Leading Causes: A Podcast by New Century Health

Underuse of evidence-based care is rampant in cardiology, with serious impacts on patient outcomes and costs. Yet, it gets much less attention, and prior authorization programs are blind to underuse. They deal only with services that have been requested, not those that have been omitted.

This episode of Leading Causes explores examples of underuse, the reasons that high-value services are not used more frequently in cardiovascular care, and strategies to improve appropriate delivery of care. NCH Senior Medical Director of Cardiology, Dr. Fernando Villacian, is joined by Dr. Nihar Desai, Associate Professor of Medicine and Associate Chief of the Section of Cardiovascular Medicine at Yale University School of Medicine, and Medical Director for Value Innovation at the Yale New Haven Health System, and Dr. Ileana Piña, Clinical Professor at Central Michigan University and past chair of the American Heart Association’s Council on Clinical Cardiology.

GDMT, or guideline-directed medical therapy, means taking the right medications at the optimal doses to treat cardiovascular problems. There's strong evidence that for many patients, GDMT is equivalent to, or better than, cardiovascular procedures, which are more costly. Yet these medications are chronically underused.

Every day, cardiologists make decisions about what is the most appropriate test, therapy or procedure for their patients. And when they make those decisions, they are guided by years or sometimes decades' worth of research into what's the best course of action--or at least we hope they do. But then COVID-19 came along. And the more we learned about how the virus wreaks havoc on the cardiovascular system, many of us started to wonder: Have the rules of the game changed?

From cytotoxic chemotherapy to targeted therapy: we’ve entered a new era of cancer care. What is life like as a provider in this new era? How can oncologists keep up with the latest science?

Palliative care—supportive care—is a glaring need in cancer care, but myths, misconceptions and mixed messages create barriers for broader palliative program implementation.

Choice paralysis. The therapeutic landscape in oncology is vast and everchanging, marked by a dramatic pace of innovation and new approvals. In this complicated specialty, how can payers and providers keep up to make decisions that maximize life for the patient?

There is tremendous excitement around the concept of precision oncology–that is, delivering therapies targeted to an individual patient’s specific type of cancer. But how many patients will truly benefit from these treatments? And do the results for these patients justify the hype?

In this series we explore the trends and forces behind the two leading causes of death in the United States: cancer and heart disease.