The Bob Harrington Show

Patient adherence to medication has long defied quantification, with many physicians assuming that the cost of medications is the primary factor explaining poor rates of compliance. The MI FREEE trial conducted by Dr Niteesh Choudry, and presented during AHA 2011 offers stunning proof that compliance is a more complicated issue than cost alone and raises numerous issues that our guest Dr Eric Peterson discusses. How do we explain abysmal rates of patient adherence to medication? Should the physician be held responsible for adherence?

What is the best way to care for patients following PCI? Is same-day discharge a viable - or even desirable - option? Dr Sunil Rao joins the show to discuss his recent paper in JAMA, including the background for the study, source of data, and methodology. Discussion focuses on the thorny issues of cost savings and policy implications as well as technical issues to consider when evaluating whether to discharge a patient (or not)

Statins have become a cornerstone therapy in the prevention of cardiovascular disease by helping to modify the risk profile of millions of people. But what about a possible connection between statin use and diabetes? Lipidologist and preventive expert Dr Michael Cobble joins the show to relate his examination of the data and clinical experience and share his thoughts on the advantages of statin use relative to the risk of diabetes.

Both cardiologists and patients grapple with the concept that fixing a blockage may not prolong life, as indicated by the results of the landmark COURAGE and BARI 2D trials and reflected by the limited effect these trials seem to have had on clinical practice. The large ISCHEMIA trial, led by Dr Judith Hochman, seeks to build on the results of COURAGE and BARI 2D to answer the important question: what is the best treatment for patients with stable coronary disease? Dr Hochman joins the show to discuss rationale and trial design and give information on how to become involved in the study issues that contribute to professional discourse and why it's important to remain optimistic.

With the multiplication of methods of communication, the democratization of access to information, and the fast pace of today's technology it's hard not to feel that professional discourse has taken a bashing and that civility in discourse is a lost art. Dr Clyde Yancy joins the show to talk about manners, anonymity, and broader societal issues that contribute to professional discourse and why it's important to remain optimistic.

Recent reports indicate that the Occluded Arteries Trial (OAT)—while continuing to stir debate—has made little impact on clinical practice among US physicians. What explains this situation? Dr David Kandzari joins the show to take a broad look at the design, implementation, and uptake of clinical trials, with focus on strategy bias, how to follow evidence-based medicine, and why physicians are quick to act on certain trial results (but not others).

Is the concept of raising HDL cholesterol still pertinent in an era of well-controlled LDL levels via statin therapy? To address this question, our guest Dr Jim Stein reviews what evidence exists to indicate low HDL cholesterol may predict heart disease, how the drug niacin fits into the equation, and what the results of the AIM-HIGH trial might mean for this hypothesis.

Reversible anticoagulation may open the door to more efficacious treatment and better outcomes in settings such as PCI and valve replacement, as well as bypass surgery. But how does the risk of bleeding fit into the equation? Dr Thomas Povsic joins the show to discuss reversible anticoagulation: the clinical imperative of the RADAR trial, background on aptamer technology, and a discussion of trial results and implications for future research.

The key to improved efficacy of antiplatelet regimens—in theory, at least—appears to be a personalized approach to therapy. But based on the TRIGGER-PCI and GRAVITAS trials, how productive is routine testing for platelet responsiveness in clinical practice? Dr Gregg Stone discusses his expertise in this field, why the hypothesis for TRIGGER-PCI did not work, his thoughts on the current role of genotype/phenotype testing, and why we should be optimistic about future research in this arena.

After decades of reliance on warfarin, there are finally new options for oral anticoagulation, with exciting results from the RE-LY, ROCKET, and AVERROES trials paving the way for dabigatran, rivaroxaban, and apixaban. With over 20 years of experience in the development of antithrombotic therapies, our guest, Dr Jonathan Halperin, discusses the road to approval of these drugs and shares practical insights for the healthcare professionals for finding their way.

Where does healthcare reform stand, and what are the implications for cardiologists? Physician and business leader Dr Kevin Schulman joins the show to help clarify the healthcare debate and shine light on how the new Congress and future presidential elections influence reform. How does the deficit shape the debate? What are the implications for the current reimbursement system and private practice partnerships with hospitals? Are there any grounds for optimism?

Quality assurance—or appropriate use of cardiology procedures—is a hot topic that defies simple quantification and has important ramifications for patients, healthcare professionals, and society at-large. Dr John Rumsfeld joins the show to share his thoughts on QA—how to measure it, who should assume responsibility for the process, the role of professional societies, and how reliable feedback can affect quality.

Heart-failure is estimated to account for two million hospital admissions per year in the US, based on primary and secondary diagnosis. Despite the amplitude of this burden, there is reason for cautious optimism, with encouraging results from clinical trials in 2010 that point to better treatment options and outcomes. In this comprehensive review, Dr Clyde Yancy discusses important recent research and how trials such as RAFT, EMPHASIS-HF, ASCEND-HF, and ADVANCE will help ambulatory, decompensated, and advance heart-failure patients.

Hotly debated among healthcare professionals, "low-carb" diets—such as Atkins—have soared in popularity, offering easy-to-follow approaches and rapid results. But are they safe? Dr Eric Westman joins the show to discuss safety, his research in lifestyle intervention, and thoughts on how curbing the intake of carbohydrates can help tackle the obesity pandemic.

Notable for their therapy-based approach, rigor, and clarity, the Canadian Cardiovascular Society (CCS) antiplatelet guidelines were recently presented by coauthors Drs Alan Bell and Jean-François Tanguay at the CCS annual meeting in Montreal. Dr Bell joins the show to discuss the raison d’être, methodology, and aspirations of the new guidelines, while addressing specific line items, including aspirin dosing, duration of dual antiplatelet therapy poststenting, primary prevention, and interaction with proton-pump inhibitors.