Heart Matters

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.

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 benefit.

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.

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.

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.

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.

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.

The role of specialization in our economy dates back to the 18th century. Now fast-forward to healthcare in the present day: one application of specialization is the concept of a focused factory, where care providers focus on one or two specific organs or disease processes. Host Dr. Jack Lewin welcomes Dr. Regina Herzlinger, the Nancy R. McPherson Professor of Business Administration at Harvard Business School, for an interesting conversation about the potential role of focused factories in healthcare. We have seen this model take hold in a few areas of medicine, including cardiology, but is the time ripe for an expansion of the focused factory model? Dr. Herzlinger also explains where a specialty hospital or a general tertiary care facility would fit within this system.

Decisions our young patients make now can have metabolic consequences for the rest of their lives. It's hard to overstate, not only how crucial it is that we reduce the incidence of childhood obesity, but also how difficult it has been for us to turn the corner on this issue. These concurrent themes are central to a campaign put forth by the American Heart Association (AHA) that aims to make major progress on childhood obesity in the years to come. Host Dr. Jack Lewin gets the details on this campaign during his conversation with the AHA's chief executive officer, Nancy Brown. How is the AHA partnering with schools to empower kids to make healthier decisions about their consumption habits and lifestyle choices? How can we help fellow clinicians move beyond the feeling that their efforts to reduce childhood obesity aren't having the desired effect?

Cardiac disease was once thought to be both progressive and irreversible. As stem cell therapies emerge across many fields of medicine, our patients with cardiac disorders may be among the first to benefit from this translation of basic science into very valuable clinical applications. What do the latest findings tell us about our ability to tap into the promise of stem cells to treat, reverse or even prevent cardiac disease? Dr. Joshua Hare, director of the Interdisciplinary Stem Cell Institute and the Louis Lemberg Professor of Medicine at the University of Miami Miller School of Medicine, walks us through the most promising developments in this cutting-edge research and provides his insights on how you can talk with your patients about where they can expect to see benefits in the short term. Dr. Janet Wright hosts.