Heart Matters

Host: Jack Lewin, MD Guest: James Wilentz, MD Before the January 2010 earthquake rattled Haiti, healthcare access for the country's citizens was unreliable, but after the disaster, everything changed. How has an influx of foreign physicians impacted Haiti's healthcare system, and what lessons can the US learn from the proposed public-private partnership solutions in Haiti? Dr. James Wilentz, assistant professor of medicine at Albert Einstein College of Medicine, and co-director of Interventional Cardiovascular Research at Lenox Hill Heart and Vascular Institute of New York, volunteered at the General Hospital in Port Au Prince shortly after the disaster struck, and explains the downsides to well-intentioned humanitarian aid. Hosted by Dr. Jack Lewin. Produced in Cooperation with

Host: Janet Wright, MD Guest: Stuart Connolly, MD, FRCPC Because atrial fibrillation increases the risk for stroke, especially among those with other underlying conditions, what anticoagulation therapies should be considered for these patients? Dr. Stuart Connolly, professor of medicine and director of the division of cardiology and the Salim Yusuf Chair in Cardiology at McMaster University in Ontario, Canada, weighs the benefits and risks of different anticoagulation therapies, in the context of the recent Randomized Evaluation of Long-Term Anticoagulation Therapy (or, RE-LY) trial. In addition to the standard warfarin and aspirin anticoagulants, there are now two promising new classes of anticoagulation therapy. How effective is dabigatran, compared to warfarin? What questions do we still need answered about anticoatulantion therapies that will be addressed in the years to come? Hosted by Dr. Janet Wright. Produced in Cooperation with

Host: Janet Wright, MD Guest: Christopher O'Donnell, MD, MPH We know that genes play a role in cardiovascular health, but new research has identified specific DNA regions that are associated with risk factors for coronary heart disease. It's estimated that 30-50% of cardiovascular health is influenced by family history or genetics, while the rest is influenced by other environmental factors, diet and exercise. How might these new genetic discoveries lead to new treatment options? Dr. Christopher O'Donnell, associate director and scientific director of the SHARe Project of the Framingham Heart Study at the National Heart, Lung and Blood Institute, and associate clinical professor of medicine at Harvard Medical School in Massachusetts, talks about his work genotyping the single-nucleotide polymorphisms of large cohort study participants. How are genome-wide association studies leading to discovery of new genes associated with various diseases, and will these findings move us into a new er

Host: Janet Wright, MD Guest: Mark Hlatky, MD Implantable cardioverter defibrillators, or ICDs, can be life saving for patients after myocardial infarction, but are also costly and may not be appropriate for all of the hundreds of thousands of patients who have had MI. Which subsets of patients might benefit most from ICDs, and might prophylactic use of ICDs early after MI reduce the risk of cardiac death? Dr. Mark Hlatky, professor of medicine and professor of health research and policy at Stanford University School of Medicine, weighs the comparative-effectiveness research on the efficacy of ICDs for patients early after MI, versus waiting a few months before implanting ICDs or trying other forms of therapy. Outside of implantable devices, what else can physicians do to reduce the risk of death after MI? Hosted by Dr. Janet Wright. Produced in Cooperation with

Host: Janet Wright, MD Guest: Albert Starr, MD On the 50th anniversary of the first successful prosthetic mitral valve replacement, how far has cardiac surgery come, and where are we headed? Tune in to hear Dr. Albert Starr, co-founder of the first artificial mitral valve, medical director of the Providence Heart and Vascular Institute, and director of Academic Affairs & Bioscience Development for Providence Health & Services in Portland, Oregon, recounts his first foray into the field of valvular disease and the extraordinary process of inventing the first artificial mitral valve. What complications did Dr. Starr encounter during the design process, and what breakthrough allowed for success in long-term artificial valve replacement? He also discusses the development of what was perhaps one of the first ventures into outcomes research, with the creation of a system for long-term follow up of patients receiving valve replacement. What does Dr. Starr see as the "next big thing" in cardiac

Host: Janet Wright, MD Guest: Sanjay Kaul, MD, MPH Atrial-fibrillation, or a-fib, affects nearly 2.5 million patients in the US, and is one of the more common forms of arrhythmia. The antiarrhythmic armamentarium has been expanded to include dronedarone, which was recently approved by the FDA for the treatment of a-fib. What's the efficacy and safety of dronedarone, compared to other antiarrhythmic agents, and how should you use it? Dr. Sanjay Kaul, director of the Vascular Physiology and Thrombosis Research Laboratory at the Burns and Allen Research Institute at Cedars-Sinai Medical Center in Los Angeles, describes the profile of patients who should be considered candidates for dronedarone therapy. Will dronedarone replace the current gold standard for treating a-fib, amiodarone, and if not, where does dronedarone fit into the management algorithm for a-fib? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Janet Wright, MD Guest: Paul Heidenreich Sudden cardiac death among high school or college athletes is rare but tragic, and is jarring to families, friends and communities. What additional measures can physicians take to prevent sudden cardiac death among these students? Current guidelines for screening of young athletes in the U.S. do not include electrocardiography but should they, especially in light of recent Italian research about the efficacy of EKG screenings in preventing sudden cardiac death in this population? Dr. Paul Heidenreich, associate professor of medicine (cardiovascular) and associate professor by courtesy of health research and policy, at the Veterens Affairs (VA) Palo Alto Health Care System, and fellow of the Center for Health Policy and the Center for Primary Care and Outcomes Research at Stanford University, weighs the benefits and risks of widespread use of ECG's in the screening of young athletes. Is there a reasonable cost effectiveness value to adding ECG to rou

Host: Janet Wright, MD Guest: Sidney Smith New evidence strengthens the link between air pollution and heart disease. How strong is the data suggesting a causal relationship between the two? Dr. Sidney Smith, professor of medicine and director of the Center for Cardiovascular Science and Medicine at the University of North Carolina in Chapel Hill says there are two areas of interest in determining the effect of air pollution on the heart. One area being examined is whether air pollution can trigger acute cardiac events, and the other is whether chronic exposure to air pollution can cause the development of long-term cardiovascular disease. Which patients are most at risk for developing cardiovascular health problems from exposure to particulate matter, and how can patients limit their risk of adverse cardiovascular disease-related events from air pollution, even in urban areas? How does heavy air pollution in developing countries or during exercise impact the heart? Dr. Janet Wright hosts. Prod

Host: Janet Wright, MD Guest: Stephen Kopecky, MD Drastic lifestyle changes can seem daunting to patients and physicians alike. Fortunately, new research is demonstrating the importance of moderation in improving cardiovascular health. How can small tweaks to a patient's lifestyle have a substantial impact his or her heart health? Dr. Steve Kopecky, cardiologist at Mayo Clinic's Cardiovascular Health Clinic, specifies some of the minor changes patients can make, and the data demonstrating the cardiovascular benefits of these modifications. How can physicians help patients implement these lifestyle changes? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Janet Wright, MD Guest: Scott Sharkey, MD Takotsubo, or stress-induced cardiomyopathy (also known as 'broken heart syndrome'), was first recognized in Japan in the 1990s. Acute emotional or physical stress trigger the condition, which mimics the symptoms of a myocardial infarction (or MI). How can physicians differentiate between stress-induced cardiomyopathy and a more conventional MI, and how is stress-induced cardiomyopathy treated? What characteristics might make a patient more susceptible to developing this condition? Our guest is Dr. Scott Sharkey, senior consulting cardiologist at Minneapolis Heart Institute and director of the Takotsubo cardiomyopathy research program at the Minneapolis Heart Institute Foundation in Minnesota, shares some of the key diagnostic tests for differentiating between stress-induced cardiomyopathy and conventional MI. How common is this condition, and how can we limit the effects of stress-induced cardiomyopathy? Dr. Janet Wright hosts. Produced in Cooper

Host: Janet Wright, MD Guest: David Wilber, MD Although medications are generally first-line therapy for patients with atrial fibrillation, or a-fib, adverse events or inadequate efficacy often make drug therapy suboptimal. How effective is catheter ablation, and should it be considered first-line therapy for some patients? Host Dr. Janet Wright talks with Dr. David Wilber, director of the Cardiovascular Institute and the George M. Eisenberg professor of cardiovascular sciences at Loyola University Chicago Stritch School of Medicine, about recent findings on the efficacy of catheter ablation for a-fib. What are the most significant risks to be aware of when considering catheter ablation therapy?

Host: Janet Wright, MD Guest: John Spertus, MD, MPH Addressing the totality of care for patients with heart failure is crucial to reducing readmissions. How can physicians better recognize the comorbities that may affect older patients with heart failure in order to improve outcomes? What type of benefits can a more holistic, nuanced approach to managing heart failure offer patients? Dr. John Spertus, cardiologist and professor of medicine at the University of Missouri-Kansas City, and clinical director of outcomes research at Saint Luke's Mid America Heart Institute, discusses some of the non-traditional patient characteristics and symptoms physicians should consider and address when caring for patients with heart failure, including impaired mobility, dementia and depression. How can physicians promote a multidisciplinary approach to system-based processes when caring for patients with heart failure, and how is health policy impacting the delivery of care? Dr. Janet Wright hosts.

Host: Janet Wright, MD Guest: Mohammad Madjid, MD, MS, FACC* When high-risk patients, such as the elderly, develop respiratory infections there can be a cascade effect of inflammation that moves from the lungs to the heart, triggering myocardial infarction (or MI). What is the mechanism by which vaccination might prevent MI? Dr. Mohammed Madjid, senior research scientist at Texas Heart Institute in Houston, explains the cause and effect relationship between the influenza and pneumococcal vaccines, and MI. What are the vaccine guideline recommendations for patients with heart disease, and can early use of antibiotics help reduce the risk of infection-related cardiovascular events? Dr. Janet Wright hosts. Produced in Cooperation with

Host: Jack Lewin, MD Guest: Jim Guest Recommendations and ratings are a dime a dozen for patients looking for more information about a physician or procedure online, but finding quality, consumer-friendly information that's also reliable can be more of a challenge. What tools can physicians recommend to patients for understanding the implications of both reform and other healthcare matters? Jim Guest, president at CEO of Consumers Union, which publishes Consumer Reports, and ConsumerReportsHealth.org, discusses ways physicians can encourage better communication and health literacy with their patients, and stresses the importance of bringing up costs with your patients. How can healthcare ratings based on outcomes data improve quality of care? Hosted by Dr. Jack Lewin. Produced in Cooperation with

Host: Jack Lewin, MD Guest: Rita Redberg, MD, MSc Guest: Bram Zuckerman, MD The FDA's premarket approval (or PMA) process was first established over 30 years ago, but thanks to technology, the development of devices has dramatically changed since then. How should the FDA modernize its premarket approval process to ensure medical device safety? Guests Dr. Rita Redberg, professor of clinical medicine at the University of California, San Francisco, School of Medicine, and director of women's cardiovascular services at the U-C-S-F National Center for Excellence in Women's Health, and Dr. Bram Zuckerman, director of the division of cardiovascular devices at the FDA, discuss current and ongoing research about the quality of the FDA PMA process. Produced in Cooperation with

Host: Janet Wright, MD Guest: Karol karol When patients present with shortness of breath, physicians often face a quandary: Is it the heart or is it the lungs? What is the relationship between chronic obstructive pulmonary disease, or COPD, and cardiac function? Are patients with even subclinical emphysema at risk for showing reductions in cardiac output and left ventricular volume? Dr. Karol Watson, director of the Women's Cardiovascular Center, co-director of the program in preventative cardiology, and director for the Center for Cholesterol and Hypertension Management at the University of California Los Angeles, discusses recent findings about mild- to moderate-COPD and cardiac function, and how this new evidence should impact the way physicians diagnose and manage patients with shortness of breath. Dr. Janet Wright hosts. Produced in Cooperation with

Host: Jack Lewin, MD Guest: Mark McClellan, MD, PhD Defensive medicine and medical liability concerns create a symbiotic relationship that costs everyone in the medical system. Has healthcare reform legislation addressed the medical malpractice issue, and will it do enough to contain healthcare costs? Dr. Mark McClellan, director of the Engelberg Center for Health Care Reform at the Brookings Institution, former commissioner of the FDA and administrator of the Centers for Medicare and Medicaid Services, discusses the impact of defensive medicine on the healthcare system. Dr. McClellan also suggests that health information technology will play a significant role in bending the healthcare cost curve by ensuring safety, as well as increasing coordination of care and effective communication. Among states have taken up tort reform, how successful have these reforms been at reducing liability pressure and overall healthcare costs? Hosted by Dr. Jack Lewin. Produced in Cooperation with

Host: Janet Wright, MD Guest: Christian Wolpert, MD It's one thing to produce guidelines, and quite another to encourage guideline adherence. The first step in this might be to gather data about current practices, and then determine ways to standardize treatment and increase access to quality therapy. The European Heart Rhythm Association (a branch of the European Society of Cardiology) conducts an ambitious annual survey of the management of arrhythmia in dozens of European and neighboring countries, which is intended to be a foundation toward standardizing quality of care. Dr. Christian Wolpert, medical director of the department of medicine-cardiology, nephrology and internal intensive care medicine, at Klinikum Ludwigsburg in Ludwigsburg, Germany, and chairman of the National Sciences Committee of the European Society of Cardiology, explains to host Dr. Janet Wright that the disparities are not directly correlated to a country's wealth, but rather, a variety of other factors. Tune in to hear

Host: Janet Wright, MD Guest: Nathalie Farpour-Lambert, MD Childhood obesity is a significant health concern in the US and worldwide. How does obesity impact a child's cardiovascular function and influence future risk of heart disease? Dr. Nathalie Farpour-Lambert, head of the Pediatric Exercise Medicine and Obesity Care Program in the department of pediatrics at the University Hospitals of Geneva in Switzerland, discusses new findings about the effect of a modest amount of physical activity in improving blood pressure, arterial function and arterial wall thickness in obese children. How can clinicians overcome the biggest challenges in encouraging a healthy lifestyle for their pediatric patients? Produced in Cooperation with

Host: Janet Wright, MD Guest: Randall Thompson, MD It's widely believed that modern behaviors of inactivity, stress and poor diet are primary causes of the development of cardiovascular disease, but history may suggest otherwise. What is new evidence from ancient Egyptian mummies teaching us about heart disease? Dr. Randy Thompson, cardiologist at St. Luke's Hospital Mid America Heart Institute in Kansas City, Missouri, shares the exciting findings of his research team in Cairo that found calcification using CT scans to study ancient Egyptian mummies. How likely is it that these mummies died from cardiovascular causes? What do these findings suggest about the etiology of heart disease? Tune in to take a historic look back at cardiovascular disease. Hosted by Dr. Janet Wright. Produced in Cooperation with