Heart Matters

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 medicine at Harvard Medical School, warns that elevated troponin may not necessarily indicate myocardial infarction. What other clinical evidence can physicians use to assess for an acute coronary syndrome? Dr. Janet Wright hosts.

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 (HHC) Clinical Translational Science Institute, reviews the most significant components of the focused update on management of STEMI and PCI. Dr. Janet Wright hosts.

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 patients with mild cardiac sympotoms? Tune in to hear Dr. Arthur Moss, professor of medicine and director of the Heart Research Follow-Up Program at the University of Rochester School of Medicine and Dentistry, discuss new findings about whether CRT might play a wider role in the prevention of heart failure. Dr. Janet Wright hosts.

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 this chronic condition? Dr. Aram Chobanian, president emeritus of Boston University, who served as dean of the BU School of Medicine and provost of the BU Medical Campus, discusses the hypertension paradox and suggests more effective strategies for managing the condition. Dr. Janet Wright hosts.

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 to help guide treatment for pediatric heart disease. Dr. Gerard Martin, senior vice president for the Center for Heart, Lung and Kidney Disease and co-director of the Children’s National Heart Institute at Children’s National Medical Center, discusses how the IMPACT registry might help improve quality outcomes for our younger patients with congenital heart disease. Dr. Janet Wright hosts.

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 embark on a campaign to reduce unnecessary readmissions, Dr. Donald M. Berwick, president and chief executive officer for the Institute for Healthcare Improvement (IHI), joins host Dr. Jack Lewin for an important conversation about the Hospital-to-Home (H2H) campaign, co-sponsored by IHI and the American College of Cardiology, to apply scientifically-based protocol to keep patients healthy at home once they leave the hospital. Dr. Berwick says the shift won't come by simply telling hospital staff to work harder; instead, we need to use the hard evidence we have to change the paradigm for transition and fol

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 and effective. A team of investigators at the University of Michigan, as part of the Project My Heart Your Heart initiative, is hoping to change this perception and increase awareness for donations overseas. It's an endeavor that has generated enthusiasm among patients and families, as well as the funeral directors who would help facilitate this process. One of the researchers, Dr. Timir Baman, a fellow in cardiac electrophysiology at the University of Michigan Hospitals and co-founder of this initiative, joins host Dr. Janet Wright for a fascinating conversation.

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 — with Dr. Geoffrey Ginsburg, founding director of the Center for Genomic Medicine at the Duke Institute for Genome Sciences and Policy and professor of medicine and pathology at Duke University School of Medicine. Dr. Ginsburg also shares what he considers to be the top priorities of this field, forging a path from the research to clinical care. How might personalized medicine impact cardiovascular care in the years to come?

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 benefits against long-term outcomes. Host Dr. Janet Wright talks with Dr. John Alexander, associate professor of medicine at Duke University School of Medicine and senior author of these findings, which have been published in the New England Journal of Medicine. How can the surgeon, cardiologist and patient work together to determine the best course of treatment for each individual undergoing coronary bypass surgery?

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. Cardiologist Dr. David Sabgir has moved beyond talk therapy and is literally walking the talk -- by taking his patients to the park, as part of this unique physician-led walking program called Walk With a Doc. Dr. Sagbir joins host Dr. Janet Wright to talk about his Ohio-based organization, which he is working to expand across the country. It may be just prescription we all need.

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 about the potential. How are we harnessing the information available to us, toward the improvement of clinical outcomes? Dr. John Rumsfeld, professor of medicine at the University of Colorado School of Medicine, and chief science officer for the National Cardiovascular Data Registry, an initiative led by the American College of Cardiology Foundation, talks with host Dr. Jack Lewin.

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 able to bend that all-important cost curve, while also improving the quality of the care they provide. Host Dr. Jack Lewin welcomes the physician executive who has overseen this prolonged period of successful innovation, Geisinger President and CEO Dr. Glenn Steele. On a grand scale, how feasible would it be to leverage the innovations developed at Geisinger across the various markets for health care around the United States?

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 Centre at Lund University in Sweden, associate professor and head of the coronary intensive care unit at Lund University Hospital, talks with host Dr. Janet Wright about his research published in the journal Science which provides compelling evidence of human cardiomyocyte renewal. How might the possibilities of endogenous cardiac cell regeneration change the dynamic of care for conditions like myocardial infarction?

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 benefits of obesity and exercise relative to heart disease. These pillars of cardiology are known today, in large part, because of the enduring work of the Framingham Heart Study. Host Dr. Janet Wright examines the evolution of Framingham with Dr. William Kannel. One of the original Framingham investigators, from 1950 to the present, Dr. Kannel served as the study's second director from 1966 to 1979. He is also professor emeritus of medicine at Boston University School of Medicine.

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 comparison of these treatment options, and what other subjects should stand at the top of our priority list? Dr. Sean Tunis shares his perspective on these questions with host Dr. Jack Lewin. Dr. Tunis, the founding director of the Center for Medical Technology Policy in Baltimore and formerly the director of the Office of Clinical Standards and Quality and chief medical officer for the Centers for Medicare and Medicaid Services, says it may not be the spotless level 1 data that proves ideal for improving our evidence base, but rather a broader range of imperfect information that can be shaped for our clinical

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 be one of our best options for better quality and reduced costs -- helping patients, providers and hospitals? Dr. Karen Davis, president of the Commonwealth Fund, a national philanthropy engaged in independent health policy research, outlines her vision for ACOs in the future of American healthcare. Dr. Jack Lewin hosts.

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 Dr. Janet Wright probes a litany of ideas in the quality discussion with Peggy O'Kane, founding president of the National Committee for Quality Assurance (NCQA), a leading accrediting organization for health plans.

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 we find physicians in Saudi Arabia treating many of the same cardiac conditions that we see in the United States. Host Dr. Janet Wright talks with Dr. Youssef about the challenges of treating a very young population with a high incidence of risk factors and distinctive pathologies, efforts parallel to those in the U.S. to develop information technologies in health care, as well as opportunities to connect with global cardiovascular leaders to continue to improve the quality of care and health outcomes across the country.

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. As national reform efforts begin to take shape, what lessons can we draw from California's experience, to inform future federal policy initiatives? Host Dr. Jack Lewin welcomes California Health and Human Services Agency Secretary Kim Belshé for a wide-ranging conversation, covering California's previous attempts at reform, progress toward greater health information technology adaptation across the state and the burden to the healthcare system posed by California's ever-expanding population of undocumented workers and their families.

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 a profound impact, reducing the incidence and cost of unnecessary readmissions, and most importantly, improving outcomes for our patients. Dr. Harlan Krumholz, the Harold H. Hines, Jr., Professor of Medicine, Epidemiology and Public Health at the Yale University School of Medicine, talks with host Dr. Jack Lewin about the new Hospital-to-Home (H2H) initiative to lower rates of unneeded readmissions, and how the field of cardiology can contribute toward improving the hospital discharge process.