Heart Matters

Cardiac surgery can improve quality of life, but it also poses risks for patients over the age of 65. Can a screening test as simple as walking speed predict the outcomes of cardiac surgery for our older patients? Dr. Janet Wright hosts this discussion.

Obesity is a nationwide epidemic, but this is nowhere more apparent than in Mississippi, which was ranked as the state with the highest obesity rate in 2009 by the Centers for Disease Control. How does the obesity issue in Mississippi mirror that of the rest of the nation, and what efforts are underway to address this public health problem? Dr. Thad Waites, director of the cardiac catheterization lab at Forrest General Hospital in Hattiesburg, Mississippi, and interventional cardiologist at the Hattiesburg Clinic, talks about how each player in the healthcare community can target the obesity epidemic. What initiatives and projects are demonstrating success in lowering obesity rates? Dr. Janet Wright hosts.

Some evidence suggests it is possible to prevent and reverse heart disease by adhering to a plant-based diet, but lifestyle changes are often the most challenging for physicians to prescribe and for patients to adopt. What strategies can physicians use to encourage a plant-based diet for patients who have or are at risk for having heart disease? Dr. Caldwell Esselstyn, director of the cardiovascular prevention and reversal program at the Cleveland Clinic Wellness Institute in Lyndhurst, Ohio and author of the book, Prevent and Reverse Heart Disease, surveys the worst culprits of the Western diet responsible for causing heart disease, and describes the crucial role that nitric oxide released from the endothelium plays in protecting blood vessels. Dr. Esselstyn shares his tips and strategies for promoting and, most importantly, following a plant-based diet, in the midst of a culture riddled with nutritionally-questionable foods. Join us for part 2 of our two-part interview with Dr. Esselstyn. Dr. Janet Wright hosts.

If you missed Part 1, listen now >>

Although most bypass grafts are sourced from other parts of a patient's body, bioengineers are examining new materials that might be used for bypass grafts to reduce the risk of second-site complications. Silk has been a standard material in sutures for decades, and is now showing promise as a biomaterial in bypass grafts. Might silkworms help repair clogged arteries? Dr. David Kaplan, endowed chair, the Stern Family Professor of Engineering, and professor & chair of the department of biomedical engineering at Tufts University, discusses the advantages of silk protein as a biomaterial and related applications to cardiology. When might this new technology be applied from the bench to the bedside? Dr. Janet Wright hosts.

Recent studies have raised doubts about the efficacy of some common treatments for cardiovascular disease, including: the use of PFO closures (based on the CLOSURE trial); some methods of cardiac resynchronization therapy (or CRT, based on the SMART-AV trial); telemonitoring for patients with congestive heart failure (based on the Tele-HF trial); and doubling the dose of clopidogrel in patients who had a poor response to the drug after percutaneous coronary intervention (based on the GRAVITAS trial). Dr. Robert Harrington, director of the Duke Clinical Research Institute at Duke University Medical Center in Durham, North Carolina, reviews the evidence in each of these trials, and gauges the clinical impact of their findings. Dr. Janet Wright hosts.

Although most bypass grafts are sourced from other parts of a patient's body, bioengineers are examining new materials that might be used for bypass grafts to reduce the risk of second-site complications. Silk has been a standard material in sutures for decades, and is now showing promise as a biomaterial in bypass grafts. Might silkworms help repair clogged arteries? Dr. David Kaplan, endowed chair, the Stern Family Professor of Engineering, and professor & chair of the department of biomedical engineering at Tufts University, discusses the advantages of silk protein as a biomaterial and related applications to cardiology. When might this new technology be applied from the bench to the bedside? Dr. Janet Wright hosts.

Recent studies have raised doubts about the efficacy of some common treatments for cardiovascular disease, including: the use of PFO closures (based on the CLOSURE trial); some methods of cardiac resynchronization therapy (or CRT, based on the SMART-AV trial); telemonitoring for patients with congestive heart failure (based on the Tele-HF trial); and doubling the dose of clopidogrel in patients who had a poor response to the drug after percutaneous coronary intervention (based on the GRAVITAS trial). Dr. Robert Harrington, director of the Duke Clinical Research Institute at Duke University Medical Center in Durham, North Carolina, reviews the evidence in each of these trials, and gauges the clinical impact of their findings. Dr. Janet Wright hosts.

What can we learn from the past century of healthcare policy that can better inform how we develop such policies today? How has the landscape of medicine and economics surrounding health policy changed, and how have these changes influenced health policy? Join host Dr. Jack Lewin as he welcomes guest Dr. Rashi Fein, professor of the economics of medicine emeritus in the department of global health and social medicine at Harvard Medical School in Boston, and author of the book, Learning Lessons: Medicine, Economics and Public Policy. Although the Affordable Care Act is thousands of pages in length, Dr. Fein suggests that policy makers "keep it simple," even with the most complex health policy issues, in order to have an efficient system that is easy to implement. How can such complicated health policy issues be clearly explained?

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Will healthcare reform do enough to alleviate the current problems in our system, or is the entire delivery model in need of a substantial re-design? Dr. Harry Greenspun, chief medical officer of Dell Services and co-author of the book Reengineering Health Care: A Manifesto for Radically Rethinking Health Care Delivery, says that while health care reform has changed payment models, reform has not done enough to change the delivery system. What elements of our current system are most in need of re-engineering, and how have some organizations successfully transformed their delivery models? Dr. Jack Lewin hosts.

One of the characteristics of our older patients with heart failure is that they often have other conditions and therefore take multiple medications. How can we reduce the risk of adverse drug events among patients with heart failure and other comorbidities? Dr. Michael Steinman, associate professor of medicine at the University of California-San Francisco and the San Francisco VA Medical Center discusses the challenge of managing medications for older patients with heart failure and offers his ideas on how to reduce drug interactions and encourage adherence. How can we better coordinate care between physicians to optimize care for patients with heart failure? Dr. Janet Wright hosts.