Heart Matters

It is apparent to most physicians that patients at high risk for having a cardiovascular event should be screened, but what about those patients who fall into the intermediate risk category (classified using the Framingham risk score)? Dr. Prediman Shah, director of the division of cardiology at Cedars-Sinai Heart Institute in Los Angeles, suggests that screening asymptomatic, intermediate-risk patients for subclinical atherosclerosis using non-invasive imaging might be beneficial. Dr. Shah also discusses the limitations of relying solely on the Framingham risk score, and recommends additional ways to classify a patient's risk for developing a cardiovascular event. What specific screening tests are best for detecting subclinical atherosclerosis? Dr. Janet Wright hosts.

As we all strive to improve quality of care, two crucial questions remain at the heart of the issue: How do we define, and identify, quality in practices, hospitals and other health care settings? Then, how can new methods of identifying quality in practices help improve the standardization of processes and care that patients receive? Join host Dr. Jack Lewin and his guest, Francois de Brantes, executive director of the Health Care Incentives Improvement Institute in Newton, Connecticut, which manages the Bridges to Excellence and PROMETHEUS payment programs. Mr. de Brantes talks about the specific data that can help identify quality, and ways to utilize these data to improve and facilitate quality improvement. How does identifying quality in cardiovascular practices coincide with the increasing interest in value-based health care delivery?

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.

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.

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 era of prevention and treatment of cardiovascular disease? Dr. Janet Wright hosts.

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.

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 surgery? Dr. Janet Wright hosts.

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.

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 routine screening for these patients, compared to a routine medical history and physical exam? How should physicians discuss the value of ECG screening with young adult athletes and their parents? Hosted by Dr. Janet Wright.

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.