? Can prophylactic resynchronization therapy, delivered by an implantable defibrillator, reduce the risk of heart failure or death in those patient...

Host: Janet Wright, MD Guest: Aram Chobanian, MD In recent years, we have developed a sufficient understanding of the mechanisms behind hypertension that has led to the evolution of numerous diagnostic and treatment options. Yet the prevalence of hypertension persists. Why does hypertension continue to disable and kill millions throughout the world, and what can we do to reduce the incidence of th...

Host: Janet Wright, MD Guest: Gerard R. Martin, MD Although congenital heart disease is one of the most common birth defects, its complexity has made the accumulation of an evidence base a challenge. The IMPACT registry, which stands for improving pediatric and adult congenital treatments, has been created to fill this information gap, and it is hoped that these data will provide clinical evidence...

Host: Jack Lewin, MD Guest: Donald Berwick, MD, MPP There are several prominent points of disagreement in today's health reform debate, but one area of general accord involves hospital readmissions: we can (and must) do much better in coordinating the transition and follow-up process for admissions and readmissions — and, if executed properly, this will improve outcomes for our patients. As we emb...

Host: Janet Wright, MD Guest: Timir Baman, MD Charitable organizations have been working for years to support the harvesting of pacemakers for implantation in individuals worldwide, for whom these lifesaving and life-prolonging devices otherwise might not be available. It is a practice that is not currently allowed for reuse within the United States, on the grounds that it has not been proven safe...

Host: Janet Wright, MD Guest: Geoffrey Ginsburg, MD, PhD Patient-centered care is a hot topic in health care these days, though usually when we think of patient-centeredness, our thinking tilts toward aspects of policymaking or system delivery. Host Dr. Janet Wright takes a look at the science side of patient-centered care — the more precise tailoring of therapy known as personalized medicine — wi...

Host: Janet Wright, MD Guest: John Alexander, MD, MHS One of the reported benefits of endoscopic vein harvesting is a lower risk of wound complications following coronary bypass grafting, though it has yet to be established that long-term clinical outcomes for this technique are superior to those achieved using open harvesting under direct vision. New findings suggest a need to weigh short-term be...

Host: Janet Wright, MD Guest: David Sabgir, MD Sometimes there is nothing more pleasant than a simple walk in the park. Encouraging your patients to take an easy stroll may also be an easy way to improve their cardiovascular health. Many of us have talked many times with our patients about the benefits of a regular exercise program, and yet this talk therapy may not be achieving the desired result...

Host: Jack Lewin, MD Guest: John Rumsfeld, MD, PhD So much of our clinical interaction with patients revolves around the collection, analysis and application of information. On a much broader scale, data registries work to assemble the information from each and every one of these clinical encounters. In this age of information, there is so much data at our fingertips, it is easy to be excited abou...

Host: Jack Lewin, MD Guest: Glenn Steele, MD, PhD At some point during the health reform debate, you've probably heard President Obama and others recognize the work of the Geisinger Health System. Through a variety of mechanisms -- among others, charging a flat fee for certain surgical procedures and other high-volume episodes of care, and working hard to integrate services -- Geisinger has been a...

Host: Janet Wright, MD Guest: Stefan Jovinge, MD, PhD A growing body of evidence tells us human cardiomyocytes are capable of endogenous regeneration. The concept has been debated in medicine for some time, but as more data accumulate behind this theory, it is very tempting to think about novel treatment strategies. Dr. Stefan Jovinge, director of the cardiovascular group at the Lund Stem Cell Cen...

Host: Janet Wright, MD Guest: William Kannel, MD, MPH Sixty years ago, a group of investigators began an ambitious research project in Framingham, Massachusetts. At the time, we didn't know smoking increased the risk of heart disease. We didn't understand that high cholesterol and hypertension were risk factors for cardiovascular conditions, and we hadn't identified the respective risks and benefi...

Host: Jack Lewin, MD Guest: Sean Tunis, MD, MSc The Institute of Medicine recently released a list of 100 priority topics for comparative effectiveness research. The first topic on the first page of the report calls for an evaluation of treatment strategies for atrial fibrillation, from surgery or catheter ablation, to pharmacologic therapy. How do we design research to produce an accurate compari...

Host: Jack Lewin, MD Guest: Karen Davis, PhD The concept of the accountable care organization (ACO) has many things going for it, not the least of which is its name: certainly any entity for care that can encourage more accountability and organization would seem to be something which we can incorporate into our reform movement. But there's more to an ACO than just the name: why might these groups...

Host: Janet Wright, MD Guest: Peggy O'Kane As the debate for health system reform heats up in Washington, we're going to take a break to focus on quality: how to achieve it, how to measure it and how to maintain it. In order to meet these objectives, there are a range of options that would either reward or punish those of us practicing in an attempt to achieve higher levels of quality. Host D...

Host: Janet Wright, MD Guest: Mostafa Youssef, MD This week on Heart Matters , we'll explore the terrain of cardiovascular care in the Kingdom of Saudi Arabia with one of the country's leading experts, Dr. Mostafa Youssef, founding director of the Prince Salman Heart Center at King Fahad Medical City in Riyadh. It is a country with vast cultural differences compared to the Western world, and yet w...

Host: Jack Lewin, MD Guest: Kim Belshé, MPP California is the largest state in our union. Bigger than a host of nations in many ways, from population to gross domestic product, its sheer size is one of many reasons why the state's health care system is under duress. Despite the state's budget woes, California is one the few states in our union to take significant steps toward health care reform. A...