The Pulse
Summer 2012
Cardiovascular News from Westchester Medical Center
Inside: 8
Leading the Tri State Area in the Use of ECMO Technology to Treat Cardiogenic Shock
10 12
Improving Detection of Thoracic Cancers
Customized Treatment for Pulmonary Hypertension
HEART & VASCULAR
Westchester Medical Center Michael D. Israel, President and CEO As an academic medical center, advanced care hospital and Level I Trauma Center, Westchester Medical Center is on the leading edge of medical research and employs the latest advances in clinical care. Because of the strong partnerships we have forged with community hospitals, local physicians and our patients, we have become a major healthcare resource to the more than 3 million people who live and work in the Hudson Valley region, lower Connecticut and northern New Jersey.
Dear Colleague: Welcome to the (Summer 2012 ) edition of The Pulse! The Vascular Surgery Program at Westchester Medical Center is highly regarded, and ranks among the top 10 percent of vascular programs in the United States according to HealthGrades™. We’ve worked hard to get there. Our team of six boardcertified surgeons specializes in diagnosing and treating vascular and endovascular conditions. As an integral part of Westchester Heart & Vascular, the vascular surgeons have the expertise to treat the entire spectrum of diseases of the arteries and veins—such as, carotid, subclavian and vertebral disease, aortic aneurysms, peripheral artery aneurysms, diseases of the extremities (PAD), disorders affecting the GI tract and an array of venous disorders like varicose veins, chronic venous insufficiency, etc. Our state-of-the-art Vein Center—with multiple locations throughout the region—is dedicated to the treatment of vein conditions. In addition, our Centers also treat conditions such as Deep Vein Thrombosis (DVT) and pulmonary embolism. Whether the condition needs minimally invasive interventions like angioplasty or stent placement, or a surgical procedure, at Westchester Medical Center, it is always carefully assessed. Additionally, our specialists always adopt a collaborative approach to cardiovascular care. The goal is to work as a team to offer the best care to our patients to achieve excellent results. A referral to Westchester Medical Center implies a continuing partnership between our group and you, the referring physician. This helps assure efficacious treatment and timely recovery for the patient. Please read this issue of The Pulse to learn more about the services our cardiothoracic surgeons, cardiologists, and vascular specialists can provide to you and your patients. On behalf of our entire team, I welcome your feedback, and look forward to speaking with you in the near future. Sateesh Babu, M.D. Chief, Vascular & Endovascular Surgery Westchester Medical Center Westchester County Health Care Corporation Board of Directors Officers Mark Tulis, Esq. Chair Mitchell Hochberg, First Vice Chair Claudia Edwards, Ph.D., Vice Chair Zubeen Shroff, Vice Chair Emmeline Rocha-Sinha, Treasurer Susan Gevertz, Secretary
Directors Orlando Adamson, M.D. William Frishman, M.D. Renee Garrick, M.D. Herman Geist John Heimerdinger Michael Israel Patrick McCoy Alfredo Quintero Stephen Rogowsky John Spicer Michael Staib James Vodola
The information in this publication is written by professional journalists and/or physicians. However, no publication can replace the direct care or advice of medical professionals and readers are cautioned to seek such help for personal problems.
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10
Table of Contents
5 HEART & VASCULAR
CORRECTION: A title caption in the Winter 2012 edition of The Pulse incorrectly listed Dr. Arthur Fass, M.D., Dina Katz, M.D., and Franklin Zimmerman, M.D. All three are noninvasive cardiologists, and practice in Westchester Heart & Vascular’s North State Division, (914) 762-5810.
Q&A With WMC’s New Director of Nuclear Cardiology
6 Skilled Hands and Sophisticated Technologies: Treatment of Advanced Peripheral Vascular Disease 8
Leading the Tri State Area in the Use of ECMO Technology to Treat Cardiogenic Shock
10
Skillful Use of Imaging Technologies Leads to Early Detection and Treatment of Thoracic Cancers
12
Improving the Odds and Quality of Life for Pulmonary Hypertension Patients
14
Quality Measures Provide Snapshot of Care at Westchester Medical Center
Published by Westchester Medical Center Department of Marketing and Corporate Communications Executive Offices, 100 Woods Road, Valhalla, NY 10595, 914-493-8024 Kara Bennorth, Senior Vice President, Corporate Communications and Fund Development Alan Bey, Vice President, Cardiovascular Service Line David Billig, Director, Media Relations Isabel Dichiara, Director, Community Relations Barbara Kram, Senior Director, Corporate Marketing and Communications Mario D. Smith, Communications Manager, Editorial Information Kathleen McDermott, Staff Writer Benjamin Cotten, Digital Imaging
For more information about any of the physicians featured in this publication or to learn more about cardiovascular services at Westchester Medical Center, please call 1-877-WMC-DOCS or visit westchestermedicalcenter.com.
HEART & VASCULAR w e s t c h e s t e r h e a r t a n d v a s c u l a r. c o m
Hawthorne Division
Valhalla Division
19 Bradhurst Avenue, Suite 3850S Hawthorne, NY 10532 (914) 909-6900 Main Number (914) 909-6925 Imaging (914) 493-2828 Fax
100 Woods Rd. Valhalla, NY 10595 (914) 493-8793
Non-Invasive Cardiology John McClung, M.D. Joshua Melcer,M.D. Tanya Dutta, M.D. Joseph Harburger, M.D. Heart Failure/VAD/Transplant Alan Gass, M.D. Gregg Lanier, M.D. Elizabeth Stevens, RN, CCRN, MSN, FNP-BC Kathy Brown, RN, BS, MS, A-NP, CCRN Electrophysiology/Devices Martin Cohen, M.D. Paul Eugenio,M.D. Invasive-Interventional Cardiology Hasan Ahmad, M.D. Martin Cohen, M.D. Linda Cuomo, M.D William Gotsis, M.D. Gary Silverman, M.D. Robert Timmermans, M.D. Nuclear Cardiology Diwahar Jain, M.D. Clinical NPs/PAs Nyree Sencion-Akhtar, RN, FNP-C Andrea Cronin, RN, FNP-C Carmela Musial, PA-C Vicki Klein, PA-C Vascular Surgery Sateesh Babu, M.D. Igor Laskowski, M.D. Romeo Mateo, M.D. Pravin Shah, M.D.
4 | 1-877-WMC-DOCS
Cardiothoracic Surgery Steven Lansman, M.D. Ph.D David Spielvogel, M.D. Rocco Lafaro, M.D. Ramin Malekan, M.D. Masashi Kai, M.D. Gilbert Tang, M.D. Cindy Yu, RN, NP North State Division 465 North State Road, Suite 1 Briarcliff Manor, NY 10510 (914) 762- 5810 Cardiology Arthur Fass, M.D. Franklin Zimmerman, M.D. Dina Katz, M.D. Deborah Okoniewski, RN, FNP Holly McNamara, RN, ANP New Windsor Division 575 Hudson Valley Avenue Suite 200 New Windsor, NY 12553 Practice: (845) 561-2773 Imaging (845) 561-1600 Clinical & Non-Invasive Cardiology John Tighe, M.D Stephen Lazar, M.D. Joseph George, M.D. Invasive-Interventional Cardiology Ahmad A. Hadid, M.D. Ahmad B. Hadid, M.D. Vascular Surgery Atrium Laser Vein Center Romeo Mateo, M.D.
Vascular Practice Locations & Atrium Laser Vein Centers
Mount Kisco 103 South Bedford Road, Suite 207 Mount Kisco, NY 10549 (914) 241-3204 Sateesh Babu, M.D. Francis Carroll, M.D. Arun Goyal, M.D. Igor Laskowski, M.D. Romeo Mateo, M.D. Pravin Shah, M.D. White Plains 15 North Broadway Suite D White Plains, NY 10601 (914) 593-1234 Arun Goyal, M.D. Carmel 672 Stoneleigh Avenue Suite C-118 Carmel, NY 10512 (845) 278-9670 Francis Carroll, M.D. Peekskill 201 Waterside Professional Park Suite 201 Putnam Valley, NY 10579 (914) 909-6900 Pravin Shah, M.D.
HEART & VASCULAR
Q&A with Dr. Diwakar Jain Director, Nuclear Cardiology, What role does nuclear cardiology play in the diagnosis and treatment of cardiovascular disease? Nuclear cardiovascular imaging techniques play a critical role in the non-invasive diagnosis and assessment of the severity of coronary Diwakar Jain, M.D., F.R.C.P., F.A.C.C., artery disease in patients with F.A.S.N.C. established or suspected heart disease. This is carried out by using techniques such as myocardial perfusion imaging and radionuclide ventriculography. A number of new imaging tests are under development which provide highly sophisticated information about myocardial metabolism, repair and regeneration and several other complex biological phenomena in the cardiovascular system. These techniques are called molecular imaging techniques. These techniques provide an understanding of the mechanism and biological phenomena which result in cardiac diseases. A better understanding of the disease process will result in novel techniques for an early detection and prevention of cardiac diseases.
How does your extensive expertise support the cardiovascular services at Westchester Medical Center? I am in the process of establishing a state-of-theat cardiovascular nuclear imaging and molecular imaging program at Westchester Medical Center. As a part of this process, we are acquiring and installing highly sophisticated cardiac imaging equipment in our nuclear cardiovascular imaging laboratory. We have installed a SPECT-CT gamma camera in our lab and we are in the process of procuring and installing a solid-state gamma camera and a PET-CT camera in our lab.
www.westchesterheartandvascular.com
What are some of the conditions that you diagnose and treat? Nuclear cardiovascular imaging is used for diagnosing and assessing the severity of coronary artery disease, cardiomyopathy, myocarditis, congestive heart failure and pulmonary hypertension. These imaging modalities provide very powerful information for selecting the most appropriate treatment modalities for our patients.
What should referring physicians know about the nuclear cardiology and molecular cardiovascular imaging services at Westchester Medical Center? We would like to educate our patients as well as our referring physicians about the services and tests which are available in our labs. We intend to hold a series of open house sessions as well other educational programs to educate our referring physicians about these tests and how to choose the most appropriate tests for their patients. We are also available to provide consultations and advice to our referring doctors to help them select the most appropriate tests for their patients. They can contact us any time to discuss their patients with us and we can help them decide what would be the most appropriate test for that particular patient.
Are there new technologies available in the field? A number of new developments have completely transformed the field of cardiovascular nuclear imaging. With the currently available techniques, we can safely perform these tests in a significantly shorter time, minimize the radiation exposure to the patients and obtain very precise information about the stage and extent of heart disease to enable the physicians to provide very high quality care to their patients.
Westchester Medical Center • The Pulse | 5
HEART & VASCULAR
Skilled Hands and Sophisticated Technologies Advanced Peripheral Vascular Disease Treatment at Westchester Medical Center
Igor A. Laskowski, M.D., Ph.D., F.A.C.S. Vascular Surgeon
Romeo B. Mateo, M.D., F.A.C.S. Vascular Surgeon
The vascular surgeons at Westchester Medical Center are using their extensive surgical expertise and the latest advances in vascular instrumentation to treat blockages present in even the smallest arteries. “We provide full diagnosis and treatment for patients suffering from a vast array of arterial and venous problems. This includes treatment for carotid artery stenosis to prevent stroke, blockages in the arteries of the intestines and kidneys, as well as treatment of patients with peripheral arterial disease to improve their lifestyle as well as minimize their risk for limb loss,” says Igor A. Laskowski, M.D., Ph.D., F.A.C.S., an attending vascular surgeon at Westchester Medical Center and assistant professor of surgery at New York Medical College. “We also provide diagnostic as well as therapeutic interventions for patients with aneurysms of the aorta and other parts of the vascular system. In addition, we treat patients with blood clots in the deep veins to minimize their symptoms related to deep vein thrombosis (DVT), improve their recovery and prevent complications. By using minimally invasive procedures, we can treat even 6 | 1-877-WMC-DOCS
“By using minimally invasive procedures, we can treat even the sickest of patients who frequently suffer from multiple problems, including heart or lung disease, and maintain excellent outcomes while minimizing complications.” the sickest of patients who frequently suffer from multiple problems, including heart or lung disease, and maintain excellent outcomes while minimizing complications.”
Less Than 5% Chance That includes people like Caroline Belasco, who at the age of 89 suffered an abdominal aortic aneurysm which the chance of survival is considered to be less than 5 percent. When other facilities refused to operate, Caroline was airlifted to Westchester Medical Center. Before her son, George, could even get to the hospital from their home in Newburgh, Caroline was in surgery, where Romeo B. Mateo, M.D., F.A.C.S., a vascular surgeon at the Medical Center, performed a complex six-hour surgery to repair the damaged vessel. Today, Caroline is back home and will celebrate her 91st birthday later this year. Aided by the newest advances in imaging equipment along with catheters, stents and intravascular ultrasound as well as clot-busting devices, the vascular
AngioJet Ultra Thrombectory System Saline jets travel backwards at high speed to create a negative pressure zone (less
“We have an increasing number of patients with old clots that turn to us for treatment and we can frequently improve their symptoms.”
than -600 mmHg) causing a powerful vacuum effect. Cross-Stream® windows optimize the fluid flow for more effective thrombus removal.
Thrombus is drawn into the catheter where it is
surgeons at the Medical Center can treat a vast range of conditions and reach virtually any artery in the body. They can also address venous conditions to help patients with these difficult and frequently disabling ailments.
fragmented by the jets and evacuated from the body. Credit: MEDRAD International
“Our experience, the volume of patients we see every year and the equipment and technology we have at our disposal makes us unique to other catheterization labs,” explains Dr. Laskowski. “We have on hand at any given time, the smallest catheters and stents, along with the latest technology of drug eluting products. This means we can safely target any artery of interest and provide the best possible outcomes through minimally invasive interventions.” Dr. Laskowski notes that Westchester Medical Center is also leading the way in interventions to treat acute deep vein clots and expanding treatments for patients with chronic clots. “We can routinely treat acute DVT within two to four weeks after the onset of a clot by using mechanical and chemical thrombectomy,” Dr. Laskowski says. “We have an increasing number of patients with old clots that turn to us for treatment and we can frequently improve their symptoms. This is becoming a growing area of recognition and interest among vascular specialists throughout the country.” By using leading thrombolysis technologies such as Trellis®, AngioJet® and lytic catheters to name a few, vascular surgeons can speed up recovery and prevent chronic vein scarring that frequently follows an episode of DVT and may lead to significant lifelong complications. “Early venous interventions enable many of our patients to avoid long-term anticoagulant treatment and affords them a much better quality of life.”
www.westchesterheartandvascular.com
MEDRAD International Trellis® Infusion Catheter
Reputation for Advanced Treatments With its reputation as a
and Dentistry of New Jersey
leader in the treatment of
and the National Institute
peripheral vascular disease,
of Neurological Disorders
Westchester Medical Center
and Stroke (NINDS). Only
was one of a select group
centers with extensive
of vascular centers invited
experience were invited
to participate in the recent
to participate in the study,
Carotid Revascularization
which enrolled more than
Endarterectomy versus
2,500 patients from 116
Stenting Trial (CREST)
hospitals in the United States
sponsored and collaborated
and Canada.
by the University of Medicine
Westchester Medical Center • The Pulse | 7
HEART & VASCULAR
Leading the Tri State Area in the Use of ECMO Technology to Treat Cardiogenic Shock In the not-so-distant past, heart transplant patients who developed severe rejection with cardiogenic shock faced the high-risk option of going back into surgery to have their chests reopened and a pump implanted, a procedure that was fraught with its own set of complications, including the risk of life-threatening infection because of immunosuppression. By utilizing non-surgical peripheral Extra-Corporeal Membrane Oxygenation (ECMO) technology, the cardiovascular team at Westchester Medical Center have successfully saved the lives of cardiac patients suffering from a range of diseases including, AMI, acute myocarditis, Takotsubo syndrome or severe rejection. Hassan Ahmad, M.D., an interventional cardiologist at Westchester Medical Center used the Centrimag percutaneous ECMO to save the life of a 60-yearold male patient who, following a heart transplant,
Hassan Ahmad, M.D Interventional Cardiologist
Alan Gass, M.D., F.A.C.C. Director of Heart Failure, Mechanical Circulatory Support and Heart Transplant
faced severe rejection. “The transplant surgery was in itself very straightforward, but six days after surgery the patient went into cardiogenic shock and an emergency biopsy revealed he was suffering from a rare form of antibody mediated rejection,” Dr. Gass recalls. But instead of sending the patient back to the operating room to re-open his chest, Dr. Ahmad placed two canulae in the blood vessels in his legs, taking the venous blood via an external pump and sending it through an oxygenator to the arterial system to perfuse his vital organs and rest the heart while he was aggressively treated for rejection. Today the patient’s transplanted heart is 100 percent functional operating normally and he is home doing well. The long-term prognosis is excellent. Westchester Medical Center is one of a very few hospitals in the tri-state area to employ this method of ECMO with very impressive results that have been presented at two national cardiology meetings and published in peer-reviewed journals.
Ramin Malekan, M.D. Cardiothoracic Surgeon
“Our team, which includes cardiac surgeons, transplant cardiologists and transplant coordinators, has many years of experience that allow them to take many patients that other centers have turned down, including older and sicker candidates” 8 | 1-877-WMC-DOCS
PAC
CENTRIMAG
Survival Rate of Patients in Cardiogenic Shock 100%
80%
Survival Rate at Westchester Medical Center
60%
80% IABP
Centrimag® Percutaneous Ventricular Assist Device
Over the course of the last three and a half years, the Heart Failure/Heart Transplant team at the Medical Center completed over 150 percutaneous ECMO procedures. While the expected survival rate for patients in cardiogenic shock is only 15 percent, thanks to the skilled team at Westchester Medical Center, nearly 80 percent of our patients treated with this technology have been discharged and gone on to live healthy, normal lives. The improved survival rates using peripheral ECMO in conjunction with VADs can be attributed to the ability to implant the devices quickly under local anesthesia in even the most unstable patients. Occasionally, these are placed in the operating room—especially in patients with small or abnormal vasculature. “The rapidly expanding use of peripheral ECMO is evolving to include many more indications due to the ease of implantation and the ability to avoid open heart surgery. In addition, we are able to rest the [patient’s] heart so there is complete recovery and patients leave with their own heart—not requiring transplant or mechanical support. This is shifting the paradigm of bridge-to-recovery which was almost impossible in the past,” Dr. Gass says.
www.westchesterheartandvascular.com
QUADROX OXYGENATOR
40%
20%
National Average
15%
Westchester Medical Center is the only hospital in the tri-state area to employ this method of ECMO with very impressive results that have been presented at two national cardiology meetings and published in peer-reviewed journals.
The ability to stabilize critically ill patients has not only led to improved overall survival, but in patients eligible for transplant, this has resulted in better outcomes after transplant. In fact, Dr. Gass points out that Westchester Medical Center’s survival rate for transplants exceeds the national average. This technology, pioneered at Westchester Medical Center, has revolutionized the management and immediate and long-term prognosis in patients with cardiogenic shock.
Westchester Medical Center • The Pulse | 9
HEART & VASCULAR
Skillful Use of Imaging Technologies Leads to Early Detection and Treatment of Thoracic Cancers With lung cancer surpassing breast cancer as the leading cause of cancer deaths and uncontrolled reflux disease contributing to the rise in esophageal cancer, thoracic surgeons at Westchester Medical Center are employing state-of-the-art technologies to diagnose the disease in its early stages to improve patient recovery and survival rates. “Whenever possible, we approach all areas of thoracic surgery—whether it be esophageal, lung or mediastinal—with minimally invasive approaches that enable us to remove a tumor or mass with a small incision,” says Rocco Lafaro, M.D., a boardcertified cardiothoracic surgeon at Westchester Medical Center “This lessens the patient’s pain and results in a faster recovery that translates into a shorter hospital stay and resulting costs.” Using new imaging modalities such as endoscopic bronchial ultrasound (EBUS), which enables thoracic surgeons to map their way through the lung’s airways (almost all the way into the bronchial tree) or endoscopic ultrasound (EUS) which allows them to see the depth of an esophageal tumor and the level of lymph node involvement, the Medical Center’s thoracic surgeons can evaluate and diagnose masses to determine the best treatment options.
Dr. Lafaro says technology is also revolutionizing the way thoracic surgeons treat mediastinal masses. By employing video assisted thorascopic surgery (VATS), Westchester Medical Center’s thoracic surgeons are able to view and biopsy masses inside the chest cavity through small incisions that may be only 3 Rocco Lafaro, M.D., Cardiothoracic Surgeon to 5 millimeters long. VATS has pulmonary applications as well, where it can be used to diagnose certain pneumonia infections and treat repeatedly collapsing lungs. Sometimes, however, factors including the location of a mass and its size make traditional surgical intervention the only option. Dr. Lafaro recalls the case of a 59-year-old male who had a large fibrous tumor of the pleura that weighed more than 5 pounds. Working with thoracic surgeon Dr. Avraham D. Merav, Dr. Lafaro performed a very complex, fourhour operation to remove the tumor, taking special care to separate the mass from surrounding tissues, including the lung, to which it had adhered. The
Did you know… Westchester Medical Center has established a lung nodule clinic for patients who have had nodules identified on an X-ray or CT scan. When immediate action is not warranted, these patients can get some extra peace-of-mind knowing their cases are being watched closely through regular follow-up by the Medical Center’s experts. Although smoking cessation remains the best way to prevent lung cancer, tobacco users can be regularly screened at Westchester Medical Center’s lung clinic to detect any early signs of tumors, thus enabling doctors to begin immediate treatment that may significantly improve their outcomes. 10 | 1-877-WMC-DOCS
surgery required a large incision that extended from the chest through the diaphragm and resulted in the removal of the patient’s eighth rib. Whether performing a complex traditional open surgery or using minimally-invasive technologies, Dr. Lafaro stresses that bringing in a team of specialists results in the best outcome. “At Westchester Medical Center, we employ a multi-disciplinary approach that includes the surgeon, the medical oncologist, the radiation oncologist and the pathologist,” he says. “This is the way cancer must be handled today because decisions have to be made whether the patient will benefit from chemotherapy and/or radiation in a staged way and, if so, when the process should begin.” Dr. Lafaro says the new screening technologies to identify and biopsy lesions in their early stages, coupled with improved patient awareness of the risks associated with thoracic cancers, has improved the outlook for many patients. “Not only are these earlier diagnoses allowing us to catch cancers before they spread, but the advances in chemotherapy have been dramatic,” he says. “Thoracic cancer survival rates are significantly better because in many cases we have caught the disease early, and as such, we can treat and control it as a chronic condition.” www.westchesterheartandvascular.com
“ At Westchester Medical Center, we employ a multi-disciplinary approach that includes the surgeon, the medical oncologist, the radiation oncologist and the pathologists,” Dr. Lafaro says. “This is the way cancer must be handled today because decisions have to be made whether the patient will benefit from chemotherapy and/or radiation in a staged way and, if so, when the process should begin.”
Westchester Medical Center • The Pulse | 11
HEART & VASCULAR
Improving the Odds and Quality of Life for Pulmonary Hypertension Patients
Gregg Lanier, M.D. Director, Heart Failure and Pulmonary Hypertension
Pulmonary hypertension, although relatively rare, can affect patients of all ages, races and ethnic backgrounds. Westchester Medical Center is the only tertiary care center in Westchester and the surrounding counties of the Hudson Valley that is evaluating and treating pulmonary hypertension patients.
Given the serious nature of the condition, Gregg Lanier, M.D., Director for Heart Failure and Pulmonary Hypertension at Westchester Medical Center, encourages all referring physicians to pay particular attention to those patients who may have some of the co-morbidities that are often associated with pulmonary hypertension. “There are some patients who are walking around without showing any of the traditional symptoms of pulmonary hypertension such as shortness of breath or fatigue yet they may have very high pulmonary pressure,” Dr. Lanier explains. “So if a patient has liver disease, COPD, obesity with obstructive sleep apnea, HIV, sickle cell anemia, a history of pulmonary embolism or a connective tissue disease such as scleroderma, it is reasonable to do a screening echocardiogram.”
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Waiting until a patient presents with significant symptoms makes treatment much more difficult and often results in a very negative prognosis. “Earlier recognition and treatment gives our team more of an opportunity to work with the patient on effective therapies that will hopefully leave him or her clinically improved and with a better quality of life. This way, the primary care provider that referred the patient will be able to focus on their routine care and other medical conditions, while we collaborate with them to treat the patient’s pulmonary hypertension,” Dr. Lanier says. Those therapies include immediate changes to diet and treatment with pharmaceuticals such as calcium channel blockers, endothelin receptor antagonists and phosphodiesterase inhibitors. For patients with significant symptoms, additional medications may be necessary, such as inhaled, subcutaneous or intravenous prostacyclin treatments.
“Although these medicines can be tricky to manage and administer, they are definitely worth using since they can significantly improve a patient’s quality of life and longevity.”
Healthy Pulmonary Arterial Vessel
Pulmonary Hypertension
Westchester Medical Center is the only tertiary care center in Westchester County and the surrounding counties of the Hudson Valley that is evaluating and treating pulmonary hypertension patients.
Narrowing of vessels
The team of cardiologists, nurse practitioners and medical assistants at Westchester Medical Center are well-versed in the protocols for using some of the most effective pulmonary hypertension medications on the market today, including sildenafil (Revatio®), tadalafil (Adcirca®), bosentan (Tracleer®), ambrisentan (Letairis®), epoprostenol (Flolan® or Veletri®), treprostinil sodium (Remodulin®, Tyvaso®), and iloprost (Ventavis®). “We work with these medications all the time so we understand what therapies work best for the particular etiologies of pulmonary hypertension,” Dr. Lanier explains. “We know what the side effects are and the level of monitoring and follow-up that is necessary to ensure they are used safely and for maximum benefit to the patient.” Just as importantly, Dr. Lanier and the Medical Center’s team of specialists have developed a strong working relationship with the specialty pharmacies
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that produce these medications. These agencies provide an excellent support system of care and education for patients as they start these specialized medications. They also help to achieve insurance reimbursement and coverage of these costly medicines. “Once on a stable therapy, most patients will do well for a long time,” Dr. Lanier says. “Although these medicines can be tricky to manage and administer, they are definitely worth using since they can significantly improve a patient’s quality of life and longevity.” Pulmonary hypertension is like many other chronic diseases, which if well-managed and recognized early, can be treated so that patients can live life doing many—if not most—of what they liked to do before being diagnosed, Dr. Lanier says.
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HEART & VASCULAR
Quality Measures Provide Snapshot of Care at Westchester Medical Center
Westchester Medical Center participates in a national initiative to gather and publicly report quality data, making it easier for consumers and referring physicians to make educated choices when seeking advanced specialty care. Rooted in evidence-based practice, the national hospital quality measures indicate how often hospitals give recommended treatments known to get the best results for patients with certain conditions.
National Hospital Quality Measures/AMI The following chart shows how Westchester Medical Center fared with regard to recommended treatments for heart attack from Q1 to Q4 2010, the most recent official numbers with New York State averages for comparison. Numbers reflect percentages. Treatment
Q1 2010
Q2 2010
Q3 2010
Q4 2010
NYS AVG Q1-Q4 2010
Aspirin at arrival
100
100
100
99
98
Aspirin prescribed at discharge
99
100
100
100
99
ACEI or ARB for LVSD
100
100
100
100
95
Adult smoking cessation advice/counseling
100
100
100
100
100
Beta blocker prescribed at discharge
100
100
100
100
98
Primary PCI within 90 minutes of arrival
75
100
100
80
89
National Hospital Quality Measures/Heart Failure The following chart shows how the Medical Center fared with regard to recommended treatments for heart failure with comparative New York State averages. Numbers reflect percentages. Treatment
Q1 2010
Q2 2010
Q3 2010
Q4 2010
NYS AVG Q1-Q4 2010
All Discharge Instructions
90
97
95
95
91
Evaluation of LVS Function
100
100
100
100
99
ACEI or ARB for LVSD
100
100
100
100
94
Adult smoking cessation advice/counseling
100
100
93
92
98
(before 1/12)
National Hospital Quality Measures/Surgical Improvement Project/CABG The following chart shows Westchester Medical Center’s rates for treatments recommended as part of the national Surgical Care Improvement Project. Percentages are given for patients undergoing coronary artery bypass grafting. The New York State averages shown are for all SCIP measures because CABG-specific averages are not available. Numbers reflect percentages. Treatment
Q1 2010
Q2 2010
Q3 2010
Q4 2010
NYS AVG Q1-Q4 2010
Antibiotic within 1 hr of incision
97
100
100
100
97
Antibiotic selection
100 100 100 100 97
Antibiotic discontinued within 48 hrs
96
96
96
96
95
Cardiac patients 6 a.m. post-op serum glucose
97
93
90
90
94
Appropriate hair removal
100
97
100
100
100
Urinary catheter removed POD 1 or POD 2
85
88
81
83
90
Beta blocker prior to admit and periop
84
96
96
100
93
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National Hospital Quality Measures/Surgical Improvement Project/Cardiac Surgery The following chart shows Westchester Medical Center’s rates for treatments recommended as part of the national Surgical Care Improvement Project. Percentages are given for patients undergoing all cardiac surgery, with the exception of coronary artery bypass grafting. The New York State averages shown are for all SCIP measures. Numbers reflect percentages. Treatment
Q1 2010
Q2 2010
Q3 2010
Q4 2010
NYS AVG Q1-Q4 2010
Antibiotic within 1 hr of incision
100
89
95
100
97
Antibiotic selection
100 100 100 100 97
Antibiotic discontinued within 48 hrs
100
94
100
100
95
Cardiac patients 6 a.m. post-op serum glucose
100
100
96
100
94
Appropriate hair removal
100
100
100
100
100
Urinary catheter removed POD 1 or POD 2
100
82
88
78
90
Beta blocker prior to admit and periop
94
100
78
94
93
Adult Cardiac Surgery The following charts shows Westchester Medical Center’s data for 2007 through 2009 compared to the statewide averages for cardiac surgery from the most recent New York State Department of Health Adult Cardiac Surgery report. Westchester Medical Center was among the top three hospitals in New York for isolated CABG surgery and valve surgery done with or without CABG. The Medical Center also had a statistically significantly lower risk adjusted mortality rate for these procedures when compared to the state average. The data includes number of cases, number of deaths, observed mortality rate (OMR), expected mortality rate (EMR) and risk adjusted mortality rate (RAMR) for isolated CABG, isolated valve and the two procedures done in combination. In-Hospital/30 Day, Observed, Expected and Risk-Adjusted Mortality Rates for Isolated CABG in New York State, 2007 - 2009 Hospital
# of Cases
WMC
1,280 13
# of Deaths
OMR
1.02 2.01 .94**
EMR
RAMR
NYS
32,300 599
1.85
1.85 1.85
In-Hospital/30 Day, Observed, Expected and Risk-Adjusted Mortality rates for Valve or Valve/CABG Surgery in New York State, 2007 – 2009 Discharges. Hospital
# of Cases # of Deaths OMR
WMC
494 19
NYS
21,828 1,095 5.02
EMR
RAMR
3.85 5.82 3.31 5.02 5.02
In-Hospital/30 Day and Risk-Adjusted Mortality Rates for Isolated CABG and for Valve Surgery (done in combination with or without CABG) in New York State, 2007 – 2009. Hospital
# Cases RAMR
WMC
1,774 --
NYS
54,128 -- 3.13
1.84**
**Risk Adjusted Mortality Rate significantly lower than statewide average.
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Westchester Medical Center • The Pulse | 15
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PAID Permit No. 9523 White Plains, NY
HEART & VASCULAR Department of Marketing and Corporate Communications 100 Woods Rd. Valhalla, NY 10595 westchesterheartandvascular.com
Cardiovascular Services at Westchester Medical Center Cardiology Diagnostic Services
Cardiac Interventional Services
Electrophysiology
Nuclear Cardiology SPECT Imaging Stress Testing Tilt Table Testing Echocardiography Stress Echocardiography Transesophageal Echocardiography Holter Monitoring Electrocardiography (ECG) Event Recorders Magnetic Resonance Imaging (MRI)
Cardiac Catheterization Coronary Stents – Bare Metal and Drug-Eluting Atherectomy Intravascular Ultrasound Brachytherapy Angioplasty
Biventricular Pacing Electrophysiologic Studies Radio Frequency Ablations Implantable Defibrillators (ICD) Signal Average ECG Permanent Pacemaker Implantation
Cardiac Surgery
Peripheral Vascular Interventional Services
Coronary Bypass Surgery Valve and Multiple Valve Procedures Aortic Aneurysm Surgery/ Thoracic Stent Graft Mitral Valve Repair Cardiac Transplant Ventricular Assist Devices
Peripheral Angiography / Angioplasty / Stent Carotid Angiography / Stent Renal Angiography / Angioplasty / Stent Intravascular Ultrasound Aortic Endovascular Stent Grafts for Abdominal Aortic Aneurysms
Vascular Diagnostic Services Pulse Volume Recording Segmental Pressure Measurement Carotid/Vertebral Duplex Venous Duplex Scan Extremity Arterial Duplex Non-invasive Vascular Testing Abdominal Aortic Ultrasound Renal and Visceral Artery Duplex
Cardiac Failure Advanced Medical Care Investigational Drug Trials Mechanical Circulatory Support
Comprehensive, State-of-the Art Therapy for all Diseases of the Heart and Lungs
Vascular Surgery Limb Salvage Surgery Carotid Endarterectomy Aneurysm Resection / Stent Graft Renal / Mesenteric Revascularization Sclerotherapy Varicose Vein Surgery Endovascular Procedures
One hospital, changing countless lives.
HEART & VASCULAR 100 Woods Road, Valhalla, NY 10595 westchesterheartandvascular.com 877.WMC.DOCS
