Tackling a Community's Cardiac Care Needs - Heartline Fall 2012 - Montefiore Einstein Center for Heart and Vascular Care - New York City

Few places in the nation offer a more challenging cardiovascular landscape than the Bronx.

High rates of obesity, diabetes and smoking paired with difficult socioeconomic conditions make this area an axis for heart disease and other cardiovascular conditions. Montefiore’s cardiologists know that the health and future of this community hinge upon two things: education and access to quality healthcare.

“It’s not enough for us to treat advanced conditions such as heart attacks or congestive heart failure,” says Mario J. Garcia, MD, Professor and Chief, Cardiology, and Co-Director, Montefiore Einstein Center for Heart and Vascular Care. “We have to also address the causes of these problems and try to eradicate them.”

Combining Outreach with Clinical Excellence

Outreach and emphasizing a healthy lifestyle and prevention are critical components of the cardiology program at Montefiore. Recently, Montefiore began aggressively expanding the number of clinics that it supports in the Bronx, South Bronx, Westchester County and Manhattan. It also added a Cardiac Wellness Center to help people who want to learn how to manage their cardiac risk factors and diet.

On the clinical side, Montefiore has an impressive treatment repertoire and exceptional outcomes, including treating acute heart attack victims with door-to-balloon times that are below the national benchmark of 90 minutes. It is now sharing this expertise with local partner hospitals by providing two dedicated teams of interventionalists who are on call to offer percutaneous coronary intervention as needed.

“An added benefit to this partnership is that patients who require more intensive therapy than what is feasible at our partner hospitals now have easier access to Montefiore,” says Vankeepuran Srinivas, MD, Director, Cardiac Catheterization Laboratories, Montefiore–Weiler Hospital, and Assistant Professor of Clinical Medicine, Albert Einstein College of Medicine.

Keeping Heart Failure Patients Healthy

Heart failure management remains a strength at Montefiore, and we recently implemented the American Heart Association’s (AHA) “Get With The Guidelines—Heart Failure (GWTG-HF)” quality improvement program to help further advance patient outcomes and reduce readmission rates.

“Heart failure is the number-one Medicare diagnosis for hospitalized patients,” explains Gerin Stevens, MD, PhD, Attending Physician, Cardiology, Montefiore Center for Advanced Cardiac Therapy, and Assistant Professor, Medicine, at Einstein. “So focusing our efforts by Tackling a Community’s Cardiac Care Needs consistently providing evidence-based care is extremely important. We want to keep these patients healthy and out of the hospital.”

GWTG-HF provides Montefiore with clinical decision support through the AHA’s Patient Management Tool™. This webbased assessment and reporting system allows clinicians to track patient data and assess the quality of the care that they are delivering.

“With this tool we track data in real time as opposed to using quarterly reports,” says Dr. Stevens. “It’s a much better system that allows for benchmarking in heart failure as well as other areas such as stroke and coronary artery disease.”

Managing Atrial Fibrillation

Montefiore has long been recognized as a pioneer in the area of atrial fibrillation and, as such, is regularly selected to participate in high-profile atrial fibrillation trials such as STOP AF and most recently the Catheter Ablation versus Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA).

“Through CABANA we’re looking at what is best for patients who have atrial fibrillation—drug therapy or catheter ablation,” explains Eugen Palma, MD, FHRS, Director, Weiler Arrhythmia Service, and Associate Professor, Clinical Medicine, at Einstein. “This is a very important study because it is the first randomized, multicenter trial looking at hard endpoints—mortality, disabling stroke and other morbidities—for these approaches.”

“I think what is important to emphasize is that we are firmly rooted in our commitment to caring for the vast cardiac needs of this region,” says Dr. Garcia. “Our goal at all times is to administer the best care possible to our patients while arming them with the knowledge they need to be successful in managing their health. This is the core of Montefiore’s mission.”