The Heart of the Matter
Local programs and technologies promote heart health in New Orleans.
Heart disease—the No. 1 cause of death in the United States for many years, accounts for one in every four deaths. It is a nationwide concern that’s evident in Louisiana. In the New Orleans area, several heart facilities are working toward prevention strategies and using innovative diagnostics and treatments to improve heart healthcare at the local level.
In honor of American Heart Month, four notable heart health institutions explain their most recent contributions.
Screening Is Key
Regular screenings for heart complications is one way patients may get ahead of heart disease before it becomes more serious. West Jefferson Medical Center (WJMC ) and its Heart Clinic understand the importance of encouraging New Orleans residents to get screenings, know their numbers, and speak with their doctor if any abnormalities surface.
Each year at WJMC's Heart Health Fair, held this year on February 24, the hospital offers a variety of free tests, including electrocardiograms (EKGs), (one of the most common procedures), and others critical to heart health, such as blood sugar, cholesterol and body mass index. After undergoing the free screenings, participants meet with a physician who reviews their results with them and facilitates referrals and appointment bookings if the numbers show a potential problem.
In addition to all of the typical diagnostic testing and treatments a heart clinic might perform, from stress tests to angioplasties, WJMC cardiologist Dr. Edmund Kenneth Kerut and Heart Clinic nurse practitioner Tracy Fife are piloting a health and wellness program to encourage patients to better manage the risk factors that lead to the beginnings or worsening of heart disease.
The 12-week program begins with a series of tests to determine general heart-related numbers, cardiac age (as opposed to chronological age) and atherosclerotic cardiovascular disease risk. After three months of changes to patients’ dietary and exercise regimens, those numbers are tested again, and often the results include lower blood pressure and cholesterol levels and weight loss.
Putting New Tech to the Test
East Jefferson General Hospital (EJGH) has a long-standing heart program, but the hospital is also employing new buzzworthy technology to better help patients with serious heart health complications. About a year and a half ago, EJGH funded and built a hybrid lab that focuses in part on nonsurgical ways to treat heart arrhythmias, namely via an electrophysiologic approach called CryoCath, performed by Dr. James McKinnie.
With CryoCath, also known as Arctic Front Cardiac CryoAblation Catheter, McKinnie uses the world’s first cryoballoon to isolate pulmonary veins while treating paroxysmal atrial fibrillation (PAF), a form of heart arrhythmia.
LEFT: Dr. James McKinnie employs new technology called CryoCath at East Jefferson General Hospital. The world’s first cryoballoon, CryoCath represents a nonsurgical way to treat heart arrhythmias. RIGHT: Interventional cardiologist Dr. Peter Fail (pictured here), along with two cardiovascular surgeons, form the “heart team” — a joint effort of the Cardiovascular Institute of the South and Terrebonne General Medical Center. The team has been involved in percutaneous valve technology to treat various heart conditions. Photos courtesy of Cardiovascular Institute of the South and East Jefferson General Hospital
Instead of taking medications the rest of their lives to control PAF, many patients have their arrhythmia eradicated for either long periods of time or forever, according to EJGH CEO Dr. Mark Peters.
EJGH is participating in heart health month through a variety of health initiatives, both through its cardiovascular department and the wellness center. But EJGH doesn’t just focus these initiatives on patients—employees are encouraged to get involved, too. The hospital offers incentives for employees who belong to wellness programs, such as walking 10,000 steps a day, Peters said.
Studying Structural Heart Conditions
The Cardiovascular Institute of the South (CIS) has worked closely with Terrebonne General Medical Center (TGMC) to form the “heart team,” which includes interventional cardiologist Dr. Peter Fail and two cardiovascular surgeons. The heart team collaborates on decisions regarding the best treatment strategies for structural heart issues.
Those conditions exclude coronary heart disease and more typically refer to other cardiac anomalies, such as a valvular heart disease, like aortic stenosis or mitral regurgitation, left ventricular dysfunction or atrial and ventricular septal defects.
The CIS and TGMC heart team has been involved in research projects that test newer percutaneous valve technology for conditions like aortic stenosis or mitral valve regurgitation. Other recent research includes trials for treatments for diastolic heart failure, systolic heart failure and left atrial exclusion.
The heart team’s state-of-the-art treatments address a variety of structural heart issues. For heart attack patients, the team may employ left ventricular restoration therapy, wherein a device placed in the heart partitions the infarcted segment (which caused the heart attack) to enable more efficient functioning of the heart. The heart team can also repair previously placed surgical valves with a perivalvular leak, which commonly happens after surgery.
Supporting Weak Hearts
The Tulane Heart and Vascular Institute (TUHVI) offers heart and vascular treatments to patients in three different clinics: Downtown New Orleans, Metairie and the Westbank. TUHVI’s heart specialists are trained in fields like nuclear cardiology, arrhythmia, atrial fibrillation, lipid management and interventional cardiovascular procedures. The institute also treats vascular problems at the Westbank clinic.
Heart failure is another focus for TUHVI and the technological innovations its facilities employ. Sometimes heart failure patients do not respond to or cannot tolerate oral medicines, and for them, TUHVI offers home infusion of inotropes, medicines delivered intravenously that help weak hearts generate blood pressure and blood flow throughout the body.
LEFT TO RIGHT: Normal Valve, Stenotic Valve, Percutaneous valve
Another option for patients with weak hearts is a left ventricular assist device (LVAD), a mechanical device that helps the heart pump blood from throughout the body and to vital organs. The device has a power source that connects to a control unit, which monitors the pump’s functions, and low power or poor functioning of the device triggers an alarm.
Some VADs employ a heartlike pumping action to distribute blood throughout the body, but some newer VADs provide a continuous flow of blood, though this might generate an abnormal pulse for these patients. VADs are also commonly used during or after heart surgery to provide temporary additional support to the heart until it recovers.
TUHVI electrophysiologist Dr. Colleen Johnson is also working with patients prone to infections from implanted devices by offering subcutaneous defibrillators, which are placed just under the skin rather than directly touching the heart or vascular system.
Patients Get Younger and Younger
One unfortunate trend acknowledged by many of these healthcare institutions is that patients coming in with heart attacks and other heart complications are not just the elderly anymore — these patients are getting younger.
“The patients we see who come in with chest pains or a heart attack, the age has continuously dropped,” said Christy Kareokowsky, director of WJGH’s Cardiac Service Line. “It used to be your 60-, 70-year-olds that came in with a heart attack, but it’s now your 40-year-olds. And that’s been consistent across the nation, not just in New Orleans.”
“We are seeing the effects of an entire generation living a more sedentary lifestyle and living on fast food,” said Suzanne Mason, senior section administrator at TUHVI. “Young people have been raised on high-fat, high-sodium and sugary foods and beverages. With age, heart complications are more prevalent in individuals with these diets.”
Heart Health in Louisiana
According to a 2015 state-by-state analysis of public health from the United Health Foundation, Louisiana ranks as the least healthy state in the country. While this ranking includes a number of health-related factors, heart health certainly plays a role.
In terms of heart health, culture could be the culprit — especially the local diet.
“There’s the great side of the food that’s available in New Orleans, but there’s a down side to that in terms of the caloric intake, the fat component, and cholesterol in a lot of food that we eat,” said Peters. “There’s a fine balance there of people being able to enjoy themselves, but I think there are steps people can take that can moderate their diet without giving up all the things that people want.”
Education about heart disease and people’s understanding of their own heart health numbers and family history are also important factors in improving the area’s less-than-appealing reputation for public health.
“Some patients come in for our free screenings who have never seen a physician or had an EKG,” said Kareokowsky. “We think it’s very important to put that out there: Here is your EKG, here are your numbers, and we’ll work with you to get to where you need to be.”
If Louisiana, and the rest of the country, can’t get heart health under control, the effects could be damaging not only to the individuals but the economy as well.
“A healthcare system that is proactive can curtail potential heart problems before they occur or become more serious problems,” said Dr. Abhishek Jaiswal, heart failure specialist at TUHVI. “This presents a cost savings to the individual and the community. As the economics of healthcare become more pressing all over the country, investing in quality heart healthcare in a place like New Orleans can make a big impact.”
Heart Health Insurance 101
With the Affordable Care Act came changes to what heart conditions are covered by insurance carriers. Some plans, such as those through Medicare or Medicaid or through the Louisiana health insurance Marketplace, have to abide by certain minimums of coverage, which generally includes care for chronic diseases.
However, anyone receiving health insurance coverage through their employer should analyze their plan to ensure treatments, diagnostic testing, and prevention for heart conditions are covered, especially if a family history of heart disease or other risk factors, such as diabetes or hypertension, are involved.
Important services for patients with heart conditions include:
• Prescription drug coverage;
• Diagnostic testing, such as EKGs and stress tests;
• Rehabilitation services;
• Emergency room and hospital coverage; and
• Counseling for diet, smoking, alcohol abuse or depression.
Some health insurance carriers even cover programs for home monitoring of blood pressure and various heart risks. Others, like Peoples Health, available statewide, offer more comprehensive services that go beyond approval and coverage for heart-related healthcare services. Peoples Health’s Chronic Care program involves groups of clinical staff working in different markets throughout the state and teaching members how to best self-manage their chronic diseases, including heart conditions.