Where Cardiology and Vascular Care Go Hand in Hand

By Helen K. Kelley

The statistics on cardiovascular disease are startling. It is the leading cause of death for both men and women and for most ethnicities in the United States — according to the Centers for Disease Control, approximately 610,000 Americans die of cardiovascular disease every year, accounting for one in every four deaths. In fact, cardiovascular diseases claim more lives than all forms of cancer combined.

Faced with the formidable challenge that cardiovascular disease presents, Northside Hospital’s team is comprised of board-certified cardiologists, vascular surgeons, cardiovascular trained nurses and technicians who are leaders in the field of the treatment and prevention of heart disease, stroke and vascular diseases. Their integrated approach includes the latest technologies and surgical techniques, along with a comprehensive network of preventive, diagnostic, medical and support services, for treating patients with cardiovascular disease.

Expansion, research, technology offer new options in cardiology

Northside’s cardiologists are dedicated to providing leading treatments for patients with cardiac conditions such as arrhythmias, coronary artery disease and heart failure, as well as early detection, diagnosis and management of other conditions that could potentially affect the heart, like high blood pressure, high cholesterol, diabetes and obesity.  Using advanced technology, the staff of cardiologists teams up with radiologists and technicians to diagnose and treat various cardiac conditions. They also perform invasive procedures to correct heart abnormalities, including pacemaker implementation, defibrillators, cardiac catheterization and stent placement.

Recently, expanded lab capabilities and the addition of staff have increased the Heart & Vascular Institute’s ability to diagnose and treat patients with cardiac issues, according to Michael Balk, M.D., Medical Director, Northside Heart and Vascular Institute.

“We’ve expanded our interventional and invasive labs, and we’ve added additional physicians,” he said. “As a result, we’re able to do more procedures. Plus, we now have a dedicated electrophysiology lab, where our electrophysiologists use the latest techniques to treat arrhythmias.”

As part of its mission to identify and treat heart disease earlier, Northside is participating in the National Heart, Lung and Blood Institute’s new research program involving low dose methotrexate. The drug, which has been used successfully to reduce inflammation in people who have arthritis, is currently being studied to see if it is effective in reducing cardiovascular inflammation.

“Doctors who were using methotrexate to treat patients for arthritis noticed that these patients also had fewer coronary events. Once this was discovered, it became important to determine whether or not the drug also could be effective in people with cardiac issues,” Balk explained.

The participants in this clinical trial are people who have experienced a heart attack or major blockage and who have additional comorbidities like diabetes or metabolic syndrome.

“We are looking at methotrexate as a treatment that can reduce inflammation and therefore, reduce the chance of a future heart attack or stroke in these individuals,” Balk explained. “If found to be effective, this drug may change how we treat patients in the future.”

Across the board, the Institute’s physicians are continuously seeking out ways to improve diagnoses and treatments.

“For example, our electrophysiologists are trained in techniques like cryoablation, which uses extreme cold to treat cardiac arrhythmias by ablating tissue. This technique can lower the risk of procedure-related complications in some patients,” Balk said. “Whether it’s electrophysiology, cardiology, nuclear cardiology, CT, angiography or vascular and interventional procedures, we’re always working to reduce risks and improve outcomes for our patients. Therefore, about 90% of our catheterization procedures are now done radially, a less-invasive approach,” Balk added.

Emphasis on early detection

Balk stresses that early detection of cardiovascular disease is a major focus for the Northside Heart & Vascular Institute, and that an aging baby boomer population has offered new reasons for changing the way cardiac problems are diagnosed. “As the demographic changes across the country, we will see larger numbers of age-related illnesses like atrial fibrillation, which is still on the rise,” he said.

Patricia Tyson, Administrative Director of Northside Heart & Vascular Institute, adds that early detection is especially beneficial to patients who are pregnant or looking to become pregnant.

“Nationally, the number one reason for maternal death and complications during the pregnancy and postpartum is cardiac-related such as embolism, preeclampsia and cardiomyopathy,” she said. “Therefore, we are working to identify those patients early and have specialists on our staff that focus on these complications in women during pregnancy and can intervene to prevent major issues and/or death.”

On the vascular side of early detection and treatment, the Northside Heart & Vascular Institute has a process called Code Rupture that alerts the hospital’s Emergency Department to the impending arrival of a patient experiencing a ruptured aortic aneurysm.

“Ruptured aortic aneurysm has one of the highest mortality rates for any health issue in the country. Our Code Rupture system is active and alerts the full ED team in advance to prepare for the patient who is being transported,” Tyson explained. “Through this effort, we’ve vastly improved the mortality rate from ruptured aortic aneurysm at Northside; in fact, it’s lower than the national average.”

Access to clinical trials, research devices offers benefits in treatment of vascular diseases

The vascular surgeons of Northside’s Heart & Vascular Institute are all academically trained physicians who have an interest in clinical research. Their education and training have provided the perfect set-up for the Institute to participate in clinical trials involving new, investigational devices that are undergoing testing, according to Siddharth Patel, a surgeon in the Department of Vascular Surgery and Endovascular Therapy.

“There are some clinical trials accessible to us that can potentially have significant benefits for our vascular patients. For example, there are drug-coated balloons and stents that were formerly available only in the cardio arena and are now available to the  patient with peripheral arterial disease, or PAD,” he said. “Additionally, many of these trials were formerly available only in the university setting.  Now, the Northside Heart & Vascular Institute is able to access these trials and we are excited to bring these treatments to our community.”

Patel cites two clinical trials currently underway for technologies that may soon benefit Northside patients — the Gore branched stent graft, used to treat iliac artery aneurysms while maintaining pelvic perfusion, and Bolton’s Treovance endograft, which has a smaller caliber that may be useful in delivering treatment to patients with smaller arteries, particularly females. He adds that Northside’s vascular team has an interest in participating in several upcoming trials, including a bedside intravascular ultrasound-guided vena cava filter for patients who are too unstable to transport to the fluoroscopy suite or patients with renal insufficiency who cannot receive contrast, and a drug-coated balloon catheter that can be used to treat lesions in the tibial arteries below the knee.

Dr. Patel also described an exciting new technology available at Northside, the Magellan endovascular robotic system. “This new robotic tool will allow us to deliver therapy with increased precision and efficiency for everything from carotid stenting to visceral and renal procedures to lower extremity interventions, thereby reducing the radiation dose for both the patient and the endovascular team. We are very excited to be the only health system in Georgia with the robot. In fact we have two, one at Northside Atlanta and one at Northside Forsyth, which is amazing considering there are only 14 total in the entire country. This speaks volumes about how committed Northside Hospital is to improving the care of the vascular patient.”

Collaboration reaches patients far beyond metro Atlanta

The Northside Heart & Vascular Institute’s network of cardiologists and vascular surgeons extends well outside the walls of Northside’s flagship hospital in Atlanta. Many physicians located throughout Georgia, utilize the vast network of specialists and leverage the Institute’s services for their patients.

Utpal H. Pandya, M.D., Chief of Cardiology with Kaiser Permanente’s Southeast Permanente Medical Group, says his association with the Northside Heart & Vascular Institute has provided a critical partnership.

“We [Southeast Permanente Medical Group] perform a wide range of diagnostic and interventional procedures, and many of our cases are at Northside,” he said. “They provide good service to our patients; moreover, they assist us in areas such as documenting heart failure readmissions and medication compliance. This collaboration is, in fact, critical to our success.”

Additionally, the collaboration offers access to the latest technologies and clinical trials to a wider patient base.

“The physician’s struggle in any highly expensive field of medicine, like cardiology, is the desire to treat patients with the newest tools available. But we always have to face the economic realities,” said Pandya. “However, the Northside Heart & Vascular Institute works very hard to bring those tools to us. They welcome our input and decision-making is collaborative. This partnership has worked very well.”