Heart Matters

It seems we all work so much these days, we might as well get our personal mail delivered at work, or maybe even consider a hide-a-bed for the office. That may seem a bit far-fetched, but many of us do receive our health insurance coverage from our place of employment, and an increasing percentage of us are participating in so-called wellness programs at work. As we anticipate reforms in our health care system, what is the future role of the employer and the workplace in this movement? For a look at these questions, host Dr. Jack Lewin welcomes Chris Jennings, president of Jennings Policy Strategies, a health policy and advocacy consulting firm based in Washington, DC, and a former White House Senior Health Care Advisor during the Clinton administration. Mr. Jennings also compares the current efforts toward health care reform to those of the early Clinton years, and outlines what he sees as the key reasons why the present climate will be more receptive to the achievement of meaningful reform.

Because new cardiac technologies are often rapidly integrated into clinical practice, we must be mindful that these innovations can contain a level of risk. Regrettably, we've seen examples of this before with previous generations of implantable cardioverter-defibrillators (ICD), and some experts say the latest advances in ICD technology could pose similar problems. Host Dr. Jack Lewin explores this issue with Dr. Robert Hauser, senior consulting cardiologist at the Minneapolis Heart Institute and a founder and past president of the Heart Rhythm Society.

Does the patient with few cardiovascular risk factors who displays little, if any, sign of heart trouble warrant a coronary CT scan? For patients who may not be best suited for a CT scan, is the coronary calcium measurement a reasonable risk-assessment alternative? Dr. Mark Hlatky, professor of medicine and professor of health research and policy at Stanford University School of Medicine, explores a range of issues related to coronary CT angiography: how the rationale for ordering can change in the emergent setting versus the clinical scenario, its merits as a ‘triple rule-out' test, and the frequency with which patients undergoing a CT scan subsequently undergo angioplasty, bypass surgery, or another coronary procedure. Dr. Janet Wright hosts.

Measuring precise risks in medicine can be a tricky proposition. Factoring risk into cost-benefit analyses can make the situation even less clear. In many ways, this is where we stand with coronary computed tomography angiograms: a scan can be immediately helpful in emergent circumstances, but at other points in the clinical care spectrum, the value of that scan is more difficult to estimate. Dr. Mark Hlatky, professor of medicine and professor of health research and policy at Stanford University School of Medicine, juxtaposes the medical aspects of these tests with the money we spend on them. Dr. Janet Wright hosts.

Is your practice one of the growing number of small healthcare businesses that cannot afford to provide health insurance for its employees? It’s a startling reality for many medical employers and employees, and more broadly, for the entire small business sector, which, in some states, is the collective employer for upwards of half of the uninsured population. As Dr. Bob Graboyes, senior healthcare advisor for the National Federation of Independent Business, tells host Dr. Janet Wright, with new proposals for restructuring health care coming in droves these days, meaningful healthcare legislation would be welcome news for small businesses around the country.

How can individual practitioners interact with industry in a positive, lawful and commendable manner? Are there regulations we can and should put on companies in this arena which fund initiatives such as continuing medical education? Industry certainly plays a major role in health care today, but one wonders whether we are managing these relationships to the best of our abilities. Greg Demske, assistant inspector general for legal affairs in the Office of the Inspector General for the United States Department of Health and Human Services, joins host Dr. Janet Wright to discuss a range of issues related to the role of industry in health care, as well as potential conflicts of interest that may arise.

New treatment guidelines regularly make headlines in medicine, recommending advances in our approach to care. In recent years, we have accelerated the speed at which we can update our guidelines and welcomed more global input into the process. Will these trends continue? Where else can we improve our process for authoring treatment guidelines? Host Dr. Jack Lewin explores these questions and more with Dr. Elliott Antman, professor of medicine at Harvard Medical School, and past chairman of the American College of Cardiology and American Heart Association’s Task Force on Practice Guidelines.

Sudden cardiac deaths are rare among elite athletes. Yet these abrupt events are confounding, in part, because they strike some of our most physically dynamic individuals, and because there remains a lengthy list of potential causes. How are we advancing our grasp of the underlying triggers of these life-threatening arrhythmias? Host Dr. Doug Weaver talks with Dr. Doug Zipes, distinguished professor emeritus of medicine at the Indiana University School of Medicine, about the balance of uncovering at-risk patients, while maintaining reasonable restrictions on their athletic activities, and avoiding unnecessary tests for those who are not in danger.

Will drug-eluting stents prove safer and more effective without a metal structure? For all their merits, current stent technologies still present a series of drawbacks, including the severe complication of late thrombosis. Biodegradable polymers may hold the key to minimizing this and other concerns. Host Dr. Doug Weaver discusses the most promising areas of research in this area with Dr. Martin Leon, professor of medicine and associate director of the Center for Interventional Vascular Therapy at Columbia University Medical Center in New York City.

Investigators are pursuing more aggressive strategies to maintain sinus rhythm. One area of current inquiry for certain arrhythmias centers on pulmonary vein isolation as an alternative to atrioventricular node ablation with biventricular pacing. How effective is pulmonary vein isolation for preventing an arrhythmia relapse? Dr. Mohammed Khan, an electrophysiologist at Cardiovascular Associates in Elk Grove Village, Illinois, joins host Dr. Doug Weaver to explain which of your patients may be optimal candidates for pulmonary vein isolation.