The Bob Harrington Show

The findings of the AVERROES trial foretell a future with appropriate treatment for patients with atrial fibrillation who are not candidates for anticoagulation with oral vitamin-K antagonists. In this discussion, Dr Stuart Connolly describes the design and findings of this important trial, the safety and efficacy data for apixaban, and shares his predictions for better anticoagulation options for this patient set. What are your thoughts on apixaban as a future alternative to warfarin?

According to the Center of Disease Control, 72.5 million Americans are obese (with a body-mass index [BMI] >30), and 27% of the increase in healthcare costs is related to the treatment of obesity. Dr Thad Waites joins the show to discuss these sobering statistics, the cardiovascular implications of obesity, what we can do to reverse the pandemic and the implications of the controversial obesity paradox in outcomes for CV disease.

From the convention hall at the European Society of Cardiology 2010 Congress, Dr Sunil Rao joins the show to give an overview of the field of antiplatelet therapy, review the key features of elinogrel, and discuss the design, features, and findings of INNOVATE PCI while mapping out the next steps for this new antiplatelet agent.

Hailed as a landmark trial by many, JUPITER has spawned a vociferous cadre of detractors whose assertions have stirred debate and some controversy throughout the cardiovascular community. Dr Paul Ridker joins the show to review key areas of criticism pertaining to the design and execution of the trial, putatively skewed results from halting the trial early, data inconsistency, and the involvement of industry in JUPITER.

There has been much research, press, and some controversy in the rapidly evolving sphere of antiplatelet therapy—culminating in the FDA's black-box warning on clopidogrel. Dr Paul Gurbel joins the show to clarify the core issues; review key terms such as hypo- and hyper-responsiveness and resistance and nonresponsiveness; discuss the roles and relative importance of genotyping vs phenotyping; and ponder how the GRAVITAS and TRIGGER PCI trials may help to lead the way forward for antiplatelet therapy. What are your thoughts on the FDA's black-box warning on clopidogrel? What roles do you see for genotyping and phenotyping for platelet responsiveness?

How many patients going to the cath lab with chest pain but without known disease—in the absence of acute MI—have obstructive coronary artery disease? Manesh Patel's latest paper sought to address this seemingly simple question. His research has had far-reaching implications for healthcare policy and reform, touching raw nerves and provoking debate across the cardiovascular community while raising a number of fundamental issues such as the notion of "acceptable" risk in an age of exploding healthcare costs. What are your thoughts on noninvasive testing to detect obstructive CAD? When is a test appropriate? Join in the discussion by commenting below. See: Patel MR, Peterson ED, Dai D, et al. Low diagnostic yield of elective coronary angiography. N Engl J Med. 2010 Mar 11;362(10):886-95.

New drugs that are brought to market in the US must face the FDA approval process, which frequently includes a public discussion or advisory committee meeting. With an extraordinary knowledge of drug approval and fresh from his experience on the FDA advisory committee that examined dronedarone, Dr Sanjay Kaul joins the show to address: - How a drug moves from the realm of research to clinical practice. - The role of the FDA in the approval process. - How the FDA influences clinical research and the way research is reported. - The thorny issue of industry-academic relationships. See: ATHENA scrutinized in media: Questions raised about access to raw data and clinical end points Avandia and FDA both subject of severe criticism at Congressional hearing Experts hash over new review challenging dronedarone's value in AF FDA approves dronedarone for atrial fibrillation

Do you fully understand the healthcare reform bill, how it will be enacted, and the implications for the business of medicine and your practice? Physician and business school leader Dr Kevin Schulman joins the show to discuss the fundamentals of reform, offer unique insight into what it could mean for practice, and challenge us to ponder two fundamental questions: Do finances allow medical care in the US to continue "as is"? How can physicians leverage a better position at the decision-making table? See: House and Senate vote to delay Medicare pay cut to June 1 Delaware cardiologists clash with insurers on nuclear stress test preauthorization requirement Heart groups applaud passing of US health reform bill but say: Real work now begins Medicare will delay paying claims for two weeks Medicare pay cut of 21.2% to take effect Monday What are your thoughts on healthcare reform and the implications for your practice? Join in the discussion by commenting below.

Chronic diseases do not respect geographical and political boundaries, and as our world becomes a smaller place, it's appropriate that our approach to disease become more global. Drs Jerry Bloomfield and Mark Huffman join the show to share their experiences with the US National Institutes of Health (NIH) Fogarty International Clinical Research Fellows' (FICR-F) program and highlight why global chronic disease research is an enriching bidirectional flow of knowledge and expertise. See: Bloomfield GS, Huffman MD. Global chronic disease research training for fellows: perspectives, challenges, and opportunities. Circulation 2010 Mar 23;121(11):1365-70. Available at: http://www.ncbi.nlm.nih.gov/sites/entrez?orig_db=PubMed&db=pubmed&cmd=Search&TransSchema=title&term=global%20chronic%20research%20training%20for%20fellows NHLBI Global Health Initiative: Collaborating Centers of Excellence Set to Combat Chronic Diseases in Developing Countries. Available at: http://www.nhlbi.nih.gov/about/globalhealth/ NHLBI Global Health Initiative: Collaborating Centers of Excellence Set to Combat Chronic Diseases in Developing Countries

While there appears to be a biological rationale for the adverse interaction between proton-pump inhibitors (PPIs) and clopidogrel, observational studies—for what they are worth—have shown mixed results. The partial results from the COGENT randomized clinical trial—although it was halted early and gathered just four months of data—appear to show no adverse interaction. Dr Deepak Bhatt joins the show to discuss this complicated issue and offer practical guidance for the clinical practitioner. What are your thoughts? Join in by commenting below.

Patients with non-ST-elevation-myocardial-infarction outnumber their STEMI counterparts by a ratio that is estimated at between 5 and 8 to 1 and hence constitute a large public-health concern. Dr Shamir Mehta, a leader in NSTEMI research, joins the show to discuss the TIMACS study and share his opinions on the use of the cath lab in invasive strategies as well as the use of antithrombotic agents in NSTEMI patients. What are your thoughts? Join in by commenting below.

"Get With the Guidelines" is a striking example of a successful nationwide initiative that addresses the gap between guidelines and performance by providing tools for healthcare providers and hospitals to improve care in both the in-patient and out-patient setting. In an era of budget cuts and heightened accountability, GWTG shows the viability of tackling quality gaps while fostering improved care across a variety of barriers such as location, age, sex, and ethnicity. Dr Ileana Piña joins the show to share her extensive experience work with the "Get With the Guidelines-Heart Failure" initiative and with information on how you can get involved.

Diabetics account for up to 25% of the patients seen in the chronic ambulatory setting and for as much as 40% of patients enrolled in clinical trials of patients with ischemic heart disease. To shine light on these disturbing statistics and chart a path forward for the care of diabetic patients with cardiovascular disease Dr Darren McGuire joins the show for an informative discussion that focuses on: Diabetes: The problem in general and background on a growing epidemic Medical treatment of diabetics, FDA guidelines for the development of drugs to treat diabetes, and cardiovascular safety issues Specificity of diabetes in cardiovascular disease: What's different about diabetics undergoing revascularization? What are your thoughts? Join in by commenting below.

With two months perspective since the simultaneous publication of PLATO trial results at ESC 2009 and in NEJM, Lars Wallentin joins the show for an insightful review of the results, context, and importance of PLATO, specifically: § An explanation of why ticagrelor is a different type of platelet inhibitor § Top line results of PLATO § Insight into the mortality finding § A review of the invasively managed cohort data presented by Chris Cannon at TCT 2009 § Discussion of the effect on stent thrombosis § The "North American issue" and what might explain the anomalous North American results compared to those of the rest of the world § Background on the late-breaker—addressing patients with STEMI—at AHA 2009 that will be presented by Gabriel Steg What are your thoughts? Join in by commenting below.

The burden of caring for patients with heart failure in the US is measured in the tens of billions of dollars annually and is one of the largest problems for a healthcare system facing skyrocketing costs and an aging population. Heart failure specialist, Dr Joe Rogers joins the show to share his thoughts and top picks from the HFSA conference and his insights on the upcoming scientific sessions of the AHA, with particular focus on "mechanical support". What are your thoughts? Join in by commenting below or calling 1-866-996-5440 to leave an audio response.