PONTE VEDRA BEACH, FLA. — Administration of an antiplatelet IIb/IIIa drug to patients undergoing percutaneous coronary intervention for bypass-graft stenosis significantly boosted the incidence of myocardial infarctions in a registry with more than 34,000 patients.

The study used data from the American College of Cardiology National Cardiovascular Data Registry, which included more than 448,000 percutaneous coronary interventions (PCIs) done during 2001–2003, reported Satish K. Surabhi, M.D., at the annual meeting of the Society for Cardiovascular Angiography and Interventions.

The registry included 34,720 patients who had PCI of a coronary artery bypass graft; 24,279 (70%) were treated with a glycoprotein IIb/IIIa inhibitor and 10,441 (30%) were not.

Following PCI, the in-hospital mortality rate was almost identical in the two subgroups: a 1.4% death rate in patients who received a IIb/IIIa inhibitor and a 1.3% rate in those who didn't get the drug.

In the first weeks following PCI, the incidence of MIs was significantly higher in patients treated with a IIb/IIIa inhibitor, 2.4% than in those who did not, 1.4%. The MIs included all new ST-segment elevations, Q-wave events, left bundle branch blocks, and elevations in serum levels of creatine kinase that exceeded three times the upper limit of normal.

In a multivariate analysis that controlled for various baseline differences in demographic and clinical variables, use of a IIb/IIIa inhibitor was linked with a significant 63% increased rate in MIs following PCI, said Dr. Surabhi, a cardiologist in private practice in Greer, S.C.

Most patients in this registry were not treated with a distal protection device, which may have been the most important element of their management, he said. “Only 5% of these patients were treated with a distal protection device. The major factor [causing bad outcomes] seems to be distal embolization, not formation of a thrombus.”

If a distal protection device or distal balloon occlusion is not used during a PCI of an aortocoronary bypass graft, then the patient should not receive a IIb/IIIa inhibitor, on the basis of the new findings, said Dr. Surabhi.

The study did not address whether it's useful to use a IIb/IIIa inhibitor to treat a patient who's undergoing a bypass graft PCI with distal protection, but Dr. Surabhi suggested that adding the drug may not help.

PONTE VEDRA BEACH, FLA. — Administration of an antiplatelet IIb/IIIa drug to patients undergoing percutaneous coronary intervention for bypass-graft stenosis significantly boosted the incidence of myocardial infarctions in a registry with more than 34,000 patients.

The study used data from the American College of Cardiology National Cardiovascular Data Registry, which included more than 448,000 percutaneous coronary interventions (PCIs) done during 2001–2003, reported Satish K. Surabhi, M.D., at the annual meeting of the Society for Cardiovascular Angiography and Interventions.

The registry included 34,720 patients who had PCI of a coronary artery bypass graft; 24,279 (70%) were treated with a glycoprotein IIb/IIIa inhibitor and 10,441 (30%) were not.

Following PCI, the in-hospital mortality rate was almost identical in the two subgroups: a 1.4% death rate in patients who received a IIb/IIIa inhibitor and a 1.3% rate in those who didn't get the drug.

In the first weeks following PCI, the incidence of MIs was significantly higher in patients treated with a IIb/IIIa inhibitor, 2.4% than in those who did not, 1.4%. The MIs included all new ST-segment elevations, Q-wave events, left bundle branch blocks, and elevations in serum levels of creatine kinase that exceeded three times the upper limit of normal.

In a multivariate analysis that controlled for various baseline differences in demographic and clinical variables, use of a IIb/IIIa inhibitor was linked with a significant 63% increased rate in MIs following PCI, said Dr. Surabhi, a cardiologist in private practice in Greer, S.C.

Most patients in this registry were not treated with a distal protection device, which may have been the most important element of their management, he said. “Only 5% of these patients were treated with a distal protection device. The major factor [causing bad outcomes] seems to be distal embolization, not formation of a thrombus.”

If a distal protection device or distal balloon occlusion is not used during a PCI of an aortocoronary bypass graft, then the patient should not receive a IIb/IIIa inhibitor, on the basis of the new findings, said Dr. Surabhi.

The study did not address whether it's useful to use a IIb/IIIa inhibitor to treat a patient who's undergoing a bypass graft PCI with distal protection, but Dr. Surabhi suggested that adding the drug may not help.

PONTE VEDRA BEACH, FLA. — Administration of an antiplatelet IIb/IIIa drug to patients undergoing percutaneous coronary intervention for bypass-graft stenosis significantly boosted the incidence of myocardial infarctions in a registry with more than 34,000 patients.

The study used data from the American College of Cardiology National Cardiovascular Data Registry, which included more than 448,000 percutaneous coronary interventions (PCIs) done during 2001–2003, reported Satish K. Surabhi, M.D., at the annual meeting of the Society for Cardiovascular Angiography and Interventions.

The registry included 34,720 patients who had PCI of a coronary artery bypass graft; 24,279 (70%) were treated with a glycoprotein IIb/IIIa inhibitor and 10,441 (30%) were not.

Following PCI, the in-hospital mortality rate was almost identical in the two subgroups: a 1.4% death rate in patients who received a IIb/IIIa inhibitor and a 1.3% rate in those who didn't get the drug.

In the first weeks following PCI, the incidence of MIs was significantly higher in patients treated with a IIb/IIIa inhibitor, 2.4% than in those who did not, 1.4%. The MIs included all new ST-segment elevations, Q-wave events, left bundle branch blocks, and elevations in serum levels of creatine kinase that exceeded three times the upper limit of normal.

In a multivariate analysis that controlled for various baseline differences in demographic and clinical variables, use of a IIb/IIIa inhibitor was linked with a significant 63% increased rate in MIs following PCI, said Dr. Surabhi, a cardiologist in private practice in Greer, S.C.

Most patients in this registry were not treated with a distal protection device, which may have been the most important element of their management, he said. “Only 5% of these patients were treated with a distal protection device. The major factor [causing bad outcomes] seems to be distal embolization, not formation of a thrombus.”

If a distal protection device or distal balloon occlusion is not used during a PCI of an aortocoronary bypass graft, then the patient should not receive a IIb/IIIa inhibitor, on the basis of the new findings, said Dr. Surabhi.

The study did not address whether it's useful to use a IIb/IIIa inhibitor to treat a patient who's undergoing a bypass graft PCI with distal protection, but Dr. Surabhi suggested that adding the drug may not help.

PHILADELPHIA — Left ventricular dysfunction is a powerful predictor of poor outcome in patients who have received a heart transplant.

During 13 years of follow-up of almost 19,000 patients with transplanted hearts, the cumulative rate of left ventricular (LV) dysfunction (ejection fraction of 40% or less) was 23%, Katherine Lietz, M.D., reported at the annual meeting of the International Society for Heart and Lung Transplantation.

In heart transplant patients with LV dysfunction, the relative risk of cardiac death was 2.65-fold higher than the risk in those without LV dysfunction. The risk of noncardiac death in patients with impaired LV function was almost twice that of controls, due mostly to renal dysfunction that was secondary to heart failure, said Dr. Lietz, a cardiologist at the University of Minnesota in Minneapolis.

The study used data from the U.S. Scientific Registry of Transplant Recipients for heart transplants done during 1990–2003 on 25,719 patients. Exclusion of patients who were lost to follow-up or did not survive for at least 1 year left a study group of 18,854 patients, who were followed until they died, until their transplanted hearts failed, or through May 2004.

Aside from the patients who developed heart failure, LV function stayed fairly constant through follow-up, which lasted up to 13 years. The average LV ejection fraction (EF) for the entire group was about 59% after 1 year of follow-up and 57% after 13 years. Development of heart failure occurred at a fairly constant rate, occurring in about 2% of patients a year.

The two most powerful risk factors for LV dysfunction were coronary vasculopathy and renal dysfunction; each more than doubled the risk. Other significant risk factors were African American race, which raised the risk by 89%; need for retransplantation (67%); and acute rejection (65%).

The prevalence of vasculopathy was 34% in patients with an EF of more than 40%. Among those with lower EFs, the prevalence was 57%.

The increased risk of death associated with LV dysfunction was proportional to the severity of the dysfunction. Patients with EFs of 45%–55% had a 25% higher risk of death than did patients with EFs of more than 65%. The mortality risk was 57% higher in patients with EFs of 35%–45%, and was 2.6-fold higher in those with EFs of less than 35%.

PHILADELPHIA — Left ventricular dysfunction is a powerful predictor of poor outcome in patients who have received a heart transplant.

During 13 years of follow-up of almost 19,000 patients with transplanted hearts, the cumulative rate of left ventricular (LV) dysfunction (ejection fraction of 40% or less) was 23%, Katherine Lietz, M.D., reported at the annual meeting of the International Society for Heart and Lung Transplantation.

In heart transplant patients with LV dysfunction, the relative risk of cardiac death was 2.65-fold higher than the risk in those without LV dysfunction. The risk of noncardiac death in patients with impaired LV function was almost twice that of controls, due mostly to renal dysfunction that was secondary to heart failure, said Dr. Lietz, a cardiologist at the University of Minnesota in Minneapolis.

The study used data from the U.S. Scientific Registry of Transplant Recipients for heart transplants done during 1990–2003 on 25,719 patients. Exclusion of patients who were lost to follow-up or did not survive for at least 1 year left a study group of 18,854 patients, who were followed until they died, until their transplanted hearts failed, or through May 2004.

Aside from the patients who developed heart failure, LV function stayed fairly constant through follow-up, which lasted up to 13 years. The average LV ejection fraction (EF) for the entire group was about 59% after 1 year of follow-up and 57% after 13 years. Development of heart failure occurred at a fairly constant rate, occurring in about 2% of patients a year.

The two most powerful risk factors for LV dysfunction were coronary vasculopathy and renal dysfunction; each more than doubled the risk. Other significant risk factors were African American race, which raised the risk by 89%; need for retransplantation (67%); and acute rejection (65%).

The prevalence of vasculopathy was 34% in patients with an EF of more than 40%. Among those with lower EFs, the prevalence was 57%.

The increased risk of death associated with LV dysfunction was proportional to the severity of the dysfunction. Patients with EFs of 45%–55% had a 25% higher risk of death than did patients with EFs of more than 65%. The mortality risk was 57% higher in patients with EFs of 35%–45%, and was 2.6-fold higher in those with EFs of less than 35%.

PHILADELPHIA — Left ventricular dysfunction is a powerful predictor of poor outcome in patients who have received a heart transplant.

During 13 years of follow-up of almost 19,000 patients with transplanted hearts, the cumulative rate of left ventricular (LV) dysfunction (ejection fraction of 40% or less) was 23%, Katherine Lietz, M.D., reported at the annual meeting of the International Society for Heart and Lung Transplantation.

In heart transplant patients with LV dysfunction, the relative risk of cardiac death was 2.65-fold higher than the risk in those without LV dysfunction. The risk of noncardiac death in patients with impaired LV function was almost twice that of controls, due mostly to renal dysfunction that was secondary to heart failure, said Dr. Lietz, a cardiologist at the University of Minnesota in Minneapolis.

The study used data from the U.S. Scientific Registry of Transplant Recipients for heart transplants done during 1990–2003 on 25,719 patients. Exclusion of patients who were lost to follow-up or did not survive for at least 1 year left a study group of 18,854 patients, who were followed until they died, until their transplanted hearts failed, or through May 2004.

Aside from the patients who developed heart failure, LV function stayed fairly constant through follow-up, which lasted up to 13 years. The average LV ejection fraction (EF) for the entire group was about 59% after 1 year of follow-up and 57% after 13 years. Development of heart failure occurred at a fairly constant rate, occurring in about 2% of patients a year.

The two most powerful risk factors for LV dysfunction were coronary vasculopathy and renal dysfunction; each more than doubled the risk. Other significant risk factors were African American race, which raised the risk by 89%; need for retransplantation (67%); and acute rejection (65%).

The prevalence of vasculopathy was 34% in patients with an EF of more than 40%. Among those with lower EFs, the prevalence was 57%.

The increased risk of death associated with LV dysfunction was proportional to the severity of the dysfunction. Patients with EFs of 45%–55% had a 25% higher risk of death than did patients with EFs of more than 65%. The mortality risk was 57% higher in patients with EFs of 35%–45%, and was 2.6-fold higher in those with EFs of less than 35%.

PHILADELPHIA — Patients with mild or moderate coronary artery disease can safely undergo lung transplantation, according to a review of more than 200 patients at Washington University in St. Louis.

In this series, the incidence of perioperative death, long-term death, and long-term cardiac morbidity was similar between patients with mild or moderate CAD and those with no detectable disease, Cliff K.C. Choong, M.B., said at the annual meeting of the International Society for Heart and Lung Transplantation.

Most U.S. transplant centers do lung transplantation in patients with mild or moderate CAD, but this is the first report to document that this approach is okay, said Dr. Choong, who is now a cardiothoracic surgeon at Papworth Hospital, Cambridge, England.

Patients with severe CAD—at least one coronary artery stenosis of 50% or greater—would require revascularization before undergoing lung transplantation, Dr. Choong told this newspaper. This should only be an option if the CAD is discrete, if left ventricular function is normal, and if the coronary anatomy is suitable for revascularization. If feasible, it should be done during the lung transplant surgery, preferably with stents, because coronary artery bypass surgery during lung transplantation requires more complex surgery that takes substantially more time, he said.

The study reviewed all 268 adults who had lung transplantation surgery at Washington University during June 1998-June 2003. Patients were excluded if they had sever CAD (3) or if they didn't undergo coronary angiography before transplant (55).

At the university, lung transplant candidates undergo routine coronary angiography if they are at least 45 years old, regardless any history or symptoms of CAD. Younger patients have angiography only if they also have risk factors for CAD.

Of the 210 patients, 177 had no evidence of CAD, 16 patients had mild CAD (coronary stenosis of less than 30%), and 17 had moderate CAD (stenosis of 30%–50%).

Thirteen of the 177 patients with no CAD died while they were hospitalized for their transplantation, compared with none of the 33 patients with CAD, he said. During an average follow-up of about 2 years, mortality was 23% in the patients without CAD and 27% in those with CAD.

PHILADELPHIA — Patients with mild or moderate coronary artery disease can safely undergo lung transplantation, according to a review of more than 200 patients at Washington University in St. Louis.

In this series, the incidence of perioperative death, long-term death, and long-term cardiac morbidity was similar between patients with mild or moderate CAD and those with no detectable disease, Cliff K.C. Choong, M.B., said at the annual meeting of the International Society for Heart and Lung Transplantation.

Most U.S. transplant centers do lung transplantation in patients with mild or moderate CAD, but this is the first report to document that this approach is okay, said Dr. Choong, who is now a cardiothoracic surgeon at Papworth Hospital, Cambridge, England.

Patients with severe CAD—at least one coronary artery stenosis of 50% or greater—would require revascularization before undergoing lung transplantation, Dr. Choong told this newspaper. This should only be an option if the CAD is discrete, if left ventricular function is normal, and if the coronary anatomy is suitable for revascularization. If feasible, it should be done during the lung transplant surgery, preferably with stents, because coronary artery bypass surgery during lung transplantation requires more complex surgery that takes substantially more time, he said.

The study reviewed all 268 adults who had lung transplantation surgery at Washington University during June 1998-June 2003. Patients were excluded if they had sever CAD (3) or if they didn't undergo coronary angiography before transplant (55).

At the university, lung transplant candidates undergo routine coronary angiography if they are at least 45 years old, regardless any history or symptoms of CAD. Younger patients have angiography only if they also have risk factors for CAD.

Of the 210 patients, 177 had no evidence of CAD, 16 patients had mild CAD (coronary stenosis of less than 30%), and 17 had moderate CAD (stenosis of 30%–50%).

Thirteen of the 177 patients with no CAD died while they were hospitalized for their transplantation, compared with none of the 33 patients with CAD, he said. During an average follow-up of about 2 years, mortality was 23% in the patients without CAD and 27% in those with CAD.

PHILADELPHIA — Patients with mild or moderate coronary artery disease can safely undergo lung transplantation, according to a review of more than 200 patients at Washington University in St. Louis.

In this series, the incidence of perioperative death, long-term death, and long-term cardiac morbidity was similar between patients with mild or moderate CAD and those with no detectable disease, Cliff K.C. Choong, M.B., said at the annual meeting of the International Society for Heart and Lung Transplantation.

Most U.S. transplant centers do lung transplantation in patients with mild or moderate CAD, but this is the first report to document that this approach is okay, said Dr. Choong, who is now a cardiothoracic surgeon at Papworth Hospital, Cambridge, England.

Patients with severe CAD—at least one coronary artery stenosis of 50% or greater—would require revascularization before undergoing lung transplantation, Dr. Choong told this newspaper. This should only be an option if the CAD is discrete, if left ventricular function is normal, and if the coronary anatomy is suitable for revascularization. If feasible, it should be done during the lung transplant surgery, preferably with stents, because coronary artery bypass surgery during lung transplantation requires more complex surgery that takes substantially more time, he said.

The study reviewed all 268 adults who had lung transplantation surgery at Washington University during June 1998-June 2003. Patients were excluded if they had sever CAD (3) or if they didn't undergo coronary angiography before transplant (55).

At the university, lung transplant candidates undergo routine coronary angiography if they are at least 45 years old, regardless any history or symptoms of CAD. Younger patients have angiography only if they also have risk factors for CAD.

Of the 210 patients, 177 had no evidence of CAD, 16 patients had mild CAD (coronary stenosis of less than 30%), and 17 had moderate CAD (stenosis of 30%–50%).

Thirteen of the 177 patients with no CAD died while they were hospitalized for their transplantation, compared with none of the 33 patients with CAD, he said. During an average follow-up of about 2 years, mortality was 23% in the patients without CAD and 27% in those with CAD.

PHILADELPHIA — Heart and lung transplants are increasingly for older patients, on the basis of data collected in the International Heart and Lung Transplant Registry.

During 1999–2003, the most recent period with available registry data, patients aged at least 60 years made up about 25% of all patients who underwent heart transplants, up from about 15% a decade earlier, Marshall I. Hertz, M.D., reported at the annual meeting of the International Society for Heart and Lung Transplantation.

The rise in transplants in elderly patients was matched by an almost identical drop in patients aged 40–49 years, from about 23% of the total in 1989–1993 to about 15% in 1999–2003. The percentage of transplants done in patients aged 50–59, held steady at about 33% of the total, reported Dr. Hertz, professor of medicine at the University of Minnesota, Minneapolis, and medical director of the transplant registry.

A similar trend existed for lung transplantations. During 1997–2004, about 15% of all lung transplants were in patients aged 60–64, up from about 8% of the total in 1985–1996. Another clear increase was in patients aged 65 and older, rising from about 2% of all lung transplants in 1985–1996 to about 4% in the most recent period. In contrast, the percentage of transplants fell in all adult patients younger than 55. The biggest drop was in patients aged 45–49, where the figure sank from about 15% of all transplants in the earlier years to about 10% of all lung transplants in 1997–2003.

These trends reflect the “greater comfort” physicians have in transplanting older patients, Dr. Hertz told this newspaper. The rise in heart transplants in older patients has also been triggered by an increased prevalence of heart failure. But the registry data also confirm that survival following transplantation of either a heart or a lung is worse in older patients, Dr. Hertz said.

PHILADELPHIA — Heart and lung transplants are increasingly for older patients, on the basis of data collected in the International Heart and Lung Transplant Registry.

During 1999–2003, the most recent period with available registry data, patients aged at least 60 years made up about 25% of all patients who underwent heart transplants, up from about 15% a decade earlier, Marshall I. Hertz, M.D., reported at the annual meeting of the International Society for Heart and Lung Transplantation.

The rise in transplants in elderly patients was matched by an almost identical drop in patients aged 40–49 years, from about 23% of the total in 1989–1993 to about 15% in 1999–2003. The percentage of transplants done in patients aged 50–59, held steady at about 33% of the total, reported Dr. Hertz, professor of medicine at the University of Minnesota, Minneapolis, and medical director of the transplant registry.

A similar trend existed for lung transplantations. During 1997–2004, about 15% of all lung transplants were in patients aged 60–64, up from about 8% of the total in 1985–1996. Another clear increase was in patients aged 65 and older, rising from about 2% of all lung transplants in 1985–1996 to about 4% in the most recent period. In contrast, the percentage of transplants fell in all adult patients younger than 55. The biggest drop was in patients aged 45–49, where the figure sank from about 15% of all transplants in the earlier years to about 10% of all lung transplants in 1997–2003.

These trends reflect the “greater comfort” physicians have in transplanting older patients, Dr. Hertz told this newspaper. The rise in heart transplants in older patients has also been triggered by an increased prevalence of heart failure. But the registry data also confirm that survival following transplantation of either a heart or a lung is worse in older patients, Dr. Hertz said.

PHILADELPHIA — Heart and lung transplants are increasingly for older patients, on the basis of data collected in the International Heart and Lung Transplant Registry.

During 1999–2003, the most recent period with available registry data, patients aged at least 60 years made up about 25% of all patients who underwent heart transplants, up from about 15% a decade earlier, Marshall I. Hertz, M.D., reported at the annual meeting of the International Society for Heart and Lung Transplantation.

The rise in transplants in elderly patients was matched by an almost identical drop in patients aged 40–49 years, from about 23% of the total in 1989–1993 to about 15% in 1999–2003. The percentage of transplants done in patients aged 50–59, held steady at about 33% of the total, reported Dr. Hertz, professor of medicine at the University of Minnesota, Minneapolis, and medical director of the transplant registry.

A similar trend existed for lung transplantations. During 1997–2004, about 15% of all lung transplants were in patients aged 60–64, up from about 8% of the total in 1985–1996. Another clear increase was in patients aged 65 and older, rising from about 2% of all lung transplants in 1985–1996 to about 4% in the most recent period. In contrast, the percentage of transplants fell in all adult patients younger than 55. The biggest drop was in patients aged 45–49, where the figure sank from about 15% of all transplants in the earlier years to about 10% of all lung transplants in 1997–2003.

These trends reflect the “greater comfort” physicians have in transplanting older patients, Dr. Hertz told this newspaper. The rise in heart transplants in older patients has also been triggered by an increased prevalence of heart failure. But the registry data also confirm that survival following transplantation of either a heart or a lung is worse in older patients, Dr. Hertz said.

GAITHERSBURG — By a vote of 9-4, the Food and Drug Administration's Circulatory Systems Devices Panel decided not to recommend the CorCap cardiac support device for approval, citing concerns about missing end point data and uncertainty about the device's effectiveness.

The cardiac support device (CSD), made by Acorn Cardiovascular Inc., is a polyester mesh wrap that is implanted around both ventricles of the heart to stop cardiac enlargement caused by heart failure. It is intended to improve the heart's function by providing beneficial changes in cardiac structure and a decrease in the need for major cardiac procedures. Acorn also claimed that patient quality of life would be improved significantly.

Acorn presented data from a prospective, randomized, controlled trial of 300 heart failure patients. The 193 patients in whom mitral valve repair or replacement was indicated were randomized to undergo surgery with (91) or without (102) CSD placement. The remaining 107 patients were randomized to undergo a thoracotomy for placement of the Acorn device and continued medical therapy (57) medical therapy alone (50).

The primary end point was a composite of survival, the need for additional major cardiac procedures, and change in New York Heart Association (NYHA) classification. Of patients treated with CorCap, 38% improved, compared with 27% of control patients. Additionally, 25% of CorCap recipients remained the same, compared with 28% of patients in the control group. A total of 37% of CorCap recipients were reported to have worsened, compared with 45% of control group patients.

The FDA questioned both the company's statistical analysis and CorCap's clinical efficacy. FDA statistician Laura Thompson, Ph.D., raised concerns that more than a third of patients were missing primary end point measurements, and more than half were missing appropriate baseline NYHA class data. FDA consultant Ileana L. Piña, M.D., professor of medicine at Case Western Reserve University, Cleveland, also highlighted the missing data and pointed out that the only component of the primary end point that was significant was that of major cardiac procedures; there were no significant differences between the CorCap group and the controls in mortality or rehospitalization.

Citing these concerns, the committee voted against approving the device. The FDA usually follows the recommendations of its advisory panels, but is under no statutory obligation to do so.

GAITHERSBURG — By a vote of 9-4, the Food and Drug Administration's Circulatory Systems Devices Panel decided not to recommend the CorCap cardiac support device for approval, citing concerns about missing end point data and uncertainty about the device's effectiveness.

The cardiac support device (CSD), made by Acorn Cardiovascular Inc., is a polyester mesh wrap that is implanted around both ventricles of the heart to stop cardiac enlargement caused by heart failure. It is intended to improve the heart's function by providing beneficial changes in cardiac structure and a decrease in the need for major cardiac procedures. Acorn also claimed that patient quality of life would be improved significantly.

Acorn presented data from a prospective, randomized, controlled trial of 300 heart failure patients. The 193 patients in whom mitral valve repair or replacement was indicated were randomized to undergo surgery with (91) or without (102) CSD placement. The remaining 107 patients were randomized to undergo a thoracotomy for placement of the Acorn device and continued medical therapy (57) medical therapy alone (50).

The primary end point was a composite of survival, the need for additional major cardiac procedures, and change in New York Heart Association (NYHA) classification. Of patients treated with CorCap, 38% improved, compared with 27% of control patients. Additionally, 25% of CorCap recipients remained the same, compared with 28% of patients in the control group. A total of 37% of CorCap recipients were reported to have worsened, compared with 45% of control group patients.

The FDA questioned both the company's statistical analysis and CorCap's clinical efficacy. FDA statistician Laura Thompson, Ph.D., raised concerns that more than a third of patients were missing primary end point measurements, and more than half were missing appropriate baseline NYHA class data. FDA consultant Ileana L. Piña, M.D., professor of medicine at Case Western Reserve University, Cleveland, also highlighted the missing data and pointed out that the only component of the primary end point that was significant was that of major cardiac procedures; there were no significant differences between the CorCap group and the controls in mortality or rehospitalization.

Citing these concerns, the committee voted against approving the device. The FDA usually follows the recommendations of its advisory panels, but is under no statutory obligation to do so.

GAITHERSBURG — By a vote of 9-4, the Food and Drug Administration's Circulatory Systems Devices Panel decided not to recommend the CorCap cardiac support device for approval, citing concerns about missing end point data and uncertainty about the device's effectiveness.

The cardiac support device (CSD), made by Acorn Cardiovascular Inc., is a polyester mesh wrap that is implanted around both ventricles of the heart to stop cardiac enlargement caused by heart failure. It is intended to improve the heart's function by providing beneficial changes in cardiac structure and a decrease in the need for major cardiac procedures. Acorn also claimed that patient quality of life would be improved significantly.

Acorn presented data from a prospective, randomized, controlled trial of 300 heart failure patients. The 193 patients in whom mitral valve repair or replacement was indicated were randomized to undergo surgery with (91) or without (102) CSD placement. The remaining 107 patients were randomized to undergo a thoracotomy for placement of the Acorn device and continued medical therapy (57) medical therapy alone (50).

The primary end point was a composite of survival, the need for additional major cardiac procedures, and change in New York Heart Association (NYHA) classification. Of patients treated with CorCap, 38% improved, compared with 27% of control patients. Additionally, 25% of CorCap recipients remained the same, compared with 28% of patients in the control group. A total of 37% of CorCap recipients were reported to have worsened, compared with 45% of control group patients.

The FDA questioned both the company's statistical analysis and CorCap's clinical efficacy. FDA statistician Laura Thompson, Ph.D., raised concerns that more than a third of patients were missing primary end point measurements, and more than half were missing appropriate baseline NYHA class data. FDA consultant Ileana L. Piña, M.D., professor of medicine at Case Western Reserve University, Cleveland, also highlighted the missing data and pointed out that the only component of the primary end point that was significant was that of major cardiac procedures; there were no significant differences between the CorCap group and the controls in mortality or rehospitalization.

Citing these concerns, the committee voted against approving the device. The FDA usually follows the recommendations of its advisory panels, but is under no statutory obligation to do so.

When Robin Orr was admitted to the ED of Santa Barbara Cottage Hospital (Calif.), she brought a long history of experience with hospitals, both as a patient and in her professional life. Orr is a cancer survivor who had undergone back surgery several months earlier and had suffered from increasing back pain since the surgery. Late one Friday night in June 24, 2005, the pain was so intense that Orr’s care partner, Sue Cook, brought her to the ED. Orr was given morphine and taken to a room for the remainder of the night.

Who Is Robin Orr?

Orr was no ordinary hospital patient. With nearly three decades of experience as a healthcare professional working with hospitals, she was well aware of how hospitals should work—and how they often don’t work. After seven years as a hospital administrator, she went to graduate school for a master’s degree in public health, then spent 12 years as executive director for Planetree Health Resource Center, San Francisco, a nonprofit consumer healthcare organization that focuses on patient-centered care. While Orr was with Planetree the organization created a revolutionary demonstration project that brought patient-centered care to three model sites. The project centered on changing the hospitals’ physical environments as well as providing patients access to their own medical records.

Approximately 12 years ago, Orr left Planetree to start her own consulting practice. The Robin Orr Group (Santa Barbara, Calif.) works with healthcare organizations to effect patient-centered care. At the time she was admitted to the ED at Cottage Hospital, Orr’s consulting work was tapering off as she struggled with constant pain.

From the perspective of a health professional, I could see that a hospitalist helps eliminate waste. I know that hospital resources are so precious, and when someone can help expedite a procedure or test, it’s extremely valuable.

—Robin Orr

Enter the Hospitalist

At 7 a.m. on the Saturday the morning after Orr was admitted, Eric Trautwein, MD, checked on her. Dr. Trautwein is a hospitalist with the Samsun Santa Barbara Medical Foundation, which employs approximately 200 physicians in multiple specialties.

“Eric was a breathe of fresh air,” says Cook. “He … had read all her charts and immediately asked about the pain and got it under control.” Throughout the ordeal, Cook says “everyone would ask Robin what the pain level was, and she’d say ‘11,’ and they’d write it down. Eric did something about it.”

The next step, as Cook recalls, was a thorough examination. “I’ll never forget—he noticed that one knee reflex had a very subtle difference,” she says. “He wanted to double check that, saying he never made assumptions. He immediately got tests scheduled for that day, which was a Saturday. That never happens.”

Orr was scheduled for an immediate CAT scan, PET scan, and MRI. The results were available by Monday: The tests showed a mass of 4.5 x 3 cm to the left retroperitoneum adjacent to the aorta, consistent with metastatic disease.

After months of dealing with healthcare professionals who focused on and treated Orr’s pain, both Orr and Cook believe that the hospitalist’s diligence in performing a thorough exam and insistence on immediate tests were remarkable.

“A hospitalist saved my life,” Orr says confidently.

Dr. Trautwein doesn’t feel his exam and diagnosis were unusual.

“I’m not sure I did anything special,” he says. “I know for sure that my partners would have done the same things I did, and so would most hospitalists.”

After the Test Results

At the end of the weekend during Orr’s stay, Dr. Trautwein’s shift ended and his partner, Jeffrey Yim, MD, took over. Before the change, Dr. Trautwein assured the women that he’d go over Orr’s case with his partner, and that he would stay in touch. This is standard procedure among the hospitalists in their practice.

“We’ll ask if there’s anything they want us to convey to the new doctor” before we go off shift, says Dr. Yim.

The hospitalists at Samsun Santa Barbara Medical Foundation take great care with transitions during shift changes because they are aware that mistakes can happen if communication is incomplete.

“Hand-offs are one of our biggest challenges,” says Dr. Yim. “Ours aren’t formalized, but we follow a standard practice of leaving what we call an ‘off-service note.’ This is very comprehensive, almost like a discharge note, and includes all important details. In addition, the outgoing and incoming hospitalists have a sign-off conversation, either in person or over the phone, to cover any social issues or dynamics. With Robin, for example, pain control was an issue.”

Dr. Yim told Orr and Cook the results of the tests.

“Dr. Yim came in on Tuesday, and it was like passing a baton in an Olympic race,” recalls Cook, who is an expert and author on customer service. “Both [of the hospitalists] have empathy, [a skill that is] relevant and timely, and a sense of urgency.”

Orr agrees that Dr. Yim’s care was as helpful as Dr. Trautwein’s.

“Both hospitalists made sure I was treated as a human being; they weren’t just treating my pain,” she says. “Dr. Yim made sure I got what I needed at discharge, which was very necessary. He was on top of it and made sure it included follow-up.”

In Praise of Hospitalists

Despite her profession, Orr says she had never heard of hospitalists before meeting Dr. Trautwein. In addition to her gratitude to him for diagnosing her cancer, she was very impressed with how the role of hospitalist affected her care.

“I felt that having a hospitalist helped streamline the process,” she says. “I was admitted through the ED in the middle of a weekend night, when labs were closed and I had no access to my primary care physician. Despite the timing, there was continuity and follow-through, and there was speed of action.”

Orr was particularly impressed at how the various departments of the hospital worked together, with a hospitalist acting as her champion with all of them.

“[Eric] has a familiarity with hospital resources and knew who to call and when to call,” she says. “He passed the baton between people in such a way that I felt I would not be dropped between departments. There were great communications, and it helped with the ease of streamlining and continuity, and it certainly helped my peace of mind.

“From the perspective of a health professional, I could see that a hospitalist helps eliminate waste,” Orr continues. “I know that hospital resources are so precious, and when someone can help expedite a procedure or test, it’s extremely valuable.”

Orr had a first-hand view of how hospitalists streamline processes and influence care for individual patients. Her experience as a patient was an educational time for her, even with her substantial background working with hospitals.

The Hospitalist’s View

While Dr. Trautwein is pleased with the outcome of his assessment of Orr, he insists that he was doing his job. In fact, he believes the toughest part of being a hospitalist is not detecting hidden illnesses, but building trust.

“The biggest part of my day is communicating. I feel like I don’t have much time to establish trust with patients,” he admits. “That’s by far the hardest thing about the job. You only get one pass to go over their medical history, but you also have to build a rapport with them. It’s not easy.”

With each new patient he sees, Dr. Trautwein is aware that that person is wary of seeing a new doctor rather than their own primary care physician.

“A lot of people are skeptical when they see a new [doctor]—especially a young doctor,” he explains. “Sometimes, I’ll start by trying to talk about something unconnected with their condition, to try to connect with them as a person. Getting patients to trust you is one of the more difficult parts of the job, but it can lead to one of the greatest satisfactions.”

As a hospitalist, Dr. Trautwein has a clear view of his role versus that of a primary care physician, and sees the value in being available to hospitalized patients.

“Primary care physicians are squeezed from every direction and can’t be around their patients in the hospital all the time,” he says. “Hospitalists get the patients’ attention; it’s not hard to drop back into someone’s room. For the patient, that’s important. They see that we care about them, and we can make the face-to-face contact with them that used to be impossible.”

Dr. Trautwein makes a special effort to see each patient as often as he can, and to share information with them.

“I try to think about it from the patient’s perspective,” he says. “The major thing that patients are hungry for in a hospital is communication.”

As for his ability to get tests scheduled on a weekend, he says that Cottage Hospital “is a pretty responsive hospital in general. I don’t spend a lot of time banging my head against the wall with them. If I talk to a person directly, in person or on the phone, they’ll respond. It is unusual to have tests done on the weekend, but it was also unusual to have a patient who needs them so much.”

Dr. Trautwein understands that a normal day’s work for a physician can mean a life-changing diagnosis for a patient. Orr and Cook understand it, too, but from their perspective, a hospitalist doing his job can lead to a miracle.

Orr’s Recovery

At the time this article was written, Orr had completed a round of radiation and was recuperating as she awaits further test results. Despite her ordeal and her pain, her outlook is as positive as her praise of hospitalists. Looking back on her experience at Cottage Hospital Santa Barbara and Dr. Trautwein’s role, she says, “The outcome of all this was my peace of mind as a patient. You can’t buy that in a hospital anywhere in America today.” TH

Contributor Jane Jerrard writes the “Hospital of the Future” series for The Hospitalist.

When Robin Orr was admitted to the ED of Santa Barbara Cottage Hospital (Calif.), she brought a long history of experience with hospitals, both as a patient and in her professional life. Orr is a cancer survivor who had undergone back surgery several months earlier and had suffered from increasing back pain since the surgery. Late one Friday night in June 24, 2005, the pain was so intense that Orr’s care partner, Sue Cook, brought her to the ED. Orr was given morphine and taken to a room for the remainder of the night.

Who Is Robin Orr?

Orr was no ordinary hospital patient. With nearly three decades of experience as a healthcare professional working with hospitals, she was well aware of how hospitals should work—and how they often don’t work. After seven years as a hospital administrator, she went to graduate school for a master’s degree in public health, then spent 12 years as executive director for Planetree Health Resource Center, San Francisco, a nonprofit consumer healthcare organization that focuses on patient-centered care. While Orr was with Planetree the organization created a revolutionary demonstration project that brought patient-centered care to three model sites. The project centered on changing the hospitals’ physical environments as well as providing patients access to their own medical records.

Approximately 12 years ago, Orr left Planetree to start her own consulting practice. The Robin Orr Group (Santa Barbara, Calif.) works with healthcare organizations to effect patient-centered care. At the time she was admitted to the ED at Cottage Hospital, Orr’s consulting work was tapering off as she struggled with constant pain.

From the perspective of a health professional, I could see that a hospitalist helps eliminate waste. I know that hospital resources are so precious, and when someone can help expedite a procedure or test, it’s extremely valuable.

—Robin Orr

Enter the Hospitalist

At 7 a.m. on the Saturday the morning after Orr was admitted, Eric Trautwein, MD, checked on her. Dr. Trautwein is a hospitalist with the Samsun Santa Barbara Medical Foundation, which employs approximately 200 physicians in multiple specialties.

“Eric was a breathe of fresh air,” says Cook. “He … had read all her charts and immediately asked about the pain and got it under control.” Throughout the ordeal, Cook says “everyone would ask Robin what the pain level was, and she’d say ‘11,’ and they’d write it down. Eric did something about it.”

The next step, as Cook recalls, was a thorough examination. “I’ll never forget—he noticed that one knee reflex had a very subtle difference,” she says. “He wanted to double check that, saying he never made assumptions. He immediately got tests scheduled for that day, which was a Saturday. That never happens.”

Orr was scheduled for an immediate CAT scan, PET scan, and MRI. The results were available by Monday: The tests showed a mass of 4.5 x 3 cm to the left retroperitoneum adjacent to the aorta, consistent with metastatic disease.

After months of dealing with healthcare professionals who focused on and treated Orr’s pain, both Orr and Cook believe that the hospitalist’s diligence in performing a thorough exam and insistence on immediate tests were remarkable.

“A hospitalist saved my life,” Orr says confidently.

Dr. Trautwein doesn’t feel his exam and diagnosis were unusual.

“I’m not sure I did anything special,” he says. “I know for sure that my partners would have done the same things I did, and so would most hospitalists.”

After the Test Results

At the end of the weekend during Orr’s stay, Dr. Trautwein’s shift ended and his partner, Jeffrey Yim, MD, took over. Before the change, Dr. Trautwein assured the women that he’d go over Orr’s case with his partner, and that he would stay in touch. This is standard procedure among the hospitalists in their practice.

“We’ll ask if there’s anything they want us to convey to the new doctor” before we go off shift, says Dr. Yim.

The hospitalists at Samsun Santa Barbara Medical Foundation take great care with transitions during shift changes because they are aware that mistakes can happen if communication is incomplete.

“Hand-offs are one of our biggest challenges,” says Dr. Yim. “Ours aren’t formalized, but we follow a standard practice of leaving what we call an ‘off-service note.’ This is very comprehensive, almost like a discharge note, and includes all important details. In addition, the outgoing and incoming hospitalists have a sign-off conversation, either in person or over the phone, to cover any social issues or dynamics. With Robin, for example, pain control was an issue.”

Dr. Yim told Orr and Cook the results of the tests.

“Dr. Yim came in on Tuesday, and it was like passing a baton in an Olympic race,” recalls Cook, who is an expert and author on customer service. “Both [of the hospitalists] have empathy, [a skill that is] relevant and timely, and a sense of urgency.”

Orr agrees that Dr. Yim’s care was as helpful as Dr. Trautwein’s.

“Both hospitalists made sure I was treated as a human being; they weren’t just treating my pain,” she says. “Dr. Yim made sure I got what I needed at discharge, which was very necessary. He was on top of it and made sure it included follow-up.”

In Praise of Hospitalists

Despite her profession, Orr says she had never heard of hospitalists before meeting Dr. Trautwein. In addition to her gratitude to him for diagnosing her cancer, she was very impressed with how the role of hospitalist affected her care.

“I felt that having a hospitalist helped streamline the process,” she says. “I was admitted through the ED in the middle of a weekend night, when labs were closed and I had no access to my primary care physician. Despite the timing, there was continuity and follow-through, and there was speed of action.”

Orr was particularly impressed at how the various departments of the hospital worked together, with a hospitalist acting as her champion with all of them.

“[Eric] has a familiarity with hospital resources and knew who to call and when to call,” she says. “He passed the baton between people in such a way that I felt I would not be dropped between departments. There were great communications, and it helped with the ease of streamlining and continuity, and it certainly helped my peace of mind.

“From the perspective of a health professional, I could see that a hospitalist helps eliminate waste,” Orr continues. “I know that hospital resources are so precious, and when someone can help expedite a procedure or test, it’s extremely valuable.”

Orr had a first-hand view of how hospitalists streamline processes and influence care for individual patients. Her experience as a patient was an educational time for her, even with her substantial background working with hospitals.

The Hospitalist’s View

While Dr. Trautwein is pleased with the outcome of his assessment of Orr, he insists that he was doing his job. In fact, he believes the toughest part of being a hospitalist is not detecting hidden illnesses, but building trust.

“The biggest part of my day is communicating. I feel like I don’t have much time to establish trust with patients,” he admits. “That’s by far the hardest thing about the job. You only get one pass to go over their medical history, but you also have to build a rapport with them. It’s not easy.”

With each new patient he sees, Dr. Trautwein is aware that that person is wary of seeing a new doctor rather than their own primary care physician.

“A lot of people are skeptical when they see a new [doctor]—especially a young doctor,” he explains. “Sometimes, I’ll start by trying to talk about something unconnected with their condition, to try to connect with them as a person. Getting patients to trust you is one of the more difficult parts of the job, but it can lead to one of the greatest satisfactions.”

As a hospitalist, Dr. Trautwein has a clear view of his role versus that of a primary care physician, and sees the value in being available to hospitalized patients.

“Primary care physicians are squeezed from every direction and can’t be around their patients in the hospital all the time,” he says. “Hospitalists get the patients’ attention; it’s not hard to drop back into someone’s room. For the patient, that’s important. They see that we care about them, and we can make the face-to-face contact with them that used to be impossible.”

Dr. Trautwein makes a special effort to see each patient as often as he can, and to share information with them.

“I try to think about it from the patient’s perspective,” he says. “The major thing that patients are hungry for in a hospital is communication.”

As for his ability to get tests scheduled on a weekend, he says that Cottage Hospital “is a pretty responsive hospital in general. I don’t spend a lot of time banging my head against the wall with them. If I talk to a person directly, in person or on the phone, they’ll respond. It is unusual to have tests done on the weekend, but it was also unusual to have a patient who needs them so much.”

Dr. Trautwein understands that a normal day’s work for a physician can mean a life-changing diagnosis for a patient. Orr and Cook understand it, too, but from their perspective, a hospitalist doing his job can lead to a miracle.

Orr’s Recovery

At the time this article was written, Orr had completed a round of radiation and was recuperating as she awaits further test results. Despite her ordeal and her pain, her outlook is as positive as her praise of hospitalists. Looking back on her experience at Cottage Hospital Santa Barbara and Dr. Trautwein’s role, she says, “The outcome of all this was my peace of mind as a patient. You can’t buy that in a hospital anywhere in America today.” TH

Contributor Jane Jerrard writes the “Hospital of the Future” series for The Hospitalist.

When Robin Orr was admitted to the ED of Santa Barbara Cottage Hospital (Calif.), she brought a long history of experience with hospitals, both as a patient and in her professional life. Orr is a cancer survivor who had undergone back surgery several months earlier and had suffered from increasing back pain since the surgery. Late one Friday night in June 24, 2005, the pain was so intense that Orr’s care partner, Sue Cook, brought her to the ED. Orr was given morphine and taken to a room for the remainder of the night.

Who Is Robin Orr?

Orr was no ordinary hospital patient. With nearly three decades of experience as a healthcare professional working with hospitals, she was well aware of how hospitals should work—and how they often don’t work. After seven years as a hospital administrator, she went to graduate school for a master’s degree in public health, then spent 12 years as executive director for Planetree Health Resource Center, San Francisco, a nonprofit consumer healthcare organization that focuses on patient-centered care. While Orr was with Planetree the organization created a revolutionary demonstration project that brought patient-centered care to three model sites. The project centered on changing the hospitals’ physical environments as well as providing patients access to their own medical records.

Approximately 12 years ago, Orr left Planetree to start her own consulting practice. The Robin Orr Group (Santa Barbara, Calif.) works with healthcare organizations to effect patient-centered care. At the time she was admitted to the ED at Cottage Hospital, Orr’s consulting work was tapering off as she struggled with constant pain.

From the perspective of a health professional, I could see that a hospitalist helps eliminate waste. I know that hospital resources are so precious, and when someone can help expedite a procedure or test, it’s extremely valuable.

—Robin Orr

Enter the Hospitalist

At 7 a.m. on the Saturday the morning after Orr was admitted, Eric Trautwein, MD, checked on her. Dr. Trautwein is a hospitalist with the Samsun Santa Barbara Medical Foundation, which employs approximately 200 physicians in multiple specialties.

“Eric was a breathe of fresh air,” says Cook. “He … had read all her charts and immediately asked about the pain and got it under control.” Throughout the ordeal, Cook says “everyone would ask Robin what the pain level was, and she’d say ‘11,’ and they’d write it down. Eric did something about it.”

The next step, as Cook recalls, was a thorough examination. “I’ll never forget—he noticed that one knee reflex had a very subtle difference,” she says. “He wanted to double check that, saying he never made assumptions. He immediately got tests scheduled for that day, which was a Saturday. That never happens.”

Orr was scheduled for an immediate CAT scan, PET scan, and MRI. The results were available by Monday: The tests showed a mass of 4.5 x 3 cm to the left retroperitoneum adjacent to the aorta, consistent with metastatic disease.

After months of dealing with healthcare professionals who focused on and treated Orr’s pain, both Orr and Cook believe that the hospitalist’s diligence in performing a thorough exam and insistence on immediate tests were remarkable.

“A hospitalist saved my life,” Orr says confidently.

Dr. Trautwein doesn’t feel his exam and diagnosis were unusual.

“I’m not sure I did anything special,” he says. “I know for sure that my partners would have done the same things I did, and so would most hospitalists.”

After the Test Results

At the end of the weekend during Orr’s stay, Dr. Trautwein’s shift ended and his partner, Jeffrey Yim, MD, took over. Before the change, Dr. Trautwein assured the women that he’d go over Orr’s case with his partner, and that he would stay in touch. This is standard procedure among the hospitalists in their practice.

“We’ll ask if there’s anything they want us to convey to the new doctor” before we go off shift, says Dr. Yim.

The hospitalists at Samsun Santa Barbara Medical Foundation take great care with transitions during shift changes because they are aware that mistakes can happen if communication is incomplete.

“Hand-offs are one of our biggest challenges,” says Dr. Yim. “Ours aren’t formalized, but we follow a standard practice of leaving what we call an ‘off-service note.’ This is very comprehensive, almost like a discharge note, and includes all important details. In addition, the outgoing and incoming hospitalists have a sign-off conversation, either in person or over the phone, to cover any social issues or dynamics. With Robin, for example, pain control was an issue.”

Dr. Yim told Orr and Cook the results of the tests.

“Dr. Yim came in on Tuesday, and it was like passing a baton in an Olympic race,” recalls Cook, who is an expert and author on customer service. “Both [of the hospitalists] have empathy, [a skill that is] relevant and timely, and a sense of urgency.”

Orr agrees that Dr. Yim’s care was as helpful as Dr. Trautwein’s.

“Both hospitalists made sure I was treated as a human being; they weren’t just treating my pain,” she says. “Dr. Yim made sure I got what I needed at discharge, which was very necessary. He was on top of it and made sure it included follow-up.”

In Praise of Hospitalists

Despite her profession, Orr says she had never heard of hospitalists before meeting Dr. Trautwein. In addition to her gratitude to him for diagnosing her cancer, she was very impressed with how the role of hospitalist affected her care.

“I felt that having a hospitalist helped streamline the process,” she says. “I was admitted through the ED in the middle of a weekend night, when labs were closed and I had no access to my primary care physician. Despite the timing, there was continuity and follow-through, and there was speed of action.”

Orr was particularly impressed at how the various departments of the hospital worked together, with a hospitalist acting as her champion with all of them.

“[Eric] has a familiarity with hospital resources and knew who to call and when to call,” she says. “He passed the baton between people in such a way that I felt I would not be dropped between departments. There were great communications, and it helped with the ease of streamlining and continuity, and it certainly helped my peace of mind.

“From the perspective of a health professional, I could see that a hospitalist helps eliminate waste,” Orr continues. “I know that hospital resources are so precious, and when someone can help expedite a procedure or test, it’s extremely valuable.”

Orr had a first-hand view of how hospitalists streamline processes and influence care for individual patients. Her experience as a patient was an educational time for her, even with her substantial background working with hospitals.

The Hospitalist’s View

While Dr. Trautwein is pleased with the outcome of his assessment of Orr, he insists that he was doing his job. In fact, he believes the toughest part of being a hospitalist is not detecting hidden illnesses, but building trust.

“The biggest part of my day is communicating. I feel like I don’t have much time to establish trust with patients,” he admits. “That’s by far the hardest thing about the job. You only get one pass to go over their medical history, but you also have to build a rapport with them. It’s not easy.”

With each new patient he sees, Dr. Trautwein is aware that that person is wary of seeing a new doctor rather than their own primary care physician.

“A lot of people are skeptical when they see a new [doctor]—especially a young doctor,” he explains. “Sometimes, I’ll start by trying to talk about something unconnected with their condition, to try to connect with them as a person. Getting patients to trust you is one of the more difficult parts of the job, but it can lead to one of the greatest satisfactions.”

As a hospitalist, Dr. Trautwein has a clear view of his role versus that of a primary care physician, and sees the value in being available to hospitalized patients.

“Primary care physicians are squeezed from every direction and can’t be around their patients in the hospital all the time,” he says. “Hospitalists get the patients’ attention; it’s not hard to drop back into someone’s room. For the patient, that’s important. They see that we care about them, and we can make the face-to-face contact with them that used to be impossible.”

Dr. Trautwein makes a special effort to see each patient as often as he can, and to share information with them.

“I try to think about it from the patient’s perspective,” he says. “The major thing that patients are hungry for in a hospital is communication.”

As for his ability to get tests scheduled on a weekend, he says that Cottage Hospital “is a pretty responsive hospital in general. I don’t spend a lot of time banging my head against the wall with them. If I talk to a person directly, in person or on the phone, they’ll respond. It is unusual to have tests done on the weekend, but it was also unusual to have a patient who needs them so much.”

Dr. Trautwein understands that a normal day’s work for a physician can mean a life-changing diagnosis for a patient. Orr and Cook understand it, too, but from their perspective, a hospitalist doing his job can lead to a miracle.

Orr’s Recovery

At the time this article was written, Orr had completed a round of radiation and was recuperating as she awaits further test results. Despite her ordeal and her pain, her outlook is as positive as her praise of hospitalists. Looking back on her experience at Cottage Hospital Santa Barbara and Dr. Trautwein’s role, she says, “The outcome of all this was my peace of mind as a patient. You can’t buy that in a hospital anywhere in America today.” TH

Contributor Jane Jerrard writes the “Hospital of the Future” series for The Hospitalist.