Heart Matters

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.

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.

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 follow-up care.

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.

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?

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?

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.

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.

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?

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?