Business of the Heart
Local hospitals offer the latest advancements in cardiovascular treatments.
From sugary king cakes to salty seafood boils, and deep fried foods to free-flowing libations, it’s easy to understand why New Orleans was known as “The City That Care Forgot” long before it was called “The Big Easy.”
Not surprisingly, heart-related injury is one of the leading killers of Louisianians and is expected to affect up to every other person in the state.
This February, amid Carnival and St. Valentine’s Day, cardiologists across south Louisiana are trying to break through the myriad distractions of festival season with a reminder – enjoy our “let the good times roll” lifestyle, but do it in moderation.
“Louisiana has a reputation for ranking among the top states in the nation with the highest prevalence for heart disease and death,” says Ochsner Health System Cardiologist Richard Milani, MD, FACC, FAHA. “Unfortunately, heart attacks are the leading cause of death, and stroke is the fourth-leading cause of death in Louisiana, which is why there is such a large focus on heart health within this region.”
Local Heart Help
According to the American Heart Association, more than 5 million Americans will rush to a hospital emergency room this year with chest pain. More than 600,000 will die a heart-related death. In addition, on average, someone in the United States suffers a stroke every 45 seconds, with a stroke-related death every three minutes.
Fortunately, our region’s medical professionals have long been among the world’s leaders in advancing cardiovascular care. With increasing competition in the local health care market, organizations are doing all they can to improve quality, services and facilities.
Below are just a sample of the cardiovascular-related advances happening at New Orleans-area hospitals.
The John Ochsner Heart and Vascular Institute
Heart failure affects approximately 5.7 million people in the United States, with 670,000 new cases diagnosed annually. For people who progress to end-stage heart failure affecting both sides of the heart (biventricular failure), there are two treatment options – an immediate transplant with a donated donor organ, or placement of an artificial heart.
According to the U.S. Department of Health & Human Services, about 4,000 people are waiting for a donor heart transplant on any given day, while only about 2,300 donor hearts become available annually.
Ochsner performs more than 20 heart transplants per year, and in 2013, became the first hospital in the Gulf South – and one of only 40 certified centers in the United States – to offer the SynCardia Total Artificial Heart, the only device that eliminates the symptoms and source of end-stage heart failure. It is the only FDA-approved total artificial heart for transplant-eligible patients at risk of imminent death from heart failure. Similar to a heart transplant, it replaces both failing heart ventricles and the four heart valves.
According to company data, one-third of all current SynCardia Artificial Heart patients have been supported by the device for more than a year. The longest patient lived on the device for 1,374 days – nearly four years – before a successful heart transplant.
Since the first artificial heart appeared in 1969, about 1,400 have been implanted worldwide. Of that number, nearly 500 SynCardia hearts, including two at Ochsner, have been implanted since the most-recent device was introduced in 2010.
“Thanks to modern technology, the artificial heart is a lifesaver and a viable option for the patient while waiting for a heart transplant,” says Hector Ventura, MD, Ochsner’s head of Heart Failure and Transplantation. “We are extremely proud to offer this technology to patients suffering from end-stage heart failure.”
A closeup look at the SynCardia Total Artificial Heart. In 2013, The John Ochsner Heart and Vascular Institute became the first hospital in the Gulf South – and one of only 40 certified centers in the United States – to offer this lifesaving option designed to keep a patient alive until a heart transplant can be performed.
Photo by Greg Miles
Heart failure affects approximately 5.7 million people in the United States, with 670,000 new cases diagnosed annually. The John Ochsner Heart and Vascular Institute performs more than 20 heart transplants each year. Photo courtesy of Ochsner Medical Center
“Ochsner has a history of innovation…it’s a testimony to what we do. Over the past 60 years, we have embraced evolving technology and innovation to bring the highest quality of care that our patients deserve. We strive to be a pioneer in leading, cutting-edge procedures not only in heart and vascular disease, but across all fields of medicine.”
-John Ochsner, MD, Emeritus Chief of Surgery for Ochsner Health System.
East Jefferson General Hospital’s Institute of Heart and Vascular Medicine
East Jefferson General Hospital’s hybrid surgical and catheterization laboratory opened in April 2014. It is one of the newest in the region and features diagnostic imaging equipment used simultaneously with catheterizations.
The lab has three suites and a seven-bed area for patients to be monitored before and after procedures. Physicians perform coronary, peripheral vascular and carotid diagnostics and interventional procedures on blockages, including stent placement.
Dr. Tod Engelhardt, a cardiovascular-thoracic surgeon at EJGH’s Institute of Heart and Vascular Medicine, says the unit’s hybrid laboratory and advanced imaging services have revolutionized the way medicine is practiced at the hospital. “It allows for more complex procedures, many of which are not open surgeries, with superior imaging capability,” he says. “It’s easier on and better overall for the patient.”
East Jefferson invested in the hybrid lab’s state-of-the-art equipment due to recent cardiovascular-related successes. In 2009, a patient arrived at East Jefferson in cardiogenic shock with chest pain and severe shortness of breath just two weeks following coronary artery bypass surgery. He was diagnosed with a massive pulmonary embolism – a blood clot that blocked blood flow to the lungs and extended into his right ventricle and right atrium.
Engelhardt suggested a treatment using the previous lab’s imaging equipment and a special vibrating catheter to directly deliver a safe dose of a blood clot-busting drug directly to the embolism without affecting his prior surgery. The patient’s symptoms began to improve within minutes, and he became stable two hours later.
The New Orleans native and Brother Martin alum has performed more than 110 similar procedures since. The technique has been written about in medical journals and presented at medical conferences in Europe, Asia, South America and throughout North America.
“It gives you a good feeling to know that you are addressing an unmet need for those with life-threatening conditions,” Engelhardt says. “It’s satisfying, and at the same time humbling, to know that your education and work has helped to cure someone.”
Louisiana Heart Hospital
With nearly 700,000 Americans experiencing a new or recurrent stroke every year, the Louisiana Heart Hospital in Lacombe is paying special interest to stroke prevention.
In 2014, The Joint Commission, in conjunction with The American Heart Association and American Stroke Association, awarded LHH the advanced certification as a Primary Stroke Center, adding to its previous designation as an accredited chest pain center by the Society of Cardiovascular Patient Care.
“Louisiana Heart Hospital is the only hospital in the North Shore area to become accredited as both a Chest Pain and Primary Stroke Center,” says LHH CEO Roy Wright.
Louisiana Heart Hospital is home to three state-of-the-art catheterization labs, which help physicians diagnose and treat cardiovascular disease. One lab is dedicated to the diagnosis of vascular disease, which includes the carotid arteries (which, when diseased, can cause strokes), renal arteries, aorta, and the vessels of the legs. The labs feature Phillips imaging equipment and a lower X-ray radiation dose to both the patient and medical staff. Digital equipment eliminates the need for film and processing, which lowers the cost of the procedure for patients.
Tulane Medical Center’s Heart & Vascular Institute
In addition to cardiology services, diagnostic testing, cardiovascular surgery and cardiac transplant procedures, Tulane Medical Center’s Heart & Vascular Institute is focusing on advancing stroke care to Louisiana’s rural areas.
“When facing a heart attack, the quicker we can get blood flowing, the better chance to preserve heart tissue. The same applies to stroke,” says Cindy Huber-Koppen, vice president of Tulane Medical Center’s Cardiology Program.
Tulane is working on a “tele-stroke” outreach program with hospitals in rural areas to increase the quality of care where neurologists aren’t readily available or affordable.
“The program will allow emergency medical staff at rural hospitals to connect with a Tulane specialist via a program similar to FaceTime or Skype,” Huber-Koppen says. “The doctors and nurses can make their assessments and confer with a brain specialist for advice and input on the patient’s treatment.”
Views of the hybrid surgical and catheterization laboratory at Tulane Medical Center’s Heart and Vascular Institute. Photos courtesy of Tulane Medical Center
West Jefferson Medical Center
West Jefferson Medical Center, along with other hospitals in the region, is using mobile technology to gain use of every second when time is most essential. Emergency Medical Services (EMS) are utilizing field EKGs, which allow them to send real-time, accurate readings of their patient’s heart functions from an ambulance to physicians in the emergency department so they can begin to coordinate the patient’s care while in transit to the hospital.
“The mobile EKG saves 20 to 30 minutes in determining a diagnosis,” says Christy Kareokowsky, RN, director of West Jeff’s cardiology service line. “The technology allows Emergency Medical Technicians (EMTs) to do an EKG and transmit it to the emergency department so physicians can make a diagnosis on whether the patient is having an acute heart attack. If they are, we can get the ball rolling, have the necessary team members in place and the cath lab ready as soon as they get here.”
Touro Infirmary Heart and Vascular Center
Touro’s Heart and Vascular Center offers comprehensive services ranging from routine check-ups to advanced therapies and diagnostics. Opened in February 2008, the center operates three cardiac cath labs and a heart and vascular care unit.
Touro provides a full spectrum of cardiac care, from prevention and diagnosis to treatment, rehabilitation, advanced cardiac interventions, pacemakers/ICD implantations, peripheral vascular studies and intervention.
Last year, Touro treated more than 1,700 patients in its cath labs and performed more than 11,000 ultrasound studies, 21,000 EKGs and 1,200 stress tests.
Opened in February 2008, the Touro Infirmary Heart and Vascular Center operates three cardiac cath labs and a heart and vascular care unit. Photo courtesy of Touro Infirmary
Heart Disease: What You Should Know
1) Gender Doesn’t Matter
While it doesn’t have nearly the exposure as breast cancer awareness, heart disease claims the lives of more women than breast cancer and lung cancer combined. Women are making up more of the local percentage of heart patients than ever, yet there is an ongoing perception that heart disease is a male-dominant condition.
“It’s a myth, a total misconception, that heart disease is more of a problem for men and that women are not prone to it,” says Gregory Tilton, MD, a cardiologist at East Jefferson General Hospital. “Generally, females have less typical symptoms, which means less testing and fewer confirmations. In addition, where men usually experience increased instances of chest pain, heart attack and coronary artery disease in their 50s and 60s, women see an onset more into their 70s.”
Although both genders are susceptible to the same risk factors (obesity, diabetes, high blood pressure, smoking, etc.), women do not present the same symptoms generally associated with heart-related issues. Women are somewhat more likely than men to have some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.
“There is a large disconnect between women and heart disease,” says Ochsner Health System Cardiologist Richard Milani, MD, FACC, FAHA. “For women, there is an awareness difference, where they tend to think the risk for heart disease/heart attack is small when in fact, it is just as high as in men. As a result, women are more likely to ignore their symptoms. It is extremely important that women understand the severity of this disease amongst their gender and take the same precautions as their spouse, brother, father or other important male figures in their life.”
2) Technology Can be Key
Imagine using your smart phone to help your physician monitor your heart health.
It’s not a glimpse into the future. It’s in practice today.
Local hospitals are utilizing innovation and technology to enhance the patient experience by offering monitors, including a wireless blood pressure cuff that can plug into your phone, and scales that email daily results directly to your physician.
“These offerings allow patients with chronic diseases to monitor their levels in the comfort of their home, allowing physicians to receive this data in real time so they can monitor for any warning signals or adjust medications as needed,” Milani says.
3) Time is of the Essence
If symptoms appear, especially more than one at a time, the patient needs immediate emergency medical attention. Clot-busting drugs and other artery-opening treatments work best to stop a heart attack or stroke if given within one hour of the start of symptoms.
If there are two or more heart attack or stroke warning signs, don’t wait more than 5 minutes at most to call 9-1-1 for emergency medical services (EMS).
Photo courtesy of Ochsner Medical Center
Create A Heart-Friendly Workplace
According to the 2014 Health Benefits Survey by The Henry J. Kaiser Family Foundation, last year average annual premiums for employer-sponsored health insurance was $6,025 for single coverage and $16,834 for family coverage – representing a 2 percent and 3 percent rise, respectively, over 2013.
Since healthier employees can mean lower premiums, better attendance and greater productivity, the new year could be a good time for businesses to start their own healthy resolutions.
As part of its Million Hearts initiative to prevent 1 million heart attacks and strokes by 2017, the Department of Health and Human Services suggests the following actions for employers:
-Provide nutrition and sodium education during new employee orientations.
– Create a smoke-free workplace via a written policy banning tobacco use on-site.
– Offer behavioral counseling and pharmacotherapy to employees at no or low cost.
– Provide health insurance coverage with no or low out-of-pocket costs for hypertension or cholesterol medications, home blood pressure-monitoring devices with clinical support, and prescription tobacco cessation medications and FDA- approved over-the-counter nicotine-replacement products.
– Provide one-on-one or group lifestyle counseling and follow-up monitoring for employees with high blood pressure, pre-hypertension, and high cholesterol.
Source: Health and Human Services’ Million Hearts Initiative – millionhearts.hhs.gov