Inova Heart and Vascular Institute - 2021 Impact Report

INOVA HEART AND VASCULAR INSTITUTE 2021 IMPACT UPDATE

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RESEARCH Enhancing Patient Outcomes through a Culture of Research Inova Heart and Vascular Institute has made outstanding progress toward achieving top-tier cardiovascular institute status.

Strengthening our reputation as a highly capable and top-tier institute is critical to attracting additional research funding, recruiting nationally renowned talent, building a reputation as a major academic teaching institution and reinforcing our status as a destination for innovative complex cardiovascular procedures and treatment.

Increase in Studies Inova Heart and Vascular Institute's dedication to engaging in clinical research is demonstrated through the tremendous growth in the number of studies initiated by our investigators. We are also proud to serve as the top enroller in several major national and international clinical trials.

Our commitment to academic excellence is further evidenced by faculty participation in national and international medical conferences and publication in high-impact journals including the New England Journal of Medicine, the Journals of the American College of Cardiology, Circulation, the Journal of Vascular Surgery and the journal Chest.

We are pleased to share that the Circulation paper “Cell-Free DNA to Detect Heart Allograft Acute Rejection,” co-authored by Palak Shah, MD (left) was selected as winner of the 2021 James T. Willerson Award in Clinical Science.

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2021 Research Report Thanks in part to your support, we have produced a formal report highlighting our research involvement—our interests, our capabilities and our special expertise in serving diverse populations. Reports like this are important to raise awareness and provide assurance of our ability to consistently deliver an outstanding research product. This report will be mailed to recipients from the American College of Cardiology as well as industry contacts, research consortia, government agencies and philanthropic partners.

Destination for Research "Inova Heart and Vascular Institute was at the forefront of research to diagnose, treat and mitigate the impact of the COVID-19 pandemic."

"We engaged in clinical trials to test the feasibility and efficacy of new treatment options and are continuing to conduct widespread serological testing to help us understand the rate of asymptomatic exposure and the prevalence of the virus in the Washington, DC, region."

CHRISTOPHER M. O’CONNOR, MD, MACC, FESC, FHFSA, FHFA PRESIDENT, INOVA HEART AND VASCULAR INSTITUTE

Our clinical research structure has made Inova Heart and Vascular Institute the premier go-to site for clinical research in the DC region.

We continue to collaborate with academic medical centers, the U.S. Food and Drug Administration (FDA), AHA, NIH, and the pharmaceutical and device industry, including partnerships with Abbott, Medtronic and Amgen, among others.

Additionally, our Northern Virginia location provides access to a highly diverse urban, suburban and rural patient population. The 21county region of Northern Virginia, Southern Maryland, Washington, DC, and its suburbs served by Inova includes ethnic, racial, socioeconomic and age diversity, making data from our patients particularly useful and extrapolatable to the U.S. population at large.

This has been especially relevant for research pertaining to the COVID-19 pandemic.

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INNOVATIVE TREATMENTS Recognition for our Cardiogenic Shock Team

164 Estimated number of lives saved through the cardiogenic shock initiative

This year, the Cardiogenic Shock Team received an Iams Quality Leadership Award, named in honor of Inova founder Franklin Iams.

This award was given in recognition of their multidisciplinary team-based approach to treating cardiogenic shock which has become a model for centers nationally and internationally.

The 164 in the photo represents the estimated number of lives saved through this innovative process.

Our Shock Team provides timely decision-making and intervention critical to patient survival. A single phone call connects specialists from interventional cardiology, cardiovascular surgery, advanced heart failure, critical care and emergency medicine to quickly gather information and recommend the best treatment for these critically ill patients.

This team-based approach has dramatically improved patient survival. To consistently achieve these results for our patients, the team focuses on: Rapid diagnosis Immediate, collaborative decision-making Early hemodynamic assessment and expedited initiation of mechanical circulatory support such as ECMO, Impella heart pump, etc.

Minimizing vasopressor and inotrope use

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Refining our Approach to the Treatment of Cardiogenic Shock

>350 Patients treated for

Thanks in part to your support, we continued to refine

cardiogenic shock in 2021

this multidisciplinary collaboration of teams and hub and spoke strategies for treating cardiogenic shock.

Our Shock team's participation in research collaborations and virtual presentations in national and international meetings is a testament to their expertise

70%+ Survival rate for patients receiving treatment for cardiogenic shock

within our field. Throughout this time, the team provided state-of-the-art care for more than 350 patients from 34 referral centers and maintained an exemplary 70%+ survival rate.

Manuscripts based on their work on risk stratification, sex-based analyses and other treatment strategies have been submitted for publication in top tier journals.

34 Referral centers who sent patients to Inova Heart and Vascular Institute

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QUALITY CLINICAL CARE Electrophysiology Program Brett Atwater, MD was recently brought on board to lead Inova's efforts in Electrophysiology.

In just a few months he has led efforts to open an Ablation Center for Atrial Fibrillation (AFib) at Inova’s Lansdowne Campus in Leesburg, providing Loudoun County residents more convenient access to that procedure.

He has also implemented a pilot AFib Center at Inova Fairfax to meet the needs for co-management and coordination of care for patients with atrial fibrillation.

This new integrated clinic includes collaboration with heart failure, sleep medicine, nutritionists, behavioral health specialists as well as non-invasive cardiologists, interventional electrophysiologists, and anticoagulation and antiarrhythmic specialists.

The goal is to provide the highest quality care, minimize the time from diagnosis to treatment and provide longitudinal follow up with a focus on prevention. Data on outcomes will be collected in addition to surveys of patient satisfaction, roundtable discussions with patients and other forms of evaluation.

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Health Equity: Addressing Disparities in Care Research initiatives to address inequities in care are underway, under the direction of Wayne Batchelor, MD and spearheaded by Nasrien E. Ibrahim, MD, who is newly on board from having served as an Assistant Professor at Harvard Medical School and Assistant in Medicine at Massachusetts

Wayne Batchelor, MD, Director of Interventional Cardiology and Interventional Cardiology Research

General Hospital. Dr. Ibrahim is an acknowledged expert in this area.

A committee on Diversity, Equity and Inclusion was formed and launched several important and timely initiatives under the direction of Cleveland Francis, MD, including a multicultural and multilingual initiative to

Nasrien E. Ibrahim, MD, Advanced Heart Failure and Transplant Cardiology, Cardiovascular Disease, Internal Medicine

fight vaccine hesitancy through 30+ short videos by Inova Heart and Vascular Institute faculty produced in 12 languages and an EMR/Epic screening tool for use with outpatients and inpatients. The tool guides care providers to determine COVID-19 vaccination status, probe reasons for

Cleveland Francis, MD, Inova Heart and Vascular Institute Diversity, Equity and Inclusion Advisor

hesitancy and offer prompts to address the patient's hesitancy and provide information.

Advancing New Therapeutics: Novel Biomarker Diagnostics Your support also helped us expand clinical chemistry capabilities to address the complex requirements associated with studies related to novel biomarkers. These analyses are critical for diagnosis, prognostication and development of precision medicine.

These ancillary studies with novel biomarkers, proteomics and genomics help us to better understand the underlying mechanisms of heart failure and atherosclerotic disease and the role of comorbidities. This type of research helps to guide both pharma and device therapy, as well as develop effective prevention strategies.

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PATIENT IMPACT Lives Saved by Extracorporeal Membrane Oxygenation (ECMO) Extracorporeal membrane oxygenation (ECMO) is a life support machine that is used during lifethreatening, reversible conditions that stop the heart or lungs from working properly, including cardiogenic shock. This machine temporarily takes over the function of the heart and lungs by pumping blood from the patient’s body to an artificial lung that adds oxygen and removes carbon dioxide. The ECMO machine then sends the blood back to the patient via a pump with the same force as the heart.

This therapy is offered to patients with cardiorespiratory failure and has also been an innovative and invaluable tool in treating COVID-19 patients.

Inova was one of the first large health systems in country to improve the outcomes of COVID-19 patients through use of ECMO, and was recognized by the Extracorporeal Life Support Organization

"“We have assembled an excellent clinical team...to provide care to our patients with outcomes that represent some of the best results in the United States. This was recently demonstrated by the exemplary results in supporting COVID-19 patients with end-stage respiratory failure."

ALAN M. SPEIR, MD MEDICAL DIRECTOR, CARDIAC SURGERY, INOVA HEALTH SYSTEM SENIOR ASSOCIATE DIRECTOR, INOVA HEART AND VASCULAR INSTITUTE

(ELSO) for this work.

The program has grown from fewer than 20 cases per year in 2015 to nearly 150 cases in 2021, providing services to both pediatric and adult patients. Below, we share about three of the many patients whose lives were saved by this procedure.

Megan, 15 years old, sudden cardiac death (SCD) at school, four hours of CPR --> ECMO --> discharged home

Hope, 56 years old, transferred here in cardiogenic shock --> ECMO --> heart transplant --> discharged home

Jaqawan, 26 years old, transferred here in cardiogenic shock--> ECMO --> multiple ventricular assist devices implanted --> discharged home

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LOOKING AHEAD In 2022 we plan to continue many of our 2021 initiatives with particular emphasis on: Developing and building out data-driven systems to support clinical decision making; Development of young researchers; Special efforts to identify and eliminate disparities in care; Research fellowship in Heart Failure; and Research fellowship in Interventional Cardiology.

We look forward to sharing ongoing projects and new initiatives in the time ahead. We remain deeply grateful for your generous support to provide exemplary care to our community.

THANK YOU FOR ALL YOU DO FOR INOVA HEART AND VASCULAR INSTITUTE.