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Welcome everyone to the Becker's Healthcare podcast series.
I'm Moriah Muhammad, writer and moderator with Becker's
Healthcare. And I'm thrilled to have with me
today, doctor Anthony Tortellani,
cardiac surgeon in New York, New York. Doctor,
welcome to the podcast. We're very excited to
have you join us today. To get us
started, would you mind please introducing yourself and
telling us a bit about your background?
Yes, Maria. Thank you for inviting me. My
background is I'm a cardiac surgeon. I, was
a cardiac surgeon. I am now retired.
I am 80 years old. I spent, 40
years,
working for Weill Cornell Medical Center in New
York Presbyterian Hospital in New York City.
2 of those,
2 of those 40 years, 2 was spent
at Albert Einstein Medical School.
I mostly,
worked
on either building cardiac programs that were in
trouble
or starting new programs
at affiliated hospitals of Weill Cornell.
The last 5 years after I stopped operating,
I was asked to be a chairman
of surgery at a safety net hospital, Brookdale
Hospital
in,
Brooklyn,
which was quite an experience.
In the last year and a half,
since I've been completely retired,
I've continued to,
do some
med mal work.
I,
sort of, throughout my career, testified in that
mail cases in defense of doctors and hospitals.
I did not do plaintiff's work. And additionally,
I worked as a consultant for the Corazon
Company out of Pittsburgh
where they help programs throughout the country
who were, either
in trouble,
programs that we're not doing well, or in
hospitals where they're trying to start new cardiac
programs.
That's my background.
Wonderful. Thank you so much for giving us
that back. I'm sure it'll help with some
of your answers kinda understanding that.
And, jumping right into the first thing I
really wanted to discuss with you. You know,
speaking with other people in your field, I've
heard a lot of, talks of issues with
reimbursements,
technology,
staffing.
In your view, what are the top three
biggest issues in cardiology today?
Well, I think the 3 biggest issues in
cardiology
reflect,
as you just stated some of the big
issues
in
in medicine today. And I think they're most
important in cardiology,
cardiac surgery,
in the heart is care
because
people die of heart disease.
It it's not a problem that changes people's,
able to function. It's the difference between life
and death. So all of cardiology
is critically important.
I think
one of the main problems
is what we've talked about is socioeconomic
determinants,
which I
don't like the term because it puts
all of the burden on the patient.
I think we really need to talk about
the routine care of marginalized
patients.
And what marginalizes
the patients
is not the patient, but the caregivers
and the hospitals.
And I
think the care for cardiac disease
in rural safety net hospitals,
county hospitals, city hospitals, hospitals where they have
financial
issues
or the issues in recruiting the doctors and
and ancillary,
professionals.
It is
that
those hospitals cannot provide the same level of
care as major tertiary centers do for cardiac
problems.
And
this is especially important, I think,
in care in emergency rooms and intensive care
units throughout the country.
I think,
a second
problem is the burden of bureaucracy.
It's also especially true in cardiology and cardiac
surgery.
And this is some people think is leading
to a health care crisis.
It may be. We do know that 22%
of our
our caregivers
are not status are are have professional satisfaction.
The majority
are
in problematic
situations.
58%
of the doctors
and 51% of the nurses
feel there's truly excess amount of paperwork
interfering with patient care.
It's been shown
that
1 in 5
of patients who received intravenous
medication in the hospitals,
those medications are given an error.
Why? Because the caregiver cannot be at the
bedside.
The new hospitals now, if you look at
the nurses' stations, they're massive.
And what are they filled with? They're filled
with caregivers looking at computers.
The caregivers,
all of us, are not at the bedside.
And
the third thing I think is critically important
is that we have the rapid evolution
in care, both noninvasive
and invasive.
It's not available to all patients who are
in need in all the clinical situations,
but it should be.
It's a standard of care.
And
bottom line
that reflects on that
is that only
25%
of the patients who get CPR
in a hospital
survive to discharge.
And people who have had one CPR, one
arrest,
which is followed during that same hospitalization with
the second one, none survive.
That has not changed over the years
despite all the other changes and improvements in
care.
Therefore, we must look
not only
at routine care,
but it's truly critical care, which I'll talk
about in a few minutes.
Yeah. Yeah. Thank you so much for giving
us that that insight,
on on what you've been seeing, and it
it completely makes sense. How do you see
heart care evolving over the next 18 months
or so?
Well, I I think what we're seeing, and
it's being published in all the journals,
is the continuous
and rapid advances in percutaneous
care.
What I mean by that is the percutaneous
valve heart valve insertions
where the the design
continues to of the valves continues to improve.
We first
have done it in patients who are relatively
elective,
young, and safe,
but we're learning as we do better in
a
and do better
in in the procedure
aspect of it and also having better valves,
we're able to do it in higher risk
patients
and older patients safely,
which are the patients that are also the
highest risk when you do them in the
operating room.
And
where we
have placed these valves in people who are
well into the progression of the disease process,
we're now able to put it into people
prior
to permanent damage of the ventricles. So if
you have someone with aortic stenosis,
if you could put those valves into people
earlier, the hypertrophy
in aortic stenosis of the left ventricle or
the dilatation of the left ventricle in mitral
regurgitation or aortic regurgitation
will be prevented.
So a long term outcome,
the life and death, They will live longer,
but, also, they will have more active and
productive lives.
Related,
to the percutaneous,
approaches is also
what we're doing with the PTCA
with percutaneous
stents.
Now
now the question is now do we put
stents in the comfort vessel
when patients are developing an intraction, or do
it in all the vessels? That's an open
question.
All the vessels that are involved with coronary
disease.
That's an open question, but that's being looked
at actively as we speak.
We continue to develop better and better,
stents that are longer lasting
and easier to
to insert.
So the stents are improving, indications are changing,
and the application
of of stents in elective situations, not only
in the emergent situations is also involved.
The the
percutaneous
care of patients with arrhythmias,
the new ablation procedures for atrial fibrillation,
the use of advanced pacemakers
that could pace both the atrium and the
ventricle,
the,
use of implantable defibrillators,
and,
the use of special types of pacemakers for,
complete heart block. All this is improving as
we speak.
Also, the,
the the utilization
of percutaneous
right ventricular
electric ventricular
assist devices,
both with people who are involving infarctions,
people in care clinics who are having problems
in the intraoperative care,
and in patients who are even arrested.
So that whole
percutaneous
intervention, both in valves,
coronary
disease,
in arrhythmias,
and finally, if people who have significant right
of ventricular heart failure, acute or chronic,
is all in developmental
or progressive stages.
I think we will do
we will discuss in a few minutes at
the meeting,
the use of our patient care labs will
continue to increase.
It's more efficient.
Patients like it better,
and it will evolve
as we do more of these percutaneous
procedures.
Also, it will save money.
I think the,
proactive screening,
where we would do a cardiac catheterization
of patients, state valve disease or or coronary
disease,
we're now looking
at people who are at high risk for
significant coronary disease,
looking at calcium scores,
PTA angiograms,
stress echoes.
This is allowing us to intervene earlier
in what could be a fatal disease as
that disease
progresses in any individual patient.
Finally, there have been some recent articles in
New England Journal of Medicine
just putting in
cardiac
assist devices,
to replace cardiac function
if people have severe
cardiac damage, it may be considered even,
people who have a cardiac death. We could
put those devices in patients.
If the people are,
or brain dead
who require those devices to sustain them, and
those patients then can be utilized
as donors
of, lung,
kidney, liver,
and or
we can sustain them with those devices
and give their chance the heart a chance
to improve
after acute damage.
Right now, many of the medications we use
in people who have acute
or severe heart failure ultimately
will cause more damage to the heart than
they delay death, but not prevent death.
I think
all of these percutaneous
interventions,
the valvular heart disease,
coronary disease,
arrhythmias, and finally for heart failure,
all developing very rapidly
and will save lives.
Yeah. Perfect. Perfect. You know, you said a
lot of great insight,
in this podcast for sure.
Very quickly before we wrap up, the last
thing I really wanted to ask you is,
I mean, you've talked a lot about
some issues that have been happening and kinda
where you see the future of cardiology.
Is there anything that is making you excited
about today and anything that is making you
nervous
about what you're seeing in cardiology?
What what what excites me is two things.
I see the doctors and nurses coming together.
The best thing is cardiology
or cardiac surgery
working together, both in decision making
and in care.
The surgeon is in the cath lab
working with the cardiologist. The cardiologists are coming
to the operating room.
We are doing much better working together.
I, I see,
that there is now
a
discussion about unifying
intensive care units
and actually
considering making
a board
a a board
or board certification
for cardiac critical care. Those patients, be it
surgery or,
cardiology,
should be cared for by the same nurses
and the same doctors 247.
And the other
thing that I see developing
is the
intervention
with,
artificial intelligence, not only to take the paperwork
away from us and to
decrease that burden,
but also in developing
collecting data, developing algorithms,
developing
models
that can give us,
develop
inference engine, which will help us making,
medical decisions.
That's a little bit in the future, but
I think it's coming. Someone recently said we're
gonna go from a dyad,
the patient
to the care and the caregiver to a
triad, the patient, the caregiver, and AI.
And if you want me to just mention
briefly what I what really makes me nervous
is
the, private equity
and corporations
taking over medicine and doctors and hospitals.
I think it's dangerous
because it's making a profession a business.
And I think that is very dangerous for
patient care.
We are not business people. We're caregivers. We're
here to
prevent death or delay death and improve people's
health. We're not in it to make a
profit.
And if the people who are keep governing
us, controlling us are gonna have to make
a profit, It will take away the profession.
It will make us purely workers for business
people who wanna make a profit. I think
it's very dangerous.
Yeah. Yeah. Absolutely. Thank you so much for
those final thoughts, doctor. This has definitely been
a a very informative discussion. So, again, I
wanna thank you so much for coming on,
Becker's, and I look forward to connecting with
you again soon.