When a backlog of patients and an aging population meet: UH's chief of cardiac surgery on the specialty's greatest issues

In recent weeks, Marc Pelletier, MD, and colleagues have seen an influx of patients with more severe heart issues. That influx and providing care to an aging population are what he calls cardiology's biggest challenges today. 

Dr. Pelletier, division chief of cardiac surgery at University Hospitals, part of Case Western Reserve University in Cleveland, recently joined Becker's cardiology and heart surgery podcast to discuss how heart care is evolving and what's driving challenges for heart specialists. 

Here is an excerpt from the podcast. To listen to the full episode, click here

Editor's note: This response was lightly edited for length and clarity.

Question: What are the biggest issues you're seeing in cardiology today?

Dr. Marc Pelletier: In 2021, the biggest issue has been COVID-19. I think COVID will slowly abate, hopefully, and get better, but it's had a tremendous impact on how we have practiced in the last year. The impact has been felt not just here, but so many places across North America and still ongoing right now in many areas that are still being hit hard by this. For us, what it's meant is that last year we saw a lot of patients staying away from hospitals and away from their physicians during the height of the pandemic. Now, we're seeing a lot of these patients coming back and we've all noticed in the last month or two as these patients are coming back maybe after not being seen for a long time, we're seeing patients that are lot sicker who, while this was going on, were maybe not getting as much care as they normally would have for various reasons.

Now, we're coming in with more coronary disease; hearts that are a bit sicker. For us, that definitely is having a big impact on our resources and the patients that we're having to treat. As an example, [recently,] we had seven patients on full life support, including an ECMO machine, which is essentially a coronary bypass circuit. So these patients are in complete heart and lung failure. To have seven of those at one time is really unusual for us. Emerging from the pandemic and dealing with the effects of that has been one big challenge. 

Along those lines too, what we are seeing currently in North America is … less of an acute change, but an aging population. So we have patients that are getting into their 80s and 90s and coming to us for cardiac care — which was very unusual before — and now every week we're seeing patients in their 80s and 90s asking about valve replacements. They're asking about coronary bypass surgery. They're asking about invasive procedures that are big procedures when you're 60 years old, but when you're in your 80s or 90s, it becomes an even bigger procedure. We're very fortunate because there've been a lot of technological advances, but still that means that a lot of patients are coming to us and needing care, and sometimes that can be a bit challenging as well.

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