Parallax by Ankur Kalra

In this week's Parallax episode, Dr Ankur Kalra welcomes Dr Haider Warraich, a cardiologist at Brigham and Women's Hospital. Dr Warraich is not only a Senior Advisor for Chronic Disease to the FDA Commissioner but also a prolific author, having written three books, including "Song of Our Scars: The Untold Story of Pain." He is a regular contributor to publications like the New York Times and the Washington Post.

During the conversation, we learn more about Dr Warraich's journey into medicine and his current role at the FDA, along with his passion for writing. Dr Kalra asks about how Dr Warraich manages his busy schedule and what it takes to write a book.

Dr Warraich openly shares his personal experience grappling with chronic pain, a pivotal event that not only influenced his career trajectory but also inspired his book "Song of Our Scars." Moreover, he discusses his role as a Senior Advisor to Dr Robert M Califf, offering insights into his day-to-day responsibilities within the FDA. The conversation also touches upon the agency's perspective on emerging technologies like artificial intelligence (AI).

How does writing complement Dr Warraich’s work as a physician? How did he become a senior advisor to Dr Robert M Califf at the FDA? What is his message to our listeners?

Join Dr Ankur Kalra on Parallax this week as he welcomes Dr Candice K Silversides, the first Editor-in-Chief of JACC: Advances.

Dr Silversides, a cardiologist and professor at the University of Toronto, wears many hats. She leads the Obstetric Medicine program and directs the Cardio-Obstetric clinic at Mount Sinai Hospital, while simultaneously steering JACC: Advances in its exciting early stages.

Dive into the unique synergy between her clinical practice and editorial leadership as Dr Silversides shares her vision for the journal. Learn how she navigates diverse responsibilities, manages peer reviews, and ensures fair evaluation of the submitted manuscripts. Get insights into launching a journal, from adapting to the needs of the readership and editorial board selection to time management. Dr Silversides joins Dr Kalra in exploring the evolving landscape of academic publishing, discussing the challenges and opportunities presented by AI and other advancements.

What does the future of academic publishing look like? What is the role of AI? What are the day-to-day tasks of an Editor-in-chief?

In the season 6 premiere of Parallax, Dr Ankur Kalra welcomes Dr Alex Carter, a Senior Lecturer at the London School of Economics and Political Science (LSE) Department of Health Policy. As the course director for the executive MSc in Health Economics, Policy & Management, Dr Carter delves into the origins and evolution of LSE's health economics program, showcasing its transformation in response to the challenges facing health systems in 2024.

The podcast embarks on an exploration of the program's three fundamental pillars: health economics, outcomes measurement, and management. Dr. Carter underscores the importance of efficiently allocating scarce resources, evaluating health system performance through population outcomes, and translating theoretical knowledge into practical application through leadership.

Dr Kalra asks Dr Carter about his work with the HyperMarker project, an EU-funded initiative that leverages big data analytics to optimize the prescription of antihypertensives and generate personalized treatment recommendations for patients with hypertension.

What do we gain by understanding health economics? How was one of the first health economics programs created? What is Dr Carter’s message to our listeners?

In this week's Parallax, Dr Ankur Kalra welcomes back Dr Sukhjinder Nijjer for their much-anticipated annual review of advancements in cardiovascular medicine that defined the year 2023.

Dr Nijjer, a Consultant Cardiologist in the UK, serves as the President of the Royal Society of Medicine and is an Honorary Senior Clinical Lecturer at Imperial College London.

Drs Kalra and Nijjer share their perspectives and experiences, offering valuable insights, practical tips and considerations when interpreting this year’s most impactful trials:

• ORBITA-2 (AHA Scientific Sessions): PCI for stable angina

• FIRE (ESC Congress): Functional versus culprit-only revascularization in elderly patients with myocardial infarction and multivessel disease

• DAPA-MI (AHA Scientific Sessions): SGLT2i in MI without diabetes or heart failure

• ILUMIEN IV (ESC Congress): OCT vs angiography-guided PCI

• OCTOBER (ESC Congress): OCT or Angiography Guidance for PCI in Complex Bifurcation Lesions

• ARTESIA (ESC Congress): Apixaban for Stroke Prevention in Subclinical Atrial Fibrillation

• SELECT (AHA Scientific Sessions): Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes

What are the most impactful cardiovascular trials of 2023? How do Dr Kalra and Dr Nijjer integrate the latest information into their daily practices?

In this thought-provoking episode, Dr Ankur Kalra is joined by Dr Anuradha Lala, assistant professor of medicine at the Zena and Michael A Wiener Cardiovascular Institute and in the Department of Population Health Science and Statistics at Icahn School of Mount Sinai and Mount Sinai Hospital. Dr Lala is also the Deputy Editor of the Journal of Cardiac Failure.

Dr Kalra and Dr Lala delve into the critical topic of disparities in care within the healthcare system from a cardiologist's point of view and explore actionable steps towards a more inclusive and fair healthcare landscape.

Dr Lala advocates for an approach focused on the patient, valuing the unique needs and preferences of each individual as crucial elements in creating a personalised treatment strategy. In this podcast, she provides insight to her study on 'Acute Heart Failure Presentation to the Emergency Department: National Trends by Race and Ethnicity 2007-2019' and how it shows there are differences based on race and ethnicity in terms of wait time and the demographic of patients presenting.

The fundamental principle that healthcare is a basic human right is emphasised, setting the stage for a deeper exploration of the disparities prevalent within the system. Through candid discussions, the episode highlights the differences in healthcare access and quality and examines methods to prevent and mitigate these discrepancies.

Addressing the 'why' behind these disparities is a central theme, exploring the presence of subconscious biases within healthcare. The conversation isn’t just theoretical, Dr Kalra and Dr Lala present real-life scenarios and personal stories, offering a refreshingly honest and open perspective.

Key questions are explored, such as identifying the top places where disparities in care exist and strategies to address these issues.

This series is supported by ZOLL and is intended for Health Care Professionals.

On October 28th, 2023, the Canadian Cardiovascular Society (CCS) released a new classification system for acute atherothrombotic myocardial infarction (MI) based on stages of tissue injury severity (CCS-AMI). This expert consensus is the result of decades of data on acute MI with reperfusion therapy.

Dr Ankur Kalra is joined this week on Parallax by Dr Andreas Kumar, Chairperson of the Writing Group of the Expert Consensus Statement, Associate Professor of Medicine at the Northern Ontario School of Medicine, Cardiologist at Health Sciences North, and President of the Canadian Society of Cardiovascular MRI.

In this informative episode, Dr Kumar shares what led his team and the CCS to introduce a new classification scheme for acute MI. He discusses how research from the past 15 years highlighted the need to incorporate tissue changes resulting from acute myocardial infarction (MI) into clinical practice. Dr Kumar outlines the four stages of CCS-AMI, and we gain insight into how this novel classification scheme could impact bedside medicine.

Dr Kalra asks about treatment optimization based on stages of tissue injury severity. Dr Kumar delves into the risks associated with the four stages, with a particular focus on CCS Stage 4, MI with reperfusion haemorrhage. Finally, Dr Kumar highlights how the use of the classification system can lay the foundation for future research studies and bring us closer to finding answers and identifying agents suitable for different stages of acute MI.

What are the key messages from CCS-AMI? What are the data behind the new scheme? How might the new classification scheme impact the development of new treatment options?

Resources:

Kumar A, et al. The Canadian Cardiovascular Society Classification of Acute Atherothrombotic Myocardial Infarction Based on Stages of Tissue Injury Severity: An Expert Consensus Statement. CJC 2023. https://doi.org/10.1016/j.cjca.2023.09.020

Gaba P & Bhatt DL. Promise of a Novel Classification System for Acute Myocardial Infarction. CJC 202. https://doi.org/10.1016/j.cjca.2023.10.011

Questions and comments can be sent to “[email protected]” and may be answered by Ankur in the next episode.

Guest: @AndreasKumarMD Host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

In this week's episode of Parallax, Dr Ankur Kalra's guest is Dr Craig R Smith, Cardiac Surgeon and Chairman of the Department of Surgery at Columbia Presbyterian Hospital.

In 2020, The Wall Street Journal called Dr Smith the pandemic's most powerful writer. Each day throughout the COVID-19 crisis, Dr Smith provided the faculty and staff with updates on pandemic response and priorities, offering both vital information and unwavering support. This month, Dr Smith released his book, 'Nobility in Small Things: A Surgeon's Path’.

In this inspiring episode, Dr Smith delves into the story behind his book and the motivating circumstances that led him to become an author. Dr Kalra asks Dr Smith about his experience as a leader during the pandemic as a surgeon. Dr Smith shares the story of his unconventional journey into medicine, emphasizing how hard physical labor built his resilience and prepared him for his residency. Dr Kalra also asks about Dr Smith's experience as a surgeon for President Bill Clinton in 2004. We learn more about some of the highlights of Dr Smith's book and his advice for listeners aspiring to become writers.

Nobility in Small Things is available for purchase here: https://us.macmillan.com/books/9781250278531/nobilityinsmallthings

Questions and comments can be sent to “[email protected]” and may be answered by Ankur in the next episode.

Guest: Dr Craig R SmithHost: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

In this week's episode of Parallax, Dr. Ankur Kalra welcomes Dr. John Mandrola, a cardiac electrophysiologist practicing in Louisville and the host of the popular podcast "This Week in Cardiology" and co-author of Sensible Medicine, among other forums.

In this insightful episode, we delve into Dr. Mandrola's career journey. He discusses how the beginnings of his career during a period of significant innovations and the reversal of expert opinions profoundly influenced his perspective on medicine, leading to a more conservative stance. Dr. Kalra then invites Dr. Mandrola to share the motivations that drive his work as a medical journalist and communicator, along with his methods of selecting studies to highlight in his writings and show.

Dr. Mandrola emphasizes the importance of bedside medicine and the critical role of translating and interpreting evidence in modern healthcare. Together, Dr. Kalra and Dr. Mandrola explore the complexities of practicing medicine today and ponder the value propositions associated with the latest innovations.

Dr. Mandrola sheds light on what he considers the most promising new advances in the field. He concludes the episode by offering valuable advice to our listeners, advocating for the implementation of innovations grounded in medical evidence and supported by sound policies.

Questions and comments can be sent to “[email protected]” and may be answered by Ankur in the next episode.

Guest: @drjohnm Host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

In the landmark centennial episode of Parallax, Dr Ankur Kalra welcomes a true luminary in the field of cardiology, Dr Valentin Fuster.

Dr Valentin Fuster, a renowned cardiologist, currently holds multiple roles. He serves as the Director of the Cardiovascular Institute and as the Physician-in-Chief at the Mount Sinai Medical Center in New York. Additionally, Dr Fuster is the General Director of the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) in Madrid. Notably, he also holds the position of Editor-in-Chief at the Journal of the American College of Cardiology (JACC).

In this candid and rich episode, Dr Fuster delves into his upbringing in Barcelona and reflects on the influential role his family played in providing him with role models and a sense of freedom during his formative years. Dr Fuster invites us to contemplate the concepts of mentorship and trust by recounting pivotal moments from his life, revealing how these principles propelled him towards a life of fulfilment.

Dr Kalra and Dr Fuster revisit one of the central questions explored in Dr Fuster's book, "The Circle of Motivation" – how can one maintain a positive outlook and prepare for life's inevitable fluctuations? Dr Fuster shares insights into his daily routine, which aids him in reflection, tuning into his intuition, and making choices that align with his true self.

While discussing his priorities, we gain insight into Dr Fuster's projects, driven by the concern that we do not intervene early enough in the treatment of individuals. Dr Kalra and Dr Fuster engage in a discussion about Dr Fuster's thoughts on JACC and Dr Fuster outlines the key principles of leadership in various contexts, accompanied by examples from his own life. Dr Kalra seeks Dr Fuster's perspective on augmentative intelligence and the future of medicine, shedding light on what Dr Fuster believes is essential for contemporary medical education in light of the transformative impact of AI.

Finally, Dr Fuster shares three influential books that have shaped his thinking, along with a message for our listeners.

Resources:

JACC Journals’ Pathway Forward With AI Tools: The Future Is Now

https://www.jacc.org/doi/10.1016/j.jacc.2023.02.030

The Circle of Motivation

https://www.amazon.com/Circle-Motivation-Valentin-Fuster-ebook/dp/B07YLVMSKH

In this week's Parallax, Dr Ankur Kalra's guest is Dr Mirvat Alasnag. Dr Alasnag is an interventional cardiologist at King Fahad Armed Forces Hospital (KFAFH) in Saudi Arabia. Additionally, she serves as the Editor-in-Chief at Current Cardiovascular Imaging Reports and is a member of the Board of Trustees at SCAI.

Dr Alasnag and Dr Kalra provide a comprehensive review of the key highlights from ESC Congress 2023. Dr Alasnag distills the background and latest evidence from key interventional trials, emphasizing their significance for patient care.

Tune in to discover the strategies that Dr Kalra and Dr Alasnag are currently employing and gain insights into how these data will shape their future decision-making in the catheterization laboratory. Don't miss this informative discussion at the forefront of interventional cardiology.

Trials included:

FIRE: Physiology-Guided Complete PCI in Older MI Patients

MULTISTARS AMI: MULTivessel Immediate Versus STAged RevaScularization in Acute Myocardial Infarction

ILUMIEN IV: Optical coherence tomography-guided coronary stent implantation compared to angiography

OCTOBER: European Trial on Optical Coherence Tomography Optimized Bifurcation Event Reduction

OCT Vs IVUS Vs Angiography Guidance

OCTIVUS: Optical coherence tomography non-inferior to intravascular ultrasound for stent guidance

What are the take-home messages from ESC 2023 for interventional cardiologists? How can we interpret the results for patient care? What new data have the power to change guidelines?

Questions and comments can be sent to “[email protected]” and may be answered by Ankur in the next episode.

Guests: @mirvatalasnag Host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.