The Bob Harrington Show

Dr Paul Armstrong joins the show to discuss the related subjects of international collaboration in research and mentorship amongst physicians. As the world continues to shrink with new opportunities to network and communicate there are numerous occasions to learn from international collaboration and improve standards of care globally. But what are the challenges of collaborating on an international basis? How do we tackle the obstacles and continue to improve research and care? Along with collaboration comes mentorship. What role does mentorship play in the development of first rate, effective, and balanced researchers? Drs Armstrong and Harrington discuss their experience and visions of this informal yet essential institution. What are your thoughts? Join in by commenting below or calling 1-866-996-5440 to leave an audio response.

The RE-LY and PLATO trials have electrified the ESC Congress 2009 with results that are both practice changing and paradigm shifting. Direct from the conference floor, Professor Ph Gabriel Steg joins the show to take a close look at trial findings and their monumental implications for clinical practice and standard of care. What are your thoughts? Join in by commenting below or calling 1-866-996-5440 to leave an audio response.

It's one of the hottest issues in medical policy today and has excited the interest of wide swathes of society. Beyond the hyperbole and simplistic rhetoric, how do we go about addressing conflicts of interest—be they financial or intellectual—to promote meaningful, fair, and productive relationships with industry? Dr Rob Califf joins the show to address these thorny subjects, notably: § What are the challenges of relationships with industry and how do they "go wrong"? § Is clinical research possible without industry support? § How do we improve on the status quo? What are your thoughts? Join in by commenting below or calling 1-866-996-5440 to leave an audio response.

ur mechanistic understanding of revascularization issues in ischemic heart disease patients has improved tremendously thanks to OAT, COURAGE, SYNTAX, BARI 2D, and countless smaller studies. What about the broader picture? Dr Gregg Stone joins me to address fundamental issues that are essential for a truly contemporary approach to revascularization: (1) Is the "anatomy-driven" cardiology model flawed? (2) What are the true advantages of coronary revascularization over vastly improved medical therapy? (3) What do we need to learn about optimal patient selection? (4) How can cardiologists and surgeons work better together to improve patient outcomes? (5) What advances does the future have in store? What are your thoughts? Join in by commenting below or calling 1-866-996-5440 to leave an audio response.

Clinicians, politicians, policy makers and payers are talking about comparative effectiveness with catch phrases as varied as "focusing on what works", "rationing care", and "limiting choices". But what does "comparative effectiveness" really mean? To help answer this question and unravel the implications for practitioners, cardiovascular research and patient care, Dr Harlan Krumholz joins the show with thoughts and expertise to tackle this controversial and timely issue. What are your thoughts? Join in by commenting below or calling 1-866-996-5440 to leave an audio response.

Science, politics, economics, ego, and turf war--all the possible subplots for a spy novel lurk in the background of this timely discussion on access to PCI. Sharing her thoughts on this debate, Dr Melissa Walton-Shirley describes her battle to provide primary PCI at her hospital in rural Kentucky, lagging guidelines, the stark comparison with realities in parts of Europe, and how best to save lives--whether in rural, suburban, or urban locations--throughout the US. This is a passionate episode that you won't want to miss! What are your thoughts? Join in the discussion by commenting below or calling 1-866-996-5440 to leave an audio response.

We all agree that antithrombotic therapy is the cornerstone in the care of patients with ACS and vascular disease as well as for preventing complications from PCI. In terms of long term therapy, we have been largely limited to antiplatelet therapy (aspirin +/- clopidogrel) which has been the standard therapy in the chronic setting and often part of a larger armamentarium of therapies in the acute setting. But with the success of clopidogrel, a new era was ushered in marked by tremendous excitement and a push to develop a wide range of new therapies. It’s been a productive period! With the prasugrel story as a backdrop, what lessons can we learn from the world of antithrombotic drug development? Dr Magnus Ohman, one of the lead investigators in antithrombotic research, joins me today to examine the following questions pertaining to the development of antithrobotics and their use: (1) What populations do we study? Why? (2) What is the comparator? (3) What constitutes a meaningful effect? (4) How do we address safety issues? (5) How do we enroll and get the trials done?

The AHA, ACC and other professional societies have done a tremendous job creating various documents to guide clinical practice. These include ACC/AHA guidelines covering numerous topics, performance measures, and clinical expert consensus documents. However there is no body of evidence that provides clear recommendations to cover all of the scenarios that we face in clinical practice. With this in mind ACC/AHA has been working on appropriateness or “appropriate use” criteria to address the issues of variability of practice from one location to another by documenting what experts deem to be the appropriate use of a particular technology. What are the implications of these new criteria? How will the information be interpreted by the public, by payers, by professional bodies? Join my discussion with Dr John Spertus from Mid America Heart Institute, an outcome investigator, clinical cardiologist, and senior author of the 2009 Appropriateness Criteria for Coronary Revascularizaton. What are your thoughts? Join in the discussion by commenting below or calling 1-866-996-5440 to leave an audio response.

Use of CT coronary angiography in the diagnostic assessment of patients with proven or suspected coronary disease is currently provoking intense discussion amongst cardiologists and radiologists. In this program, Dr Julie Miller provides background to the observational CORE 64 study for which she was co-principal investigator and discusses the results and their far reaching implications. In the ensuing discussion, Julie and I tackle some of the broader issues that are brought up by CORE 64 including: - How do we develop new technology and successfully adopt it into clinical practice? - How do we decide which patients should benefit from the new technology? - How do we deal with “turf wars” as the different specialists maneuver to administer the new technology? - What are the risks of new the new technology?

Over the past 15-18 years, research in the field of antithrombotic therapy has been stunning, fueled by an explosion of interest and breakthroughs. In this episode I discuss this exciting field with Dr Mike Gibson focusing specifically on the ATLAS trial: What was learned? What do the results mean? What challenges will the coming decade hold? More generally, how are phase II trials changing? Join in the discussion by listening to our exchange and then sharing your thoughts by commenting in the space below or by calling 1-866-996-5440 to leave an audio response.

HF-ACTION is a bold step into the realm of behavioral intervention and its role in altering clinical practice. In this episode, Dr O’Connor provides background on why he wanted to undertake the trial and how it came to life while discussing the goals of the trial, the major concerns from the outset and the ways to interpret the results. On a more philosophical level, what can we learn from “negative” trials? What are your thoughts? Join in the discussion by commenting below or calling 1-866-996-5440 to leave an audio response.

The high point of the 2008 American Heart Association (AHA) meeting was the release of the results of the JUPITER trial, a home run for the science and for the public health. I’m joined by Dr Paul Ridker from Brigham and Women's Hospital in Boston, who was the principal investigator on the JUPITER trial, to give us his insights on the results. Please join me by sending in your comments, questions and feedback. Write a comment (heartradio@theheart.org) or call 1-866-996-5440 to leave an audio comment.

The European Society of Cardiology (ESC) meeting continues to grow in scope. The breadth of educational offerings and the quality of the science presented greatly impressed me. The ESC has become a fantastic meeting for people who want to learn the latest in cardiovascular medicine and research. Two big things that I thought I would share with you: the SYNTAX and TRITON-TIMI 38 trials, and what they mean for practitioners. Please join me by sending in comments, questions and feedback. Write a comment (heartradio@theheart.org) or call 1-866-996-5440 to leave an audio comment.

Welcome to episode #1 of The Bob Harrington Show. Dr Robert A Harrington is explaining why he is taking on podcasting with theheart.org and what his show format will be. As the Arthur L Bloomfield Professor of Medicine and Chair of the Department of Medicine at Stanford University, and a practicing interventional cardiologist, Dr Harrington is bringing a unique perspective in this podcast about cardiology and clinical trials. Please join him by sending in comments, questions and feedback. Write a comment (radio@theheart.org) or call 1-866-996-5440 to leave an audio comment.