2014 Lehigh Valley Health Network Heart and Vascular Center Statistical Report

H E A R T

A N D

VA S C U L A R

C E N T E R

STATISTICAL REPORT AND PHYSICIAN REFERRAL GUIDE

INSIDE THIS REPORT

4

ADVANCED HEART FAILURE

10 CARDIOTHORACIC SURGERY

6

ARRHYTHMIA CARE

12 VASCULAR SURGERY

8

HEART ATTACK CARE

13 MULTIDISCIPLINARY PROGRAMS

9

INTERVENTIONAL CARDIOLOGY

14 RESEARCH AND EDUCATION

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DEAR COLLEAGUE,

We are pleased to share this report on cardiac and vascular patient care and statistics of the Heart and Vascular Center of Lehigh Valley Health Network (LVHN).

We are proud to inform you that our cardiology and heart surgery program at Lehigh Valley Hospital (LVH) is the only program in the region ranked in the top 50 hospitals in the nation and is one of the top four programs in Pennsylvania in the 2013 U.S. News & World Report’s Best Hospitals list.1 This is the sixth time in the last 10 years our program has received a national ranking from U.S. News & World Report.

LVH is among the top three highest-volume hospitals for cardiothoracic surgery programs according to the Pennsylvania Health Care Cost Containment Council (PHC4) Cardiac Surgery in Pennsylvania report (July 2011 to December 2012).

Since its inception, the PHC4 report has consistently shown higher-volume surgeons and hospitals typically have better outcomes.

We continue to strengthen our division of vascular and endovascular surgery.

Our depth and scope of practice has increased with the addition of two new surgeons and an increased focus on minimally invasive and hybrid surgical procedures. We offer all aspects of minimally invasive treatment of occlusive disease.

As LVHN expands, we are caring for more people throughout the region. A recent merger between LVHN and the Greater Hazleton Health Alliance is giving Hazleton area residents access to specialized heart and vascular services. LVHN also entered into an alliance with six other health systems to form AllSpire Health Partners. The new consortium is carrying out joint activities in the areas of patient care services, research and education to enhance the value of health care communities receive.

LVH and LVH–Muhlenberg are recognized Blue Distinction® Centers+ for Cardiac Care by Blue Cross and Blue Shield. The distinction is given to hospitals that achieve better quality and improved outcomes for patients, with lower rates of complications following certain cardiac procedures and lower rates of health care-associated infections compared with their peers. Blue Distinction Centers+ also are 20 percent more cost-efficient than non-designated hospitals for those same cardiac procedures.

The American Nurses Credentialing Center has designated us a MagnetTM hospital – the highest recognition of nursing excellence in the nation. We are among only 7 percent of hospitals in the nation with this honor and are the only Magnet hospital in the Lehigh Valley region. In 2013, LVHN was awarded the Magnet Prize® for the involvement of our nurses in establishing innovative telehealth services.

We encourage you to read about these and other accomplishments in this report.

Our Heart and Vascular Center serves physicians and patients throughout eastern Pennsylvania and western New Jersey at our sites in Allentown and Bethlehem, Pa. We welcome the opportunity to discuss our program with you in more detail and to work with you to ensure the best care for your patients. Accompanying this report is a referral guide listing all physicians in our cardiology, cardiothoracic surgery and vascular surgery departments. Please call any of the physicians listed to make a referral, or phone the Heart and Vascular Center at 610-402-7150 to speak with one of us about our center’s services.

2 LEHIGH VALLEY HEALTH NETWORK

1. 2013 US News and World Report Best Hospitals

Ronald Freudenberger, MD Walter and A. Hazel May Chair for Excellence in Cardiology Medical director, Heart and Vascular Center Chief, division of cardiology

Raymond Singer, MD, MMM Associate medical director, Heart and Vascular Center Chief, division of cardiothoracic surgery

David Winand, MD Chief, division of vascular and endovascular surgery

L E H I G H V A L L E Y H E A LT H N E T W O R K H E A R T A N D V A S C U L A R C E N T E R

OUR PATIENT VOLUMES ARE AMONG THE HIGHEST IN PENNSYLVANIA Lehigh Valley Health Network treats more heart patients than any other hospital in our area at our two Heart and Vascular Center sites in Allentown and Bethlehem, Pa.1

Our cardiothoracic surgeons perform more than

Our interventional cardiologists

Our arrhythmia specialists performed more than

950 20,000 1,200 700 performed more than

heart surgeries and more than

diagnostic and therapeutic procedures in fiscal years 2012 and 2013 (chart, page 9).

procedures annually in fiscal years 2012 and 2013 (chart, page 7).

thoracic surgeries each fiscal year.

Our vascular surgery program offers innovative procedures like endovascular aneurysm repair and carotid bypass and valve surgery.

Source of date cited unless source is internal. Note: Lehigh Valley Health Network’s fiscal year runs July of the previous year through June of the named year.

1 Cardiology Inpatient Discharge Volume from Pennsylvania Hospital by Network/Hospital, FY 12, FY 13 (PHC4, HCAB)

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m

m 15

m

3m

ADVANCED HEART FAILURE PROGRAM Lehigh Valley Health Network’s heart failure program has the region’s only board-certified advanced heart failure practitioners. The

multidisciplinary team treating patients with heart failure provides access to the most recent and promising treatment options available.

These include:  Proven state-of-the-art medications  Behavior self-management and monitoring  Clinical trials providing early access to

new technology  Mechanical heart assist devices  Surgical interventions, including

resynchronization therapy that may allow patients to avoid heart transplantation  Evaluation for heart transplantation

Our Advanced Heart Failure program was involved in developing the CardioMems sensor for use in heart failure patients. This miniature wireless

sensor is implanted using minimally invasive techniques and transmits real-time data to an external electronics module, which then communicates information to the patient’s physician via the Internet. Pending FDA approval, this technology will be available only in specialized centers that were involved in the device’s development.

For referrals to our Heart Failure program, please contact Alma Ohl, CRNP, at 610-402-3110.

CARE FOR TREATMENT-RESISTANT

Lehigh Valley Heart Network (LVHN) data is reported according to guidelines and definitions established by the Society of Thoracic Surgeons (STS) National Database. Participation in the STS registry allows for the monitoring of patient outcomes of those undergoing procedures at LVHN and for the fair comparison of those outcomes to the overall experience reported in the registry.

DIGITAL IMAGING We offer every modality of advanced cardiac imaging including 2-D echo, 3-D echo, TEE, 3-D TEE, nuclear imaging, cardiac MRI and cardiac CT in order to gain a clear picture of the patient’s health.

Our board-certified cardiologists all receive training in cardiac imaging during their fellowship. As a digital hospital, we work with consulting referring physicians to provide timely and easy access to data, images and reports.

4 LEHIGH VALLEY HEALTH NETWORK

1. Lehigh Valley Health Network interventional cardiology

HYPERTENSION

For patients with treatment-resistant hypertension, the pending FDA approval of renal denervation means providers at LVHN will be able to offer a minimally invasive endovascular procedure to control blood pressure. By applying radiofrequency pulses to the renal arteries, a series of two-minute ablations are delivered along the renal artery to disrupt the nerves.

LVHN offers three-dimensional transesophageal echocardiography, an innovative test that provides 3-D moving images of the heart in real time. This test is particularly useful for the diagnosis and treatment of valve problems.

Our cardiac MRI produces superior images of the heart, enabling us to more accurately assess heart structure and function. Our cardiac MRI program is accredited by the American College of Radiology.

We performed more than 350 cardiac MRIs in fiscal year 2013 and are participating in national trials and registries in a variety of cardiac MRI-related areas.1

MECHANICAL ASSIST DEVICES Lehigh Valley Hospital is certified

by The Joint Commission to provide left ventricular assist device (LVAD) as a destination therapy for advanced heart failure.

LVAD is part of our Mechanical Heart Assist Device program and has been shown to restore hemodynamics, functional support and quality of life in patients. Postoperative care involves a lifetime commitment to care for patients implanted with an LVAD. We are the only program in the region to offer this treatment.

For adult patients in cardiogenic shock, extracorporeal membrane oxygenation (ECMO) is provided as a lifesaving intervention. ECMO provides temporary respiratory and/ or cardiac support for patients who have an underlying and potentially reversible heart condition. Patients typically remain on ECMO for less than a week. During this time, ECMO allows the patient’s lungs and heart to rest, and gives physicians an opportunity to evaluate treatment options, which may include ventricular assist device implantation or heart transplantation.

Photos reprinted with the permission of Thoratec Corporation

If you have questions or wish to make a referral, please contact LVAD coordinator Barbara Ebert, CRNP, at 610-402-4VAD.

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INNOVATIONS IN ARRHYTHMIA CARE Despite medical treatment and traditional ablation techniques, atrial fibrillation (AF) persists in about half of patients with refractory or long-standing AF. We are one of the first hospitals

in the nation to use nContact, a new multidisciplinary epicardial-endocardial ablation approach for treating AF. By combining the techniques of electrophysiologists and cardiovascular surgeons, we offer a minimally invasive treatment solution for patients with difficult-to-treat AF. To meet the challenge of diagnosing complex arrhythmias, we are one of the first hospitals in the nation to provide focal impulse and rotor modulation (FIRM) 3-D mapping technology. This tool identifies the patient-specific electrophysiologic source that sustains serious heart rhythm disorders. This breakthrough will enable us to meaningfully help patients with long-term, difficult-to-treat AF. For AF patients unable to be treated with anticoagulant medication, we soon will provide an alternative treatment that has been shown to reduce stroke risk in patients with nonvalvular AF. The WATCHMAN™ device, which is pending FDA approval, is a percutaneously inserted, permanent implant designed to keep harmful blood clots from entering the bloodstream and potentially causing a stroke.

6 LEHIGH VALLEY HEALTH NETWORK

A subcutaneous ICD contains a lead that runs up the sternum, not in the heart itself.

SUBCUTANEOUS ICD FOR HEART RHYTHM PATIENTS

The recent FDA approval of the subcutaneous ICD (S-ICD) will permit a lower risk and less invasive implantation option for some of our heart rhythm patients. As opposed to traditional transvenous ICDs, S-ICDs use a single insulated wire that is tunneled under the skin from the ICD generator, which is implanted by making a few small incisions under the arm. For patients who have trouble with access for leads through their veins, this new implantable defibrillator will shock the heart back into a healthy rhythm without having the lead actually enter the heart.

The cannula creates lesions along the posterior surface of the heart.

ARRHYTHMIA CARE

Electrophysiology Procedures

Our heart rhythm specialists care for all types of arrhythmias and offer a full spectrum of ablation procedures for supraventricular tachycardias, atrial fibrillation and ventricular tachycardias.

In 2013, our electrophysiologists began partnering with cardiothoracic surgeons to perform a hybrid ablation procedure known as the Convergent Procedure. An endocardial ablation procedure is performed in conjunction with epicardial ablation of the left atrium for the treatment of atrial fibrillation. While the technique has been conducted nearly 3,000 times worldwide, Lehigh Valley Hospital is the first hospital in the region to offer this new dual therapeutic approach.

Our experienced board-certified electrophysiologists collaborate with other cardiologists, surgeons, and imaging and nursing specialists and use state-of-the-art computer technology to ensure the highest likelihood of control or elimination of abnormal heart rhythms.

DIAGNOSTIC

 Complex EP studies  ICD checks and follow-up  Tilt-table studies THERAPEUTIC

 Pacemaker insertions and generator changes  Pacemaker lead extractions  Pacemaker upgrades, single to dual  ICD insertions  ICD generator changes  Pacemaker upgrade to ICD and/or biventricular ICD

Electrophysiology Procedures B IV PA C ER/ IC D

IC D S

A B LATION S

PA C EMA K E R S

FY 12

FY 12

FY 12

FY 12

277 263 459 590

 Pacer/ICD lead extraction

F Y13

F Y13

F Y13

F Y13

296 294 413 556

 Biventricular pacemaker insertion  AV node ablation  SVT ablation  VT ablation  Epicardial VT ablation  Atrial tachycardia ablation  Atrial flutter ablation  Wolf-Parkinson-White pathway ablation  Radiofrequency atrial fibrillation ablation  Balloon cryoablation of atrial fibrillation  Event recorder implants

Source for all procedures: Lehigh Valley Health Network Interventional Cardiology

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HEART ATTACK STEMI Volumes

MI ALERT

Lehigh Valley Health Network’s four hospital sites (Lehigh Valley Hospital–Cedar Crest, Lehigh Valley Hospital–Muhlenberg, Lehigh Valley Hospital–17th Street and Lehigh Valley Hospital–Hazleton) are accredited by the Society of Cardiovascular Patient Care as Chest Pain Centers; Lehigh Valley Hospital– Cedar Crest and Lehigh Valley Hospital– Muhlenberg are Percutaneous Coronary Intervention (PCI) centers.

Our MI Alert program, MI Alert for Heart Attacks, began in 1997. For fiscal year 2013, LVHN treated 401 STEMIs. The teamwork of our physicians and staff, our MedEvac helicopters and area first responders has resulted in local median door-to-balloon times in the one-hour range, well below the 90-minute reference standard.

90

F Y13

LVH–MUHLENBERG

401 TOTAL VOLUME

311

LVH–CEDAR CREST

THERAPEUTIC HYPOTHERMIA

Since 2005, we have used therapeutic hypothermia on cardiac arrest patients with return of spontaneous circulation (ROSC) but without return of consciousness in order to improve neurological outcomes.

This program relies on collaboration among specialists in cardiac care, neurology and critical care, as well as emergency responders and referring hospitals. As part of the International Cardiac Arrest Registry, we collaborate with major U.S. and international heart centers to produce data that will guide treatment.

Lehigh Valley Hospital consistently ranks in the top

10%

Local Median Door-to-Balloon Times F Y13

52

LVH–CEDAR CREST

LVH–MUHLENBERG

MINUTES

MINUTES

in the U.S. for heart attack survival.

Source: medicare.gov/hospital Source: LVHN MI Alert Database

8 LEHIGH VALLEY HEALTH NETWORK

52

INTERVENTIONAL CARDIOLOGY CARE FOR ADVANCED HEART FAILURE

Lehigh Valley Health Network operates seven cardiac catheterization laboratories at our two Heart and Vascular Center sites in Allentown and Bethlehem, Pa. Since Lehigh Valley Hospital became the first hospital in the region to offer transcatheter aortic valve replacement (TAVR) in 2012, interventional cardiologists and their cardiothoracic surgeon colleagues have collaborated on this procedure. TAVR replaces severely diseased aortic valves in patients who are not eligible for traditional open-heart valve replacement surgery or are deemed too high risk for conventional valve surgery.

Catheterization Procedures DIAGNOSTIC AND THERAPEUTIC

F Y12

F Y13

8,578 8,354

Peripheral Procedures DIAGNOSTIC AND THERAPEUTIC

F Y12

F Y13

1,639 1,483

Interventional Cardiology Procedures DIAGNOSTIC

 Left heart catheterization  Right heart catheterization  Transeptal left heart catheterization  Combined left and right heart catheterization with transeptal approach  Cardiac biopsy  Intracardiac echo  Fractional flow reserve  Intravascular ultrasound THERAPEUTIC

 Transradial approach to catheterization and stenting  Percutaneous transluminal coronary angioplasty  Coronary stenting  Drug-eluting coronary stenting  Intra-aortic balloon pump insertion  Valvuloplasty – aortic and mitral  Pericardiocentesis  Coronary rotational atherectomy  PFO closure  ASD closure  VSD closure  Coronary thrombectomy  Laser atherectomy  Mechanical circulatory support  Transcatheter aortic valve replacement  Cardioversion

Peripheral Procedures DIAGNOSTIC

 Peripheral angiography – cerebral, carotid, thoracic, aortic, renal, iliac, femoral, lower extremities THERAPEUTIC

 Peripheral angioplasty and stenting  Vena cava filter placement  Carotid stenting  Laser atherectomy  Chronic total occlusion

Source for all charts: Lehigh Valley Health Network Interventional Cardiology

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PIONEERS

CARDIOTHORACIC SURGERY

IN TRANSCATHETER AORTIC VALVE

REPLACEMENT (TAVR), A MINIMALLY INVASIVE AORTIC VALVE REPLACEMENT PROCEDURE

1

st

hospital in the Lehigh Valley to provide TAVR

More than

100

procedures completed since the program’s inception in May 2012

85 years of experience and have performed an estimated 19,000 cardiothoracic surgery procedures.

The Pennsylvania Health Care Cost Containment Council (PHC4) ranks Lehigh Valley Hospital–Cedar Crest among the top three busiest programs in the state for coronary artery bypass and valve surgery. Since 2002, the hospital has experienced an approximately 1 percent or lower mortality for CABG surgery. The most recent state average is 1.5 percent.1 HEART VALVE SURGERY

Less than two years since the program’s inception, the transcatheter aortic valve replacement (TAVR) team at Lehigh Valley Hospital has completed more than 100 TAVR procedures. With patients ranging in age from 56 to 99, the team remains at the forefront of TAVR research and treatment. By offering transfemoral and transapical approaches to valve deployment, patients with smaller vessels or peripheral artery disease are considered for catheter-based replacement. With FDA approval of the Medtronic CoreValve, which offers a lower profile delivery device and a greater range of annulus sizes, we will be able to improve the availability of the transfemoral approach and offer greater flexibility in patient selection.

4

cardiothoracic surgeons

certified to perform TAVR for the treatment of aortic stenosis using the transfemoral and transapical approach

If you have questions or wish to make a referral, please contact TAVR coordinator Rhonda Moore, CRNP, at 610-402-TAVR.

10 LEHIGH VALLEY HEALTH NETWORK

MILESTONES

4

interventional cardiologists

Lehigh Valley Health Network’s cardiothoracic surgery program has one of the highest patient volumes in Pennsylvania, with more than 1,650 surgeries each year. Our surgeons have a collective

MARCH

2012 MAY

2012 SEPTEMBER

2012

Lehigh Valley Hospital opens the region’s first hybrid operating room Region’s first Edwards Sapien TAVR procedure using transfemoral approach Approval of TAVR program by The Joint Commission

J A N U A RY

First TAVR procedure using transapical approach

J A N U A RY

FDA approves Medtronic CoreValve

2013 2014

F E B R U A RY

2014 MARCH

2014

Edwards Sapien Valve

100th patient receives TAVR at Lehigh Valley Hospital Lehigh Valley Hospital performs region’s first CoreValve implant

Medtronic CoreValve

A team of cardiothoracic surgeons, cardiologists and a dedicated nurse practitioner is available to evaluate patients with complex heart valve disease. We provide expedited appointments for elective patients or an automatic transfer of in-hospital patients without delay. In addition to offering a team approach that includes all aspects of heart valve disease therapies, including minimally invasive surgery, we provide referring physicians with frequent updates, and patients return to the referring physician for their follow-up and continuing care.

Lehigh Valley Hospital–Cedar Crest ranks third in the state for total volumes of CABG and valve surgeries2 and is the only hospital in the region ranked in the top 50 hospitals in the country by U.S. News and World Report.

Lehigh Valley Hospital–Cedar Crest is the only hospital in the region ranked in the

TOP 50 HOSPITALS in the country by U.S. News and World Report.

COMPLEX MITRAL VALVE REPAIR

Mitral valve repair affords patients freedom from anticoagulation and less risk for endocarditis as well as overall preserved ventricular function. Our surgeons have undergone mitral valve repair education with international leaders. Our mortality rate for isolated mitral valve repair is 0 percent, putting us among the country’s leading organizations.

THORACIC SURGERY

Our thoracic surgery program continues to grow in volume, scope and reputation. In fiscal year 2013, we completed more than 700 thoracic surgeries. We offer many minimally invasive approaches for the treatment of diseases of the lung, esophagus and chest including robotic and video-assisted approaches. We are a recognized program for single-port sympathectomy for hyperhidrosis and decompression surgery for thoracic outlet syndrome.

For lung and esophageal cancer patients, we provide a multidisciplinary, collaborative team approach that includes dedicated thoracic oncologic surgeons as well as medical and radiation oncologists.

THORACIC AORTA DISEASE

Cardiothoracic surgeons at Lehigh Valley Health Network have been treating aneurysms and dissections of the thoracic aorta for 20 years. These conditions include aortic dissections, thoracic aortic aneurysms, aortic ulcers, intramural hematomas and traumatic aortic transections (ruptures). We treat these conditions with both open and less-invasive techniques, such as TEVAR (thoracic endovascular aortic repairs).

CABG and Valve Surgery VOLUME

LVH–CC

LVH–M

TOTAL

CABG WITHOUT VALVE

424

86

510

VALVE WITHOUT CABG

290

31

321

CABG WITH VALVE

126

27

153

TOTAL SURGERIES

840

144

984

Source: PHC4 Cardiac Surgery in Pennsylvania July 1, 2011-Dec. 31, 2012

CABG and Valve Surgery In-Hospital Mortality M O RTA L IT Y

LVH–CC

LVH–M

PA

CABG WITHOUT VALVE

0.9

1.2

2.3

VALVE WITHOUT CABG

1

3.2

4.9

CABG WITH VALVE

2.4

NR

3.2

TOTAL VALVE

1.4

1.7

1.5

Source: PHC4 Cardiac Surgery in Pennsylvania July 1, 2011-Dec. 31, 2012 Note: These key findings are based only on data for calendar year 2012 per PHC4 report.

NR: Not reported-The minimum reporting number is 30 cases for in-hospital mortality

1. PHC4 Cardiac Surgery in Pennsylvania 2011-2013 2. PHC4 Cardiac Surgery in Pennsylvania 2011-2013

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VASCULAR SURGERY Lehigh Valley Health Network (LVHN) provides state-of-the-art diagnosis and treatment for the complete spectrum of arterial and venous conditions. Care starts with proper evaluation and diagnosis. Our providers use ICAVL-certified

vascular labs to assist in the diagnosis and followup care associated with vascular disease. We specialize in the treatment of carotid disease, peripheral aneurysmal and occlusive disease, venous disease and aortic pathology.

The addition of our hybrid operating room has allowed us to increase our focus on minimally invasive and hybrid surgical procedures to treat vascular disease, including endovascular aneurysm repair (EVAR). We also combine open arterial reconstruction with endovascular techniques in a single procedure.

Complex aortic reconstruction is available for patients who are not candidates for EVAR. We perform endovascular procedures for the treatment of thoracic and abdominal aneurysmal disease, traumatic transections and dissections.

Collaboration with our cardiothoracic surgeons is important in the optimal treatment of these complex aortic pathologies. LVHN will continue to expand its endovascular capability by adding new techniques, including fenestrated stent grafts.

This will allow broader treatment indications for endovascular aneurysm repair. Currently, the division performs more than 150 cases a year for aortic disease.

Peripheral arterial occlusive disease has many manifestations. Our division has expert providers who can determine the best treatment options. Based on the extent of disease and indications, open bypass may be recommended. Whenever possible and appropriate, an endovascular solution is utilized. We offer all aspects of minimally invasive treatment of occlusive disease.

These techniques include treatment of chronic total occlusions, atherectomy, angioplasty and stenting. The division performed more than 90 peripheral bypasses last fiscal year. This resulted in a greater than 95 percent immediate limb salvage rate and was durable at 90 percent within the fiscal year.

Cervical cerebral vascular disease is a leading cause of stroke. The division of vascular and endovascular surgery performs more than 120 carotid endarterectomies a year for the treatment of carotid artery disease.1 Our combined stroke and death rate over the last year is 0 percent. We perform carotid stenting as well as endarterectomy in the appropriate patient population.

The division also provides services in the treatment of venous disease and dialysis access.

Endoluminal venous ablation and sclerotherapy are two primary minimally invasive treatment options for varicose veins and venous insufficiency.

LVHN will continue to deliver quality vascular care to its patients. Our providers are responsive, knowledgeable and committed to deliver state-ofthe-art care in all aspects of vascular disease.

1. NSQIP July 1 to June 30, 2013

MORE THAN

MORE THAN

MORE THAN

carotid endarterectomies annually

aortic disease cases annually

peripheral bypasses last fiscal year

120 150 90

ď‚ STENT GRAFT REPAIR OF A THORACIC AORTIC ANEURYSM (TAA) Illustrations courtesy of Medtronic

12 LEHIGH VALLEY HEALTH NETWORK

ď‚ STENT GRAFT REPAIR OF AN ABDOMINAL AORTIC ANEURYSM (AAA)

MULTIDISCIPLINARY SPECIALIZED PROGRAMS CARDIOLOGY FELLOWSHIP PROGRAM

MECHANICAL HEART ASSIST DEVICE

The Lehigh Valley Health Network (LVHN) cardiology fellowship program addresses our region’s demand for heart and vascular specialists due to the aging population and increase in patients requiring advanced clinical therapies. Our program has quickly developed a reputation as a premier training destination for future cardiologists.  One of just 14 cardiology fellowships offered in Pennsylvania  Three-year fellowship with 15 fellows  Accredited by the Accreditation Council of Graduate Medical Education

PROGRAM

SPORTS CARDIOLOGY AND HYPERTROPHIC CARDIOMYOPATHY

Cardiologists in LVHN’s sports cardiology program work with local colleges and high schools to evaluate athletes in a variety of sports. We care for and educate patients with hypertrophic cardiomyopathy (HCM), the leading cause of sudden cardiac death in young people who often experience no symptoms. Last year, we evaluated more than 200 patients and performed nearly 50 surgical myectomies to remove portions of patients’ septums that were restricting blood flow.

Because HCM is transmitted genetically, people with a family history of HCM or sudden cardiac death should be tested.

To support patients with end-stage heart failure who do not qualify for a heart transplant, the mechanical assist device program at LVHN has received Joint Commission certification to provide ventricular assist device (LVAD) as a destination therapy. Our team includes cardiologists, cardiac surgeons, a cardiac surgical intensive care unit and an LVAD coordinator to provide support in the preoperative evaluation phase, during surgery, through recovery and after discharge through the adjustment to a new life with LVAD. Extra corporeal membrane oxygenation (ECMO) is another state-of-the-art treatment used for heart failure patients.

KEEPING WOMEN HEART HEALTHY

Because women have special cardiovascular risks and needs, LVHN created a program just for them.

Led by a team of cardiologists, this program provides patient care, community outreach and educational activities to identify and treat patients who have heart disease or are at risk for developing it. Collaboration with colleagues in ob/gyn, maternal fetal medicine, bariatrics and diet/nutrition give women access to critical resources with the goal of keeping them as healthy as possible at every stage of life.

PACER/ICD LEAD REMOVAL

LVHN’s cardiac lead removal program has grown, as has the use of implantable cardiac resynchronization therapy defibrillators, cardioverter defibrillators and pacemakers. Our cardiac surgeons and electrophysiologists use lasers to safely and effectively dissolve binding fibrous tissue around leads. We also have a complement of lead extraction products for calcific tissue and femoral approaches.

As in any procedure, individual patient factors are evaluated to determine viability to proceed with a lead removal procedure.

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RESEARCH

For more information, visit LVHN.org/research or contact our Network Office of Research and Innovation at 610-402-9543.

AAHRPP ACCREDITATION

Miracle EF – This prospective randomized, controlled,

Lehigh Valley Health Network (LVHN) is accredited by the Association for the Accreditation of Human Research Protection Programs (AAHRPP), which ensures all network research participants receive the highest level of protection, above and beyond the requirements of the federal regulations.

double-blinded, global multicenter study is examining cardiac resynchronization therapy (CRT) in symptomatic heart failure patients with less severe ventricular systolic dysfunction (LVEF range 36-50 percent).

The study will evaluate Medtronic market-released CRT pacemaker devices in this patient population.

CARDIOVASCULAR RESEARCH

Odyssey Outcomes (A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study to Evaluate the Effect of Alirocumab on the Occurrence of Cardiovascular Events in Patients Who Have Recently Experienced an Acute Coronary Syndrome) – The

Cardiovascular research facilitates the development of new therapies that potentially offer patients new treatment options and better outcomes. We participate in national and international research studies of medications and devices to treat heart failure, arrhythmias, ischemic heart disease, acute myocardial infarction, carotid artery disease and abdominal aortic aneurysms, including: Defeat-HF (Determining the Feasibility of Spinal Cord Neuromodulation for the Treatment of Chronic Heart Failure) – LVHN was the second-highest recruiter in

the nation of participants for this study. Data from the study will provide insight on whether spinal cord neuromodulation is a viable modality for mitigating the abnormal neuro-hormonal activation that contributes to worsening heart failure and whether it can be a viable treatment option for patients for whom a CRT device is not presently indicated (either by QRS</=0.12 or EF>35 percent), but are still symptomatic.

Pitch Heart Failure Study (Phosphodiesterase Type 5 Inhibition With Tadalafil Changes Outcomes in Heart Failure Protocol) – This multicenter, prospective, ran-

domized, double-blind trial is enrolling heart failure patients with LVEF <40 percent and secondary pulmonary hypertension to determine if tadalafil therapy will improve clinical outcomes and quality of life.

TOTAL Pilot Trial (A Randomized Trial of Routine Aspiration Thrombectomy With PCI versus PCI Alone in Patients With STEMI Undergoing PCI) – LVHN

is one of eight U.S. institutions participating in this international randomized, controlled, parallel group trial recruiting patients who present with STEMI criteria in order to compare outcomes of cardiovascular death, recurrent MI, cardiogenic shock, and new or worsening NYHA heart failure in patients undergoing PCI alone or PCI with thrombectomy procedure.

14 LEHIGH VALLEY HEALTH NETWORK

purpose of this international study is to compare the effect of the investigational medication alirocumab (a PCSK9 inhibitor) versus placebo in patients who have had an ACS event within the last year and are treated with intensive statin therapy or other maximally tolerated doses of lipid-lowering therapies.

(SAFE-PCI for Women) Trial – LVHN was a top-five

enrolling site for this national study comparing femoral and radial approaches in women undergoing PCI. As presented at TCT 2013, the study showed an initial strategy of radial access is reasonable and may be preferred by some operators for women undergoing cardiac catheterization or PCI, with the recognition that a proportion of patients will require conversion to femoral access. Proportional bleeding reduction with radial approach was similar to that seen in prior studies.

PUBLICATIONS

Many LVHN cardiologists are actively involved in clinical research and publications. Recent publications include:  A report on Competence in Coronary Interventional Procedures, which makes recommendations on qualifications for interventional cardiologists performing coronary procedures and for the cardiac catheterization facilities and hospitals doing these procedures  A white paper on Percutaneous Hemodynamic Support in the Cardiac Catheterization Suite  A paper on Cardiac Auscultation and Sports Screening For links to these and other publications, visit scholarlyworks.lvhn.org/cardiology_division.

THE HEART AND VASCULAR CENTER AT LEHIGH VALLEY HEALTH NETWORK

One-call direct admit: 610-402-4508 Physician-to-physician consultation and referral 1-800-LVH-2040 On-call admissions or scheduling diagnostic testing 610-402-TEST Lehigh Valley Hospital–Cedar Crest cardiac cath lab 610-402-8828

Lehigh Valley Hospital–Cedar Crest, Allentown, Pa.  Region’s leader in cardiovascular care for more than 35 years  Five cardiac catheterization labs and two electrophysiology labs with digital imaging systems  Region’s first hybrid OR

Lehigh Valley Hospital–Muhlenberg, Bethlehem, Pa.  Two cardiac catheterization labs and one electrophysiology lab with digital imaging systems  Spacious ICU and cardiovascular care units with all private patient rooms  “Universal bed” concept keeps patients in one unit throughout the stay

One-call patient transfer (available 24/7): 610-402-6100 or 1-800-280-5524  Critical care nurses gather patient information and the physician’s transfer process  Can dispatch MedEvac helicopter or assist with ground transportation  Any acute critical transfer is accepted without precertification  Physicians can choose the physician or group to whom the patient will be referred  Physician-to-physician communication is coordinated prior to the patient’s transfer

Lehigh Valley Hospital–Cedar Crest EP lab 610-402-5339 Lehigh Valley Hospital–Muhlenberg cardiac cath/EP lab 484-884-7020 Lehigh Valley Hospital–Cedar Crest and Muhlenberg Heart Station (exercise stress test, nuclear stress test, outpatient EKG, holter monitor, 2-D echo, 3-D echo, stress echo, TEE) 610-402-TEST Lehigh Valley Hospital–Cedar Crest and Muhlenberg Cardiac Diagnostic Center (exercise stress test, nuclear stress test, holter monitor, 2-D echo, 3-D echo, stress echo, vascular) 610-402-TEST Lehigh Valley Hospital–Cedar Crest cardiac rehabilitation 610-402-5915 Lehigh Valley Hospital–Muhlenberg cardiac rehabilitation 484-884-2559 Heart and Vascular Center administrative offices 610-402-7150 Transcatheter valve replacement program 610-402-TAVR

Patients who have questions about Lehigh Valley Health Network services can call 610-402-CARE.

Left ventricular assist device program 610-402-4VAD Hackerman-Patz House (overnight accommodation for patients/guests) 610-402-CARE

VISIT LVHN.ORG

CALL 610-402-CARE 15