Heart Matters

Host: Jack Lewin, MD Guest: David Blumenthal, MD, MPP Electronic management of health information will someday replace the pen and paper chart. How significant a role will health information technology, or HIT, play in the newly-reformed healthcare system? What incentives are the federal government offering to foster the widespread, meaningful use of or HIT, and more importantly, what qualifies as meaningful use? Dr. David Blumenthal, National Coordinator for Health Information Technology under President Barack Obama, weighs in on the value of the National Cardiovascular Data Registry and explains meaningful use criteria. How can your practice implement an electronic system that will comply with federal meaningful use guidelines? Hosted by Dr. Jack Lewin.

Host: Jack Lewin, MD Guest: Kevin Weiss, MD Although the Maintenance of Certification (MOC) program may conjure up unpleasant testing jitters, its value to both patients and the medical professional community should not be underestimated. How does MOC improve clinical performance, increase physician accountability and ultimately improve quality of care for patients? How will the MOC program evolve in the future? Dr. Kevin Weiss, president and CEO of the American Board of Medical Specialties, joins host Dr. Jack Lewin to discuss the MOC program's areas of competency as well as plans to integrate MOC with health information technology. Produced in Cooperation with

Host: Jack Lewin, MD Guest: Ralph Brindis, MD, MPH How will the recently-passed health reform legislation impact cardiologists and other physicians in the next year? What can physicians do to prepare for the changes ahead? Dr. Ralph Brindis, senior advisor for cardiovascular disease for Northern California Kaiser Permanente, clinical professor of medicine at the University of California, San Francisco, and president of the American College of Cardiology, joins host Dr. Jack Lewin to discuss various elements of health reform, including the further needs for tort reform as well as the sustainable growth rate formula (or SGR) and the need for payment reform. Dr. Brindis also weighs in on the role of registries in measuring success, ensuring quality of care, reducing disparities and decreasing healthcare costs.

Host: Jack Lewin, MD Guest: Stephen Ubl How do physicians play a particularly crucial role in the development of medical devices, and how does the device innovation model differ from the drug development model? How can we encourage transparent, ethical relationships between healthcare professionals and the medical device industry, as collaborations between these parties are vital to the development process? Mr. Stephen Ubl, president and CEO of AdvaMed, the Advanced Medical Technology Association, provides an overview of the medical device industry landscape, and stresses the need to reward innovation in order to create the environment for new technologies to thrive. Dr. Jack Lewin hosts.

Host: Jack Lewin, MD Guest: John Tooker, MD, MBA, FACP How can cardiologists and our internal medicine colleagues work together to promote the patient-centered medical home as an efficient strategy for re-organizing care that will reduce costs and improve quality of care? How can we improve communication between specialist and subspecialist providers? Dr. John Tooker, executive vice president and CEO of the American College of Physicians, joins host Dr. Jack Lewin to outline some of the best practices and lessons learned from current integrated health systems, and emphasizes the importance of accountable care organizations. Can some of these lessons even apply to more fragmented delivery of care models?

Host: Alfred Bove, MD Guest: Leslie Miller, MD Options for patients with advanced heart failure used to be limited to heart transplantation, but ventricular assist devices have rapidly evolved into viable treatment options for these patients. How is the newest generation of continuous-flow devices impacting the way we care for patients with advanced heart failure? Which patients are the best candidates for ventricular assist devices, or VADs, and are many patients with VADs now undergoing the procedure as destination therapy, rather than a bridge to transplant? Dr. Leslie Miller, professor and chief of the Integrated Cardiology Programs at Washington Hospital Center and Georgetown University Hospital and School of Medicine, as well as the Walters Chair in Cardiovascular Medicine at Georgetown University in Washington, DC, tells host Dr. Alfred Bove about the evolution of VADs from pulsatile pumps to continuous flow design, and the various applications for these technologies. Will these devices p

Host: Alfred Bove, MD Guest: Gregg Stone, MD Results of a recent study may change the standard of care for patients with acute coronary syndromes. Although clopidogrel is generally the antiplatelet therapy of choice for patients for whom an invasive strategy is planned for treating their acute coronary syndromes, bleeding can be of concern. Prasugrel often presents the same dilemma. Enter, ticagrelor. The PLATelet inhibition and patient Outcomes, or PLATO, trial compared ticagrelor and clopidogrel, which demonstrated promising results for ticagrelor. Dr. Gregg Stone, professor of medicine and director of research and education at the Center for Interventional Vascular Therapy at the Columbia University Medical Center, and director of medical research and education at the Cardiovascular Research Foundation in New York City, hails the PLATO findings as transformative to the standard of care for acute coronary syndromes. He joins host Dr. Alfred Bove to discuss the new place of ticagrelor among the

Host: Janet Wright, MD Guest: Mikhail Kosiborod, MD Elevated blood sugar levels are quite common among even non-diabetic patients presenting with acute myocardial infarction (or AMI). Does lowering a patient's glucose level actually improve outcomes, and if so, what glucose-control therapies are most effective for these patients? Dr. Mikhail Kosiborod, associate professor of medicine at the University of Missouri-Kansas City and cardiologist at St. Luke's Hospital Mid America Heart Institute in Kansas City, Missouri, reviews recent findings about glucose control and AMI with host Dr. Janet Wright.

Host: Janet Wright, MD Guest: Eduardo Marbán, MD, PhD Stem cell therapies across multiple disciplines continue to demonstrate promising results. How successful are autologous cardiac stem cell treatments proving to be at regenerating cardiac tissue after a heart attack? Which patients would be the best candidates for this procedure, and when might this treatment move from clinical trials into the clinic? Dr. Eduardo Marbán, director of the Cedars-Sinai Heart Institute, developed this procedure, and joins host Dr. Janet Wright to discuss its exciting applications.

Host: Janet Wright, MD Guest: Glenn Chertow, MD, MPH Guest: Kirsten Bibbins-Domingo, MD, PhD We are well aware that the overabundance of processed, frozen and fast foods contribute to many Americans exceeding the recommended daily allowance of sodium. But there are potentially enormous cardiovascular benefits to cutting down on salt intake by even a very modest amount. How can we quantify the actual clinical impact of salt reduction? Dr. Kirstin Bibbins-Domingo, associate professor of medicine and of epidemiology and biostatistics at the University of California San Francisco, and Dr. Glenn Chertow, professor of medicine and chief of the division of nephrology at Stanford University School of Medicine in Stanford, California, discuss findings from their study on the effects of modest salt reduction using a computerized model. How would reducing salt intake cut down on healthcare costs, in addition to promoting better overall public health? Can the health benefits of reducing population-wide

Host: Jack Lewin, MD Guest: Richard Katz, MD Use of electronic medical records (EMRs) and personal health records (PHRs) can improve adherence, increase efficiency and better coordinate patient care. What role are health information exchanges playing in the integration of EMRs and PHRs, and how effective are disease management software programs? How can we meet the challenges of integrating health information technology, or HIT, tools into cardiology practices? Dr. Richard Katz, the Bloedorn Professor of Cardiology, director of the division of cardiology at George Washington University Hospital, and director of the George Washington Cardiovascular Institute in Washington, DC, discusses the opportunities to utilize existing and emerging technologies to improve patient care. Dr. Katz also offers pragmatic advice about implementing HIT systems, and reviews current HIT initiatives. Hosted by Dr. Jack Lewin.

Host: Jack Lewin, MD Guest: Chris Kaiser What payment cuts does the 2010 Medicare Physician Fee Schedule include for cardiology? How will these lower reimbursements affect cardiology practices and impact patients' access to care? Chris Kaiser, editor of Cardiovascular Business, joins host Dr. Jack Lewin to discuss ways cardiology practices can try to adapt to payment cuts by increasing practice efficiency. How can cardiologists optimize use of health information technology to help their practices thrive and encourage better outcomes, despite these payment cuts? What economic challenges will cardiology practices continue to face? Tune in to hear more.

Host: Janet Wright, MD Guest: Michael Ho, MD, PhD Medication adherence is a significant problem in the US. Patients with chronic conditions such as hypertension or high cholesterol can be particularly susceptible to non-adherence, because patients may not experience symptoms that would seem to justify taking medication, and thus may not notice any immediate benefits from their medications. What are some of the other barriers to medication adherence? Dr. Michael Ho, associate professor in the department of medicine at the University of Colorado, Denver, has examined the prevalence of non-adherence, and says that good communication and patient education can go a long way toward encouraging patients to take their medications. Tune in to hear other strategies cardiologists can use to address the issue with patients, including utilization of health information technology. Dr. Janet Wright hosts.

Host: Janet Wright, MD Guest: Michael Mooney, MD Therapeutic hypothermia is a relatively new treatment option for patients who suffer cardiac arrest, that can significantly improve neurologic outcomes. What factors determine the success of cooling therapy for cardiac arrest, and what resources does the procedure require? Dr. Michael Mooney, Director of Interventional Cardiology, Minneapolis Cardiology Associates, at Minneapolis Heart Institute / Abbott Northwestern Hospital in Minnesota, explores the indications for therapeutic hypothermia with host Dr. Janet Wright. Might therapeutic hypothermia be approached with a strategy similar to initiatives aimed at reducing door-to-balloon time for ST-elevation MI?

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, percutaneous coronary intervention, cardiac resynchronization, surgical ventricular reconstruction and pharmacologic therapies for treating this condition. Specifically, he describes results of the recent Surgical Treatment for Ischemic Heart Failure, or STITCH, trial, and also tells us about the various ventricular-assist device options currently available. Dr. Alfred Bove hosts.

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 cardiology and director of vascular medicine at Mount Sinai in New York City, offers his insights on FMD, as Dr. Olin has dedicated much of his professional career to spreading awareness about the condition. Dr. Alfred Bove hosts.

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 Hospital Heart Center, and the Roman W. DeSanctis Professor of Medicine at Harvard Medical School, discusses the Ferinject Assessment in Patients with Iron Deficiency and Chronic Heart Failure, or FAIR-HF, trial, and shares his excitement about this new potential pharmacologic therapy for patients with heart failure. Hosted by Dr. Alfred Bove.

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. Charles Love, professor of clinical medicine in the division of cardiovascular medicine and director of Cardiac Rhythm Device Services at Ohio State University Medical Center, discusses ways to manage the risks of lead extraction with host Dr. Alfred Bove.

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 statins in slowing atherosclerosis. However, this study was not based on clinical outcomes, but rather on measuring carotid intima-media thickness (CIMT). In addition, the ARBITER trial was relatively small, based on 208 patients completing the trial. Are these data enough to impact clinical use of ezetimibe and niacin, or should we await results of further large-scale trials? Dr. Christopher Cannon, associate professor of medicine at Harvard Medical School and editor-in-chief of the American College of Cardiology's Cardiosource, weighs in on these questions and more regarding adjunctive therapy to high-dos

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 discuss the advantages of a collaborative care model and the importance of efficient data flow. How might such a systematic, coordinated model impact the discussion of health care reform?