Dr. Alessi revisits his American Heart Month conversation with UConn Health cardiologist Dr. Peter Schulman, drilling down on advances in prevention, treatment, and management of heart disease, heart attack, and heart failure, how they've changed over the years, and further changes potentially on the horizon.

The Healthy Rounds Podcast at UConn Health:

https://www.uconnhealth.org/healthyrounds

Submit questions for Healthy Rounds:

HealthyRounds@uchc.edu (mailto:HealthyRounds@uchc.edu)

Dr. Peter Schulman:

https://www.uconnhealth.org/providers/profiles/schulman-peter

Pat and Jim Calhoun Cardiology Center at UConn Health:

https://health.uconn.edu/cardiology/

UConn Health:

https://www.uconnhealth.org (https://www.uconnhealth.org/)

Support from UConn Health Orthopedics and Sports Medicine:

https://www.uconnhealth.org/orthopedics-sports-medicine

Grant support from Coverys:

www.coverys.com (http://www.coverys.com/)

Transcript

Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your personal physician.

I’m your host, Dr. Anthony Alessi, and it’s great to be with you on what has become known as our deep dive. And this particular episode of our deep dive is dedicated to a show we did with Dr. Peter Schulman last week. As you’ll recall, Dr. Schulman is a cardiologist and professor of medicine here at the University of Connecticut, where he has practiced for 44 years, and he has been a cardiologist for longer than that.

But before we get to Dr. Schulman, I want to go back to something that was discussed in a previous episode with Dr. Juthani, and that was the use of messenger RNA. We’re hearing a lot about that this week, because the Food and Drug Administration refused to review a flu vaccine that is based on messenger RNA, that’s put out by the Moderna company. And they really haven’t given good reason for why they have refused to review this.

Now, let’s take a step back, because we know that the current administration has stopped research to the degree of $500 million cut, just on the topic of messenger RNA. And that’s because there is misinformation out there -- I almost think it’s disinformation, but it’s misinformation -- that messenger RNA, somehow changes a cell structure, and that’s not the case at all. Dr. Juthani used a good example of it, but I’m going to go a step further.

Messenger RNA is just that. It’s a messenger. It brings a message to a cell. Think about it this way: If you were to order food from Uber Eats or DoorDash, right, that food is brought to your door by a messenger, he leaves the food and then leaves your premises.

Think of messenger RNA as just being that messenger. He doesn’t come in your house and start telling you how to rearrange your furniture. He just brings the message about what it is your body needs to be fighting, in this case, the flu.

Now, one of our problems is that we keep coming up a little bit off target when it comes to influenza, and Dr. Juthani explained that it’s because we have to decide in February. So right now in February, we’re deciding what flu we’re going to be fighting in the fall. We base that on information that we get from the southern hemisphere with the flu. That is the flu strain that is most prominent there. It takes a long time because you grow it in eggs and that’s how you produce the vaccine messenger RNA.

And thanks to Operation Warp Speed, we are now able to come up with a vaccine in a much shorter period of time. So let’s think about it. If we could do it in a shorter period of time, we will have a better idea of what our target is. For influenza that year. So now we’re talking about instead of February, possibly doing it in May or June when we have a better idea of the target and a better chance of hitting it. So again, I want to emphasize the fact that messenger RNA is purely a messenger and it’s not changing your cell structure in any way.

But let’s get to our discussion with Dr. Schulman, which we put out on the airwaves on February 9, and that is, we wanted to get him on because this is American Heart Month. That’s something that was started in 1964 by Lyndon Johnson, and they did it to coincide with Valentine’s Day and the heart. And I guess, many of you listeners are probably my age or thereabouts. And remember, the one thing about the heart I remember is, Dr. Christian Barnard, right? Dr. Barnard, on December 3, 1967, he performed the first human heart transplant into a fellow by the name of Louis Washkansky in South Africa. Now it only lasted 18 days and, and that was ostensibly because we didn’t really have immune-suppressant drugs that would avoid th...

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Heart disease and heart attack are much more treatable, manageable, and preventable today than they were 40 or 50 years ago. For American Heart Month, Dr. Alessi speaks with Dr. Peter Schulman, UConn Health cardiologist, about the evolution of care for and prevention of cardiovascular disease, from medications to procedures to lifestyle changes.

Still, some things haven’t changed, including the crucial difference early intervention, defibrillation, CPR, and getting to the hospital as soon as possible can make with a suspected heart attack.

They also discussed the evolving recommendations on baby aspirin, the current and future state of statins, the difference between the sexes when it comes to heart disease, and the continued trajectory of cardiology care in the future.

Submit questions for Healthy Rounds:

HealthyRounds@uchc.edu (mailto:HealthyRounds@uchc.edu)

Dr. Peter Schulman:

https://www.uconnhealth.org/providers/profiles/schulman-peter

Pat and Jim Calhoun Cardiology Center at UConn Health:

https://health.uconn.edu/cardiology/

UConn Health:

https://www.uconnhealth.org (https://www.uconnhealth.org/)

Support from UConn Health Orthopedics and Sports Medicine:

https://www.uconnhealth.org/orthopedics-sports-medicine

Grant support from Coverys:

www.coverys.com (http://www.coverys.com/)

Transcript

Dr. Alessi: Welcome to the Healthy Rounds podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. It is not designed to direct your personal health care, which should only be done by your physician.

I’m your host, Dr. Anthony Alessi, and it gives me great pleasure to welcome my guest today, Dr. Peter Schulman. Dr. Schulman is a professor of medicine here at the University of Connecticut, where he is also a cardiologist and has worked in the Department of Cardiology for the past 44 years. Peter, welcome to the show.

Dr. Schulman: Thank you very much. I’m happy to be here.

Dr. Alessi: So, this is American Heart Month and it’s kind of interesting ’cause it’s one of those concepts that’s developed over time where we make people a little bit more aware of heart disease. But I’d like to take a step back a little bit, since you’ve been here 44 years and you and I are relatively of the same generation.

Can you talk a little bit about kind of the evolution of cardiology and the things you’ve found over the past 44 years?

Dr. Schulman: Well, that’s a very good question. I think I would almost call it a revolution, but evolution is pretty good. So, I was just thinking back on this, when I started cardiology practice more than 45 years ago at one other institution, if you had a heart attack and you survived the heart attack, you would probably have your second heart attack within 5 or 10 years, almost for sure. Because there was such a high risk of recurrent heart attacks, we didn’t have ways to prevent the second heart attack once you had one.

Actually, we didn’t even have ways to reduce your risk of your first heart attack. Now, 45 years later, in 2026, we not only have ways to dramatically reduce your risk of your first heart attack, but should you be unfortunate enough to have one, we can substantially reduce your risk of a second heart attack.

So, people who have a heart attack, that may be the end of it. They may have no further heart problems for the rest of their lives, and that’s what we’re striving for. Now, the same thing happened in heart failure. If you had severe heart failure back 50 years ago, if your heart was weak, well, sorry about that, but you probably would not live another 5 or 10 years. Your heart function, it’s like a motor of a car, would just lose horsepower over the years and decades and you’d be possibly gasping for breath in 5 or 7 years. Heart function would decline inexorably, just keep on going down.

Nowadays, we have ways to reduce the risk of heart failure, and we have ways to actually improve heart function if you already have a weakened heart. We have whole host of medications and many are very new within the last 5 years and we have devices that can strengthen the heart. So really, it’s major advances in heart disease prevention, heart disease treatment, and patient wellbeing that I’ve seen over the past 50 years. Those are just two examples.

Dr. Alessi: You know, that’s interesting because you talked about, you know, this revolution in medication as opposed to the more sexy things, right? The angioplasties, bypass surgery, so many of them, replacing valves through a catheter. I mean, those are the things you hear about and yet, I’m impressed that we’re hearing about the medical things, in terms of treating with drugs, as opposed to those. Have those things changed things a lot? I mean, it used to be an angioplasty was a big d...

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The Biomedical Science PhD program at UConn Health educates and trains individuals to pursue careers in the biomedical workforce in a wide variety of settings including academia, the private sector and government. To achieve this goal, we maintain an academic environment that fosters critical thinking and supports excellence in scholarship, research and teaching.

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The UConn School of Dental Medicine is celebrating the Class of 2026 as they receive their residency placements.

Out of the 51 students, 19 are staying in Connecticut, with five staying at UConn. Fifty-two percent placed in general dentistry residency programs, while the remaining placed in specialties including endodontics, oral pathology, oral and maxillofacial surgery, orthodontics, pediatrics, periodontics, and prosthodontics. Five students will head to private practice.

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Despite what’s coming out of Washington, Connecticut’s public health commissioner says the state has not changed its recommended vaccine schedule. Dr. Manisha Juthani joins Dr. Alessi to discuss the state of public health, beyond the confusion over current government recommendations. Topics include Connecticut’s standing among the most vaccinated states, the challenges of public health policy, access to health care, how the flu shot formula is determined, some of the Department of Public Health’s lesser-known functions, and how she came to be DPH commissioner.

Submit questions for Healthy Rounds:

HealthyRounds@uchc.edu (mailto:HealthyRounds@uchc.edu)

DPH Commissioner Manisha Juthani:

https://portal.ct.gov/DPH/About-the-Commissioner 

UConn Health:

https://www.uconnhealth.org (https://www.uconnhealth.org/)

Support from UConn Health Orthopedics and Sports Medicine:

https://www.uconnhealth.org/orthopedics-sports-medicine

Grant support from Coverys:

www.coverys.com (http://www.coverys.com)

Watch a video of this interview:

https://youtu.be/BA1Tg6CXA9A

Transcript

Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we bring you up to date and timely medical information provided by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery, in addition to a grant from Coveris.

This podcast is not designed to modify or in any way influence your medical care. That should only be done with the cooperation of your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have with me today my guest, Dr. Manisha Juthani. Dr. Juthani is a medical doctor and she also serves as the Commissioner of the Connecticut Department of Public Health.

Dr. Juthani: Thank you so much for having me.

Dr. Alessi: Manisha, let’s start with a little bit about your background. How’d you end up with this job?

Dr. Juthani: It’s a really interesting story, actually. I was an Infectious Disease Physician in practice at Yale School of Medicine, was there for about 20 years, ran the fellowship program, saw patients, did research, and then the COVID-19 pandemic hit, and we as a hospital had to figure out a way to care for a hospital full of COVID-19 patients, had to expand our fellowship services from 3 services to 10 over three different hospitals. And as the pandemic wore on, the first wave was our biggest hit. And in the second wave, if you think back, it was December of 2020, and indoor dining had reopened in the state of Connecticut. And, we were seeing patients coming in who never left their home, but whose son went to a restaurant or a bar and came home and infected their immunocompromised mother. Or somebody who had just had a transplant who, again, never left their home, but whose relative went to a restaurant and brought the virus back home. Again, remember back to December, 2020, this was pre vaccines.

Dr. Alessi: Sure.

Dr. Juthani: And at that time, a friend of mine said, let’s write a letter to the governor complaining, and would you sign on asking him to shut down indoor dining again? And I said, yeah, I can sign on to that.

And I’m seeing these patients myself. So I signed on. And the governor, to his credit, said, there are a bunch of these physicians complaining, and I think we should meet with them. So, he met with us and I told him the stories of the patients that I was seeing, and he said, you know, “Manisha, I think the people of Connecticut need to hear what you have to say, will you come onto one of my press conferences?”

So I said, sure. And the next week I was on one of his press conferences. And even though I had a feeling the policy of the administration was not gonna change because I know the governor really felt like businesses had struggled, and if people were gonna gather, they were either gonna gather at home or gather in restaurants, so might as well let the restaurants stay open.

And I thought that may be the case, but I still advised people what he asked me to do, and that really built a connection for us and a foundation for public health principles, maybe you could say. And six months later they asked me to take this job, which was a complete diversion from what I had done for 20 years of my life.

And here we are, four years in running that I have stuck with it.

Dr. Alessi: Do you like it?

Dr. Juthani: I do really like it. And maybe part of that is in infectious diseases you are tasked with dealing with emergent problems and challenges, and I was brought into one, which was the COVID pandemic and public health, as you already mentioned, is the backbone of so much in our society.

And so, I really started to enjoy more than just addressing the pandemic in the job. And now we’re in a phase where we are losing guidance from the federal government on certain things, and so now I feel a responsibility to the state to try to lead us during a t...

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Patients with severe back and leg pain are finding relief and a faster path to recovery thanks to an ultra-minimally invasive spine procedure at UConn Health.

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Severe back and leg pain brought Martin’s active life to a sudden stop. Thanks to an ultra-minimally invasive spine procedure, he found relief and a faster path back to doing what he loves.

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In our first “bonus episode,” Dr. Alessi further explores some of the relevant topics from his conversation with Dr. Andrew Agwunobi, UConn Health CEO and executive VP for health affairs, such as patient safety, the per-capita cost of health care in the U.S. compared to other parts of the world, how aligned incentives might address that, and electronic medical records.

Watch for periodic “deep dives” released as bonus episodes as Dr. Alessi brings in more guests throughout the year.

Submit questions for Healthy Rounds With Dr. Anthony Alessi:

HealthyRounds@uchc.edu (mailto:HealthyRounds@uchc.edu)

Dr. Andrew Agwunobi:

https://www.uconnhealth.org/about-us/leadership

UConn Health:

https://www.uconnhealth.org (https://www.uconnhealth.org/)

Support from UConn Health Orthopedics and Sports Medicine:

https://www.uconnhealth.org/orthopedics-sports-medicine

Grant support from Coverys:

www.coverys.com (http://www.coverys.com)

Transcript

Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopedic Surgery and a grant from Coverys. Our podcasts here are not designed to direct your personal healthcare, which should only be done by your physician.

I’m your host, Dr. Anthony Alessi, and today we’re going to do something a little bit different. Our first episode last week was with Dr. Andrew Agwunobi, the Chief Executive Officer for UConn Health and the Executive VP for Health Affairs.

And, in our discussion with him, he brought up several topics and you know, we only have 20 minutes or so to have the conversation, but he brought up many topics and I think this is going to be happening as we do more and more of these interviews because they provide topics for us to really take what we’re going to be calling the “deep dive”.

And that being these topics that we discussed really provoke further thought and the need for further explanation. So, I thought we’d have some fun with that by looking at some of the topics he brought up and maybe looking at them a little more carefully.

Among the things he talked about were research, education, things that UConn can be doing to improve the stature of the university and you know, I guess we expect research and education to be part of it. But he also talked about patient safety, patient satisfaction, improving the patient experience. You know, when I first heard the term patient safety, I thought it was an odd term because you think right away, “well, I’m in a hospital, I should be safe.”

But years ago, and I would say about 20, 30 years ago, we started looking at the entire hospital system and how we deliver care from the standpoint of industrial engineering. For those of you familiar with industrial engineering, it’s a way of looking at a process and finding a way to make it more efficient.

So, you look for the weak points in that process and make corrections. So, in the case of healthcare, we looked at a lot of different things and I guess probably the most relevant change came in the operating room where we now have a timeout that’s mandatory. So, before surgery begins, when everyone who’s involved is in the room, they take a timeout to make sure we’ve identified the right patient by their armband, make sure we’ve identified what side or what procedure we’re going to be doing and where it’s going to be done. We also make sure we have all the proper equipment in the room.

 So basically, you have a checklist. And that brings me to a book called The Checklist Manifesto by Atul Gawande. Dr. Gawande is a surgeon and a famous author, but he looked at the use of checklists in medicine. Much like a pilot, right, before a pilot takes off, they go through a whole checklist to make sure various things are working, we know who’s available, what they should do, but they go through a checklist of all their buttons and dials before they even initiate taking off.

So, medicine took that same, those same practices and applied it to really every procedure we do. If I’m giving an injection, say a nerve block, right, part of what I have to do is make sure that I’ve identified the procedure I’m doing, what side I’m doing, how have I marked my landmarks, and what I’m using. So again, a checklist to do a procedure. And that is to really help patient safety, and that’s just one example.

We’re going to get Dr. Scott Allen on the show. Dr. Allen is an internist who is really the guru here in the state of Connecticut when it comes to patient safety and quality, and he won a great award last year from the Connecticut Hospital Association, so, I look forward to having him on as a guest as well and talk a little bit about that.

One of the other things Dr. Agwunobi brought up was the per capita cost of care in the United States versus Europe. We spend twice as mu...

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