Topol and Teirstein - Click and Rub

Recent ruminations on public reporting (of PCI) generally conclude with the notion that patient outcomes are better in states that report. Right? Not according to Dr Paul Teirstein, who offers his cath-lab experience in California and New York to present his case. Will Dr Eric Topol be persuaded?

What parallels can we draw between practicing cardiology and piloting airplanes? From exhilaration and human error to aviation safety reports as a guide for bettering practice in the cath lab, Dr Paul Teirstein waxes poetic with Dr Eric Topol about his new passion for flight.

From the floor of the TCT convention center, Drs Topol and Teirstein ponder live cases: immoral grandstanding or important learning and treatment opportunity?

What constitutes a "top hospital"? Drs Eric Topol and Paul Teirstein review the notion of hospital ranking and the criteria used to select "top hospitals" in the renowned US News and World Report listing, the recent Joint Commission annual report, and the Thomson Reuters top hospital picks.

Does a top-ranked hospital necessarily deliver the best care

Study results recently published by Chan et al in JAMA point to remarkably good rates of appropriate use of PCI. But how meaningful is the definition of "appropriate"? How enlightening are the results? The debate continues . . .

The backbone of cardiovascular research is the randomized clinical trial, which at great expense and effort seeks to enroll thousands of patients in the pursuit of an absolute reduction that is frequently around 1%. Is it really worth it? Is it time to find a new paradigm?

In this inaugural episode, Drs Topol and Teirstein focus on SYNTAX. From the basic questions--Does the trial have value? Has it affected clinical practice?--to the problematic issue of randomizing patients to a 20-minute intervention or a weeklong hospitalization, they also ponder what they have learned from revascularization trials and paper cuts as well as the whimsical image of performing PCI on CV surgeons.

The media is buzzing with discussions of Dr Atul Gawande's article in the New Yorker magazine, which looks at the astounding healthcare costs in the town of McAllen, TX. How did this "outlier" capture the attention of the nation and fuel the debate for healthcare reform? Is the debate fair and balanced or rather tainted by journalistic hyperbole?

From fiction to fact: in the near future most aortic valve procedures will be percutaneous. Join Drs Topol and Teirstein for a light hearted discussion that—while also evoking harpoons and pulp fiction—illustrates why this procedure is transformational for patient outcomes, a welcome collaboration between interventionalist and vascular surgeon, and the path forward for aortic valve replacement.

Medicine is frequently slow to adapt to change. In this philosophical exchange, Drs Topol and Teirstein seek to explain the phenomenon by examining evidence-based medicine, direct-to-consumer advertising, hectic schedules, general conservatism, randomized trials, physician incentives, and pay-for-performance.