Latest / Becker’s Healthcare Podcast / Transforming Cardiology Through Innovation, Training, and Technology with Pranav Loyalka, MD

Transcript

Transforming Cardiology Through Innovation, Training, and Technology with Pranav Loyalka, MD · Becker’s Healthcare Podcast

• 0:00
  Welcome, everyone, to the Becker's health care cardiology
• 0:03
  and heart surgery podcast. I'm Mariah Taylor, assistant
• 0:05
  editor, and I'm thrilled to be speaking with
• 0:08
  Pranav Loyoka,
• 0:09
  cardiologist at HCA Houston Health Care Medical Center,
• 0:12
  medical director of structural heart disease, heart failure,
• 0:16
  heart transplant,
• 0:17
  and mechanical circulatory support at HCA Gulf Coast
• 0:20
  division,
• 0:21
  and the program director for the cardiology
• 0:24
  fellowship program at HCA Kingwood Hospital.
• 0:27
  Thank you so much for joining me today.
• 0:29
  I'm really excited to learn more about everything
• 0:31
  you're doing in cardiology. But before we dive
• 0:33
  into that, I'd love for you to introduce
• 0:35
  yourself and tell us a little bit about
• 0:36
  your background.
• 0:38
  So thank you so much.
• 0:40
  Really happy and excited to be on the
• 0:42
  show and, get in front of, you to,
• 0:45
  answer questions.
• 0:46
  I actually, grew up in, Columbia, Missouri,
• 0:50
  spent my life running around the country getting
• 0:52
  educated, and
• 0:54
  after about sixteen years of,
• 0:57
  education after high school,
• 1:00
  ended up being a cardiologist here in Houston.
• 1:03
  And, I've got
• 1:05
  two kids,
• 1:06
  wife and a furry baby at home, and,
• 1:10
  really enjoy living in Houston.
• 1:13
  Excellent.
• 1:14
  Now you've obviously been in cardiology for a
• 1:16
  long time, and interventional cardiology has undergone a
• 1:20
  lot of transformation
• 1:21
  even just in the last two decades
• 1:24
  So from your perspective on the front lines,
• 1:27
  what's the single advancement whether that's device a
• 1:30
  technique or a procedural approach that has most
• 1:33
  changed what's possible for your patients?
• 1:36
  So interventional cardiology has been a very exciting
• 1:39
  field. We have really,
• 1:42
  changed since the time I trained in 2000,
• 1:46
  you know, five when I ended my training
• 1:48
  to where we are now.
• 1:50
  Interventional cardiology at the time I trained really
• 1:53
  dealt just with coronary artery disease. In other
• 1:56
  words, the arteries that sit on top of
• 1:58
  the heart that get blockages.
• 2:00
  The surgeons do bypasses. We put stents into
• 2:02
  it.
• 2:03
  The single biggest advance
• 2:05
  probably happened, and, you know, I was very
• 2:08
  fortunate to be a part of this.
• 2:10
  In 2008,
• 2:11
  2009,
• 2:12
  when we started the trials for the new
• 2:15
  heart valve
• 2:16
  that we could replace through the leg
• 2:19
  in patients
• 2:20
  called the transcatheter
• 2:22
  aortic valve replacement.
• 2:24
  That really opened a new era in interventional
• 2:27
  cardiology.
• 2:29
  And we were a part of the early
• 2:31
  trials,
• 2:33
  that were performed in The United States
• 2:36
  and got FDA approval later.
• 2:39
  And, basically,
• 2:41
  patients with what we call aortic stenosis, a
• 2:44
  disease that leads to death, especially in the
• 2:47
  elderly.
• 2:49
  It was a disease either you got surgery
• 2:51
  or you passed away from it. So many
• 2:53
  elderly patients, 80, 90, even 100 years old,
• 2:57
  would be medically managed, would get congestive heart
• 3:00
  failure,
• 3:01
  and have really poor quality of life.
• 3:04
  We were now able to rescue those patients,
• 3:06
  place a heart valve through the leg, and
• 3:09
  send them home the next day.
• 3:11
  That's probably the biggest advance that we've had,
• 3:15
  and that's led to subsequent advances
• 3:17
  in the other valves, whether it's the what
• 3:20
  we call the tricuspid valve, mitral valve, pulmonic
• 3:23
  valve.
• 3:24
  Now we have options
• 3:26
  other than surgery.
• 3:28
  To be sure, you know, surgery plays a
• 3:29
  role, will always continue to play a role,
• 3:32
  but now we have alternatives, which is really
• 3:34
  exciting.
• 3:36
  Absolutely.
• 3:38
  And as I said in the beginning,
• 3:40
  you are the program director for the cardiology
• 3:43
  fellowship. And it can be a little bit
• 3:45
  hard as a fellow coming into the industry
• 3:47
  as a whole, but especially with all the
• 3:49
  changes that have happened recently.
• 3:51
  So what's one piece of advice you have
• 3:54
  from someone who's a first year cardiology fellow,
• 3:57
  that you wish you had gotten early in
• 3:59
  your training?
• 4:01
  So
• 4:01
  probably the one piece of advice,
• 4:04
  and and we had it in our training,
• 4:06
  but it's different in this generation,
• 4:09
  is that you really need to put in
• 4:11
  a lot of time and effort in order
• 4:14
  to master this craft.
• 4:16
  We
• 4:17
  educate. We talk.
• 4:19
  But at the end of it, it's a
• 4:20
  hand skill.
• 4:22
  And just like any hand skill,
• 4:24
  and it's probably Malcolm Gladwell all over again.
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  It's the ten thousand hour rule.
• 4:29
  You just have to do a lot of
• 4:30
  it to get good, and you have to
• 4:32
  pay attention to details.
• 4:35
  You know, you just have to be prepared
• 4:37
  that you're in it for the long run.
• 4:40
  It it's not just, hey, two, three years,
• 4:43
  four years, you've learned your craft. You're gonna
• 4:45
  end up learning your craft
• 4:48
  well into your practicing years.
• 4:51
  Absolutely.
• 4:52
  And knowing what you do now about the
• 4:54
  field and how it's evolved, is there anything
• 4:56
  you would have done differently in your training
• 4:59
  or how you built your career if you
• 5:01
  were to start all over again?
• 5:03
  No. Not really. Actually, I'm very fortunate that
• 5:06
  I ended up in the right place at
• 5:07
  the right time. So I actually did,
• 5:10
  my early training, my residency in internal medicine
• 5:13
  and pediatrics. And for folks who don't know,
• 5:16
  for cardiology,
• 5:18
  you have to either start an internal medicine
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  or pediatrics
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  to then go on to what we call
• 5:23
  fellowship.
• 5:24
  So I actually did both,
• 5:27
  and then I started cardiology
• 5:29
  fellowship in the adult world.
• 5:31
  When I was at St. Luke's, I was
• 5:32
  very fortunate. I met Charles Mullins, who was
• 5:35
  the father of pediatric interventional cardiology.
• 5:39
  And when he found out that I had
• 5:41
  done both and that I was
• 5:43
  interested in interventions,
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  he kinda took me under his wing at
• 5:47
  that time.
• 5:48
  Pediatric interventions, unlike adults,
• 5:51
  was dealing with the big arteries, the valves,
• 5:54
  holes in the heart,
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  and that skill really paid dividends
• 5:58
  when we started, you know, fixing aortic valves
• 6:02
  through the leg because that type of work
• 6:04
  we were doing in pediatrics,
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  although they weren't valves, they were bigger stents,
• 6:09
  bigger arteries.
• 6:11
  I also had the ability when I was
• 6:13
  at Texas Heart Institute,
• 6:15
  some phenomenal teachers,
• 6:18
  who taught me peripheral vascular. In other words,
• 6:21
  the plumbing and the pipes and the,
• 6:23
  arteries outside of the heart.
• 6:26
  And so that skill also layered onto that.
• 6:28
  And the other field that I did, heart
• 6:30
  failure transplant,
• 6:32
  really evolved to where we learned how to
• 6:35
  support the heart if things went bad. And,
• 6:39
  that also added to this field.
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  So
• 6:43
  I actually considered myself really lucky to have
• 6:46
  been there at the right time, right place.
• 6:49
  There there's a
• 6:51
  thing that happens now in medicine. People train
• 6:55
  to be an expert
• 6:56
  in less and less and less. In other
• 6:58
  words,
• 7:00
  somebody may pick one
• 7:02
  valve to work in, and then they become
• 7:04
  super specialized in that one area.
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  But, really, where I was fortunate was that
• 7:09
  I had a broad and deep education
• 7:12
  in all of those areas,
• 7:14
  and it's been, you know, I think
• 7:17
  paid dividends over the years for me to
• 7:19
  be able to pivot, to be able to
• 7:21
  research and where those fields overlap.
• 7:25
  And so if I had to advise a
• 7:27
  a fellow,
• 7:28
  train broadly and train deeply.
• 7:30
  Just don't learn more and more about less
• 7:33
  and less, which is what super specialization is.
• 7:37
  Absolutely.
• 7:38
  I'd love to dig into that a little
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  bit more because I'm sure you're well aware
• 7:42
  that there's a shortage of cardiologists
• 7:44
  coming into the field. And so there's just
• 7:46
  gonna be a continuing shortage going on as
• 7:49
  the years come down. And there's a lot
• 7:52
  of cardiology fellows that appear to be
• 7:55
  really specializing or focusing on one part of
• 7:57
  the heart for one kind of a procedure.
• 7:59
  And right now, it appears our system kind
• 8:01
  of rewards that. Right? We want people to
• 8:04
  be super specialists.
• 8:06
  But with an ongoing shortage that leaves a
• 8:08
  lot of open gaps for care and patients
• 8:10
  who can't find people who can do maybe
• 8:12
  more general care or pediatric
• 8:14
  care or these other kind of more general
• 8:16
  specialties.
• 8:18
  I guess, what are your thoughts on kind
• 8:20
  of the future
• 8:22
  of specialization
• 8:23
  within cardiology, and what movement do we need
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  going forward to make sure we're meeting the
• 8:28
  patients and their needs?
• 8:30
  Boy, that's
• 8:32
  Pandora's box that you're opening there. Right?
• 8:35
  That question really covers,
• 8:38
  the whole health system, how we function, and
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  how we do things.
• 8:42
  So, actually, the shortage that we have
• 8:45
  of cardiologists
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  is not in the cities.
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  It's in the rural areas.
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  How do you get care into the rural
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  areas closer to home to affect change
• 8:57
  so that people don't progress to as bad
• 9:00
  of disease that we see and that we're
• 9:03
  able to take care of that part of
• 9:04
  the population that we otherwise couldn't.
• 9:08
  So there's a there's there's a little bit
• 9:10
  of an issue. Right? So
• 9:12
  most cardiologists
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  and, you know, most people in medicine
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  get paid by the number of procedures they
• 9:20
  do, the number of patients that they see.
• 9:23
  If you're in a rural area, there aren't
• 9:25
  that many patients.
• 9:27
  There aren't that many procedures to do.
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  And,
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  you know, it's it's much harder to,
• 9:35
  make a living as a cardiologist.
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  So you're really talking about changing the whole
• 9:40
  system if you have to do something like
• 9:42
  that and incentivizing.
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  Now
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  Medicare does pay a little bit more if
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  you're in a rural area,
• 9:49
  per procedure,
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  but it's still not enough to incentivize
• 9:53
  people to go into those areas and really
• 9:56
  settle and establish practices.
• 9:59
  So I think that's gonna be an ongoing
• 10:00
  problem.
• 10:02
  I I I don't know that today that
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  anybody in the health care system
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  or in the government has an appetite to
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  tackle that big of a problem.
• 10:13
  Interesting. And I wanna ask a little bit
• 10:15
  more about the future
• 10:16
  and what's exciting you. So
• 10:19
  right now, there's all kinds of new devices
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  coming out, new imaging technology, AI assisted diagnostics,
• 10:25
  structural procedures. We here at Becker's have covered
• 10:27
  all kinds of really cool new things.
• 10:30
  But I'm curious what excites you the most
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  or what you think is gonna be the
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  most disruptive to the industry over the next
• 10:36
  ten years?
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  I think over the next ten years, I
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  think, like all fields, I think,
• 10:42
  artificial intelligence is gonna be very disruptive in
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  a in a positive way.
• 10:47
  I think you will start to see
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  AI not only help in diagnosis, but the
• 10:53
  management of patients.
• 10:55
  You know, when patients get really sick, they
• 10:57
  go to an ICU.
• 10:58
  How do you manage
• 11:00
  what you're gonna do, when you're gonna do
• 11:02
  it, when do you send them on?
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  You know, it may be clear at a
• 11:07
  place that gets the sickest of the sick,
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  but it may not be easy in, you
• 11:12
  know, a hospital in rural America. What do
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  you what do I do with the patient
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  next? Because part of getting sick patients better
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  who are acutely sick or sick at that
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  moment
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  is really getting them to the right place
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  at the right time.
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  And
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  not a lot of people have
• 11:30
  the repetition or the training to know how
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  to do that. I think that's where artificial
• 11:35
  intelligence will come in. It will be able
• 11:38
  to say, hey. You've got a patient here.
• 11:40
  This is what we're doing. This is probably
• 11:43
  the right treatment algorithm for them. And if
• 11:46
  this doesn't work, this is where you need
• 11:48
  to send the patient on.
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  And often what we see is that's where
• 11:52
  we have the gaps in care and the
• 11:54
  poor outcomes.
• 11:56
  So I think it'll be a very, very
• 11:58
  disruptive but useful technology
• 12:00
  in managing patients.
• 12:02
  And it'll also double check,
• 12:05
  you know, is the diagnosis correct,
• 12:08
  or is there a better diagnosis? Again,
• 12:11
  we're good at diagnosing common things, but the
• 12:14
  things that are a little rarer
• 12:16
  slip by and don't get diagnosed for many
• 12:18
  years,
• 12:19
  and I think AI will probably help with
• 12:21
  that as well. So I think it's it's
• 12:23
  gonna have a positive change,
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  but I think there's a lot of work
• 12:28
  to be done. And then the other thing
• 12:30
  that's a more practical aspect is physicians spend
• 12:33
  a ton of time on paperwork.
• 12:35
  And I always liken this to, you know,
• 12:38
  an airplane
• 12:40
  takes more people places
• 12:42
  if it spends less time at the gate.
• 12:45
  So if you have a physician doing paperwork
• 12:47
  all day related to, you know, patient care,
• 12:50
  if you can simplify that, if AI can
• 12:53
  listen, transcribe, which what we're seeing,
• 12:56
  it's gonna change the nature of that game.
• 12:57
  That physician is gonna be able to see
• 13:00
  more patients and be more productive.
• 13:02
  So I think there are a lot of
• 13:03
  good changes.
• 13:05
  Absolutely. Well, thank you so much for taking
• 13:07
  the time to share more of your perspective
• 13:09
  and experience. This has been such a great
• 13:11
  discussion and just I really appreciate having you
• 13:14
  on the podcast today.
• 13:15
  Thank you so much. I really appreciate you.