Welcome to Touch Briefings

Sylvan Lee Weinberg
American Heart Journal Volume 7 No.1

It is my great pleasure and privilege to participate in the return of The American Heart Hospital Journal (AHHJ).The first issue of The AHHJ was published in winter2003 and its last, until now, five years later. Thereappearance of The AHHJ would not have occurred without the vision and determination of JonathanMcKenna, Editorial Director at Touch Briefings, a Londonbased medical publisher. I also want to express my profound appreciation for the overwhelming support ofour Editorial Board members, whose continued presence is integral to the ultimate success of The AHHJ.

The introduction of The AHHJ in 2003 occurred at a time of great ferment in the hospital phase of American cardiovascular medicine and surgery, engendered by the growing presence of free-standing heart hospitals. Many of these were proprietary with physician investors. It was this heart hospital model that aroused the ire and a confrontational response from general hospitals, particularly those with proximity to the new heart hospitals. Beyond resentment for this new competition, with its inevitable economic consequences, there was widespread denigration of the heart hospital concept itself, with an emphasis on the role of its physician investors. It was in this milieu, generally hostile to the heart hospital concept, that The AHHJ appeared. In that first issue, my editorial1 noted: "The scope of The AHHJ is as broad and inclusive as the heart hospital concept itself-a concept which even now can take various forms and will doubtless evolve with changing times."

The heart hospital concept finds expression in several forms. Among them are stand-alone proprietary heart hospitals, where doctors share ownership and management. There are also free-standing heart hospitals owned by not-for-profit hospitals with physician investors. These two heart hospital models may be found in profusion by entering the heart hospital concept into Google. There is a very significant third heart hospital model with no doctor financial participation, which is being implemented in major not-for-profit hospitals and leading academic institutions nationally. A superb example of this model is described in detail in this issue of The AHHJ by Dr Charles Bush et al., titled The Ohio State University Richard M. Ross Heart Hospital Proof of Concept-Five Years of Growth and Development.² Rogers and Laird, writing in The AHHJ,³ recount their successful experience in a heart hospital with physician investors. They conclude that this model "creates an alignment of interests that better serve the patients."

In an AHHJ editorial titled The Specialty Heart Hospital Concept-Transcending the Economic Issues,⁴ I refer to an observation by Nallamothu et al. in JAMA⁵ that "In fact, it may be that the opening of cardiac hospitals may lead to more appropriate use of these procedures (coronary revascularization). Further studies will need to focus on these issues at both cardiac and general hospitals." Guterman noted that the Medpac Study⁶ reported: "Specialty hospitals do not seem to affect adversely the finances of community hospitals. Yet the heart hospital concept seems to be inevitably endangered by economic rather than by medical considerations." Thus, it appears that based on credible evidence and experience, the heart hospital concept has proved effective in both community and academic environments.

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