Heart Matters

It is no longer a question of whether antiplatelet therapy should be used following implantation of a drug-eluting stent, but rather to what extent and to what duration. With this in mind, many new challenges arise, from bleeding risks to drug intolerance and product cost. Host Dr. Doug Weaver welcomes Dr. Peter Berger, associate chief research officer and director of the Center for Clinical Studies at the Geisinger Clinic in central Pennsylvania, to discuss how we’re moving to address these concerns. Dr. Berger also details a series of related procedural circumstances—dental surgery, bronchoscopy, certain orthopaedic procedures and more—in which antiplatelet therapy need not be discontinued.

Dr. Charles Kerr, president of the Canadian Cardiovascular Society, and director of the electrophysiology program at St. Paul's Hospital in Vancouver, British Columbia, joins host Dr. Janet Wright, to discuss the challenges of managing patients with atrial fibrillation. For those patients who may warrant ablation, what is the current thinking about who should be referred for this procedure, and how should we define its success? Given that there are multiple approaches to ablation for atrial fibrillation, are we seeing the field gravitate toward one or a few of the most effective strategies?

For patients diagnosed with aortic valve stenosis, corrective surgery is advised and is often extremely safe and effective. But there are some patients with advanced disease whose symptoms may be difficult to recognize, and thus may remain undiagnosed without careful consideration. As Dr. Arvind Agnihotri, assistant professor of surgery at Harvard Medical School, tells host Dr. Janet Wright, some of these symptoms—including decreased exercise tolerance or subtle dyspnea—may be more easily dismissed in older patients, in particular, because we expect these symptoms to appear in this population. In what other ways can we improve our detection of aortic valve disease? Dr. Agnihotri will also guide us through the process of a percutaneous valve replacement, from the initial decision-making process to the early post-operative period.

Artificial heart valves have steadily evolved since their arrival on the surgical scene in the 1960s. A range of the newest devices have shown significant potential, including the prospect of valve replacement in high-risk, symptomatic patients with severe aortic stenosis. What are the most promising devices on the horizon today, and how will these new tools allow us to care for populations with precarious cardiac function without conducting a major surgical procedure? Dr. Arvind Agnihotri, assistant professor of surgery at Harvard Medical School, explores the ways in which we are improving upon traditional aortic valve surgery with host Dr. Janet Wright.

Host Dr. Jack Lewin speaks with Dr. James Dove, immediate past president of the American College of Cardiology, about strategies to improve the integration of quality into our healthcare system. No physician wants to fall short of providing the best care available, so it is imperative, Dr. Dove says, that physicians receive the tools they need to succeed, based on clinical data they trust. What are these tools and how can we integrate them into the workflow? Further, how do we incorporate these challenges into an efficient payment system?

In a recent survey tracked by Dr. Uwe Reinhardt, the James Madison Professor of Political Economy and professor of economics and public affairs at Princeton University, Medicare patients in northern New Jersey accrued three times the medical costs in their last two years of life as patients in the southern half of the state. Save for seismic demographic differences, Dr. Reinhardt explains how our current system produces these staggering billing disparities. How could a peer-review mechanism stem the tide of clinical ‘cost-ineffectiveness' and concurrently improve quality assurance in American healthcare? Dr. Jack Lewin hosts.

Who would expect that a hole in the heart and a pain in the head are related? If you take care of patients who suffer from migraine headaches, host Dr. Janet Wright's interview with Dr. Jill Jesurum, scientific director of the Heart & Vascular Institute at Swedish Medical Center in Seattle, may shed light on some unanticipated benefits of treatment for migraineurs. Dr. Jesurum explains how patent foramen ovale (PFO) closure may impact the symptoms experienced by a migraine sufferer, and shares her perspective on which populations may benefit most from a PFO procedure.

Recent guidelines for unstable angina and non-ST-segment-elevation myocardial infarction (NSTEMI) can be characterized as a progression and fine-tuning of past recommendations, which have contributed to a remarkable decline in the devastating outcomes. Dr. Elliott Antman, professor of medicine at Harvard Medical School and director of the Samuel A. Levine Cardiac Unit at Brigham and Women's Hospital in Boston, talks with host Dr. Janet Wright about the key updates to the latest guidelines and what we need to do to continue this trend toward fewer adverse outcomes. When initiating anticoagulant therapy, for instance, Dr. Antman says it is more important for your local institution to agree upon one therapeutic regimen, to avoid any unnecessary oscillations. Further, how do the guidelines address our oversight of patients' other medications, including nonsteroidal anti-inflammatory drugs and hormone replacement therapy? Tune in to find out more.

Revising treatment guidelines is a continuous process, with authors always monitoring the latest data that needs to be shared with practitioners. What developments prompted the latest updates to the guidelines for care of patients with acute myocardial infarction? Host Dr. Janet Wright visits with Dr. Elliott Antman, professor of medicine at Harvard Medical School, to discuss several of recent refinements that warrant our attention: distinguishing acceptable candidates for beta blocker therapy, as well as management of facilitated and rescue percutaneous coronary intervention.

It is a condition that most commonly affects our young athletes, but many of the symptoms of hypertrophic cardiomyopathy (HCM) do not manifest until it is too late. How are we improving our techniques and strategies for preventing, identifying and addressing HCM before it leads to tragedy? Dr. Theodore Abraham, associate professor of medicine at the Johns Hopkins University School of Medicine, and associate director of the echocardiography laboratory at Johns Hopkins Hospital, joins host Dr. Janet Wright to talk over key issues in our understanding of HCM, including his advice for patients with phenotypically mild disease progression.