CHICAGO — In his presidential address to the American Heart Association on Sunday, Keith Churchwell, a clinical cardiologist and past hospital administrator, started right at the very beginning. Born in still-segregated Nashville, Tenn., he grew up in a household where academic achievement was expected, by his mother who earned advanced degrees while teaching in an elementary school and by his father whose work at a newspaper earned him the not always admiringly meant nickname “the Jackie Robinson of journalism.”
As his East Nashville neighborhood morphed over the decades into a gentrified destination for fine dining, so too has medicine changed, Churchwell said. Most cardiologists were in private practice when he started his career, but now nearly 80% of heart specialists are employed by hospitals or other businesses.
What has that meant for patients and the quality of their care? What about health equity? Churchwell sat down with STAT over the weekend to answer these and other questions. This conversation has been lightly edited for length and clarity.
Let’s start with how cardiovascular care in the hospital has evolved over the years for something like a heart attack.
If you’re acutely ill, you’re having an acute infarction and cardiogenic shock, dying at home or dying on the way in the ambulance getting to the hospital, in many cases, 36 hours later, you’re completely back to normal. From a patient’s perspective, many of them don’t even remember the event.
Then what?
We need to work towards ensuring that they don’t have a second event. And that’s more towards prevention, the ambulatory environment, understanding that we actually have multiple medications that can help in terms of reducing their overall cardiovascular event rate.
But even more importantly, the next big steps are thinking about how do we prevent that event ever happening? What can we do to actually reduce the rate of cardiovascular disease in the population so that the heart attack doesn’t occur or heart failure doesn’t occur or stroke doesn’t occur?
What role do you see for primary care?
Primary care is at the tip of the spear. If we were depending upon cardiologists, we come in actually somewhere in the middle of the story. Primary care should be at the beginning of the story.
The primary care physician is the person who’s going to write the prescription for blood pressure medication or follow the patient for their diabetes care. And actually, as the GLP-1s have actually continued to expand throughout the community, that’s where many of the initial prescriptions are going to be written.
So much research is coming out about GLP-1s, at this AHA conference and around the world. What questions still need to be answered?
It’s kind of remarkable what’s been found so far. There are cardiovascular effects, there are cerebrovascular effects there, there are cancer effects — where did that come from — smoking cessation and alcohol cessation in terms of possible effects as things go forward.
As we have a larger population to study and follow, we’ll get a greater sense in terms of what their true impact is going to be, not in just one year, but five years and 10 years, and also to understand exactly what the real side effect profile is.
They’re considered lifetime drugs, which also raises the question of access.
Blood pressure medicines are lifetime drugs, as are diabetes medicines. There is going to be that population that actually has taken their blood pressure medicine and they’ve reduced their weight by 25% and they’ve reduced their salt intake by 30%. And it turns out that actually they’re getting hypotensive on their blood pressure medicine. That’s a good thing. We can stop them.
But the great majority, they’re going to be on blood pressure medicine for a while. And there are salutary effects from blood pressure medicines that we have now. And we now understand after 20, 30, 40 years they have significant and positive impacts in terms of kidney function, cardiovascular function, brain function, that makes them very good medicines to take.
Given the political winds in Washington right now, are you concerned about the nomination of Robert F. Kennedy Jr. to lead the Department of Health and Human Services?
As an organization, we have been in this particular work for over 100 years. We’ve worked with multiple administrations. We worked with the Trump administration previously. And not only common ground, but we’ve actually found ways that are actually aligned in what they want to accomplish that are aligned with the mission of AHA.
And that’s my expectation over the next four years that we, grounded in science, can bring a conversation forward that is actually concrete and accurate, that going forward is going to actually make sense for AHA. It makes sense for the population. It makes sense for the administration. So I think we expect that we will actually have a very good conversation and actually work with the administration to actually achieve these goals.
Are we making strides in health equity, in care and in research? Will that continue?
I continue to be very positive and hopeful that the messaging that we’ve actually evolved over the past four years will continue to grow. We have a whole generation of physicians, nurses, ancillary support within the health care system who believe this message to their core. They understand that it actually needs to not only be latched on to everything we do, it needs to be part of every part of the solutions that we bring to the table.
Herman Taylor, professor and director of the Cardiovascular Research Institute at Morehouse College, told me this summer that he sees a backlash against efforts to improve equity. Do you?
I was telling some young folks about an hour ago, the journey is not straight. It’s like the road in San Francisco, trying to get up to Nob Hill, with a few stops and turns and we’ve got to reverse the car 10 times. But we’ll get there.
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.
