5 Questions with Dr. Bhatt

A Conversation With Lloyd W. Klein, MD

Deepak L. Bhatt

For this issue, Dr. Bhatt talks with Cardiology Today’s Intervention Editorial Board Member Lloyd W. Klein, MD, clinical professor at the University of California, San Francisco.

After graduating from high school in Manhattan, Klein attended Kenyon College and the University of Cincinnati Medical School, where he served as class vice president. He completed his medical residency at Albert Einstein Medical Center and a cardiology fellowship at Mount Sinai Hospital Medical Center in New York. Since then, he has served on the faculties of the University of Pennsylvania, Northwestern University and Rush University Medical Center.

During his distinguished career, Klein has balanced clinical responsibilities with extensive research in various areas of interventional cardiology. He has also become an authority on appropriate use and has written the definitive chapter on the subject in Interventional Cardiology.

What are your hobbies outside of practicing medicine?

Dr. Klein: I read biographies and books on history from all time periods, but I have a special interest in the American Civil War. My wife and I also travel frequently, work out regularly and pride ourselves on being “foodies,” enjoying culinary experiences locally and around the world. I am an avid fan of classical music, and jazz and blues, and when we travel, we seek out jazz venues that support outstanding contemporary musicians.

Lloyd W. Klein

What was the defining moment that led you to your field?

Dr. Klein: The major epiphany in my career occurred after I was part of the team that published the first prediction algorithm of outcomes for coronary interventions. My original motivation was, as a clinical interventionist, to try to better understand which patients had the highest potential risk for complications. Being able to identify the factors associated with risk allowed us to recognize that many of the patients who experienced complications had characteristics that made them more likely to have problems, so no blame should be ascribed to the doctor or to the cath lab.

The flipside of that, however, is that if repeatedly patients with few risk factors experienced complications, then perhaps the quality of care should be explored in greater depth. I found that insight intriguing, and only afterwards did I recognize that this was the “back door” into measuring program and operator quality, and to advance the concept of appropriate use in interventional practice, which would then become the essential theme of my work. Until that point, my research focused on coronary physiology, acute MI and unstable ischemic syndromes. Many people who enter the arena of evaluating quality standards have public health or statistical backgrounds, whereas I am a clinician.

What has been the greatest challenge of your career thus far?

Dr. Klein: The quest to define what constitutes excellent clinical decision-making and describe methods to measure and better achieve that goal continues to be the central challenge of my career. As interventional techniques improve, our view of what comprises optimal practice must be adjusted.

On a more personal level, being able to actively contribute intellectually and influence policy in this area while also maintaining active clinical practices in downtown Chicago and its suburbs has been both a fabulous opportunity and a challenge. I was living in two worlds and trying to do my best in each one of them.

Have you ever been fortunate enough to witness or to have been part of medical history in the making?

Dr. Klein: I participated in the revolution in the invasive management of ACS and MI. I assisted Peter Rentrop, MD, in administering intracoronary streptokinase in the first U.S. cases; was among the first to perform balloon angioplasty in STEMI and unstable angina; and developed the first ACS risk prediction model. I also worked with William S. Weintraub, MD, who led the field in recognizing how computerized databases could improve clinical care; that ultimately led to being a co-founder of the National Cardiovascular Data Registry. The use of point-of-care anticoagulant testing in the cath lab was also initiated in our laboratory, as was routine surveillance of myonecrosis.

What’s up next for you?

Dr. Klein: I want to continue to advocate for high-quality interventional procedures and medical care for our patients and work to improve principled resource allocation. I would like to help delineate optimal care, promulgate how to measure its delivery and develop guidelines and other means to distinguish its practice. Moreover, I want to ensure that these policies are part of everyday practice by working with our professional societies, hospital and system administrators, and other stakeholders.

Also, last year, my wife and I moved to Sonoma County. I am beginning a new chapter of my life at the University of California, San Francisco, while still traveling back to Chicago several days a month to teach and manage an ongoing research program. I look forward to continuing to mentor young physicians and participate in clinical teaching and practice.

Deepak L. Bhatt

For this issue, Dr. Bhatt talks with Cardiology Today’s Intervention Editorial Board Member Lloyd W. Klein, MD, clinical professor at the University of California, San Francisco.

After graduating from high school in Manhattan, Klein attended Kenyon College and the University of Cincinnati Medical School, where he served as class vice president. He completed his medical residency at Albert Einstein Medical Center and a cardiology fellowship at Mount Sinai Hospital Medical Center in New York. Since then, he has served on the faculties of the University of Pennsylvania, Northwestern University and Rush University Medical Center.

During his distinguished career, Klein has balanced clinical responsibilities with extensive research in various areas of interventional cardiology. He has also become an authority on appropriate use and has written the definitive chapter on the subject in Interventional Cardiology.

What are your hobbies outside of practicing medicine?

Dr. Klein: I read biographies and books on history from all time periods, but I have a special interest in the American Civil War. My wife and I also travel frequently, work out regularly and pride ourselves on being “foodies,” enjoying culinary experiences locally and around the world. I am an avid fan of classical music, and jazz and blues, and when we travel, we seek out jazz venues that support outstanding contemporary musicians.

Lloyd W. Klein

What was the defining moment that led you to your field?

Dr. Klein: The major epiphany in my career occurred after I was part of the team that published the first prediction algorithm of outcomes for coronary interventions. My original motivation was, as a clinical interventionist, to try to better understand which patients had the highest potential risk for complications. Being able to identify the factors associated with risk allowed us to recognize that many of the patients who experienced complications had characteristics that made them more likely to have problems, so no blame should be ascribed to the doctor or to the cath lab.

The flipside of that, however, is that if repeatedly patients with few risk factors experienced complications, then perhaps the quality of care should be explored in greater depth. I found that insight intriguing, and only afterwards did I recognize that this was the “back door” into measuring program and operator quality, and to advance the concept of appropriate use in interventional practice, which would then become the essential theme of my work. Until that point, my research focused on coronary physiology, acute MI and unstable ischemic syndromes. Many people who enter the arena of evaluating quality standards have public health or statistical backgrounds, whereas I am a clinician.

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What has been the greatest challenge of your career thus far?

Dr. Klein: The quest to define what constitutes excellent clinical decision-making and describe methods to measure and better achieve that goal continues to be the central challenge of my career. As interventional techniques improve, our view of what comprises optimal practice must be adjusted.

On a more personal level, being able to actively contribute intellectually and influence policy in this area while also maintaining active clinical practices in downtown Chicago and its suburbs has been both a fabulous opportunity and a challenge. I was living in two worlds and trying to do my best in each one of them.

Have you ever been fortunate enough to witness or to have been part of medical history in the making?

Dr. Klein: I participated in the revolution in the invasive management of ACS and MI. I assisted Peter Rentrop, MD, in administering intracoronary streptokinase in the first U.S. cases; was among the first to perform balloon angioplasty in STEMI and unstable angina; and developed the first ACS risk prediction model. I also worked with William S. Weintraub, MD, who led the field in recognizing how computerized databases could improve clinical care; that ultimately led to being a co-founder of the National Cardiovascular Data Registry. The use of point-of-care anticoagulant testing in the cath lab was also initiated in our laboratory, as was routine surveillance of myonecrosis.

What’s up next for you?

Dr. Klein: I want to continue to advocate for high-quality interventional procedures and medical care for our patients and work to improve principled resource allocation. I would like to help delineate optimal care, promulgate how to measure its delivery and develop guidelines and other means to distinguish its practice. Moreover, I want to ensure that these policies are part of everyday practice by working with our professional societies, hospital and system administrators, and other stakeholders.

Also, last year, my wife and I moved to Sonoma County. I am beginning a new chapter of my life at the University of California, San Francisco, while still traveling back to Chicago several days a month to teach and manage an ongoing research program. I look forward to continuing to mentor young physicians and participate in clinical teaching and practice.