Bayhealth Cardiovascular Services Annual Report 2018

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Your recovery is at the heart of our drive.


Dear friends, I am pleased to present to you the Bayhealth Cardiovascular 2018 Annual Report. In this report, you will find a brief overview of our publicly reported quality data, patient stories and new programs we have added to meet our community needs. Due to the COVID-19 pandemic and our shift into crisis mode, this report was delayed. In these unprecedented times, it’s more important than ever that we reinforce our commitment to the communities we serve — not just in times of emergency but with all our services as we resume our pre-COVID-19 operations. Our mission remains unchanged; to deliver world-class cardiovascular and thoracic care here in central and southern Delaware. According to the Centers for Disease Control, the leading cause of death in the United States continues to be cardiovascular disease. The American Heart Association reports that 2,300 Americans die each day from cardiovascular disease — about one every 38 seconds — and another 91.2 million American adults are living with some form of it, including heart failure, high blood pressure, the effects of heart attack or stroke, or other diseases of the heart and blood vessels. At Bayhealth, we are proud of our comprehensive approach to cardiovascular care. Bayhealth Kent Campus was among the original five hospitals on the East Coast selected to receive early access to Boston Scientific’s Eluvia™, a new FDA-approved drug-eluting device for the treatment of peripheral artery disease. We are the only hospital in Delaware to implant the new EDWARDS INTUITY Elite valve system. The INTUITY valve offers another innovative procedure option for patients with aortic stenosis, to complement our transcatheter aortic valve replacement (TAVR) program. Once again, Bayhealth Cardiovascular Services received multiple accolades in 2018 at the state and national level for exceptional cardiovascular care, including: • Mission: Lifeline® Silver Receiving Quality Achievement award for timely treatment of patients suffering a ST elevation myocardial infarction (STEMI), the deadliest type of heart attack • Blue Distinction Centers for Cardiac Care designation from Highmark Blue Cross Blue Shield Delaware in recognition of improved patient safety and better health outcomes • HealthHelp’s CardiacSite certification for interventional cardiology services We are proud of our achievements, but what matters most is making a difference in the lives of our patients and providing life-saving care close to home. I hope you enjoy our Bayhealth Cardiovascular Services 2018 Annual Report. Sincerely,

Brad D. Kirkes, MBA, MHA, OTR/L, CHT, FACHE Vice President of Ancillary and Clinical Services

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Medical leadership Bayhealth Cardiovascular Services has talented physicians, leadership and staff members committed to exceptional heart and vascular care, low readmission rates, and optimal patient outcomes and satisfaction. Gary Szydlowski, MD

Pedro Perez, MD

Chief of Bayhealth Cardiovascular and Thoracic Surgery

Medical Director of Cardiology at Bayhealth Hospital, Sussex Campus

John Shuck, MD

Sanjeev Patel, MD

Medical Director of the Cardiovascular Laboratory

Medical Director of Cardiac Rehabilitation

Raymond Miller, MD

Brian Walsh, DO

Medical Director of Electrophysiology Laboratory

Medical Director of Pulmonary Rehabilitation

Robert Scaffidi, MD Medical Director of Cardiology at Bayhealth Hospital, Kent Campus


Paul LeBlanc, MS

Senior Director of Operations, Cardiovascular Service Line

Manager, Cardiopulmonary Rehabilitation

Barbara Smith, RN, MSN, CNML, RCIS

Leslie McClements, BS, CMPE, CCVTC

Manager, Cardiovascular and Electrophysiology Lab

Senior Manager, Cardiovascular and Thoracic Surgery, Neurology and Neurosurgery Operations

Cathy Mundorf, BS, RRT Manager, Cardiology Services


Meghan Holland, RN, MSN, CCRN Nurse Manager, Cardiovascular Surgical Intensive Care Unit

Interventional suite brings enhancements to cardiovascular and interventional radiology services Sussex County residents are benefitting from an enhanced environment for interventional radiology and interventional cardiovascular procedures at the Bayhealth Hospital, Sussex Campus. The addition of an interventional suite is bringing access to many cardiac and peripheral vascular procedures for which Southern Delaware cardiac patients previously had to be sent to the Kent Campus. Overall, it better equips physicians and medical staff in the two departments to bring responsive, high-quality care to patients in Sussex County. “We’re very excited about the lab and the state-of-theart equipment that we have there,” said Cardiovascular and Electrophysiology Lab System Medical Director John Shuck, MD, of Bayhealth Cardiology Consultants. Designed as a shared space, interventional radiology uses the suite to perform vascular access procedures and implantation of IVC filters and ports for cancer patients, among other procedures. Cardiovascular services schedules the suite for mostly outpatient cardiac catheterizations, peripheral vascular diagnostic and interventional procedures, electrophysiology (EP) studies, and implantation of devices such as pacemakers and defibrillators. The new capabilities are convenient and attracting Sussex County residents who now have a choice when they need a cardiac diagnostic procedure. “A program of growth in offerings for cardiovascular services and cardiac studies at Sussex is planned, and the addition of this interventional suite is a step in that development,” said Dr. Shuck.

Bayhealth Cardiology Consultants welcomed two new physicians, Mussaber Ahmad, DO, and Manjeet Singh, DO, to support the expansion. Dr. Ahmad works primarily in Milford and does EP studies and treatment, as well as device implantation and management, in the new suite. Dr. Singh is based at Bayhealth Hospital, Kent Campus but is one of several interventional cardiologists who are using the Sussex Campus space to bring cardiac care to patients residing in that area. The size and location of the new suite also facilitates improved cooperation between different specialties. Interventional Radiologist Michael Amygdalos, MD, said it gives their team a much larger space in which to work and enables better support with more staff in the room comfortably. “With the new location in the OR, interventional radiology isn’t isolated and we can do procedures with anesthesia, cardiology or surgery without having to move the patient from one department to another.” “We are excited to better serve our patients who live in southern Delaware by reducing the numbers that need to transfer to Kent for cardiac procedures. Our patients, physicians and Bayhealth staff benefit from our growth of cardiac services at the Sussex Campus, as well as the enhancements for interventional radiology,” noted Vice President of Ancillary and Clinical Services Brad D. Kirkes, MBA, MHA, OTR/L, CHT, FACHE. “I am confident that within a short period of time, we’ll further expand our procedural offerings and scheduling.”


Bayhealth first hospital in Delaware to implant Intuity heart valve As another step forward in the growth of Bayhealth’s cardiac surgery program, the team led by Chief Cardiothoracic Surgeon Gary Szydlowski, MD and Cardiothoracic Surgeon Daniel Marelli, MD have successfully performed implantation of the EDWARDS INTUITY heart valve in several patients for the treatment of aortic stenosis. This condition is a hardening or narrowing of the aortic valve opening. It affects millions of older adults worldwide and typically worsens with age. Bayhealth became the first hospital in Delaware to use the next generation device after it received Food and Drug Administration (FDA) approval. Bayhealth introduced its heart surgery program 15 years ago to offer to the community the same expertise and care as large medical centers, but close to home. The program has been advancing ever since. Since 2003, a partnership with Penn Medicine, ranked #6 in the nation for cardiology and heart surgery, has provided elite training and resources for Bayhealth doctors and staff. This has been valuable in the evolution of Bayhealth’s program, which offers comprehensive surgical and interventional cardiac services on par with the best in the region. Advancements have included aortic stenting and the Transcatheter Aortic Valve Replacement (TAVR) procedure, which replaces the aortic valve without the need for open heart surgery.

Since 2016, Bayhealth’s cardiac surgery team has performed the TAVR procedure. It was originally designed for patients with severe aortic stenosis considered too ill or weak for surgery, and in August 2019, the FDA expanded its use to those with lower risk of complications. Edwards Lifesciences introduced its EDWARDS INTUITY Elite valve system as a competing treatment option, available to a wider group of patients suffering from aortic stenosis. The Journal of Geriatric Cardiology reports that aortic valve disease affects over 25% of individuals over the age of 65. About 2%–5% show signs of significant aortic stenosis. Common symptoms may include chest pain, shortness of breath, lightheadedness or feeling dizzy, or inability to exercise. Experts agree that patients with strong symptoms of this condition have a poor prognosis without intervention, such as aortic valve replacement. Drs. Szydlowski and Marelli answered questions related to this new device for aortic valve replacement and its use at Bayhealth. This adds to the growing number of options to help their patients with cardiovascular conditions improve their function and quality of life.



Q. PLEASE EXPLAIN HOW THIS DEVICE AND THE IMPLANTATION PROCEDURE ARE UNIQUE. This is a bovine pericardial valve much like the type we’ve been implanting for years. When patients have aortic stenosis, their valve does not open properly. This means the heart must work harder to pump blood through it and results in reduced blood flow to the body and a weakened heart muscle. It may lead to heart failure if left untreated. The difference with this new heart valve is that it’s sutureless. Not to be confused with TAVR, implantation of this device still requires full cardiac surgery, or open heart surgery, but an advantage is that it can facilitate a less invasive approach. Unlike other valves which require 12 to 15 reinforced sutures to secure the valve, this new valve is balloon dilated into place using the EDWARDS INTUITY Elite valve system.

Q. WHAT ARE THE BENEFITS AND RISKS OF THIS PROCEDURE? A. The benefits are a quicker operation, the fact that it can enable a minimally invasive approach with a smaller incision, and there is evidence that this new device may relieve the obstruction better than traditional sutured valves.

Because it takes up less space on the wall of the aorta, there is less resistance which creates superior results. There are standard risks to any open heart surgery and this would be no different. Pacemakers are a possibility after any cardiac procedure, especially aortic valve replacement, and the chance is slightly higher in these procedures. With any tissue valve like this, patients typically avoid the need for long-term blood thinners. Clinical studies show that this procedure may mean shorter hospital stays and faster healing times for patients.

Q. WHAT ARE THE FUTURE PLANS FOR USE OF THIS PROCEDURE? A. At Bayhealth we strive to stay on the cutting edge with advances in medicine. This is another option in the toolbox for aortic valve replacement. As with any treatment, however, this may not be for everyone. We consider the unique conditions of each of our patients and work with them to determine a course of action. A disadvantage of this device is that it is expensive, and we want to be fiscally responsible and use it appropriately. Over the years we have been moving forward with less invasive options and we’ll continue to see how this procedure fits in among our other cardiac services.


Bayhealth among elite group receiving early access to new stent technology Bayhealth Hospital, Kent Campus was chosen as one of a select group of hospitals nationwide — only 50 in the U.S. and five on the entire East Coast — to receive early access to a new FDA approved stent treatment. Produced by Boston Scientific, the Eluvia stent system is an innovative technology that gradually releases a medication to the main arteries supplying blood to the legs and other extremities. It is designed to help those with peripheral vascular disease (PVD), a common circulatory condition caused by a buildup of fatty deposits in the arteries that restricts blood flow. PVD is estimated to affect one in every 20 Americans, causing pain, ulceration and in the most severe cases, a need for leg amputation. When left untreated, it can increase a person’s risk for heart attack and stroke. During clinical trials, the Eluvia stent system showed superior results in treating blockages in the legs and relieving symptoms compared to similar products on the market. Because of the muscles and bones in the legs, blockages in that location are traditionally harder to treat with stenting than are those in the heart.


Bayhealth has had successful results in using the new medication-coated stent to benefit numerous patients in the area. “We were thrilled to get early access to this improved leg stent technology with a proven track record in helping patients suffering from PVD,” said Medical Director of the Cardiovascular Laboratory John Shuck, MD, of Bayhealth Cardiology Consultants. “The fact that Bayhealth was chosen in the initial launch, as one of only a handful of East Coast hospitals to receive the product, is quite an honor.”


Cardiovascular Volumes and Quality Measures OVERALL VOLUMES PER DEPARTMENT FOR FISCAL YEAR 2018

57,174 Cardiopulmonary Rehabilitation Encounters 10,913 Cardiovascular & Electrophysiology Lab Cases 1,869 Cardiovascular Surgical Associates Cases 565 Cardiology Studies and Tests

Society of Thoracic Surgeons (STS) Overall Composite Score and Star Quality Rating for coronary artery bypass grafting (CABG) and aortic valve replacement (AVR) (calendar year 2018) Bayhealth Hospital, Kent Campus CABG Quality Rating AVR Quality Rating


CABG + AVR Quality Rating

Outpatient Satisfaction Scores for Calendar Year 2018 (average of all four quarters)

Survivability Rate

Cardiovascular Services (paper survey) Percentage of patients who would recommend Bayhealth’s Cardiovascular Services to others

Like hospital systems


Cardiovascular Testing Percentage of patients who would recommend Bayhealth’s Cardiovascular Testing to others


Cardiopulmonary Rehabilitation (paper survey) Percentage of patients who would recommend Bayhealth’s Cardiopulmonary Rehabilitation to others


★ ★ ★ 95.9% ★ ★ ★ 95.2% ★ ★ ★ 91.1%

Bayhealth Hospital, Kent Campus All participating hospitals

98.2% 97.7% 98%

Source: The Society of Thoracic Surgeons (STS) January 2018 – December 2018 As part of Bayhealth’s commitment to creating better outcomes for heart patients, we voluntarily collect and report surgical records to the Society of Thoracic Surgeons (STS) to include in their National Database. The data collected from Bayhealth and many other hospital systems who participate is used for ratings as well as clinical research to better understand cardiac care across the country.

Inpatient Satisfaction Scores for Calendar Year 2018 (average of all four quarters)

Door-to-Balloon Times for Calendar Year 2018

Cardiovascular Surgery and CVSICU Percentage of patients who would recommend Bayhealth’s Cardiovascular Surgery to others

The American Heart Association defines door-to-balloon time as the amount of time between first medical contact and the time a person receives percutaneous coronary intervention (PCI), such as angioplasty.


Cardiovascular Surgical Intensive Care Unit (CVSICU) Percentage of patients who would recommend Bayhealth’s CVSICU to others 100% Complication Rate for Cardiac Catheterizations Diagnostic Vascular (Benchmark = 2%) Bayhealth


Interventional Cardiac Catheterization (Benchmark = 2%) Bayhealth


What is door-to-balloon time?

Average door-to-balloon times within 90 minutes of arrival All reporting hospitals in the United States All reporting hospitals in Delaware Bayhealth Hospital, Kent Campus

80% 85.8% 100%

Source: American Heart Association Get with the Guidelines — Coronary Artery Disease Registry


Awards and Accreditations MISSION LIFELINE Bayhealth Hospital, Kent Campus received a Mission: Lifeline® Silver Receiving Quality Achievement award in 2018 for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients suffering heart attacks, specifically those suffering a ST elevation myocardial infarction (STEMI). This is the deadliest type of heart attack, caused by a complete blockage in a coronary artery. The goal of the Mission: Lifeline program is to reduce system barriers to prompt heart attack care, starting with the 911 call, to EMS transport and continuing through hospital treatment and discharge. The initiative provides tools, training and other resources based on the most recent evidence-based treatment guidelines.

BLUE DISTINCTION Bayhealth Hospital, Kent Campus was recognized in 2018 with a Blue Distinction Center® designation for delivering quality cardiac care, as part of Highmark Blue Cross Blue Shield’s Blue Distinction Centers


for Specialty Care® program. This program was developed in 2006 to help patients find excellent specialists and to improve standards of care nationwide. To be named a Blue Distinction Center, a hospital must demonstrate delivery of high-quality specialty care based on specific measures developed with input from the medical community. These focus on patient safety, such as preventing hospitalacquired infections; and quality factors for cardiac surgical and non-surgical procedures, such as cardiac stent placement.

IAC ACCREDITATION Bayhealth is proud that its Cardiology Diagnostic Laboratories have earned and maintained accreditation by the Intersocietal Accreditation Commission (IAC). IAC is a national accrediting body that is widelyrespected for its standards and methods in evaluating the delivery of quality patient care within numerous diagnostic modalities. Bayhealth Cardiac Diagnostics in Dover and Milford are accredited in nuclear cardiology, and Bayhealth Heart & Vascular is accredited in echocardiography, nuclear medicine and vascular.

A sincere thank you for great patient care On a normal Friday in October 2017, Bayhealth Foundation President Lindsay Rhodenbaugh left his office with a feeling of heaviness in his chest. Having already sustained a heart attack a few years before, he knew something was wrong and immediately went to Bayhealth Emergency and Trauma Services, Kent Campus. There he was admitted and underwent a successful triple bypass open heart surgery, which cleared potentially fatal blockages. After surgery, Rhodenbaugh recovered in the Cardiovascular Intensive Care Unit (CVSICU) at Bayhealth Hospital, Kent Campus and continued to benefit from the services provided at Cardiopulmonary Rehabilitation. As a grateful patient, Rhodenbaugh and his wife, Tami, made a generous donation to Bayhealth, which allowed them the opportunity for their giving to be recognized with a plaque. The Rhodenbaughs decided on having their plaque placed outside of his CVSICU recovery room to show appreciation for the care he received by his physicians, nurses and other caregivers on the unit.

A reception was held to commemorate the placement of the plaque and to thank not only the cardiac team but Emergency Department staff as well as the numerous physicians who played a role in saving his life. “No amount of monetary donation can ever express how grateful we are for the outstanding caregivers, but it’s a start,” Rhodenbaugh said. “My life was literally saved by the caregivers here. I’m blessed to work here, blessed to have been healed here and blessed to live in a community with such a great hospital system.” The plaque and reception came at the completion of the couple’s multi-year pledge to Bayhealth. They donate regularly through payroll deduction to the Bayhealth Foundation. CVSICU Clinical Coordinator Paul Pahren says the team doesn’t feel like they did anything special in their care for Rhodenbaugh, but is honored to be recognized. “We’re driven to be kind and caring with our patients. We hope every patient has the same experience here,” Pahren said.


Jacked up about his cardiac rehab Retired from the Dover Police Department, John “Jack” Foley always had good impressions of Bayhealth Emergency physicians and nurses he occasionally interacted with through work. Suffering a series of dire medical events over the course of two weeks — sudden cardiac arrest followed by two strokes — gave him firsthand exposure to Bayhealth’s lifesaving care and dedication to improving patients’ long-term health. Almost three years ago, Foley had a near-death experience, as he describes it, when his heart stopped beating en route from the Emergency Department to the Cardiac Catheterization Lab to get a stent put in for a heart blockage. This reconfirmed not only his faith, but also his determination to do all he could to bounce back and avoid a family pattern of dying young from a heart attack. The prompt care Foley benefited from has been nationally recognized by the American Heart Association and the American Stroke Association. Bayhealth has earned awards for consecutive years of quality improvement measures for treatment of ST elevation myocardial infarction (STEMI), the deadliest type of heart attack; cardiac arrest resuscitation; and the quality and timeliness of its stroke care. These measures include patient safety protocols, emergency team response and post-resuscitation care.


With more than 50 percent damage to his heart, Foley was initially told he wouldn’t be able to lift more than 25 pounds and would have a difficult road ahead. For the energetic 69-year-old looking forward to many activities in his new retirement, this was hard news to hear. “I’m used to being active and outside a lot. I was afraid I wouldn’t be able to do anything,” said Foley.


As soon as he could do so, Foley started his Cardiopulmonary Rehabilitation (Rehab). These medically supervised programs, certified by the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), are offered at both Bayhealth campuses to help improve the health and well-being of patients with heart problems. “The first few weeks were very hard. But my cardiologist had said my heart muscle would continue to atrophy if I didn’t work out, so that kept me motivated.” Bayhealth’s Cardiac Rehab team provides assessment and individualized programs to help patients better manage their condition, make changes in diet and lifestyle, and follow monitored exercise plans. After program completion, patients are encouraged to continue a maintenance program with the team or on their own at home. Foley attends Cardiopulmonary Rehab Maintenance twice weekly and his typical regimen consists of stretching and 40 minutes on the treadmill. As he progresses, Exercise Physiologist Devin Rhodes bumps up his workouts. “Jack’s journey has been a long process, but his progression in Cardiac Rehab was incredible,” Rhodes said. He’s now walking 3.8 miles per hour at a 3 percent incline, has a lot more energy and can run up and down stairs at home without a problem. The program also has provided him with a positive emotional support system, said Rhodes. “Jack has made many friends with the same heart conditions. He’s a great example of someone who turned a tragic situation into a positive life change.” A recent follow-up cardiologist visit revealed significant healing on both sides of his heart — a result Foley and his wife consider “miraculous.” They know the care he received and his commitment to a rehabilitation program have dramatically improved his outcome. “Bayhealth is top-notch,” said Foley. “Having been in the community a long time, it’s always been a good place. It’s changed a lot with the times, and has gotten even better.”


Out in the community Bayhealth team members, not only in Cardiovascular Services but throughout the organization, have a deep commitment to improving heart health in our community. They have demonstrated their passion for raising awareness about heart disease through regional events. Broad participation in activities such as Go Red for Women and Southern Delaware Heart Walks are prime examples of how Bayhealth goes the extra mile to support research and education to strengthen heart health and provide life-saving treatments.

Bayhealth employees participated in the American Heart Association’s local Go Red for Women event in February 2018. This fundraiser luncheon, which featured a fashion show and silent auction, advocates for more research and quicker action for women’s heart health. Collectively, Bayhealth team members volunteered their time and energy for this annual event by serving as committee members, participating in the fashion show and contributing gift baskets for the auction.

The Bayhealth Foundation plays an important role in helping to connect Bayhealth’s medical staff with the community by hosting physician engagement receptions for patients, their families and community members. Past forums held in central and southern Delaware have been an opportunity for medical leaders to share information on cutting-edge treatment options and answer questions posed by audience members. Bayhealth administrators and the cardiovascular and thoracic surgeons who presented are pictured at the event held at Baywood Greens in Long Neck.


Bayhealth also participated in the 2018 Southern Delaware Heart Walk at Delaware Technical Community College in Georgetown. Pictured above are some team members and their children practicing CPR technique.

Pictured below is a small group of team members among the large Bayhealth contingency represented at the 2018 Southern Delaware Heart Walk held at Delaware Technical Community College Terry Campus in Dover.


Physicians & Practices In our mission to provide exceptional cardiovascular and thoracic care to our patients close to home, Bayhealth employs physicians and surgeons in various sub-specialties and also works with affiliated physicians in our community. Here are the specialists we work with in central and southern Delaware.

BAYHEALTH CARDIOVASCULAR AND THORACIC SURGICAL ASSOCIATES 540 S. Governors Avenue, Suite 101A, Dover 302-744-7950 802 N. Dupont Highway, Milford 302-265-0515

AFFILIATED PHYSICIANS Jennifer Eakin, DO Khaled Eljazzar, MD Eranga Haththotuwa, MD Antony Leslie Innasimuthu, MD Michael Shea, MD Gurmeet Singh, DO

Paul Fedalen, MD Daniel Marelli, MD Gary Szydlowski, MD

BAYHEALTH CARDIOLOGY CONSULTANTS 110 Forest Avenue, Dover 302-672-4600 315 S. Carter Road, Smyrna 302-672-4600 Harjinder S. Grewal, MD Raymond Miller, MD David Ramos, MD Roberto Scaffidi, MD John Shuck, MD Manjeet Singh, DO

BAYHEALTH HOSPITAL, KENT CAMPUS 640 S. State Street, Dover, DE 19904 302-674-4700

802 N. Dupont Highway, Milford 302-422-6050 Mussaber Ahmad, DO Laeeq Ahmer, MD E. Mark Johnson, MD Pedro Perez, MD

BAYHEALTH HEART & VASCULAR 200 Banning Street, Suite 340, Dover 302-734-1414 315 N. Carter Road, Smyrna 302-734-1414 112 Sussex Avenue, Suite 101, Milford 302-734-1414 Vincent Abbrescia, DO Sanjeev Patel, MD Judith Rippert, DO

BAYHEALTH HOSPITAL, SUSSEX CAMPUS 100 Wellness Way, Milford, DE 19963 302-422-3311 Visit to learn more about our department team and offerings or call 1-866-BAY-DOCS (229-3627) if you’re in need of a cardiologist or a heart or vascular surgeon.

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