Heart Matters

Host: Jack Lewin, MD Guest: Harlan Krumholz, MD The transition from inpatient to outpatient status is a vulnerable spot in our health care system: more than one in four patients with congestive heart failure are back in the hospital within 30 days of discharge, and readmission rates for a host of other conditions are above 20 percent. The right improvements during this transition phase could have...

Host: Jack Lewin, MD Guest: Regina Herzlinger, PhD The role of specialization in our economy dates back to the 18th century. Now fast-forward to healthcare in the present day: one application of specialization is the concept of a focused factory, where care providers focus on one or two specific organs or disease processes. Host Dr. Jack Lewin welcomes Dr. Regina Herzlinger, the Nancy R. McPherson...

Host: Jack Lewin, MD Guest: Nancy Brown Decisions our young patients make now can have metabolic consequences for the rest of their lives. It's hard to overstate, not only how crucial it is that we reduce the incidence of childhood obesity, but also how difficult it has been for us to turn the corner on this issue. These concurrent themes are central to a campaign put forth by the American Heart A...

Host: Janet Wright, MD Guest: Joshua Hare, MD Cardiac disease was once thought to be both progressive and irreversible. As stem cell therapies emerge across many fields of medicine, our patients with cardiac disorders may be among the first to benefit from this translation of basic science into very valuable clinical applications. What do the latest findings tell us about our ability to tap into t...

Host: Janet Wright, MD Guest: Salim Yusuf, DPhil, FRCPC Start with one part diuretic. Add one part ACE inhibitor, and sprinkle in one part beta blocker. Then add a dose of statins, and top it off with a portion of antiplatelets. Here we have the proposed recipe for a singular pill that some experts believe will eventually help us stick a fork in heart disease. Yet there are pharmacologic concerns...

Host: Janet Wright, MD Guest: Noel Bairey Merz, MD Research tells us that more than 80 percent of American women have used hormonal contraception during their lives. Though evidence suggests hormonal contraception could offer anti-atheromatous effects, the verdict is far from in. Further, we have a lot to learn about the long-term risks for thrombosis, arrythmogenesis, vasomotion and beyond. As we...

Host: Janet Wright, MD Guest: Rita Redberg, MD, MSc Does elective percutaneous coronary intervention (PCI) make sense for patients with stable coronary artery disease (CAD), or are some better off with optimal medical therapy? The answer may depend on our ability to document ischemia in these patients, but it also leads us to another question: are we doing enough, through stress testing or other m...

Host: Janet Wright, MD Guest: Rita Redberg, MD, MSc It is increasingly recognized that symptoms of heart disease are different for men and women. But it appears we are often slower to recognize heart disease in women, resulting in important distinctions in early treatment and outcomes. What are these differences, and how can we, as providers, help narrow this gender gap? Host Dr. Janet Wright welc...

Host: Janet Wright, MD Guest: Robert Hendel, MD We're seeing some progress in cardiac imaging toward this lofty goal, thanks, in part, to a system that combines online technology with science-based selection criteria. The system will help us track patterns of care, provide insights into variations in care across the country and ensure that patients get the test that brings the most value to their...

Host: Jack Lewin, MD Guest: Mark McClellan, MD, PhD It takes a substantial measure of time, money and manpower to bring a new drug from the bench to the marketplace. One key aspect of this sequence is the drug approval process, overseen by the Food and Drug Administration (FDA). Host Dr. Jack Lewin welcomes Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brooking...

Host: Jack Lewin, MD Guest: Alfred Bove, MD The next year promises to be an important one in health policy, in cardiology and in many other areas of medicine, as we set our sights on significant transformations across our health care system. What improvements can you anticipate that will enrich your practice environment and enhance the care you provide to your patients? Host Dr. Jack Lewin welcome...

Host: Doug Weaver, MD Guest: Don Poldermans, MD, PhD For patients undergoing major non-cardiac surgery, perioperative management often focuses on recognition and treatment of cardiac risk factors and disease. Dr. Don Poldermans, professor of medicine and head of perioperative cardiac care at Erasmus Medical Center in Rotterdam, the Netherlands, joins host Dr. Doug Weaver to explain how medical tre...

Host: Doug Weaver, MD Guest: John A. Cairns, MD Long-term anticoagulation is often viewed as inconvenient and somewhat risky, even for patients with atrial fibrillation who are at elevated risk for stroke. Are these factors overshadowing the evidence that demonstrates the effectiveness of anticoagulant therapy in preventing stroke? Dr. John Cairns, professor of medicine in the division of cardiolo...

Host: Doug Weaver, MD Guest: Spencer King, III, MD The performance of percutaneous coronary intervention (PCI) without a surgical backup has long produced controversy. In recent years, off-site PCI has become more common, and clinical evidence demonstrates comparable outcomes for on-site and off-site procedures. How does this shift allow us to serve a broader patient population? Will guidelines ch...

Host: Jack Lewin, MD Guest: Chris Jennings It seems we all work so much these days, we might as well get our personal mail delivered at work, or maybe even consider a hide-a-bed for the office. That may seem a bit far-fetched, but many of us do receive our health insurance coverage from our place of employment, and an increasing percentage of us are participating in so-called wellness programs at...

Host: Jack Lewin, MD Guest: Robert Hauser, MD Because new cardiac technologies are often rapidly integrated into clinical practice, we must be mindful that these innovations can contain a level of risk. Regrettably, we've seen examples of this before with previous generations of implantable cardioverter-defibrillators (ICD), and some experts say the latest advances in ICD technology could pose sim...

Host: Janet Wright, MD Guest: Mark Hlatky, MD Does the patient with few cardiovascular risk factors who displays little, if any, sign of heart trouble warrant a coronary CT scan? For patients who may not be best suited for a CT scan, is the coronary calcium measurement a reasonable risk-assessment alternative? Dr. Mark Hlatky, professor of medicine and professor of health research and policy at St...

Host: Janet Wright, MD Guest: Mark Hlatky, MD Measuring precise risks in medicine can be a tricky proposition. Factoring risk into cost-benefit analyses can make the situation even less clear. In many ways, this is where we stand with coronary computed tomography angiograms: a scan can be immediately helpful in emergent circumstances, but at other points in the clinical care spectrum, the value of...

Host: Janet Wright, MD Guest: Bob Graboyes, PhD Is your practice one of the growing number of small healthcare businesses that cannot afford to provide health insurance for its employees? It’s a startling reality for many medical employers and employees, and more broadly, for the entire small business sector, which, in some states, is the collective employer for upwards of half of the uninsured po...

Host: Janet Wright, MD Guest: Gregory Demske How can individual practitioners interact with industry in a positive, lawful and commendable manner? Are there regulations we can and should put on companies in this arena which fund initiatives such as continuing medical education? Industry certainly plays a major role in health care today, but one wonders whether we are managing these relationships t...

Host: Jack Lewin, MD Guest: Elliott Antman, MD New treatment guidelines regularly make headlines in medicine, recommending advances in our approach to care. In recent years, we have accelerated the speed at which we can update our guidelines and welcomed more global input into the process. Will these trends continue? Where else can we improve our process for authoring treatment guidelines? Host Dr...

Host: Doug Weaver, MD Guest: Doug Zipes, MD Sudden cardiac deaths are rare among elite athletes. Yet these abrupt events are confounding, in part, because they strike some of our most physically dynamic individuals, and because there remains a lengthy list of potential causes. How are we advancing our grasp of the underlying triggers of these life-threatening arrhythmias? Host Dr. Doug Weaver talk...

Host: Doug Weaver, MD Guest: Martin Leon, MD Will drug-eluting stents prove safer and more effective without a metal structure? For all their merits, current stent technologies still present a series of drawbacks, including the severe complication of late thrombosis. Biodegradable polymers may hold the key to minimizing this and other concerns. Host Dr. Doug Weaver discusses the most promising are...

Host: Doug Weaver, MD Guest: Mohammed Khan, MD Investigators are pursuing more aggressive strategies to maintain sinus rhythm. One area of current inquiry for certain arrhythmias centers on pulmonary vein isolation as an alternative to atrioventricular node ablation with biventricular pacing. How effective is pulmonary vein isolation for preventing an arrhythmia relapse? Dr. Mohammed Khan, an elec...

Host: Doug Weaver, MD Guest: Peter Berger, MD It is no longer a question of whether antiplatelet therapy should be used following implantation of a drug-eluting stent, but rather to what extent and to what duration. With this in mind, many new challenges arise, from bleeding risks to drug intolerance and product cost. Host Dr. Doug Weaver welcomes Dr. Peter Berger, associate chief research officer...