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 winter 2003 and its last, until now, five years later. The reappearance of The AHHJ would not have occurred without the vision and determination of Jonathan McKenna, Editorial Director at Touch Briefings, a London-based medical publisher. I also want to express my profound appreciation for the overwhelming support of our 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.
With the rebirth of The AHHJ, I believe it is important to reaffirm that its mission and philosophy have not changed. I would therefore like to recall the closing paragraphs from my editorial in the inaugural edition of The AHHJ in 2003: “The ‘reason for being’ of The AHHJ is to create a forum for the exchange of ideas, experience and observations among all involved with or interested in the hospital care of heart patients. The Journal encourages, with equal enthusiasm, the views of those who espouse, reject or remain skeptical of the heart hospital concept in any or all of the various models in which it now appears. The great 17th century English physician and philosopher, John Locke is said to have been the first to understand the nature of knowledge. He believed that knowledge is derived from experience gained by the active human mind and tested ‘against the realities of nature’; In the present context, to borrow from Locke, ‘against the realities of medical practice’. Only in this way can our concepts, heart hospital and otherwise become knowledge.
The ultimate goal of The AHHJ, in keeping with Locke’s philosophy, is to participate in the relentless pursuit of knowledge of quality hospital cardiovascular medicine and surgery, and in the search for better ways to bring that quality to our patients.”
I encourage members of our Editorial Board and all who read The AHHJ to participate with your observations, commentaries, manuscripts, editorials, and suggestions for improving our coverage. And please do not forget that health policy, which affects all aspects of medicine, both in practice and in academia, is also a major interest of The AHHJ.
- Weinberg SL, A New Journal and a New Concept: The Heart Hospital, Am Heart Hosp J, 2003;1:11–12.
- Bush C, The Ohio State U. R.M.Ross Hosp: Proof of Concept, Am Heart Hosp J, 2009;7:21–26.
- Rodgers DP, Laird D, Heart Hospitals with Physician Investors:A Successful Model, Am Heart Hosp J, 2007;5:68–72.
- Weinberg SL, The Specialty Heart Hospital Concept: Transcending the Economic Issues, Am Heart Hosp J, 2007;5:l65–7.
- Nallamothu BK, Rogers MA, Chernew ME, et al., Opening of specialty cardiac hospitals and the use of revascularization in Medicare beneficiaries, JAMA, 297:962–8.
- Guterman S, Specialty Hospitals: A problem or a symptom?, Health Aff (Millwood), 2006;25:5–105.
- Weinberg SL, A New Journal and a New Concept, Am Heart Hosp J, 2003;1:11–12.