Dr. John Spertus is the director of health outcomes research at Saint Luke's Mid America Heart Institute and a professor at the University of Missouri-Kansas City's School of Medicine.
Spertus co-led a large-scale study that found, in some situations, invasive treatment such as stents and bypass surgery are no more effective than medication and lifestyle changes for preventing heart attacks or death in patients with heart disease.
The International Study of Comparative Health Effectiveness With Medical and Invasive Approaches, or ISCHEMIA, has wide-reaching implications for how physicians will deliver individualized health care at the lowest possible risk and cost. Spertus spoke with the Kansas City Business Journal about the study and how precision medicine will change the business of cardiology.
What do the findings of this study mean for physicians and patients?
I think it will have a big impact on the way we practice medicine going forward, because the public at large and certainly doctors really believe that if an artery is blocked, we ought to fix it. Now, we can be much more judicious at thinking about, well, what are we going to gain from fixing it? We're not going to make them live longer. We're not going to prevent heart attacks. But if we could alleviate their symptoms, then they should get it done. I think that's an important message. It's a simple message, but we didn't have such convincing data to distill it down until this trial.
What does this study mean for an industry that's focusing more on quality versus quantity health care?
These kinds of data are going to be very important for proactive health care systems that are preparing for value-based health care, which is just starting to penetrate our own reimbursement scheme. A forward-thinking health care system would be taking data like this and really thinking about new strategies for treating patients — investing more in medical prevention, exercise and smoking cessation — and reserving these more expensive and invasive treatments for those who are most symptomatic.
What does precision medicine look like in cardiology right now?
We've really been leaders in that we're one of the few systems in the world that every day, with every patient going into our cath lab, we implement precision medicine. Meaning we run risk models on each patient so we can tailor the treatment to that individual patient. This trial will just extend the kinds of evidence-based precision medicine discussions we have with our patients based on the data that comes from the ISCHEMIA trial.
What is the most exciting technological advancement you see in the field of cardiology?
I think implementing precision medicine is very exciting and is the future (of medicine), whether that's done with AI or whether it's done with taking the risk models we already have developed and using them. We're going to be incentivized with value-based care to reimagine how we deliver care in a more patient-centric fashion and we'll be thinking about things outside of just procedures and treatment, like social determinants of health. Kansas City is starting to really build a collaboration across our hospitals with something called the Kansas City Quality Improvement Consortium that brings these hospitals together to collaborate on implementing new strategies to improve care. If we can pull that off we would be the only city in the country where these hospitals that compete for patients are collaborating to improve the value of health in our community.
Have you seen any changes in the operational structure of cardiology since you've been in the industry?
Over the last 15 years, the vast majority of cardiologists are now employed by hospitals. What we need now, is to create novel and creative approaches to more efficiently delivery care and I believe that's just starting. The first decade was just getting everybody employed and developing all of the mechanics. But now that there's a great alignment between hospitals and cardiologists, we need to develop new and innovative strategies of delivering more value-based care.