The Heart and Vascular Institute at Englewood Hospital and Medical Center

Transcription

1 treatment of abnormal heart rhythms. Most recently, for example, we ve incorporated technology that significantly enhances our mapping systems, providing a high-resolution 3-D model on a graphic interface, Dr. Simons shares. He reports that Englewood Hospital has just invested in one of the newest mapping systems available to most accurately visualize real-time images of electrical activity within the heart. p Englewood Hospital recently invested in one of the newest mapping systems available to visualize real-time images of electrical activity within the heart Herbert Dardik, MD, Chief of Surgery and Vascular Surgery at Englewood Hospital, relates how this collaboration has resulted in substantially improved outcomes over traditional approaches to repair an aneurysm in the chest. Now instead of making a large incision in the chest, we can puncture an artery, remote from where the problem is and repair the problem with minimal impact on the patient, physiologically, he explains. Dr. Dardik looks forward to the establishment of a Hybrid Angiographic OR Suite, which will further advance the ongoing collaborative work of cardiac and vascular patient care. This state-ofthe-art facility joins highly advanced equipment, technology and computer systems with skilled surgeons, interventional cardiologists, radiologists, anesthesiologists and specialized nursing and technical staff to perform complex cases. For example, Dr. Dardik reports, in the new hybrid suite, minimally invasive percutaneous (through needle puncture of a peripheral artery) aortic valve replacement can be performed for certain appropriate patients, rather than a more invasive open procedure. This is another reflection of how cardiac surgery and vascular surgery will continue to NJP_May2011_Reprint.indd 1-3 work together more and more in the years to come, Dr. Dardik foresees. The continuous introduction of groundbreaking technology is also the driving force behind the renowned success of the Arrhythmia Center within the Heart and Vascular Institute at Englewood Hospital. Grant R. Simons, MD is Director of Cardiac Electrophysiology, which focuses on the detection, diagnosis and Robotically guided catheter ablation for the treatment of atrial fibrillation (AF) is another innovative procedure performed by the cardiac electrophysiology team at Englewood Hospital. Instead of the physician manually manipulating the catheter during the curative ablation, as was traditionally the case, a robotic arm, integrated by computer with the mapping system, precisely guides the catheter while the physician operates the controls from a workstation located a few feet away from the patient. This technology enables us to produce more durable lesions because we can achieve better contact and better stability, asserts Dr. Simons. medication to prevent blood clots and stroke. We are one of the few sites in the country and the only one in New Jersey that is now involved in a trial of a device called the Watchman, Dr. Simons shares. The device, which is delivered via catheter through a puncture in the groin, seals off a pouch in the left atrium to prevent clots from traveling to the brain and causing a stroke. The hope is that this technique will negate the need for blood thinners, which can cause dangerous bleeding and have therapeutic levels that are difficult to maintain, even with frequent blood testing. In the trial that has been published, the atrial fibrillation patients with this device who stopped their medication had fewer strokes than those patients who did not have the device and were on blood thinners, Dr. Simons reports. Therefore, if and when the device receives FDA approval, patients with AF will have a safer and more effective treatment option to prevent strokes. Our Arrhythmia Center is at the forefront of advances in the treatment of arrhythmia so that we can deliver the best therapies to our patients, he says. Englewood Hospital s cardiac team recognizes that all cardiac patients benefit from effective follow-up care. If someone already has heart disease, the best way to prevent a recurrence, in addition to Looking towards the future, Dr. Simons is excited about a clinical trial presently being conducted at Englewood Hospital to dramatically alter the treatment for patients with AF who must remain on anti-coagulant medications, is to help minimize the risk factors with exercise, says Englewood Hospital s Director of Cardiac Rehab, Samuel Suede, MD. The Cardiac Rehab Center at Englewood Hospital is equipped with treadmills, bicycles, elliptical machines, step machines and a rower. Also, the aerobic exercise is supplemented with resistance training. There is one registered nurse on site for every five patients and a staff of exercise specialists who assist patients with their work-out regime. Patients, who have recently had a significant event, such as heart attack, angioplasty or bypass surgery, are placed in a 12 week monitoring program. These individuals have their blood pressure and heart rate checked before they exercise. Diabetics will also have their glucose tested. While they exercise their heart rate is being continuously monitored in order to detect a possible arrhythmia that will then be reported to the patient s physician. If an emergent problem occurs, the patient already in the hospital - is sent for immediate treatment. In addition to physical activity, those in the monitoring program attend weekly lectures which have a dedicated topic of the week, such as Smoking Cessation, Stress Reduction, Cholesterol Reduction, How to Read a Food Label, etc. At the inception of the monitoring program patients are administered Endurance Testing, a Quality of Life Test and an Educational Quiz. After their 12 week program is completed, patients are asked to re-take those tests and the two sets of scores are compared. Patients see the benefit they derived in just 12 weeks and hopefully, this will be an incentive for them to continue, Dr. Suede relates. After 12 weeks in the monitoring program many individuals do opt to continue at the Cardiac Rehab Center at Englewood Hospital in its maintenance program, even though insurance no longer covers this service at that point. A nominal fee is charged and Dr. Suede reports that many patients have been coming to the center for years, a testimony to the valuable contribution that Englewood Hospital continues to make towards the goal of restoring and maintaining cardiac health within the community. As the data shows, the comprehensive cardiac program at Englewood Hospital s Heart and Vascular Institute has a long track record of accomplishing its goal of providing the highest quality care for patients with heart disease. With a consistent ranking amongst the top facilities in the nation for cardiac care and treatment and a determination to build on its record of excellence, Englewood Hospital and Medical Center continues its journey into another decade. Along the way, countless New Jersey patients with heart disease will have the opportunity to live a longer, healthier and more productive life. p The physician operates the controls of a robotic arm that is integrated with the mapping system to precisely guide the catheter during ablation for the treatment of atrial fibrillation. For more information, call (201) or visit The Heart and Vascular Institute at Englewood Hospital and Medical Center p The patient s heart rate is continuously monitored during exercise.

2 The Heart and Vascular Institute at Englewood Hospital and Medical Center By Iris Goldberg When it opened its doors in July of 2000, the Heart and Vascular Institute at Englewood Hospital and Medical Center was the realization of a vision to create a comprehensive program for cardiac care unlike any in the surrounding region. Cardiac services including invasive and non-invasive cardiology, cardiac surgery and cardiac electrophysiology were offered to area patients who previously had to travel elsewhere to receive comparable care. In the years since, data has continued to show rates of success that are consistently among the highest in New Jersey and in the nation at large. Also, Englewood Hospital has a track record of accepting the most complex cardiac cases. Englewood Hospital and Medical Center has received numerous accolades for its highly successful and well recognized cardiac program: New Jersey Department of Health and Senior Services Cardiac Surgery Report lists a 100% survival rate for Englewood Hospital in isolated coronary artery bypass surgery a perfect record in the past four reports. CareChex presented Englewood Hospital and Medical Center with its prestigious Medical Excellence Award for cardiac care, ranking it as the #3 hospital for cardiac care in the state of New Jersey ( ). HealthGrades recognized Englewood Hospital with a Five-Star rating for Treatment of Heart Attack and Coronary Artery Bypass Surgery ( ). J.D. Power and Associates recognized Englewood Hospital and Medical Center for providing an Outstanding Cardiovascular Patient Experience (2010). The Center for Medicare and Medicaid Services (CMS) ranked Englewood Hospital and Medical Center #1 in New Jersey and # 3 nationwide for heart attack survival (based on CMS data for Medicare patients discharged between July 2006 and June 2007). p Englewood Hospital and Medical Center offers a comprehensive program for Cardiac Care unlike any in the surrounding region. NJP_May2011_Reprint.indd 4-6 Emphasizing individualized patient care and a multi-disciplinary team approach, the specialized cardiac experts at Englewood Hospital and Medical Center diagnose and treat all manifestations of cardiovascular disease. Additionally, recognition by the team of the cardiac needs of Bloodless Medicine and Surgery, Dr. Goldweit emphasizes the importance of PBM in improving patient outcomes. specific populations within the community and reaching out to those groups with a variety of educational and support services further enhances the dramatic role Englewood Hospital and Medical Center has in preserving heart health for so many New Jersey residents. There is no question in my mind that if you look at the literature in general, bleeding is a horrible thing in the interventional cardiologist s arena. In fact, in terms of all of us cardiac surgeons, interventional cardiologists, electrophysiologogists bleeding is associated with bad outcomes, Dr. Goldweit maintains. Jeffrey S. Matican, MD, Section Chief of Cardiology at Englewood Hospital and Medical Center discusses some of the important factors that set the Heart and Vascular Institute apart from other facilities. There is a very collegial relationship amongst all of the doctors the cardiologists from various groups, the electrophysiologists and the cardiac surgeons. It is common practice here for doctors in these various disciplines to engage in a group-think consultation about how to best handle a particular patient, Dr. Matican states. Another source of pride for Dr. Matican is Englewood Hospital s dedicated nursing staff, which has earned Magnet status for excellence in nursing for the third time a distinction shared by only 6% of hospitals, nationwide. In addition to their clinical experience, the nurses here are interested, energetic and committed to staying informed about medical advances to help their patients, he notes. In addition to the informal sharing of ideas, Dr. Matican proudly points to the weekly cardiology conference at the Heart and Vascular Institute as a crucial component of the well-established success of the cardiac program at Englewood Hospital. Originally started to discuss the various issues regarding patients undergoing cardiac catheterization, the meeting still informally called a Cath Conference has now evolved into a valuable forum for the entire cardiology team. At these meetings, we review cardiac-related articles in the medical literature and even in the lay press. We discuss new developments in cardiology and cardiac programs, Dr. p Englewood Hospital s state-of-the-art Cardiac Catheterization laboratory Matican shares. Whether it s a new treatment or modality for acute coronary syndromes, or one of our cardiac electrophysiologists talking about something new in arrhythmias, or perhaps the cardiac surgeons speaking about the latest advances in aortic aneurysm surgery, there s a wealth of information shared amongst the cardiac team at these weekly meetings, he adds. The weekly conference is led by Richard S. Goldweit, MD, Director of the Cardiac Catheterization Laboratory and Director of Interventional Cardiology at Englewood Hospital and Medical Center. Our dynamic weekly cardiology conference is unique in that all cardiology-related disciplines attend - cardiac surgeons, the entire array of cardiologists, including the electrophysiologists, non-invasive cardiology and invasive cardiologists, nurses and cath lab technologists. Everyone finds value in these meetings, Dr. Goldweit states. That interdisciplinary cooperation carries over into how we practice here. We pride ourselves on having an interactive program where a team of specialists in various disciplines work together, he adds. It would be impossible to enumerate the ways in which Englewood Hospital s cardiac program is distinctive without a discussion of Patient Blood Management (PBM), which has become the standard of care at the Medical Center, a world-renowned leader in PBM. A growing body of evidence points to an increased risk of infection, complications and death associated with blood transfusions. PBM is an initiative to improve patient outcomes that seeks to avoid unnecessary blood transfusions and reduce the risks and costs associated with blood and blood products. By practicing Patient Blood Management, we have strategies and methods to help avoid unnecessary transfusions and the risks associated with them, Dr. Matican explains. We don t transfuse by the numbers but rather assess each patient s individual situation. Patient Blood Management is based on three main principles or pillars : optimizing hematopoiesis and appropriate management of anemia; minimizing bleeding and blood loss; and harnessing and optimizing physiological tolerance of anemia. As assistant director of Englewood Hospital s renowned Institute of Patient Blood Management and It s not just the bleeding itself or the loss of blood but the changes that might have to be made to stem the excessive bleeding may not be best for the patient in other ways, he adds. As an example of this he notes that if a patient with a cardiac stent bleeds excessively, that patient will have to stop antiplatelet therapy, which is key to keeping stents open and preventing another heart attack. If you bleed, you might be told to stop those agents and then you become compromised, Dr. Goldweit notes. Dr. Goldweit also points to evidence-based treatment decisions as another factor supporting positive patient outcomes. At Englewood Hospital, we emphasize doing only what the data suggests will be effective. If the data suggests an option that is less complex, less fancy, or less high-tech but it delivers an equally good result, that s the option we ll choose, Dr. Goldweit states. He shares that this option is preferable in terms of reducing excessive costs but most importantly in terms of doing the best for the patient, who, generally will do better with a simpler approach. In the end it s all about the patient. We want data-driven approaches that enhance quality and length of life, Dr. Goldweit emphasizes. Dr. Goldweit s point is well-illustrated in the impressive survival rate for heart attack patients brought to the Emergency Medicine Department at Englewood Hospital. With an interventional cardiologist on staff 24/7, an excellent ER team and vital patient information called in ahead by EMS transporters, Englewood Hospital has held one of the three p Since the inception of its cardiac surgery program 11 years ago, patient outcomes at Englewood Hospital have been consistently excellent. best heart attack survival records in the nation. The time from patient arrival to the start of a cardiac interventional procedure, known as door to balloon time, has for the past five years been, on average, nearly 15 minutes below the limit set by national guidelines. Patient outcomes for cardiac surgery at Englewood Hospital are consistently excellent as well. Since the inception of its cardiac surgery program 11 years ago, the average mortality rate for isolated bypass surgery is 0.57% - a survival rate of 99.43% over the past 11 years, as defined by the State of New Jersey. James J. Klein, MD, Chief of the Department of Cardiothoracic Surgery at Englewood Hospital discusses the significantly successful outcomes the medical center s cardiac surgery team has had for bypass surgery as well as for various other complex procedures such as multivalve repair, aneurysm/aortic dissection repair and endovascular thoracic aneurysm graft (TAG) repair. In the 11 years since the inception of Englewood Hospital s cardiac surgery program, we ve submitted multiple pieces of literature that have been accepted by peer reviewed journals, including two in the prestigious Annals of Thoracic Surgery. These articles explored our success with avoiding blood transfusions during cardiac surgery. I do believe this is certainly part of the reason that our cardiac surgery survival rates are so high and our complication rates are so low, asserts Dr. Klein. With each passing year Dr. Klein relates that more and more hospitals come to Englewood Hospital to learn the blood management techniques that are so closely linked to its superb record of successful surgical outcomes. Nearly 80% of cardiac surgeries at Englewood Hospital are performed without blood transfusions. Dr. Klein points out that Jehovah s Witnesses, who for religious reasons may not accept blood transfusions, comprise 13% of his practice. Close to 200 Jehovah s Witnesses from areas across the United States have undergone cardiac surgery at Englewood Hospital since the start of its cardiac surgery program. At Englewood Hospital the Department of Cardiothoracic Surgery works in partnership with the Department of Vascular Surgery to perform innovative, minimally invasive thoracic endografting to an increasing number of patients with diseases of the thoracic aorta.

3 The Heart and Vascular Institute at Englewood Hospital and Medical Center By Iris Goldberg When it opened its doors in July of 2000, the Heart and Vascular Institute at Englewood Hospital and Medical Center was the realization of a vision to create a comprehensive program for cardiac care unlike any in the surrounding region. Cardiac services including invasive and non-invasive cardiology, cardiac surgery and cardiac electrophysiology were offered to area patients who previously had to travel elsewhere to receive comparable care. In the years since, data has continued to show rates of success that are consistently among the highest in New Jersey and in the nation at large. Also, Englewood Hospital has a track record of accepting the most complex cardiac cases. Englewood Hospital and Medical Center has received numerous accolades for its highly successful and well recognized cardiac program: New Jersey Department of Health and Senior Services Cardiac Surgery Report lists a 100% survival rate for Englewood Hospital in isolated coronary artery bypass surgery a perfect record in the past four reports. CareChex presented Englewood Hospital and Medical Center with its prestigious Medical Excellence Award for cardiac care, ranking it as the #3 hospital for cardiac care in the state of New Jersey ( ). HealthGrades recognized Englewood Hospital with a Five-Star rating for Treatment of Heart Attack and Coronary Artery Bypass Surgery ( ). J.D. Power and Associates recognized Englewood Hospital and Medical Center for providing an Outstanding Cardiovascular Patient Experience (2010). The Center for Medicare and Medicaid Services (CMS) ranked Englewood Hospital and Medical Center #1 in New Jersey and # 3 nationwide for heart attack survival (based on CMS data for Medicare patients discharged between July 2006 and June 2007). p Englewood Hospital and Medical Center offers a comprehensive program for Cardiac Care unlike any in the surrounding region. NJP_May2011_Reprint.indd 4-6 Emphasizing individualized patient care and a multi-disciplinary team approach, the specialized cardiac experts at Englewood Hospital and Medical Center diagnose and treat all manifestations of cardiovascular disease. Additionally, recognition by the team of the cardiac needs of Bloodless Medicine and Surgery, Dr. Goldweit emphasizes the importance of PBM in improving patient outcomes. specific populations within the community and reaching out to those groups with a variety of educational and support services further enhances the dramatic role Englewood Hospital and Medical Center has in preserving heart health for so many New Jersey residents. There is no question in my mind that if you look at the literature in general, bleeding is a horrible thing in the interventional cardiologist s arena. In fact, in terms of all of us cardiac surgeons, interventional cardiologists, electrophysiologogists bleeding is associated with bad outcomes, Dr. Goldweit maintains. Jeffrey S. Matican, MD, Section Chief of Cardiology at Englewood Hospital and Medical Center discusses some of the important factors that set the Heart and Vascular Institute apart from other facilities. There is a very collegial relationship amongst all of the doctors the cardiologists from various groups, the electrophysiologists and the cardiac surgeons. It is common practice here for doctors in these various disciplines to engage in a group-think consultation about how to best handle a particular patient, Dr. Matican states. Another source of pride for Dr. Matican is Englewood Hospital s dedicated nursing staff, which has earned Magnet status for excellence in nursing for the third time a distinction shared by only 6% of hospitals, nationwide. In addition to their clinical experience, the nurses here are interested, energetic and committed to staying informed about medical advances to help their patients, he notes. In addition to the informal sharing of ideas, Dr. Matican proudly points to the weekly cardiology conference at the Heart and Vascular Institute as a crucial component of the well-established success of the cardiac program at Englewood Hospital. Originally started to discuss the various issues regarding patients undergoing cardiac catheterization, the meeting still informally called a Cath Conference has now evolved into a valuable forum for the entire cardiology team. At these meetings, we review cardiac-related articles in the medical literature and even in the lay press. We discuss new developments in cardiology and cardiac programs, Dr. p Englewood Hospital s state-of-the-art Cardiac Catheterization laboratory Matican shares. Whether it s a new treatment or modality for acute coronary syndromes, or one of our cardiac electrophysiologists talking about something new in arrhythmias, or perhaps the cardiac surgeons speaking about the latest advances in aortic aneurysm surgery, there s a wealth of information shared amongst the cardiac team at these weekly meetings, he adds. The weekly conference is led by Richard S. Goldweit, MD, Director of the Cardiac Catheterization Laboratory and Director of Interventional Cardiology at Englewood Hospital and Medical Center. Our dynamic weekly cardiology conference is unique in that all cardiology-related disciplines attend - cardiac surgeons, the entire array of cardiologists, including the electrophysiologists, non-invasive cardiology and invasive cardiologists, nurses and cath lab technologists. Everyone finds value in these meetings, Dr. Goldweit states. That interdisciplinary cooperation carries over into how we practice here. We pride ourselves on having an interactive program where a team of specialists in various disciplines work together, he adds. It would be impossible to enumerate the ways in which Englewood Hospital s cardiac program is distinctive without a discussion of Patient Blood Management (PBM), which has become the standard of care at the Medical Center, a world-renowned leader in PBM. A growing body of evidence points to an increased risk of infection, complications and death associated with blood transfusions. PBM is an initiative to improve patient outcomes that seeks to avoid unnecessary blood transfusions and reduce the risks and costs associated with blood and blood products. By practicing Patient Blood Management, we have strategies and methods to help avoid unnecessary transfusions and the risks associated with them, Dr. Matican explains. We don t transfuse by the numbers but rather assess each patient s individual situation. Patient Blood Management is based on three main principles or pillars : optimizing hematopoiesis and appropriate management of anemia; minimizing bleeding and blood loss; and harnessing and optimizing physiological tolerance of anemia. As assistant director of Englewood Hospital s renowned Institute of Patient Blood Management and It s not just the bleeding itself or the loss of blood but the changes that might have to be made to stem the excessive bleeding may not be best for the patient in other ways, he adds. As an example of this he notes that if a patient with a cardiac stent bleeds excessively, that patient will have to stop antiplatelet therapy, which is key to keeping stents open and preventing another heart attack. If you bleed, you might be told to stop those agents and then you become compromised, Dr. Goldweit notes. Dr. Goldweit also points to evidence-based treatment decisions as another factor supporting positive patient outcomes. At Englewood Hospital, we emphasize doing only what the data suggests will be effective. If the data suggests an option that is less complex, less fancy, or less high-tech but it delivers an equally good result, that s the option we ll choose, Dr. Goldweit states. He shares that this option is preferable in terms of reducing excessive costs but most importantly in terms of doing the best for the patient, who, generally will do better with a simpler approach. In the end it s all about the patient. We want data-driven approaches that enhance quality and length of life, Dr. Goldweit emphasizes. Dr. Goldweit s point is well-illustrated in the impressive survival rate for heart attack patients brought to the Emergency Medicine Department at Englewood Hospital. With an interventional cardiologist on staff 24/7, an excellent ER team and vital patient information called in ahead by EMS transporters, Englewood Hospital has held one of the three p Since the inception of its cardiac surgery program 11 years ago, patient outcomes at Englewood Hospital have been consistently excellent. best heart attack survival records in the nation. The time from patient arrival to the start of a cardiac interventional procedure, known as door to balloon time, has for the past five years been, on average, nearly 15 minutes below the limit set by national guidelines. Patient outcomes for cardiac surgery at Englewood Hospital are consistently excellent as well. Since the inception of its cardiac surgery program 11 years ago, the average mortality rate for isolated bypass surgery is 0.57% - a survival rate of 99.43% over the past 11 years, as defined by the State of New Jersey. James J. Klein, MD, Chief of the Department of Cardiothoracic Surgery at Englewood Hospital discusses the significantly successful outcomes the medical center s cardiac surgery team has had for bypass surgery as well as for various other complex procedures such as multivalve repair, aneurysm/aortic dissection repair and endovascular thoracic aneurysm graft (TAG) repair. In the 11 years since the inception of Englewood Hospital s cardiac surgery program, we ve submitted multiple pieces of literature that have been accepted by peer reviewed journals, including two in the prestigious Annals of Thoracic Surgery. These articles explored our success with avoiding blood transfusions during cardiac surgery. I do believe this is certainly part of the reason that our cardiac surgery survival rates are so high and our complication rates are so low, asserts Dr. Klein. With each passing year Dr. Klein relates that more and more hospitals come to Englewood Hospital to learn the blood management techniques that are so closely linked to its superb record of successful surgical outcomes. Nearly 80% of cardiac surgeries at Englewood Hospital are performed without blood transfusions. Dr. Klein points out that Jehovah s Witnesses, who for religious reasons may not accept blood transfusions, comprise 13% of his practice. Close to 200 Jehovah s Witnesses from areas across the United States have undergone cardiac surgery at Englewood Hospital since the start of its cardiac surgery program. At Englewood Hospital the Department of Cardiothoracic Surgery works in partnership with the Department of Vascular Surgery to perform innovative, minimally invasive thoracic endografting to an increasing number of patients with diseases of the thoracic aorta.

4 The Heart and Vascular Institute at Englewood Hospital and Medical Center By Iris Goldberg When it opened its doors in July of 2000, the Heart and Vascular Institute at Englewood Hospital and Medical Center was the realization of a vision to create a comprehensive program for cardiac care unlike any in the surrounding region. Cardiac services including invasive and non-invasive cardiology, cardiac surgery and cardiac electrophysiology were offered to area patients who previously had to travel elsewhere to receive comparable care. In the years since, data has continued to show rates of success that are consistently among the highest in New Jersey and in the nation at large. Also, Englewood Hospital has a track record of accepting the most complex cardiac cases. Englewood Hospital and Medical Center has received numerous accolades for its highly successful and well recognized cardiac program: New Jersey Department of Health and Senior Services Cardiac Surgery Report lists a 100% survival rate for Englewood Hospital in isolated coronary artery bypass surgery a perfect record in the past four reports. CareChex presented Englewood Hospital and Medical Center with its prestigious Medical Excellence Award for cardiac care, ranking it as the #3 hospital for cardiac care in the state of New Jersey ( ). HealthGrades recognized Englewood Hospital with a Five-Star rating for Treatment of Heart Attack and Coronary Artery Bypass Surgery ( ). J.D. Power and Associates recognized Englewood Hospital and Medical Center for providing an Outstanding Cardiovascular Patient Experience (2010). The Center for Medicare and Medicaid Services (CMS) ranked Englewood Hospital and Medical Center #1 in New Jersey and # 3 nationwide for heart attack survival (based on CMS data for Medicare patients discharged between July 2006 and June 2007). p Englewood Hospital and Medical Center offers a comprehensive program for Cardiac Care unlike any in the surrounding region. NJP_May2011_Reprint.indd 4-6 Emphasizing individualized patient care and a multi-disciplinary team approach, the specialized cardiac experts at Englewood Hospital and Medical Center diagnose and treat all manifestations of cardiovascular disease. Additionally, recognition by the team of the cardiac needs of Bloodless Medicine and Surgery, Dr. Goldweit emphasizes the importance of PBM in improving patient outcomes. specific populations within the community and reaching out to those groups with a variety of educational and support services further enhances the dramatic role Englewood Hospital and Medical Center has in preserving heart health for so many New Jersey residents. There is no question in my mind that if you look at the literature in general, bleeding is a horrible thing in the interventional cardiologist s arena. In fact, in terms of all of us cardiac surgeons, interventional cardiologists, electrophysiologogists bleeding is associated with bad outcomes, Dr. Goldweit maintains. Jeffrey S. Matican, MD, Section Chief of Cardiology at Englewood Hospital and Medical Center discusses some of the important factors that set the Heart and Vascular Institute apart from other facilities. There is a very collegial relationship amongst all of the doctors the cardiologists from various groups, the electrophysiologists and the cardiac surgeons. It is common practice here for doctors in these various disciplines to engage in a group-think consultation about how to best handle a particular patient, Dr. Matican states. Another source of pride for Dr. Matican is Englewood Hospital s dedicated nursing staff, which has earned Magnet status for excellence in nursing for the third time a distinction shared by only 6% of hospitals, nationwide. In addition to their clinical experience, the nurses here are interested, energetic and committed to staying informed about medical advances to help their patients, he notes. In addition to the informal sharing of ideas, Dr. Matican proudly points to the weekly cardiology conference at the Heart and Vascular Institute as a crucial component of the well-established success of the cardiac program at Englewood Hospital. Originally started to discuss the various issues regarding patients undergoing cardiac catheterization, the meeting still informally called a Cath Conference has now evolved into a valuable forum for the entire cardiology team. At these meetings, we review cardiac-related articles in the medical literature and even in the lay press. We discuss new developments in cardiology and cardiac programs, Dr. p Englewood Hospital s state-of-the-art Cardiac Catheterization laboratory Matican shares. Whether it s a new treatment or modality for acute coronary syndromes, or one of our cardiac electrophysiologists talking about something new in arrhythmias, or perhaps the cardiac surgeons speaking about the latest advances in aortic aneurysm surgery, there s a wealth of information shared amongst the cardiac team at these weekly meetings, he adds. The weekly conference is led by Richard S. Goldweit, MD, Director of the Cardiac Catheterization Laboratory and Director of Interventional Cardiology at Englewood Hospital and Medical Center. Our dynamic weekly cardiology conference is unique in that all cardiology-related disciplines attend - cardiac surgeons, the entire array of cardiologists, including the electrophysiologists, non-invasive cardiology and invasive cardiologists, nurses and cath lab technologists. Everyone finds value in these meetings, Dr. Goldweit states. That interdisciplinary cooperation carries over into how we practice here. We pride ourselves on having an interactive program where a team of specialists in various disciplines work together, he adds. It would be impossible to enumerate the ways in which Englewood Hospital s cardiac program is distinctive without a discussion of Patient Blood Management (PBM), which has become the standard of care at the Medical Center, a world-renowned leader in PBM. A growing body of evidence points to an increased risk of infection, complications and death associated with blood transfusions. PBM is an initiative to improve patient outcomes that seeks to avoid unnecessary blood transfusions and reduce the risks and costs associated with blood and blood products. By practicing Patient Blood Management, we have strategies and methods to help avoid unnecessary transfusions and the risks associated with them, Dr. Matican explains. We don t transfuse by the numbers but rather assess each patient s individual situation. Patient Blood Management is based on three main principles or pillars : optimizing hematopoiesis and appropriate management of anemia; minimizing bleeding and blood loss; and harnessing and optimizing physiological tolerance of anemia. As assistant director of Englewood Hospital s renowned Institute of Patient Blood Management and It s not just the bleeding itself or the loss of blood but the changes that might have to be made to stem the excessive bleeding may not be best for the patient in other ways, he adds. As an example of this he notes that if a patient with a cardiac stent bleeds excessively, that patient will have to stop antiplatelet therapy, which is key to keeping stents open and preventing another heart attack. If you bleed, you might be told to stop those agents and then you become compromised, Dr. Goldweit notes. Dr. Goldweit also points to evidence-based treatment decisions as another factor supporting positive patient outcomes. At Englewood Hospital, we emphasize doing only what the data suggests will be effective. If the data suggests an option that is less complex, less fancy, or less high-tech but it delivers an equally good result, that s the option we ll choose, Dr. Goldweit states. He shares that this option is preferable in terms of reducing excessive costs but most importantly in terms of doing the best for the patient, who, generally will do better with a simpler approach. In the end it s all about the patient. We want data-driven approaches that enhance quality and length of life, Dr. Goldweit emphasizes. Dr. Goldweit s point is well-illustrated in the impressive survival rate for heart attack patients brought to the Emergency Medicine Department at Englewood Hospital. With an interventional cardiologist on staff 24/7, an excellent ER team and vital patient information called in ahead by EMS transporters, Englewood Hospital has held one of the three p Since the inception of its cardiac surgery program 11 years ago, patient outcomes at Englewood Hospital have been consistently excellent. best heart attack survival records in the nation. The time from patient arrival to the start of a cardiac interventional procedure, known as door to balloon time, has for the past five years been, on average, nearly 15 minutes below the limit set by national guidelines. Patient outcomes for cardiac surgery at Englewood Hospital are consistently excellent as well. Since the inception of its cardiac surgery program 11 years ago, the average mortality rate for isolated bypass surgery is 0.57% - a survival rate of 99.43% over the past 11 years, as defined by the State of New Jersey. James J. Klein, MD, Chief of the Department of Cardiothoracic Surgery at Englewood Hospital discusses the significantly successful outcomes the medical center s cardiac surgery team has had for bypass surgery as well as for various other complex procedures such as multivalve repair, aneurysm/aortic dissection repair and endovascular thoracic aneurysm graft (TAG) repair. In the 11 years since the inception of Englewood Hospital s cardiac surgery program, we ve submitted multiple pieces of literature that have been accepted by peer reviewed journals, including two in the prestigious Annals of Thoracic Surgery. These articles explored our success with avoiding blood transfusions during cardiac surgery. I do believe this is certainly part of the reason that our cardiac surgery survival rates are so high and our complication rates are so low, asserts Dr. Klein. With each passing year Dr. Klein relates that more and more hospitals come to Englewood Hospital to learn the blood management techniques that are so closely linked to its superb record of successful surgical outcomes. Nearly 80% of cardiac surgeries at Englewood Hospital are performed without blood transfusions. Dr. Klein points out that Jehovah s Witnesses, who for religious reasons may not accept blood transfusions, comprise 13% of his practice. Close to 200 Jehovah s Witnesses from areas across the United States have undergone cardiac surgery at Englewood Hospital since the start of its cardiac surgery program. At Englewood Hospital the Department of Cardiothoracic Surgery works in partnership with the Department of Vascular Surgery to perform innovative, minimally invasive thoracic endografting to an increasing number of patients with diseases of the thoracic aorta.

5 treatment of abnormal heart rhythms. Most recently, for example, we ve incorporated technology that significantly enhances our mapping systems, providing a high-resolution 3-D model on a graphic interface, Dr. Simons shares. He reports that Englewood Hospital has just invested in one of the newest mapping systems available to most accurately visualize real-time images of electrical activity within the heart. p Englewood Hospital recently invested in one of the newest mapping systems available to visualize real-time images of electrical activity within the heart Herbert Dardik, MD, Chief of Surgery and Vascular Surgery at Englewood Hospital, relates how this collaboration has resulted in substantially improved outcomes over traditional approaches to repair an aneurysm in the chest. Now instead of making a large incision in the chest, we can puncture an artery, remote from where the problem is and repair the problem with minimal impact on the patient, physiologically, he explains. Dr. Dardik looks forward to the establishment of a Hybrid Angiographic OR Suite, which will further advance the ongoing collaborative work of cardiac and vascular patient care. This state-ofthe-art facility joins highly advanced equipment, technology and computer systems with skilled surgeons, interventional cardiologists, radiologists, anesthesiologists and specialized nursing and technical staff to perform complex cases. For example, Dr. Dardik reports, in the new hybrid suite, minimally invasive percutaneous (through needle puncture of a peripheral artery) aortic valve replacement can be performed for certain appropriate patients, rather than a more invasive open procedure. This is another reflection of how cardiac surgery and vascular surgery will continue to NJP_May2011_Reprint.indd 1-3 work together more and more in the years to come, Dr. Dardik foresees. The continuous introduction of groundbreaking technology is also the driving force behind the renowned success of the Arrhythmia Center within the Heart and Vascular Institute at Englewood Hospital. Grant R. Simons, MD is Director of Cardiac Electrophysiology, which focuses on the detection, diagnosis and Robotically guided catheter ablation for the treatment of atrial fibrillation (AF) is another innovative procedure performed by the cardiac electrophysiology team at Englewood Hospital. Instead of the physician manually manipulating the catheter during the curative ablation, as was traditionally the case, a robotic arm, integrated by computer with the mapping system, precisely guides the catheter while the physician operates the controls from a workstation located a few feet away from the patient. This technology enables us to produce more durable lesions because we can achieve better contact and better stability, asserts Dr. Simons. medication to prevent blood clots and stroke. We are one of the few sites in the country and the only one in New Jersey that is now involved in a trial of a device called the Watchman, Dr. Simons shares. The device, which is delivered via catheter through a puncture in the groin, seals off a pouch in the left atrium to prevent clots from traveling to the brain and causing a stroke. The hope is that this technique will negate the need for blood thinners, which can cause dangerous bleeding and have therapeutic levels that are difficult to maintain, even with frequent blood testing. In the trial that has been published, the atrial fibrillation patients with this device who stopped their medication had fewer strokes than those patients who did not have the device and were on blood thinners, Dr. Simons reports. Therefore, if and when the device receives FDA approval, patients with AF will have a safer and more effective treatment option to prevent strokes. Our Arrhythmia Center is at the forefront of advances in the treatment of arrhythmia so that we can deliver the best therapies to our patients, he says. Englewood Hospital s cardiac team recognizes that all cardiac patients benefit from effective follow-up care. If someone already has heart disease, the best way to prevent a recurrence, in addition to Looking towards the future, Dr. Simons is excited about a clinical trial presently being conducted at Englewood Hospital to dramatically alter the treatment for patients with AF who must remain on anti-coagulant medications, is to help minimize the risk factors with exercise, says Englewood Hospital s Director of Cardiac Rehab, Samuel Suede, MD. The Cardiac Rehab Center at Englewood Hospital is equipped with treadmills, bicycles, elliptical machines, step machines and a rower. Also, the aerobic exercise is supplemented with resistance training. There is one registered nurse on site for every five patients and a staff of exercise specialists who assist patients with their work-out regime. Patients, who have recently had a significant event, such as heart attack, angioplasty or bypass surgery, are placed in a 12 week monitoring program. These individuals have their blood pressure and heart rate checked before they exercise. Diabetics will also have their glucose tested. While they exercise their heart rate is being continuously monitored in order to detect a possible arrhythmia that will then be reported to the patient s physician. If an emergent problem occurs, the patient already in the hospital - is sent for immediate treatment. In addition to physical activity, those in the monitoring program attend weekly lectures which have a dedicated topic of the week, such as Smoking Cessation, Stress Reduction, Cholesterol Reduction, How to Read a Food Label, etc. At the inception of the monitoring program patients are administered Endurance Testing, a Quality of Life Test and an Educational Quiz. After their 12 week program is completed, patients are asked to re-take those tests and the two sets of scores are compared. Patients see the benefit they derived in just 12 weeks and hopefully, this will be an incentive for them to continue, Dr. Suede relates. After 12 weeks in the monitoring program many individuals do opt to continue at the Cardiac Rehab Center at Englewood Hospital in its maintenance program, even though insurance no longer covers this service at that point. A nominal fee is charged and Dr. Suede reports that many patients have been coming to the center for years, a testimony to the valuable contribution that Englewood Hospital continues to make towards the goal of restoring and maintaining cardiac health within the community. As the data shows, the comprehensive cardiac program at Englewood Hospital s Heart and Vascular Institute has a long track record of accomplishing its goal of providing the highest quality care for patients with heart disease. With a consistent ranking amongst the top facilities in the nation for cardiac care and treatment and a determination to build on its record of excellence, Englewood Hospital and Medical Center continues its journey into another decade. Along the way, countless New Jersey patients with heart disease will have the opportunity to live a longer, healthier and more productive life. p The physician operates the controls of a robotic arm that is integrated with the mapping system to precisely guide the catheter during ablation for the treatment of atrial fibrillation. For more information, call (201) or visit The Heart and Vascular Institute at Englewood Hospital and Medical Center p The patient s heart rate is continuously monitored during exercise.

6 treatment of abnormal heart rhythms. Most recently, for example, we ve incorporated technology that significantly enhances our mapping systems, providing a high-resolution 3-D model on a graphic interface, Dr. Simons shares. He reports that Englewood Hospital has just invested in one of the newest mapping systems available to most accurately visualize real-time images of electrical activity within the heart. p Englewood Hospital recently invested in one of the newest mapping systems available to visualize real-time images of electrical activity within the heart Herbert Dardik, MD, Chief of Surgery and Vascular Surgery at Englewood Hospital, relates how this collaboration has resulted in substantially improved outcomes over traditional approaches to repair an aneurysm in the chest. Now instead of making a large incision in the chest, we can puncture an artery, remote from where the problem is and repair the problem with minimal impact on the patient, physiologically, he explains. Dr. Dardik looks forward to the establishment of a Hybrid Angiographic OR Suite, which will further advance the ongoing collaborative work of cardiac and vascular patient care. This state-ofthe-art facility joins highly advanced equipment, technology and computer systems with skilled surgeons, interventional cardiologists, radiologists, anesthesiologists and specialized nursing and technical staff to perform complex cases. For example, Dr. Dardik reports, in the new hybrid suite, minimally invasive percutaneous (through needle puncture of a peripheral artery) aortic valve replacement can be performed for certain appropriate patients, rather than a more invasive open procedure. This is another reflection of how cardiac surgery and vascular surgery will continue to NJP_May2011_Reprint.indd 1-3 work together more and more in the years to come, Dr. Dardik foresees. The continuous introduction of groundbreaking technology is also the driving force behind the renowned success of the Arrhythmia Center within the Heart and Vascular Institute at Englewood Hospital. Grant R. Simons, MD is Director of Cardiac Electrophysiology, which focuses on the detection, diagnosis and Robotically guided catheter ablation for the treatment of atrial fibrillation (AF) is another innovative procedure performed by the cardiac electrophysiology team at Englewood Hospital. Instead of the physician manually manipulating the catheter during the curative ablation, as was traditionally the case, a robotic arm, integrated by computer with the mapping system, precisely guides the catheter while the physician operates the controls from a workstation located a few feet away from the patient. This technology enables us to produce more durable lesions because we can achieve better contact and better stability, asserts Dr. Simons. medication to prevent blood clots and stroke. We are one of the few sites in the country and the only one in New Jersey that is now involved in a trial of a device called the Watchman, Dr. Simons shares. The device, which is delivered via catheter through a puncture in the groin, seals off a pouch in the left atrium to prevent clots from traveling to the brain and causing a stroke. The hope is that this technique will negate the need for blood thinners, which can cause dangerous bleeding and have therapeutic levels that are difficult to maintain, even with frequent blood testing. In the trial that has been published, the atrial fibrillation patients with this device who stopped their medication had fewer strokes than those patients who did not have the device and were on blood thinners, Dr. Simons reports. Therefore, if and when the device receives FDA approval, patients with AF will have a safer and more effective treatment option to prevent strokes. Our Arrhythmia Center is at the forefront of advances in the treatment of arrhythmia so that we can deliver the best therapies to our patients, he says. Englewood Hospital s cardiac team recognizes that all cardiac patients benefit from effective follow-up care. If someone already has heart disease, the best way to prevent a recurrence, in addition to Looking towards the future, Dr. Simons is excited about a clinical trial presently being conducted at Englewood Hospital to dramatically alter the treatment for patients with AF who must remain on anti-coagulant medications, is to help minimize the risk factors with exercise, says Englewood Hospital s Director of Cardiac Rehab, Samuel Suede, MD. The Cardiac Rehab Center at Englewood Hospital is equipped with treadmills, bicycles, elliptical machines, step machines and a rower. Also, the aerobic exercise is supplemented with resistance training. There is one registered nurse on site for every five patients and a staff of exercise specialists who assist patients with their work-out regime. Patients, who have recently had a significant event, such as heart attack, angioplasty or bypass surgery, are placed in a 12 week monitoring program. These individuals have their blood pressure and heart rate checked before they exercise. Diabetics will also have their glucose tested. While they exercise their heart rate is being continuously monitored in order to detect a possible arrhythmia that will then be reported to the patient s physician. If an emergent problem occurs, the patient already in the hospital - is sent for immediate treatment. In addition to physical activity, those in the monitoring program attend weekly lectures which have a dedicated topic of the week, such as Smoking Cessation, Stress Reduction, Cholesterol Reduction, How to Read a Food Label, etc. At the inception of the monitoring program patients are administered Endurance Testing, a Quality of Life Test and an Educational Quiz. After their 12 week program is completed, patients are asked to re-take those tests and the two sets of scores are compared. Patients see the benefit they derived in just 12 weeks and hopefully, this will be an incentive for them to continue, Dr. Suede relates. After 12 weeks in the monitoring program many individuals do opt to continue at the Cardiac Rehab Center at Englewood Hospital in its maintenance program, even though insurance no longer covers this service at that point. A nominal fee is charged and Dr. Suede reports that many patients have been coming to the center for years, a testimony to the valuable contribution that Englewood Hospital continues to make towards the goal of restoring and maintaining cardiac health within the community. As the data shows, the comprehensive cardiac program at Englewood Hospital s Heart and Vascular Institute has a long track record of accomplishing its goal of providing the highest quality care for patients with heart disease. With a consistent ranking amongst the top facilities in the nation for cardiac care and treatment and a determination to build on its record of excellence, Englewood Hospital and Medical Center continues its journey into another decade. Along the way, countless New Jersey patients with heart disease will have the opportunity to live a longer, healthier and more productive life. p The physician operates the controls of a robotic arm that is integrated with the mapping system to precisely guide the catheter during ablation for the treatment of atrial fibrillation. For more information, call (201) or visit The Heart and Vascular Institute at Englewood Hospital and Medical Center p The patient s heart rate is continuously monitored during exercise.