1 00:00:00,240 --> 00:00:03,060 Imagine this. You're at the Hyatt Regency Chicago 2 00:00:03,439 --> 00:00:06,000 immersed in insightful discussions with the health care 3 00:00:06,000 --> 00:00:07,459 industry's top leaders. 4 00:00:07,839 --> 00:00:10,580 Welcome to Becker's 12th annual CEO 5 00:00:10,880 --> 00:00:14,740 and CFO roundtable from November 11th to 14th 6 00:00:15,134 --> 00:00:15,634 2024. 7 00:00:16,175 --> 00:00:19,315 Picture yourself networking with over a 1000 executive 8 00:00:19,454 --> 00:00:20,275 level attendees, 9 00:00:20,734 --> 00:00:23,795 collecting business cards, and forging valuable connections. 10 00:00:24,255 --> 00:00:26,654 Feel the excitement as you engage in 4 11 00:00:26,654 --> 00:00:28,675 days of sessions featuring 400 12 00:00:29,135 --> 00:00:30,870 elite health system speakers. 13 00:00:31,429 --> 00:00:35,049 Envision yourself diving deep into critical topics like 14 00:00:35,109 --> 00:00:37,450 rural health care, digital transformation, 15 00:00:38,070 --> 00:00:40,409 health equity, and c suite diversity. 16 00:00:41,190 --> 00:00:44,729 Now imagine being inspired by our celebrity keynotes, 17 00:00:45,195 --> 00:00:48,234 pro football hall of famers Troy Aikman and 18 00:00:48,234 --> 00:00:52,075 Emmett Smith, 43rd president George w Bush, and 19 00:00:52,075 --> 00:00:55,435 author and journalist Jenna Bush Hager. Their stories 20 00:00:55,435 --> 00:00:56,495 will leave you motivated 21 00:00:56,875 --> 00:00:57,695 and energized. 22 00:00:58,234 --> 00:00:59,535 Don't miss this unparalleled 23 00:00:59,995 --> 00:01:00,495 opportunity. 24 00:01:00,990 --> 00:01:03,329 Get registered today. Visit beckershospitalreview.com 25 00:01:05,230 --> 00:01:06,989 and click on the events page to find 26 00:01:06,989 --> 00:01:08,129 the conference website. 27 00:01:08,510 --> 00:01:09,489 That's the beckershospitalreview.com 28 00:01:11,709 --> 00:01:13,729 events page. See you in Chicago. 29 00:01:14,754 --> 00:01:17,394 Welcome everyone to the Becker's Healthcare podcast series. 30 00:01:17,394 --> 00:01:19,875 I'm Moriah Muhammad, writer and moderator with Becker's 31 00:01:19,875 --> 00:01:21,634 Healthcare. And I'm thrilled to have with me 32 00:01:21,634 --> 00:01:23,254 today, doctor Anthony Tortellani, 33 00:01:23,634 --> 00:01:25,875 cardiac surgeon in New York, New York. Doctor, 34 00:01:25,875 --> 00:01:27,480 welcome to the podcast. We're very excited to 35 00:01:27,480 --> 00:01:29,079 have you join us today. To get us 36 00:01:29,079 --> 00:01:30,920 started, would you mind please introducing yourself and 37 00:01:30,920 --> 00:01:32,380 telling us a bit about your background? 38 00:01:33,159 --> 00:01:35,640 Yes, Maria. Thank you for inviting me. My 39 00:01:35,640 --> 00:01:39,560 background is I'm a cardiac surgeon. I, was 40 00:01:39,560 --> 00:01:42,060 a cardiac surgeon. I am now retired. 41 00:01:42,525 --> 00:01:45,245 I am 80 years old. I spent, 40 42 00:01:45,245 --> 00:01:45,745 years, 43 00:01:46,364 --> 00:01:49,084 working for Weill Cornell Medical Center in New 44 00:01:49,084 --> 00:01:51,424 York Presbyterian Hospital in New York City. 45 00:01:52,525 --> 00:01:53,424 2 of those, 46 00:01:54,045 --> 00:01:56,010 2 of those 40 years, 2 was spent 47 00:01:56,329 --> 00:01:58,270 at Albert Einstein Medical School. 48 00:01:58,650 --> 00:01:59,469 I mostly, 49 00:02:01,689 --> 00:02:02,189 worked 50 00:02:02,490 --> 00:02:05,290 on either building cardiac programs that were in 51 00:02:05,290 --> 00:02:05,790 trouble 52 00:02:06,490 --> 00:02:08,030 or starting new programs 53 00:02:08,650 --> 00:02:11,469 at affiliated hospitals of Weill Cornell. 54 00:02:12,465 --> 00:02:14,965 The last 5 years after I stopped operating, 55 00:02:15,425 --> 00:02:17,284 I was asked to be a chairman 56 00:02:17,664 --> 00:02:20,645 of surgery at a safety net hospital, Brookdale 57 00:02:20,705 --> 00:02:21,205 Hospital 58 00:02:21,504 --> 00:02:22,004 in, 59 00:02:22,784 --> 00:02:23,284 Brooklyn, 60 00:02:24,064 --> 00:02:25,604 which was quite an experience. 61 00:02:26,349 --> 00:02:27,969 In the last year and a half, 62 00:02:28,990 --> 00:02:30,689 since I've been completely retired, 63 00:02:31,550 --> 00:02:32,849 I've continued to, 64 00:02:33,389 --> 00:02:34,129 do some 65 00:02:34,430 --> 00:02:35,490 med mal work. 66 00:02:36,349 --> 00:02:36,750 I, 67 00:02:37,310 --> 00:02:40,334 sort of, throughout my career, testified in that 68 00:02:40,334 --> 00:02:43,134 mail cases in defense of doctors and hospitals. 69 00:02:43,134 --> 00:02:45,555 I did not do plaintiff's work. And additionally, 70 00:02:45,614 --> 00:02:47,555 I worked as a consultant for the Corazon 71 00:02:47,614 --> 00:02:48,754 Company out of Pittsburgh 72 00:02:49,294 --> 00:02:51,555 where they help programs throughout the country 73 00:02:51,854 --> 00:02:53,314 who were, either 74 00:02:54,090 --> 00:02:54,830 in trouble, 75 00:02:55,370 --> 00:02:57,770 programs that we're not doing well, or in 76 00:02:57,770 --> 00:03:00,189 hospitals where they're trying to start new cardiac 77 00:03:00,250 --> 00:03:00,750 programs. 78 00:03:01,210 --> 00:03:02,750 That's my background. 79 00:03:04,169 --> 00:03:06,090 Wonderful. Thank you so much for giving us 80 00:03:06,090 --> 00:03:07,814 that back. I'm sure it'll help with some 81 00:03:07,814 --> 00:03:09,754 of your answers kinda understanding that. 82 00:03:10,135 --> 00:03:12,215 And, jumping right into the first thing I 83 00:03:12,215 --> 00:03:14,215 really wanted to discuss with you. You know, 84 00:03:14,215 --> 00:03:16,215 speaking with other people in your field, I've 85 00:03:16,215 --> 00:03:18,629 heard a lot of, talks of issues with 86 00:03:18,950 --> 00:03:19,450 reimbursements, 87 00:03:19,830 --> 00:03:20,330 technology, 88 00:03:20,790 --> 00:03:21,290 staffing. 89 00:03:21,830 --> 00:03:23,669 In your view, what are the top three 90 00:03:23,669 --> 00:03:25,930 biggest issues in cardiology today? 91 00:03:26,950 --> 00:03:29,430 Well, I think the 3 biggest issues in 92 00:03:29,430 --> 00:03:29,930 cardiology 93 00:03:30,710 --> 00:03:31,210 reflect, 94 00:03:31,594 --> 00:03:33,594 as you just stated some of the big 95 00:03:33,594 --> 00:03:34,094 issues 96 00:03:34,794 --> 00:03:35,294 in 97 00:03:35,674 --> 00:03:38,474 in medicine today. And I think they're most 98 00:03:38,474 --> 00:03:39,694 important in cardiology, 99 00:03:40,555 --> 00:03:41,454 cardiac surgery, 100 00:03:42,394 --> 00:03:44,430 in the heart is care 101 00:03:44,889 --> 00:03:45,389 because 102 00:03:46,329 --> 00:03:48,109 people die of heart disease. 103 00:03:49,049 --> 00:03:52,430 It it's not a problem that changes people's, 104 00:03:53,689 --> 00:03:56,329 able to function. It's the difference between life 105 00:03:56,329 --> 00:03:58,444 and death. So all of cardiology 106 00:03:58,745 --> 00:03:59,965 is critically important. 107 00:04:00,584 --> 00:04:01,245 I think 108 00:04:01,544 --> 00:04:03,164 one of the main problems 109 00:04:03,705 --> 00:04:05,965 is what we've talked about is socioeconomic 110 00:04:06,504 --> 00:04:07,004 determinants, 111 00:04:07,544 --> 00:04:08,364 which I 112 00:04:08,745 --> 00:04:10,924 don't like the term because it puts 113 00:04:11,490 --> 00:04:13,590 all of the burden on the patient. 114 00:04:14,129 --> 00:04:16,290 I think we really need to talk about 115 00:04:16,290 --> 00:04:18,629 the routine care of marginalized 116 00:04:19,009 --> 00:04:19,509 patients. 117 00:04:20,209 --> 00:04:21,350 And what marginalizes 118 00:04:21,730 --> 00:04:22,470 the patients 119 00:04:23,009 --> 00:04:25,110 is not the patient, but the caregivers 120 00:04:25,490 --> 00:04:26,389 and the hospitals. 121 00:04:27,384 --> 00:04:28,125 And I 122 00:04:28,425 --> 00:04:30,925 think the care for cardiac disease 123 00:04:31,305 --> 00:04:33,324 in rural safety net hospitals, 124 00:04:33,944 --> 00:04:36,824 county hospitals, city hospitals, hospitals where they have 125 00:04:36,824 --> 00:04:37,324 financial 126 00:04:37,865 --> 00:04:38,365 issues 127 00:04:39,399 --> 00:04:42,120 or the issues in recruiting the doctors and 128 00:04:42,120 --> 00:04:43,259 and ancillary, 129 00:04:43,959 --> 00:04:44,459 professionals. 130 00:04:46,039 --> 00:04:46,860 It is 131 00:04:47,240 --> 00:04:47,740 that 132 00:04:48,360 --> 00:04:51,240 those hospitals cannot provide the same level of 133 00:04:51,240 --> 00:04:54,584 care as major tertiary centers do for cardiac 134 00:04:54,745 --> 00:04:55,245 problems. 135 00:04:55,944 --> 00:04:56,444 And 136 00:04:57,544 --> 00:04:59,805 this is especially important, I think, 137 00:05:00,504 --> 00:05:03,144 in care in emergency rooms and intensive care 138 00:05:03,144 --> 00:05:04,444 units throughout the country. 139 00:05:05,785 --> 00:05:06,444 I think, 140 00:05:06,985 --> 00:05:07,724 a second 141 00:05:09,000 --> 00:05:11,339 problem is the burden of bureaucracy. 142 00:05:12,599 --> 00:05:15,879 It's also especially true in cardiology and cardiac 143 00:05:15,879 --> 00:05:16,379 surgery. 144 00:05:17,560 --> 00:05:19,639 And this is some people think is leading 145 00:05:19,639 --> 00:05:20,939 to a health care crisis. 146 00:05:22,064 --> 00:05:24,725 It may be. We do know that 22% 147 00:05:25,105 --> 00:05:25,685 of our 148 00:05:26,545 --> 00:05:27,205 our caregivers 149 00:05:27,665 --> 00:05:31,285 are not status are are have professional satisfaction. 150 00:05:32,064 --> 00:05:32,725 The majority 151 00:05:33,025 --> 00:05:33,525 are 152 00:05:34,305 --> 00:05:35,045 in problematic 153 00:05:35,425 --> 00:05:35,925 situations. 154 00:05:37,370 --> 00:05:37,870 58% 155 00:05:38,329 --> 00:05:39,230 of the doctors 156 00:05:40,089 --> 00:05:41,870 and 51% of the nurses 157 00:05:42,490 --> 00:05:45,149 feel there's truly excess amount of paperwork 158 00:05:45,529 --> 00:05:47,149 interfering with patient care. 159 00:05:48,250 --> 00:05:49,230 It's been shown 160 00:05:49,850 --> 00:05:50,350 that 161 00:05:51,395 --> 00:05:52,535 1 in 5 162 00:05:53,235 --> 00:05:55,175 of patients who received intravenous 163 00:05:55,955 --> 00:05:57,574 medication in the hospitals, 164 00:05:58,514 --> 00:06:00,694 those medications are given an error. 165 00:06:01,235 --> 00:06:04,194 Why? Because the caregiver cannot be at the 166 00:06:04,194 --> 00:06:04,694 bedside. 167 00:06:05,970 --> 00:06:08,290 The new hospitals now, if you look at 168 00:06:08,290 --> 00:06:10,230 the nurses' stations, they're massive. 169 00:06:11,810 --> 00:06:13,730 And what are they filled with? They're filled 170 00:06:13,730 --> 00:06:15,830 with caregivers looking at computers. 171 00:06:17,250 --> 00:06:17,830 The caregivers, 172 00:06:18,529 --> 00:06:20,550 all of us, are not at the bedside. 173 00:06:21,584 --> 00:06:22,084 And 174 00:06:22,464 --> 00:06:24,805 the third thing I think is critically important 175 00:06:25,264 --> 00:06:27,365 is that we have the rapid evolution 176 00:06:28,384 --> 00:06:30,004 in care, both noninvasive 177 00:06:30,464 --> 00:06:31,204 and invasive. 178 00:06:31,824 --> 00:06:34,625 It's not available to all patients who are 179 00:06:34,625 --> 00:06:37,459 in need in all the clinical situations, 180 00:06:38,800 --> 00:06:39,939 but it should be. 181 00:06:41,120 --> 00:06:42,660 It's a standard of care. 182 00:06:44,079 --> 00:06:44,579 And 183 00:06:45,360 --> 00:06:46,259 bottom line 184 00:06:47,040 --> 00:06:48,419 that reflects on that 185 00:06:49,074 --> 00:06:49,895 is that only 186 00:06:50,595 --> 00:06:51,095 25% 187 00:06:51,634 --> 00:06:53,415 of the patients who get CPR 188 00:06:53,795 --> 00:06:54,615 in a hospital 189 00:06:55,795 --> 00:06:56,935 survive to discharge. 190 00:06:58,355 --> 00:07:01,074 And people who have had one CPR, one 191 00:07:01,074 --> 00:07:01,574 arrest, 192 00:07:02,089 --> 00:07:04,569 which is followed during that same hospitalization with 193 00:07:04,569 --> 00:07:06,509 the second one, none survive. 194 00:07:08,650 --> 00:07:10,750 That has not changed over the years 195 00:07:11,050 --> 00:07:13,610 despite all the other changes and improvements in 196 00:07:13,610 --> 00:07:14,110 care. 197 00:07:14,889 --> 00:07:16,509 Therefore, we must look 198 00:07:17,414 --> 00:07:18,154 not only 199 00:07:19,254 --> 00:07:20,555 at routine care, 200 00:07:21,414 --> 00:07:23,334 but it's truly critical care, which I'll talk 201 00:07:23,334 --> 00:07:24,555 about in a few minutes. 202 00:07:25,654 --> 00:07:27,574 Yeah. Yeah. Thank you so much for giving 203 00:07:27,574 --> 00:07:28,714 us that that insight, 204 00:07:29,414 --> 00:07:31,095 on on what you've been seeing, and it 205 00:07:31,095 --> 00:07:33,329 it completely makes sense. How do you see 206 00:07:33,329 --> 00:07:35,969 heart care evolving over the next 18 months 207 00:07:35,969 --> 00:07:36,629 or so? 208 00:07:37,889 --> 00:07:40,849 Well, I I think what we're seeing, and 209 00:07:40,849 --> 00:07:42,949 it's being published in all the journals, 210 00:07:43,810 --> 00:07:44,870 is the continuous 211 00:07:45,329 --> 00:07:47,509 and rapid advances in percutaneous 212 00:07:47,889 --> 00:07:48,225 care. 213 00:07:49,185 --> 00:07:51,605 What I mean by that is the percutaneous 214 00:07:51,985 --> 00:07:54,004 valve heart valve insertions 215 00:07:55,024 --> 00:07:56,884 where the the design 216 00:07:57,264 --> 00:08:00,084 continues to of the valves continues to improve. 217 00:08:01,080 --> 00:08:01,740 We first 218 00:08:02,120 --> 00:08:04,220 have done it in patients who are relatively 219 00:08:04,520 --> 00:08:05,020 elective, 220 00:08:05,399 --> 00:08:06,620 young, and safe, 221 00:08:06,920 --> 00:08:09,699 but we're learning as we do better in 222 00:08:09,720 --> 00:08:10,220 a 223 00:08:10,759 --> 00:08:11,819 and do better 224 00:08:12,360 --> 00:08:13,259 in in the procedure 225 00:08:13,685 --> 00:08:16,425 aspect of it and also having better valves, 226 00:08:16,884 --> 00:08:19,125 we're able to do it in higher risk 227 00:08:19,125 --> 00:08:19,625 patients 228 00:08:20,085 --> 00:08:21,865 and older patients safely, 229 00:08:23,125 --> 00:08:24,805 which are the patients that are also the 230 00:08:24,805 --> 00:08:26,485 highest risk when you do them in the 231 00:08:26,485 --> 00:08:27,384 operating room. 232 00:08:29,279 --> 00:08:29,779 And 233 00:08:30,800 --> 00:08:32,019 where we 234 00:08:33,039 --> 00:08:35,700 have placed these valves in people who are 235 00:08:36,240 --> 00:08:38,720 well into the progression of the disease process, 236 00:08:38,720 --> 00:08:40,899 we're now able to put it into people 237 00:08:42,065 --> 00:08:42,565 prior 238 00:08:43,264 --> 00:08:45,825 to permanent damage of the ventricles. So if 239 00:08:45,825 --> 00:08:47,684 you have someone with aortic stenosis, 240 00:08:49,504 --> 00:08:52,065 if you could put those valves into people 241 00:08:52,065 --> 00:08:53,524 earlier, the hypertrophy 242 00:08:54,470 --> 00:08:56,950 in aortic stenosis of the left ventricle or 243 00:08:56,950 --> 00:08:59,429 the dilatation of the left ventricle in mitral 244 00:08:59,429 --> 00:09:01,290 regurgitation or aortic regurgitation 245 00:09:01,830 --> 00:09:02,730 will be prevented. 246 00:09:03,590 --> 00:09:05,290 So a long term outcome, 247 00:09:06,309 --> 00:09:08,394 the life and death, They will live longer, 248 00:09:08,394 --> 00:09:10,555 but, also, they will have more active and 249 00:09:10,555 --> 00:09:11,615 productive lives. 250 00:09:12,394 --> 00:09:12,894 Related, 251 00:09:13,754 --> 00:09:14,654 to the percutaneous, 252 00:09:16,875 --> 00:09:18,335 approaches is also 253 00:09:19,115 --> 00:09:20,495 what we're doing with the PTCA 254 00:09:21,115 --> 00:09:21,870 with percutaneous 255 00:09:22,669 --> 00:09:23,169 stents. 256 00:09:23,870 --> 00:09:24,370 Now 257 00:09:24,909 --> 00:09:26,990 now the question is now do we put 258 00:09:26,990 --> 00:09:28,610 stents in the comfort vessel 259 00:09:28,990 --> 00:09:31,549 when patients are developing an intraction, or do 260 00:09:31,549 --> 00:09:33,549 it in all the vessels? That's an open 261 00:09:33,549 --> 00:09:34,049 question. 262 00:09:35,705 --> 00:09:37,545 All the vessels that are involved with coronary 263 00:09:37,545 --> 00:09:38,045 disease. 264 00:09:38,425 --> 00:09:40,985 That's an open question, but that's being looked 265 00:09:40,985 --> 00:09:42,764 at actively as we speak. 266 00:09:43,785 --> 00:09:46,365 We continue to develop better and better, 267 00:09:47,865 --> 00:09:49,839 stents that are longer lasting 268 00:09:50,139 --> 00:09:51,279 and easier to 269 00:09:51,580 --> 00:09:52,639 to insert. 270 00:09:53,820 --> 00:09:56,879 So the stents are improving, indications are changing, 271 00:09:58,059 --> 00:09:59,279 and the application 272 00:10:00,139 --> 00:10:02,860 of of stents in elective situations, not only 273 00:10:02,860 --> 00:10:05,545 in the emergent situations is also involved. 274 00:10:06,965 --> 00:10:07,785 The the 275 00:10:08,325 --> 00:10:08,825 percutaneous 276 00:10:09,285 --> 00:10:11,065 care of patients with arrhythmias, 277 00:10:12,165 --> 00:10:15,305 the new ablation procedures for atrial fibrillation, 278 00:10:16,085 --> 00:10:17,705 the use of advanced pacemakers 279 00:10:18,940 --> 00:10:20,860 that could pace both the atrium and the 280 00:10:20,860 --> 00:10:21,360 ventricle, 281 00:10:21,980 --> 00:10:22,460 the, 282 00:10:22,940 --> 00:10:24,960 use of implantable defibrillators, 283 00:10:25,899 --> 00:10:26,220 and, 284 00:10:27,019 --> 00:10:29,820 the use of special types of pacemakers for, 285 00:10:30,060 --> 00:10:32,940 complete heart block. All this is improving as 286 00:10:32,940 --> 00:10:33,680 we speak. 287 00:10:34,754 --> 00:10:35,654 Also, the, 288 00:10:37,315 --> 00:10:38,375 the the utilization 289 00:10:39,235 --> 00:10:40,134 of percutaneous 290 00:10:40,995 --> 00:10:41,735 right ventricular 291 00:10:42,035 --> 00:10:43,014 electric ventricular 292 00:10:43,715 --> 00:10:44,615 assist devices, 293 00:10:45,554 --> 00:10:47,575 both with people who are involving infarctions, 294 00:10:48,220 --> 00:10:50,480 people in care clinics who are having problems 295 00:10:50,620 --> 00:10:52,320 in the intraoperative care, 296 00:10:53,580 --> 00:10:55,679 and in patients who are even arrested. 297 00:10:56,379 --> 00:10:57,600 So that whole 298 00:10:58,139 --> 00:10:58,639 percutaneous 299 00:10:59,899 --> 00:11:01,679 intervention, both in valves, 300 00:11:02,294 --> 00:11:02,794 coronary 301 00:11:03,174 --> 00:11:03,674 disease, 302 00:11:04,455 --> 00:11:05,115 in arrhythmias, 303 00:11:05,575 --> 00:11:08,294 and finally, if people who have significant right 304 00:11:08,294 --> 00:11:11,034 of ventricular heart failure, acute or chronic, 305 00:11:11,495 --> 00:11:12,714 is all in developmental 306 00:11:13,095 --> 00:11:14,554 or progressive stages. 307 00:11:15,750 --> 00:11:16,629 I think we will do 308 00:11:17,350 --> 00:11:19,029 we will discuss in a few minutes at 309 00:11:19,029 --> 00:11:19,690 the meeting, 310 00:11:20,470 --> 00:11:23,029 the use of our patient care labs will 311 00:11:23,029 --> 00:11:24,410 continue to increase. 312 00:11:25,429 --> 00:11:26,490 It's more efficient. 313 00:11:27,590 --> 00:11:28,970 Patients like it better, 314 00:11:29,794 --> 00:11:31,174 and it will evolve 315 00:11:32,434 --> 00:11:34,454 as we do more of these percutaneous 316 00:11:34,834 --> 00:11:35,334 procedures. 317 00:11:36,194 --> 00:11:37,495 Also, it will save money. 318 00:11:38,514 --> 00:11:39,315 I think the, 319 00:11:41,154 --> 00:11:42,294 proactive screening, 320 00:11:43,490 --> 00:11:45,429 where we would do a cardiac catheterization 321 00:11:45,809 --> 00:11:49,190 of patients, state valve disease or or coronary 322 00:11:49,250 --> 00:11:49,750 disease, 323 00:11:50,610 --> 00:11:51,750 we're now looking 324 00:11:52,289 --> 00:11:54,289 at people who are at high risk for 325 00:11:54,289 --> 00:11:55,909 significant coronary disease, 326 00:11:56,934 --> 00:11:58,875 looking at calcium scores, 327 00:11:59,414 --> 00:12:00,394 PTA angiograms, 328 00:12:01,334 --> 00:12:02,394 stress echoes. 329 00:12:02,934 --> 00:12:05,674 This is allowing us to intervene earlier 330 00:12:06,774 --> 00:12:09,174 in what could be a fatal disease as 331 00:12:09,174 --> 00:12:10,110 that disease 332 00:12:10,490 --> 00:12:12,669 progresses in any individual patient. 333 00:12:13,370 --> 00:12:15,690 Finally, there have been some recent articles in 334 00:12:15,690 --> 00:12:16,990 New England Journal of Medicine 335 00:12:18,410 --> 00:12:19,870 just putting in 336 00:12:20,410 --> 00:12:20,910 cardiac 337 00:12:21,370 --> 00:12:22,190 assist devices, 338 00:12:24,105 --> 00:12:25,804 to replace cardiac function 339 00:12:26,345 --> 00:12:27,884 if people have severe 340 00:12:29,384 --> 00:12:32,205 cardiac damage, it may be considered even, 341 00:12:32,665 --> 00:12:35,144 people who have a cardiac death. We could 342 00:12:35,144 --> 00:12:37,085 put those devices in patients. 343 00:12:37,549 --> 00:12:38,929 If the people are, 344 00:12:40,029 --> 00:12:41,250 or brain dead 345 00:12:41,709 --> 00:12:45,549 who require those devices to sustain them, and 346 00:12:45,549 --> 00:12:47,970 those patients then can be utilized 347 00:12:48,509 --> 00:12:49,250 as donors 348 00:12:50,325 --> 00:12:51,465 of, lung, 349 00:12:52,004 --> 00:12:53,144 kidney, liver, 350 00:12:54,165 --> 00:12:55,065 and or 351 00:12:55,684 --> 00:12:57,865 we can sustain them with those devices 352 00:12:58,245 --> 00:13:00,485 and give their chance the heart a chance 353 00:13:00,485 --> 00:13:01,144 to improve 354 00:13:01,764 --> 00:13:03,065 after acute damage. 355 00:13:03,860 --> 00:13:06,440 Right now, many of the medications we use 356 00:13:06,740 --> 00:13:08,519 in people who have acute 357 00:13:09,139 --> 00:13:11,560 or severe heart failure ultimately 358 00:13:12,100 --> 00:13:14,259 will cause more damage to the heart than 359 00:13:14,259 --> 00:13:17,080 they delay death, but not prevent death. 360 00:13:17,534 --> 00:13:18,274 I think 361 00:13:18,975 --> 00:13:20,355 all of these percutaneous 362 00:13:20,815 --> 00:13:21,315 interventions, 363 00:13:22,575 --> 00:13:23,954 the valvular heart disease, 364 00:13:24,495 --> 00:13:25,554 coronary disease, 365 00:13:26,174 --> 00:13:28,674 arrhythmias, and finally for heart failure, 366 00:13:29,054 --> 00:13:31,235 all developing very rapidly 367 00:13:31,615 --> 00:13:32,914 and will save lives. 368 00:13:34,629 --> 00:13:36,710 Yeah. Perfect. Perfect. You know, you said a 369 00:13:36,710 --> 00:13:38,250 lot of great insight, 370 00:13:38,710 --> 00:13:40,490 in this podcast for sure. 371 00:13:41,269 --> 00:13:43,429 Very quickly before we wrap up, the last 372 00:13:43,429 --> 00:13:45,029 thing I really wanted to ask you is, 373 00:13:45,029 --> 00:13:46,649 I mean, you've talked a lot about 374 00:13:46,964 --> 00:13:49,204 some issues that have been happening and kinda 375 00:13:49,204 --> 00:13:51,384 where you see the future of cardiology. 376 00:13:52,324 --> 00:13:54,725 Is there anything that is making you excited 377 00:13:54,725 --> 00:13:56,884 about today and anything that is making you 378 00:13:56,884 --> 00:13:57,384 nervous 379 00:13:57,684 --> 00:13:59,225 about what you're seeing in cardiology? 380 00:14:00,500 --> 00:14:03,639 What what what excites me is two things. 381 00:14:04,019 --> 00:14:07,399 I see the doctors and nurses coming together. 382 00:14:07,779 --> 00:14:09,159 The best thing is cardiology 383 00:14:09,620 --> 00:14:10,839 or cardiac surgery 384 00:14:11,460 --> 00:14:13,879 working together, both in decision making 385 00:14:14,964 --> 00:14:15,865 and in care. 386 00:14:16,404 --> 00:14:18,504 The surgeon is in the cath lab 387 00:14:19,044 --> 00:14:21,684 working with the cardiologist. The cardiologists are coming 388 00:14:21,684 --> 00:14:23,065 to the operating room. 389 00:14:23,764 --> 00:14:27,705 We are doing much better working together. 390 00:14:28,620 --> 00:14:30,160 I, I see, 391 00:14:30,940 --> 00:14:32,080 that there is now 392 00:14:32,620 --> 00:14:33,120 a 393 00:14:33,660 --> 00:14:35,279 discussion about unifying 394 00:14:35,740 --> 00:14:37,120 intensive care units 395 00:14:37,660 --> 00:14:38,320 and actually 396 00:14:39,660 --> 00:14:40,799 considering making 397 00:14:41,179 --> 00:14:41,840 a board 398 00:14:43,745 --> 00:14:44,485 a a board 399 00:14:45,184 --> 00:14:46,644 or board certification 400 00:14:47,425 --> 00:14:50,384 for cardiac critical care. Those patients, be it 401 00:14:50,384 --> 00:14:51,425 surgery or, 402 00:14:51,825 --> 00:14:52,325 cardiology, 403 00:14:52,945 --> 00:14:55,264 should be cared for by the same nurses 404 00:14:55,264 --> 00:14:56,965 and the same doctors 247. 405 00:14:57,899 --> 00:14:58,720 And the other 406 00:14:59,180 --> 00:15:00,559 thing that I see developing 407 00:15:00,860 --> 00:15:01,440 is the 408 00:15:01,820 --> 00:15:02,320 intervention 409 00:15:02,779 --> 00:15:03,279 with, 410 00:15:04,139 --> 00:15:07,279 artificial intelligence, not only to take the paperwork 411 00:15:08,220 --> 00:15:09,600 away from us and to 412 00:15:09,980 --> 00:15:11,360 decrease that burden, 413 00:15:12,065 --> 00:15:13,524 but also in developing 414 00:15:14,945 --> 00:15:17,204 collecting data, developing algorithms, 415 00:15:17,584 --> 00:15:18,084 developing 416 00:15:18,704 --> 00:15:19,204 models 417 00:15:19,825 --> 00:15:20,784 that can give us, 418 00:15:22,865 --> 00:15:23,365 develop 419 00:15:23,904 --> 00:15:26,500 inference engine, which will help us making, 420 00:15:27,440 --> 00:15:28,500 medical decisions. 421 00:15:28,960 --> 00:15:30,960 That's a little bit in the future, but 422 00:15:30,960 --> 00:15:33,679 I think it's coming. Someone recently said we're 423 00:15:33,679 --> 00:15:34,899 gonna go from a dyad, 424 00:15:35,279 --> 00:15:36,019 the patient 425 00:15:36,399 --> 00:15:38,320 to the care and the caregiver to a 426 00:15:38,320 --> 00:15:41,524 triad, the patient, the caregiver, and AI. 427 00:15:42,225 --> 00:15:44,065 And if you want me to just mention 428 00:15:44,065 --> 00:15:46,485 briefly what I what really makes me nervous 429 00:15:47,825 --> 00:15:48,325 is 430 00:15:48,705 --> 00:15:50,485 the, private equity 431 00:15:50,945 --> 00:15:51,845 and corporations 432 00:15:52,225 --> 00:15:55,044 taking over medicine and doctors and hospitals. 433 00:15:55,590 --> 00:15:56,570 I think it's dangerous 434 00:15:57,190 --> 00:16:00,170 because it's making a profession a business. 435 00:16:00,950 --> 00:16:03,029 And I think that is very dangerous for 436 00:16:03,029 --> 00:16:03,850 patient care. 437 00:16:04,389 --> 00:16:07,590 We are not business people. We're caregivers. We're 438 00:16:07,590 --> 00:16:08,330 here to 439 00:16:09,794 --> 00:16:13,235 prevent death or delay death and improve people's 440 00:16:13,235 --> 00:16:15,554 health. We're not in it to make a 441 00:16:15,554 --> 00:16:16,054 profit. 442 00:16:16,674 --> 00:16:19,394 And if the people who are keep governing 443 00:16:19,394 --> 00:16:21,794 us, controlling us are gonna have to make 444 00:16:21,794 --> 00:16:24,070 a profit, It will take away the profession. 445 00:16:24,370 --> 00:16:27,089 It will make us purely workers for business 446 00:16:27,089 --> 00:16:29,009 people who wanna make a profit. I think 447 00:16:29,009 --> 00:16:29,909 it's very dangerous. 448 00:16:31,730 --> 00:16:33,649 Yeah. Yeah. Absolutely. Thank you so much for 449 00:16:33,649 --> 00:16:35,809 those final thoughts, doctor. This has definitely been 450 00:16:35,809 --> 00:16:38,177 a a very informative discussion. So, again, I 451 00:16:38,177 --> 00:16:39,537 wanna thank you so much for coming on, 452 00:16:39,537 --> 00:16:41,297 Becker's, and I look forward to connecting with 453 00:16:41,297 --> 00:16:42,197 you again soon.