Cardiovascular Services Annual Report
2015
Contents Opening Message 2 Leadership 4 Excellence in Cardiovascular Care 6 Clinical Services 8 Surgical Services 8 u Cardiovascular Surgery Procedures 8 u Vascular Surgery Procedures 8 Interventional Services 12 12 u Structural Heart Procedures u 15 Catheterization Lab Procedures 16 u Electrophysiology Lab Procedures u Interventional Radiology Procedures 16 Non-Invasive Diagnostic Services 21 21 u Computed Tomography (CT) Procedures 21 u Echo and Vascular Lab Procedures 21 u EKG Procedures 21 u Nuclear Medicine Procedures Outpatient Services 24 u Sleep Medicine Services 24 25 u Cardiac Rehabilitation
Research and Continuing Education 30 30 u Lexington Cardiology Clinical Trials 32 u Vascular Odyssey Symposium u Cardiology Symposium 32 Patient Support 33 33 u Heart to Heart Support Group u 33 AWAKE Support Group Community Outreach 35 35 u Heart & Sole Women’s Five Miler 35 u Heart Fair 35 u Speakers Bureau 35 u CT Heart Screenings Physicians 36 Demographics & Statistics 38 39 u Heart Catheterizations 40 u Heart Attacks 42 u Implantable Cardioverter Defibrillators u Bypass Surgery (CABG) 44 u T ranscatheter Aortic Valve Replacement (TAVR) 46 48 u Stroke Timeline 50
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Lexington Medical Heart Center
Cardiovascular Services Annual Report
2015
LEXINGTON MEDICAL HEART CENTER
Opening Message COMPLETE CARDIAC CARE
The pathway to providing open heart cardiovascular services to the patients of
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Lexington Medical Center can probably be traced to the late 1960s. That’s when the leadership of Lexington County began to push for a local option to provide for the health of their community. Lexington Medical Center opened its doors in 1971 with that singular goal. Fast forward some 30 years and a more defined focus on cardiovascular disease began.
ardiovascular disease is the number one killer in the Midlands and across the U.S. With the goal of providing quality health care to the community, Lexington Medical Center wanted to be able to care for its cardiac patients. In 2002, the hospital opened its first diagnostic heart catheterization laboratory. While this service enabled physicians at Lexington Medical Center to diagnose coronary artery disease, they were not able to treat the disease with either percutaneous stents or open heart surgery. The pathway to providing complete cardiac care came to a crossroads in June 2010 when the South Carolina Department of Health and Environmental Control approved Lexington Medical Center to start an open heart surgery program and, as a result, perform percutaneous coronary interventions or stents. This approval allowed the hospital to return to its roots and again provide a local option for the health of its community. On March 28, 2012, a three-vessel coronary artery bypass graft (CABG) was performed in Operating Room 23 at Lexington Medical Center. This surgery was the first of many. The patient did well and was discharged home on postoperative day six. Cardiovascular services at Lexington Medical Center has seen significant and sizable growth since that first open heart operation. Cardiac surgery, catheterization lab, structural heart/transcatheter aortic valve replacement (TAVR), electrophysiology and cardiac rehabilitation have all made significant advances in volume and unique services offered to the community. The Cardiac Cath Lab began elective interventional procedures on April 1, 2012. Since that first elective case, the Cath Lab has performed more than 3,000 percutaneous coronary interventions with either balloon angioplasty or placement of a coronary stent. Lexington Medical Center’s electrophysiology program kicked off in March 2013. Complex electrophysiology procedures such as atrial fibrillation ablations are now performed routinely at the hospital. Lexington Medical Center next started offering structural heart procedures with the addition of a specially trained cardiologist. The TAVR program kicked off in late May 2014. Since the beginning of the program, more than 100 patients who were not candidates for open heart surgery have had their aortic valves replaced with this minimally invasive procedure.
Cardiovascular services at Lexington Medical Center has seen significant and sizable growth since that first open heart operation.
The cardiovascular surgery service line has been in operation for more than four years. Since that time, the surgical team has performed more than 1,300 open heart cases. The program continues to grow at an amazing pace. In 2015, volume grew to nearly 400 cases, which represents a 100 percent increase from 2012. The program continues to have excellent outcomes, with recognition from the Society of Thoracic Surgeons and a coronary artery bypass graft mortality rate well below the national average. Every successful cardiovascular program must have a robust cardiac rehabilitation program. Today, Lexington Medical Center offers cardiac rehabilitation programs on the main hospital campus in West Columbia and at its community medical centers in Lexington and Irmo for patients’ convenience. Lexington
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Medical Center is proud of the role its Cardiac Rehabilitation staff serves in the preoperative setting, as well as with families on the day of surgery. The hospital also offers a Heart to Heart support group that provides education and encouragement to heart patients and their families. The mission statement at Lexington Medical Center is simple: to provide quality health services that meet the needs of the community. The hospital established its heart program to provide complete cardiac care. Staff members in the Cardiac Surgery, Cath Lab, TAVR, Electrophysiology and Cardiac Rehabilitation departments all work together to deliver quality care that meets patients’ needs. While the beginning has been very successful, the best is yet to come. – Jeffrey A. Travis, MD
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CARDIOVASCULAR SERVICES COMMITTEE
Leadership
The Cardiovascular Services Committee is a multidisciplinary team of health care professionals that reviews quality measures and assists the hospital in strategic planning for the hospital’s cardiac services. Amy Rawl Epps, MD, FACC, Chair Lisa Altman William W. Brabham, MD, FHRS June Duggan Darlene Fry Wes Harden Harriet Horton David N. Knight, MD Robert A. Leonardi, MD, FACC, FSCAI Robert M. Malanuk, MD, FACC William M. Moore Jr., MD, FACS Donna Peterson Deyanira “Dee” Prastein, MD Michael C. Roberts, MD, FACC Ted Sims Jeffrey A. Travis, MD
CARDIOVASCULAR ACTION TEAM
STROKE COMMITTEE
The Cardiovascular Action Team, a multidisciplinary group of cardiac care professionals, facilitates a systemwide comprehensive care approach for patients with chest pain, acute myocardial infarction and acute coronary syndrome. Team members collaborate to ensure a good working relationship between local Emergency Medical Service providers, referring facilities and Lexington Medical Center to improve patient care.
Lexington Medical Center’s Stroke Committee is a multidisciplinary team with the goal of improving the outcomes of stroke patients. Team members regularly review data and processes, then develop and implement interventions based on best practice guidelines.
Kay Austin Ciji Bell Michael Dawkins Theresa Falcone Darlene Fry Michelle Gilland Cathy Jashinsky Joey Herauf Harriet Horton James Jeffcoat Wendi Knight Paul LeDuc John Leech Laura McMahan Lara Lott Moore
Christine M. Scott-Demonbreun, MD, Medical Director and Chair Benjamin Amberg Debbie Azarowicz Carol Beckett Ciji Bell Janet Carlson Jody Durden Wesley Frierson, MD Frances Glover Debra Heaton Doris Jordan Andrea Kendrick Melanie Lake Christopher T. McCarty, MD Kelly Nyberg Connie Parson Linda Perkins, MD Frank O. Pusey, MD Gloria Robinson Brandi Shull Lori Sutton Debbie Waites Kathy West
Donna Peterson Michael C. Roberts, MD, FACC Suzanne Rogers Wesley Shuler, MD Ted Sims Nicole Smith Lori Sutton Mary Tanner Sharon Young
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Excellence in Cardiovascular Care THE MIDLANDS’ ONLY HEART CENTER AFFILIATED WITH DUKE HEALTH hen Lexington Medical Center started its complete cardiac care program, it wanted to offer its community the best cardiovascular services available. For this reason, the hospital developed an affiliation with Duke Health, a national leader in cardiovascular diagnostics, treatment and research. As an affiliate of Duke Health in heart, the hospital has access to the most current guidelines, training and staff education to enhance the quality of cardiovascular care we deliver in our community. As Lexington Medical Center prepared to begin its open heart surgery program, Duke helped the hospital set up policies and procedures, train staff and recruit members for the cardiovascular surgery team. Duke assisted Lexington Medical Center in setting up its cardiovascular catheterization lab to prepare for interventional procedures and conducted monthly site visits to review progress in planning the open heart surgery program. Since Lexington Medical Heart Center’s inception, Duke has also provided educational opportunities and quality oversight for Lexington Medical Center physicians and staff, including best practice conferences, physician-to-physician consultations and peer case review. Duke Health has extensive experience working with hospitals throughout the Southeast to help strengthen and expand cardiac services at the local level. As the Midlands’ only affiliate of Duke Health in heart, Lexington Medical Heart Center patients receive the most advanced treatment and protocols medicine has to offer.
ACCREDITATIONS AND DESIGNATIONS Lexington Medical Heart Center has earned key accreditations and designations from many prestigious programs.
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AWARDS Lexington Medical Center’s dedication to delivering outstanding health care services has earned many national accolades. The American Association of Critical-Care Nurses awarded Lexington Medical Center its Gold Beacon Award, which recognizes outstanding patient care, outcomes and work environment. Currently, only 11 U.S. hospitals have earned gold distinction with this award. In addition, Lexington Medical Center has received the Get With The GuidelinesŽ Gold Plus Award, the highest honor bestowed by the American Heart Association and American Stroke Association, for four consecutive years. This award recognizes commitment and success in implementing excellent care for stroke patients. ANNUAL REPORT 2015
LEXINGTON MEDICAL HEART CENTER
Clinical Services Lexington Medical Heart Center combines the latest advances in technology and innovative surgical techniques with the expertise of clinical and surgical specialists to care for patients who need cardiac or vascular surgery. Healthy Aortic Valve
Healthy valve closed
Diseased Aortic Valve
Diseased valve closed
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Healthy valve open
Diseased valve open
Surgical Services CARDIOVASCULAR SURGERY PROCEDURES
VASCULAR SURGERY PROCEDURES
◆◆ Aortic great vessel repair: a type
◆◆ Aortic replacement: surgery to
of open heart surgery used to repair aortic aneurysms. ◆◆ ASD/VSD closure: surgical closure of
an atrial or ventricular septal defect. ◆◆ Coronary artery bypass grafting:
(CABG): a type of open heart surgery that improves blood flow to the heart in people with severe coronary heart disease. ◆◆ Laser Lead Extraction: procedure in
which a laser is used to surgically remove a pacemaker or ICD lead, usually due to a device malfunction or infection. ◆◆ Myxoma: surgical removal of a tumor
within the heart. ◆◆ Valve surgery (aortic, mitral and tricuspid
repair or replacement): a type of open heart surgery used to treat disease or repair of the heart’s valves.
replace thoracic or abdominal aorta due to aortic aneurysms (when an aorta weakens, enlarges or ruptures) or aortic dissection (when an aorta splits). ◆◆ Embolectomy: surgical removal of
a blood clot from an artery. ◆◆ Endarterectomy: surgical removal of
plaque or other disease from the inner lining of an artery, usually the carotid and femoral artery. ◆◆ Endovascular aortic repair: an
alternative to vascular surgery, endovascular repair treats disease from inside the blood vessels. ◆◆ Femoral-femoral bypass, femoral-
popliteal bypass and femoral-tibial bypass: a treatment for peripheral vascular disease that restores blood flow to the peripheral vessels by bypassing the blockage. ◆◆ Port insertion: a device implanted
under the skin to provide intravenous access for medications or transfusions.
Abdominal Aortic Aneurysm — Who’s at Risk? hen people think “AAA,” they might think of a roadside rescue. But there’s another type of AAA that also requires a rescue — in an operating room. An abdominal aortic aneurysm, or AAA, is a swelling and weakening in the aorta, the main vessel that carries blood from the heart to the rest of the body. Over time, the aneurysm can grow larger and eventually burst, leading to life-threatening bleeding. Those who do survive a ruptured AAA are at risk for major heart attacks, strokes and kidney failure.
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Finding AAA early is the key to survival. Anyone with an immediate family history of AAA should have an abdominal ultrasound screening. Once diagnosed, he or she should see a surgeon to evaluate when or if the AAA needs to be repaired. In the past, surgeons had to make a large incision down the middle of the abdomen to repair AAA. Now, it can be repaired with an endograft, a hollow fabric-covered tube that surrounds a mesh metal cylinder (stent). Surgeons place the endograft inside the aorta through small incisions in the groin. This minimally invasive surgery lessens recovery time and reduces the complications associated with an open abdominal procedure.
An abdominal aortic aneurysm repaired with an endograft
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Surgeons at Lexington Medical Center have been treating AAA for more than 20 years. “Technical advances in vascular surgery have revolutionized the treatment of patients with vascular disease, particularly AAA. The endovascular surgery program at Lexington FEATURE Medical Center has remained at the forefront of those developments, which has benefited our patients through STORY improved outcomes,” said William M. Moore Jr., MD, FACS, of Southern Surgical Group, a Lexington Medical Center physician practice.
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William M. Moore Jr., MD, FACS
An aneurysm can develop as a result of genetic weakening of the vessel and, over time, it can expand. High blood pressure and smoking increase the risk of enlargement and rupture of AAA. Diabetes can also lead to changes in the vessel wall. These risk factors must be controlled to reduce the likelihood of AAA rupture.
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The Light at the End of the Tunnel LEARNING FROM HEART DISEASE
arris McBride recalls the day she thought she was going to die. “All I saw were the white lights of the cars ahead of us turning into one big light. And then it got darker — as if the lights were closing into a tunnel.” Parris was in the passenger seat with her frantic sister and teenage daughter racing to Lexington Medical Center. She was clammy, cold, weak and nearly unconscious. With severe chest pains and a terrible headache, the Batesburg mother was having a serious cardiac event. And she was only 41 years old. It was December 9, 2014.
Stories of women such as Parris who have suffered from heart disease are a primary reason Lexington Medical Center began its campaign to focus on educating women about their hearts in 2015.
“I didn’t want to die. I have kids and I need to take care of them.” Inside the hospital, tests revealed severe blockages in her arteries. Parris needed open heart surgery to survive. It was the pivotal moment for heart problems that began months before. In October, Parris started having back, shoulder and neck pain, and one night, while working in the kitchen, another weird feeling. “I thought, ‘My goodness, I’m having some bad indigestion.’” She chewed nearly a whole bottle of Tums®, but it didn’t go away. At first, she thought she was tired and stressed. Both of her parents had died recently, and she was a busy single mom of two daughters with a job as a salon manager. But with a history of heart disease in her family — including a father having heart surgery in his 30s and a grandfather with a heart attack in his 50s, high blood pressure, high cholesterol and a smoking habit, she went to urgent care. Tests revealed she had suffered a heart attack. She had two stents placed. Soon the symptoms came back. “I couldn’t even walk up a flight of steps without not being able to breathe,” she said. “Even talking on the phone would make me out of breath.” The chest pain continued — and got so bad that Parris was vomiting, too. “It was like someone was stabbing a knife right between my heart and my esophagus,” she said. “It didn’t feel like an elephant on my chest, but it was the worst pain you could ever describe.”
With symptoms that had become unbearable, her sister rushed her to the hospital, where Parris learned that arteries were blocked and she would need open heart surgery. Surgeons also needed to fix a blockage in her carotid artery. “At first, I had a lot of fear and anxiety. I had some anger. But I also had hope that everything would go away and I’d be better.” Stories of women such as Parris who have suffered from heart disease are a primary reason Lexington Medical Center began its campaign to focus on educating women about their hearts in 2015. For women like her, she has advice. “Be aware of what’s around you to be healthy. You can say every day that you’re going to quit smoking or eat right — but you have to commit to it.” She also turns to her faith. Her late father was a pastor at Saxe Gotha Presbyterian Church in Lexington, where Parris grew up and graduated from Lexington High School. “You ask yourself, ‘Why me, God? Why did you put this in my life?’ And for the first time in my life, I can finally say that I know why this experience happened. It’s my calling to go around and make women more aware about heart health.” She adds that her 8-year-old daughter asked her if what she had was contagious. She told her “No,” but that it can be hereditary. So she’s working to get her family on a healthy path, too. “I have two beautiful children. This is my third chance at life. I want to do it right this time.”
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Interventional Services Lexington Medical Heart Center gives patients access to state-of-the-art diagnostics and non-surgical treatments for heart and vascular diseases. These minimally invasive procedures are ideal for most patients, specifically those considered high risk due to their age, weak cardiac function, chronic illness or other co-morbidities.
Striking Back Against Heart Disease
STRUCTURAL HEART PROCEDURES
On Friday nights, you can count on finding
◆◆ Alcohol septal ablation: a
Martha Gregg at the Gamecock Lanes
percutaneous, minimally invasive treatment performed by an interventional cardiologist to relieve symptoms and improve function in severely symptomatic patients with hypertrophic cardiomyopathy (HCM). ◆◆ Percutaneous transvenous mitral
commissurotomy for rheumatic mitral stenosis: an invasive procedure that uses a balloon to open an abnormally constricted mitral valve. ◆◆ PFO/ASD closure: a catheter-based,
minimally invasive closure of patent foramen ovale (PFO) and atrial septal defect (ASD). ◆◆ Transcatheter aortic valve
replacement (TAVR): a minimally invasive type of surgery used to replace faulty heart valves in high-risk patients who are not candidates for open heart surgery. Four different approaches are available: femoral; apical; aortic; and caval.
bowling alley in Sumter. he bowls there every week with her son and daughter, and participates in bowling tournaments. Her personal best is a 195. She’s back in the game after a serious setback in 2014. During that time, the 68 year old noticed she was getting very tired. “I would get so tired when walking. I couldn’t stand up in church, either. I couldn’t bake. I couldn’t lift my clothes. I was so tired and out of breath.” It was so bad that she fell asleep at work one night. The fatigue affected her bowling, too. “I was too tired to bowl,” she said. “I’d bowl one game and couldn’t finish it. My son would say, ‘Mom, just sit down.’” Tests revealed something was wrong with Martha’s aortic valve, the heart valve that allows oxygenated blood back into the body. Martha was referred to Lexington Medical Center in West Columbia for further testing. “They said the valve was not pumping enough blood through my body to keep me going full force. The valve was slowing me down,” she said. “They said it needed to be replaced. That scared me.”
Instead of traditional open heart surgery, Martha underwent transcatheter aortic valve replacement. 13 ART
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But that June, instead of traditional open heart surgery, Martha underwent transcatheter aortic valve replacement, known as TAVR, at Lexington Medical Center. This state-of-the-art cardiovascular technology allows doctors to replace the aortic valve without open heart surgery.
through the body to the inside of the diseased aortic valve, then deploy the new valve inside the diseased aortic valve, which becomes the anchor for the new valve. The new valve is functional immediately and normal blood flow is restored.
TAVR is considered the most significant advancement in cardiology since coronary angioplasty.
With this minimally invasive technique, doctors deploy the new aortic valve through just a small puncture in the femoral artery in the leg.
Currently, TAVR is for patients with severe aortic stenosis who are high-risk candidates for open heart surgery because of their age, history of heart disease or other health issues.
“After a few days in the hospital, I noticed that I could walk more,” Martha said. “I thought, ‘I don’t feel tired.’ I couldn’t do that before without stopping and resting.”
Patients with severe aortic stenosis have a narrowed aortic valve that does not allow blood to flow efficiently. As the heart works harder to pump enough blood through the smaller opening in the valve, the heart eventually becomes weak. Over time, it can lead to life-threatening heart problems.
Two months later, she was back at the bowling alley impressing the competition at tournaments again.
To replace the diseased aortic valve with TAVR, the new aortic valve is compressed into a catheter. Doctors thread the catheter
And she’s thankful to the Lexington Medical Center team that fixed her up. “I feel like I can run a marathon now. It’s really good. I can kick my heels up, too.”
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Quick Thinking, Experienced Hands Head Off Heart Attack is regular boot camp workout finished, Alan Courtney decided he was up for a game of Ultimate Frisbee last December. But as he and his workout group jogged through the tunnel at River Bluff High School, his heart shifted gears. “I’ve been winded before when I’ve run, but this sensation was different,” Alan recalled. “I slowed down, taking deeper breaths. Then my vision started fading, like an old black and white TV tube going black. I knew I was in a place I’d never been before.”
Before losing consciousness, Alan sat on the curb and called out to his friends. The 57-year-old was fortunate to have John Nickles, a pacemaker sales representative, at his side. Recognizing his friend was suffering a cardiac event, John asked Alan if he should call 911, and Alan quickly agreed. John felt for a pulse moments later and couldn’t find one — and started CPR. “The last thing I remember was John starting chest compressions. I was annoyed,” Alan said. The forceful pushing was the first time he felt pain, even though his heart was in real trouble.
Alan keeps good company in his exercise circle. Among them was Robert A. Leonardi, MD, FACC, Robert A. Leonardi, MD, FACC, FSCAI FSCAI, a cardiologist with Lexington Cardiology, a Lexington
Medical Center physician practice. Dr. Leonardi had just completed his workout, too. Jenny McKeown and Susan Wright, both nurses, were also nearby for Saturday morning workouts. They took turns with John giving chest compressions until the ambulance arrived. As emergency personnel shocked Alan back into a normal heart rhythm on the road to Lexington Medical Center, Dr. Leonardi called to ensure the hospital’s catheterization lab was ready to take Alan right away. He arrived without any identification, but among friends. At the hospital, Joseph J. Lawton III, MD, FACC, FSCAI, a cardiologist with Lexington Cardiology, inserted a cardiac catheter to evaluate Alan and discover what made his heart stop. He found a blockage in the left anterior descending artery — often called the “widow maker” because of its association with patient death — and opened the artery using a stent. The procedure Joseph J. Lawton III, restored Alan’s blood flow and MD, FACC, FSCAI eliminated the need for surgery. “After a cardiac arrest, which is often caused by abnormal blood flow to the heart, immediate cardiac catheterization is often indicated to diagnose and treat the obstruction to blood flow with angioplasty and stent placement,” said Dr. Lawton. Alan doesn’t remember anything until he awoke the next day. He left the hospital just days later, grateful to many friends, and with a normally functioning heart. “I didn’t realize I was having a heart attack,” he said. His wife, Lisa, found it hard to believe that her husband, who eats right, works out every week and runs a couple of times a week — could be the one in the hospital with heart issues. “There were so many variables that could have made the story totally different and devastating for my family — the time, the place and the people I was with,” Alan said. “I really don’t know when the flap of plaque broke off and blocked the artery, but I imagine that it happened sometime after we started jogging. The ball was ready to drop at any moment, and had I not decided to go play Ultimate Frisbee after the workout, that ball could have dropped when I was driving home or walking the dog, and the outcome would have been very different.”
CATHETERIZATION LAB PROCEDURES ◆◆ Cardioversions: a procedure used to
restore a fast or irregular heartbeat (arrhythmia) to a normal rhythm. ◆◆ EKOS®: a specific type of treatment
for pulmonary embolism that uses a catheter-directed EkoSonic ultrasound endovascular system. ◆◆ Heart catheterization: a procedure
used to diagnose and treat various heart conditions. During the test, a long thin tube (catheter) is inserted into an artery or vein in the groin, neck or arm and threaded through the blood vessels to the heart. ◆◆ Percutaneous coronary
interventions (PCI): a non-surgical procedure that uses a catheter to place a small mesh tube called a stent to open up blood vessels in the heart that have been narrowed by plaque buildup. ◆◆ Peripheral vascular diagnostics
and interventions: a catheter-based approach used to look at blood vessels in the extremities (outside the heart and brain) and treat as necessary. ◆◆ Tilt table test: a test that can help
identify the causes of fainting. ◆◆ Transesophageal echocardiography
(TEE): a test that produces pictures of the heart and heart valves using high-frequency sound waves (ultrasound). ◆◆ Valvuloplasty: a procedure that uses
a balloon to open a blocked heart valve or break up scars in a valve.
Alan went back to his workout after just two weeks of giving his bruised ribs time to heal. He ran a 5k race a few weeks later, then the Cooper River Bridge Run in Charleston — this time wearing a dog tag with his health information inscribed on it, just in case. ANNUAL REPORT 2015
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◆◆ Cardiac ablation: a procedure that uses catheters
inserted through a vein in the groin and threaded to the heart to correct structural problems in the heart that can cause heart rhythm problems (arrhythmias). ◆◆ Cardiac rhythm management: implantation of a
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heart rhythm problems (arrhythmias).
INTERVENTIONAL RADIOLOGY PROCEDURES ◆◆ Angioplasty: repair of a blood vessel by either
inserting a balloon-tipped catheter to unclog it or replacing part of the vessel. ◆◆ Arteriogram: an imaging test that uses X-rays and
contrast to see inside the arteries. ◆◆ Atherectomy: a minimally invasive endovascular
surgery technique that uses a catheter with a blade to remove plaque from a blood vessel. ◆◆ Carotid stent: a procedure that can help prevent
stroke by using a small, expandable tube called a stent to open carotid arteries that have narrowed. ◆◆ Embolization: a procedure used to treat abnormal
blood vessels and control bleeding that involves placing a catheter in a vessel and injecting contrast dye to determine the extent of the abnormality. ◆◆ Inferior vena cava filter placement and removal:
a procedure that places or removes a small, coneshaped device that traps large clot fragments and keeps the fragments from traveling through the vena cava vein to the heart and lungs. ◆◆ Stent grafts: a type of vascular stent with a fabric
coating used to reinforce the wall of the aorta and keep the damaged area from rupturing. ◆◆ Stroke therapy: use of thrombolytic drugs inside the
arteries to treat stroke.
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◆◆ Electrophysiology (EP) study: a test used to detect
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small electronic device (usually in the chest) to help monitor and regulate abnormal cardiac rhythms. Devices can include pacemakers, implantable cardioverter defibrillators, biventricular pacemakers and loop recorders.
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ELECTROPHYSIOLOGY LAB PROCEDURES
IT’S ELECTRIC!
Understanding and Treating Atrial Fibrillation id you know the heart has an electrical system? It does, and it plays an important role. The heart is a pump that requires energy to work. The heart’s electrical system coordinates the heart’s chambers to move blood throughout the body. There’s a lot of talk lately about an electrical problem in the heart called atrial fibrillation. We even hear about it in television commercials with celebrities talking about their experience with the condition. Categorized by chaotic electrical activity in the top of the heart, atrial fibrillation is a rapid, disorganized abnormality of the rhythm of the top chambers of the heart. It tends to make the bottom chambers beat more rapidly and irregularly, and it can put patients at increased risk for heart failure and stroke. Causes include older age, high blood pressure, mitral valve disease, heart failure, hyperthyroidism and obstructive sleep apnea. Most patients with atrial fibrillation have palpitations, lightheadedness, shortness of breath, or fatigue. Some patients do not have any symptoms at all. Occasionally, atrial fibrillation is diagnosed during evaluation after the onset of heart failure or a stroke. Based on symptoms, patients may undergo testing in electrophysiology — an area of cardiology that identifies and treats abnormal heart rhythms.
William W. Brabham, MD, FHRS
“Atrial fibrillation is the most common cardiac arrhythmia, and its incidence increases with age. As our population in general grows older, we will continue to see more and more patients with this condition,” said William W. Brabham, MD, FHRS, of Lexington Cardiology, a Lexington Medical Center physician practice. “Fortunately, the treatment options for patients with atrial fibrillation have continued to expand.” In addition to atrial fibrillation ablation, where doctors electrically isolate the sources of the abnormal heart rhythm to reduce the likelihood of atrial fibrillation in the future, they may control the heart rhythm with medication or shock the heart back into rhythm. And they work to treat underlying causes such as obstructive sleep apnea. Each patient requires a comprehensive evaluation to determine the best course of action to treat and prevent complications of atrial fibrillation. If left untreated, atrial fibrillation can lead to heart failure or a stroke. Heart failure can occur because of persistently high heart rates, and strokes can happen because of clots forming in the heart and ultimately going to the brain.
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Clot Retrieval Puts Young Stroke Victim Back on the Road hristopher Ford awoke that day in August with a bit of a headache. But it was nothing that would stop the 34-year-old truck driver and father of five from getting on with the business of hauling a load from Mullins to Columbia. As the miles passed, the headache became worse. Chris thought briefly he should take an aspirin when he stopped. VE
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“I was probably 10 minutes from the loading dock, and from out of nowhere it felt like someone took a sledge hammer and hit me on the back of the head,” he said. “It felt like my head exploded for a minute, and I started feeling lightheaded and dizzy.”
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At 5:45 a.m., the pain suddenly escalated.
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Although still in pain, the intensity subsided and Chris finished his trip. But when he stepped out of his truck, he noticed the left side of his shirt was soaked — with his own saliva.
“I couldn’t figure out how that happened. I remember thinking, ‘why am I drooling?’” he said. A co-worker struck up a conversation on the loading dock, but Chris realized he couldn’t form the simple words to respond. He tried
to put together the pieces in his mind to understand what was happening: the severe headache, the drooling, the feeling that his tongue was numb and wouldn’t function. “I’d never had anything like this happen to me,” he said. “But I thought, ‘it’ll go away, just keep working.” Unloading complete, he stumbled briefly on his way back to his truck cab to finally take an aspirin. That’s when he noticed two missed calls from his wife Renee on his phone. “I called her back, and she said, ‘Chris, were you asleep or something? You sound funny.’ I told her no, but I couldn’t make her understand me. None of the words sounded right. So I told her I couldn’t talk and hung up. “I knew something was really wrong, and so did she,” he said. Chris had been diagnosed with elevated blood pressure just a year before. A high-stress job was something he had recently left behind, but poor eating habits and several years with little regular exercise contributed to his risk. Renee wasted no time calling Chris back, this time with a colleague by her side to listen to him, too. “She put me on speaker and I tried to say things, and I heard her co-worker at the school tell Renee, ‘I think your husband is having a stroke.’ “I said, that’s impossible. Not me, I’m 34. I was athletic in school. I can’t be having a stroke.”
the ambulance it appeared he was having a stroke, he still didn’t believe it. At the hospital, a quick review of Chris’ CT scan and angiogram revealed a large blockage of his right cerebral artery, which nourishes the majority of the right brain. Christopher T. McCarty, MD of Lexington Radiology Associates, a Lexington Medical Center physician Christopher T. practice, knew he had to McCarty, MD act fast. “Without blood flow, the neural damage to the brain was rapidly progressing,” he said. “Expedited treatment was critical to arrest the injury.” Dr. McCarty confirmed the large blood clot with an arteriogram and removed it successfully, restoring blood flow to the brain so healing could begin.
NEARLY NINE OUT OF 10 STROKES ARE CAUSED BY A BLOOD CLOT THAT BLOCKS AN ARTERY SUPPLYING BLOOD TO THE BRAIN.
But a stroke is exactly what Chris experienced. Nearly nine out of 10 strokes are caused by a blood clot that blocks an artery supplying blood to the brain. Chris experienced some of the most common warning signs of stroke: sudden weakness of the face, causing excessive drooling; trouble speaking; dizziness; trouble walking; and that sudden, severe headache. Renee urged Chris to call an ambulance, but when he hesitated, she took matters into her own hands. Emergency medical help was there within minutes to take Chris to Lexington Medical Center. When told in
Chris was fortunate. Fast action on the part of his wife, emergency medical technicians and the staff at Lexington Medical Center made it possible to quickly dissolve and clear the clot. Chris was home after only three days in the hospital, with no symptoms or long-term effects from the stroke.
Chris has completely changed his lifestyle choices to guard against a future occurrence. He limits salt intake, no longer drinks soft drinks, and has also eliminated alcohol from his diet. He manages stress and is building his muscle mass with gym workouts four to five times a week. And he takes a baby aspirin every day, as recommended by his doctor. “I’m keeping my blood pressure at a healthy level — I have to make sure nothing happens again to scare me or my family,” he says. “It dawned on me, finally, that you’re never too young to have a stroke, especially if you’re not taking care of yourself.” ANNUAL REPORT 2015
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Non-Invasive Diagnostic Services Lexington Medical Heart Center offers comprehensive non-invasive cardiovascular diagnostic testing. Along with its highly skilled technologists and nurses, access to the latest technology to detect heart disease enables cardiologists to discover potential problems early.
COMPUTED TOMOGRAPHY (CT) PROCEDURES ◆◆ Cardiac computed tomography
angiography: an imaging test that uses a CT scanner to determine if plaque buildup has narrowed a patient’s coronary arteries.
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◆◆ Coronary artery calcium scoring: a non-
invasive scan that identifies plaque in the coronary arteries and calculates a patient’s risk of developing coronary artery disease.
ECHO AND VASCULAR LAB PROCEDURES ◆◆ Carotid ultrasound: uses ultrasound imaging
and Doppler to check blood flow in the two carotid arteries on both sides of the neck that carry blood from the heart to the brain. ◆◆ Echocardiogram (ECHO): evaluates the
structure and functions of the heart and associated vessels. The ultrasound imaging is performed over the chest area. ◆◆ Lower extremity arterial study (PAD): uses
a Doppler “pencil” and blood pressure cuffs to check arterial circulation in the legs. ◆◆ Renal arterial study: uses ultrasound
imaging and Doppler to check the blood flow to the kidneys and renal arteries. ◆◆ Upper extremity arterial study: uses a
Doppler “pencil” and blood pressure cuffs to check arterial circulation in the arms. ◆◆ Venous duplex (DVT) study: uses ultrasound
imaging and Doppler to check venous circulation in legs and arms to search for blood clots.
EKG PROCEDURES ◆◆ Electrocardiogram (EKG): records the
heart’s electrical activity to determine how fast the heart is beating, the rhythm of the heartbeat, and the strength and timing of the electrical signals as they pass through each part of the heart. ◆◆ Event monitors: similar to Holter monitors,
these devices are worn for up to 30 days and record events such as chest pain or fluttering in the heart. ◆◆ Holter monitors: battery-operated portable
devices that measure and record the heart’s activity for a period of time, usually 24 to 48 hours. ◆◆ Stress test (treadmill): provides information
about how the heart responds to exertion. Involves walking on a treadmill that increases speed and elevates every three minutes.
NUCLEAR MEDICINE PROCEDURES ◆◆ Multigated acquisition (MUGA) scan:
a scan that creates video images of the lower chambers of the heart that hold blood to determine whether they are pumping blood properly. ◆◆ Myocardial perfusion imaging: a scan
that evaluates the heart’s function and blood flow. ANNUAL REPORT 2015
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Advances in the Diagnosis of Heart Disease in Women eart disease knows no gender. It kills more women and men each year than all types of cancer combined. But, according to the American Heart Association, cardiovascular disease causes one death every minute among U.S. women. And the guiltiest culprit among heart conditions is coronary artery disease (CAD), also known as atherosclerosis. Often, heart disease goes undetected in women, who tend to experience different symptoms from coronary heart disease compared to men. Not only do women experience a broader list of symptoms, such as nausea and fatigue, they may experience pain in the arms and neck rather than the
chest. In addition, women often have a nonobstructive form of heart disease, which may not be detected using traditional tests. “I see a wide spectrum of types of heart disease, and I am constantly amazed at how atypical some symptoms can be. In women, a lot of times the more atypical symptoms
Amy Rawl Epps, MD, FACC
Robert M. Malanuk, MD, FACC
Stephen E. Van Horn, MD, FACC
get ignored or blamed on stress or hormones,” said Amy Rawl Epps, MD, FACC, of Lexington Cardiology, a Lexington Medical Center physician practice. “Certainly very benign cardiac conditions can be caused by an imbalance of female and stress hormones; however, no symptom should be ignored. It is always better to discuss concerning symptoms with your doctor than to wait until a problem develops,” she said. Several non-invasive tests, such as cardiac computed tomography (CT) angiography and multigated acquisition (MUGA) scans, can provide useful and unique information to help detect heart disease in women. While these tests were once considered research techniques, they have become more commonplace in everyday practice.
WHETHER A WOMAN SHOULD UNDERGO TESTING FOR HEART DISEASE AND WHAT TYPE OF TEST IS MOST APPROPRIATE DEPENDS ON HER RISK OF HEART DISEASE.
Cardiac CT angiography can find evidence of narrowing or blockages from plaques forming in the coronary arteries, which supply oxygen-rich blood to the heart muscle and allow it to function properly. This technology is useful for patients who have chest pain and a low risk of coronary artery disease because it can rule out significant narrowing of the coronary arteries.
A MUGA scan is a nuclear medicine test that allows doctors to see how well the heart muscle is supplied with blood, how well the heart’s chambers are working and whether part of the heart has been damaged by heart attack.
According to Robert M. Malanuk, MD, FACC, of Lexington Cardiology, using routine treadmill stress testing for women is less reliable, as many women will produce false-positive results. “In general, women benefit from imaging to better assess their risk and symptoms. Your physician can help determine which test might be best suited for you, be it either nuclear, echo or coronary CT imaging,” he said. Women can also benefit from other non-invasive tests, including electrocardiograms, Holter monitors and exercise stress tests. Whether a woman should undergo testing for heart disease and what type of test is most appropriate depends on her risk of heart disease. Stephen E. Van Horn Jr., MD, FACC, of Lexington Cardiology, also emphasizes the importance of talking with providers. “While testing for CAD is an excellent way to screen for problems, these tests are not foolproof and, occasionally, tests have false negatives. Symptoms are really the best way of alerting a patient that he or she may have a cardiac issue. Patients should trust their instincts, and let their doctor know right away if they feel something is out of the ordinary. Communication with your doctor is key,” said Dr. Van Horn. ANNUAL REPORT 2015
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Outpatient Services Outpatient services at Lexington Medical Heart Center include sleep medicine and cardiac rehabilitation. Sleep medicine services are available at Lexington Sleep Solutions, a Lexington Medical Center physician practice, which offers comprehensive sleep labs at three convenient locations in West Columbia, Irmo and Northeast Columbia. State-of-the-art cardiac rehabilitation services are offered at the hospital’s main campus in West Columbia, as well as in Irmo and Lexington.
SLEEP MEDICINE SERVICES ◆◆ Home sleep testing: a limited baseline sleep test performed in a
patient’s home that uses a type 3 monitoring device to screen for obstructive sleep apnea. ◆◆ Maintenance wakefulness testing: a series of tests that measures a patient’s
ability to stay awake during a time when the patient would normally be awake. ◆◆ Multiple sleep latency testing: a series of tests used to diagnose narcolepsy that measures
how long it takes patients to fall asleep and determines if they are able to achieve dream (rapid eye movement, or REM) sleep. ◆◆ PAP mask education and desensitization: personalized educational sessions for patients
having difficulty acclimating to the PAP mask and PAP therapy to ensure proper fit and help them better adjust to therapy. ◆◆ Pediatric sleep studies: sleep studies performed on children ages 3 and older. ◆◆ Polysomnogram: a baseline sleep test that records several body functions during sleep,
including brain activity, to determine what stages of sleep the patient achieves. ◆◆ Polysomnogram with therapy (continuous positive airway pressure, or CPAP, bi-level positive
airway pressure, or BPAP, and adaptive servo ventilation): an additional sleep test that includes various types of positive airway pressure (PAP) therapy performed on patients with obstructive sleep apnea. ◆◆ Split-night testing (partial PSG with PAP intervention): sleep studies performed on two
different nights on patients who need PAP therapy and meet the criteria of significant obstructive sleep apnea.
Cardiac Rehabilitation is designed to optimize a cardiac patient’s physical, psychological and social functioning, in addition to stabilizing, slowing or even reversing the progression of cardiovascular disease.
CARDIAC REHABILITATION Cardiac rehabilitation is a medically supervised program designed to optimize a cardiac patient’s physical, psychological and social functioning. Cardiac rehabilitation also stabilizes, slows or reverses the progression of cardiovascular disease. Lexington Medical Center’s program consists of three phases: ◆◆ Inpatient cardiac rehabilitation (Phase I): takes place while patients are in the hospital. ◆◆ Outpatient cardiac rehabilitation (Phase II): takes place after patients are discharged from
the hospital; usually includes up to 36 sessions. ◆◆ Maintenance cardiac rehabilitation (Phase III): takes place after Phase II rehabilitation ends,
usually lasting for three months. ◆◆ Maintenance vascular rehabilitation (Phase III): takes place after peripheral artery disease
patients are discharged from the hospital or after diagnosis, and usually lasts for three months.
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Snore No More
Better Sleep Means Better Health
T
o say Ryan McClanahan snored is an understatement. His wife Sarah slept with earplugs — and still had to sleep in the guest bedroom if Ryan fell asleep first.
“It was pretty intense,” Sarah said. “I would describe it as peeling paint off the walls.” For years, Ryan denied he snored at all. “My dad snores. You could hear him all across the house. Mom would say that I was worse than he was, but it never bothered me,” Ryan laughed. All that changed after the birth of Ryan and Sarah’s second child. He still slept — in fact, he sometimes dropped to sleep after just a moment on the couch, or even at his desk. But he didn’t feel rested when morning came. Sarah, up at night more often with the new baby, also noticed that the snoring was irregular. Sometimes Ryan would snore a few times and then stop breathing; moments later he’d choke and would start OBSTRUCTIVE breathing again. “I told him, ‘you could die from that. You can’t leave me with two small children,’” Sarah said. She urged Ryan to see a sleep specialist.
SLEEP APNEA, HAS BEEN KNOWN TO HAVE SIGNIFICANT HARMFUL EFFECTS ON CARDIAC HEALTH.
Ryan’s daytime sleep problems were becoming worse. At times, he nodded off while driving. “It culminated one day when I was coming off an interstate exit ramp,” Ryan said. “I was slowing down to approach the light, dozed off and hit the car in front of me. That was the straw that broke the camel’s back.” “I told him, ‘enough is enough, You’re going to end up hurting yourself or someone else,’” Sarah said.
Ryan agreed to see his family practitioner, Dr. Clarence E. Coker III, a physician at Lexington Sleep Solutions, a Lexington Medical Center physician practice. Dr. Coker thought Ryan might be suffering from Clarence E. Coker obstructive sleep apnea, III, MD which happens when the airway is partially or completely blocked during sleep. Sleep apnea makes the muscles work harder to push open the airway and pull air into the lungs, so breathing may start again with a loud gasp or jerk. Ryan’s snoring was a precursor for more problems associated with sleep apnea. The condition interrupts the restorative sleep the body needs for healthy functioning. Sleep apnea can reduce the flow of oxygen to vital organs and cause irregular heart rhythms. People with the condition are more likely to have heart attacks and type 2 diabetes. “I had slightly high blood pressure, prehypertension, and the triglyceride level in my blood was super high,” Ryan said. “I was also overweight for a number of years, and that certainly exacerbates sleep apnea.” “Sleep-disordered breathing, otherwise known as obstructive sleep apnea, has been known to have significant harmful effects on cardiac health,” Dr. Coker said. “These include elevated nocturnal blood pressure and low oxygen levels while asleep, and changes in hormone levels that often contribute to cardiovascular disease.” Dr. Coker recommended an overnight and a daytime sleep study to test for both insomnia and obstructive sleep apnea. In a comfortable room at Lexington Sleep
C EEP MEDI
E
SL
Thanks to a consistent, diligent use of a CPAP machine, Ryan is waking up feeling more rested.
IN
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Solutions, the staff hooked Ryan up to monitors to measure air flow, blood oxygen levels, breathing patterns, brain electrical activity, eye movement, heart rate and muscle activity. Halfway through the nighttime study, the staff became concerned as Ryan stopped breathing multiple times. They put Ryan on a CPAP machine — a face mask hooked to a unit about the size of a clock radio that forces air through the nose or mouth, just enough to keep the upper airway open during sleep. Dr. Coker, who is board-certified in sleep medicine, confirmed the diagnosis. He recommended that Ryan work toward wearing the CPAP machine every night. “While surgery and oral appliances can improve sleep apnea, CPAP has been shown to be effective about 95 percent of the time,” Dr. Coker said. “Consistent, diligent use of CPAP at the proper pressures has been shown to drastically reduce the risk of cardiovascular disease and reduce recurrent events in patients with previously diagnosed cardiovascular disease. Thankfully, modern CPAP machines are easier to use and more comfortable for patients.” “The idea of sleeping with a mask strapped to my face every night — I was apprehensive, to say the least,” Ryan said. But he took it as a personal challenge. His
machine feeds nightly data to a mobile app so he can take a “tour” of his last night’s sleep. “The app tells you how many times you woke up and how much air is leaking out of the mask, and it gives you a score. So for that first month or so, I was competing with myself: Can I beat my score from the day before? That helped in the adjustment period. It was something to achieve.” Ryan experienced the effects of better sleep quickly. “The fatigue I was feeling during the day went away. I wasn’t falling asleep at the wheel or dozing off at my desk at work. I woke up feeling more rested — that was a great thing. It had been nearly a year since I felt rested.” His health improved as well; blood pressure, cholesterol and triglycerides are now within normal levels, and he no longer has to take some medications. He’s even lost weight. Sleep has improved for Sarah, too, who can sleep in her own bed without ear plugs. “For the first time in 10 years, I’ve been able to watch Ryan sleep when I’m the first one to wake up in the morning,” she says. “To look over and see a continuous rise and fall of his chest — it gives me such comfort to know that he’s breathing well.” ANNUAL REPORT 2015
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Heart Attack Inspires Winning Recipe for Life upre Percival eased into his “final quarter” of life without changing his game plan. The entrepreneur and founder of Dupre Catering and Events worked long and full days. He oversaw operations at his Senate Street events kitchen and guest venues in Columbia, networked with business clients, hovered over his executive chef ’s imaginative creations, parked cars and washed dishes. “We do about a thousand events a year,” he said “It’s a physically demanding business, with a lot of late nights, a lot of lifting and carrying. I ate when I wanted and what I wanted.”
As Dupre approached 75, he began to feel the effects of an over-full life. He dismissed sleep problems, indigestion and pain in his back as signs of age. Then, on August 13 of 2015, he felt winded as he climbed the slight slope from the Senate Street catering kitchen to his office. At 3:00 p.m., he surprised his wife and business partner son by going home. Dupre has a wealth of professional friends. Recognizing that something was seriously wrong, he called a friend who is a surgeon. The friend advised Dupre to head straight to Lexington Medical Center. Although Dupre has genetic longevity on his side (his mother will soon be 102 years
old), his lifestyle was the perfect mix for coronary artery disease: a high-stress career; uneven sleep patterns; little regular exercise; and a diet high in sugar, salt and fat. His symptoms flashed no warning lights. That’s not uncommon; coronary artery disease sometimes appears with symptoms similar to indigestion or heartburn. Related symptoms may be masked as shoulder, arm, neck, back or jaw pain. It wasn’t until Dupre experienced shortness of breath that the disease got his attention. “In retrospect, I was feeling heart pain, but I was not listening to my body. I’m lucky — I could have had a serious heart attack.”
The diagnosis and surgery got Dupre’s attention. He delegated all his professional concerns to his son and executive chef to focus 100 percent on his health. “After surgery, what I needed was quiet and healing.” Dupre signaled “do not disturb” to his family to focus exclusively on recovery. He dove into physical therapy just weeks after surgery, starting cardiac rehabilitation at “my little club,” Lexington Medical Center Irmo. “They monitor you and help you get through it. I started doing just one minute on each exercise, and now I’m at 25 minutes.” Dupre, now a cardiac rehab graduate, dropped 30 pounds in just four months. The trim,
With three badly clogged arteries, a stent was not a treatment “I had great confidence in the option for Dupre. As he professional approach of the entire team. faced open heart surgery, he remembered how I was given the most professional care impressed he was with a I’ve ever had in 75 years.” — Dupre Percival young cardiovascular surgeon at Lexington buoyant 75-year-old appears healthy, happy Medical Center and full of life. — Jeffrey Travis, MD, of Lexington Cardiovascular Surgery. They met when “I am playfully moving forward to my Dupre catered an event at the hospital. last quarter of life, and I’d like to have an Dupre requested that Dr. Travis, who influence,” he said. “I’ve been impacted spearheaded Lexington Medical Center’s by the total care package I received after comprehensive heart surgery, so I’ve decided to stay with the program, take his exercise program, and maybe have a positive case and perform the effect on others who are there.” needed surgery. Dupre adjusted his own cooking with low-fat, Dupre playfully calls low-salt alternatives, and welcomed some Dr. Travis “John healthier recipes in his catering kitchen as Wayne” now. well. He says more people are interested in options that are both delicious and healthy. “I had great confidence in the Jeffrey A. Travis, MD There have been other changes for Dupre. professional approach He is more intentional with his meals, and of the entire team. I the work day slows down at 4:00 p.m., when was given the most professional care I’ve ever he lets his staff, which proved quite capable had in 75 years,” Dupre said. in his absence, run with the business. He also tries to remove himself from “the conflicts Dr. Travis called Dupre a true Southern of life.” gentleman whom he enjoyed getting to know, but added that his journey to heart surgery is “Business has its conflicts — just living has a familiar one. its conflicts. That’s where God comes in. Probably the only way you can change is to “Dupre is one-of-a-kind, but his story is not have a good balance between spirit and life. unique,” Dr. Travis said. “Stress and lack of focus on one’s own health is a recipe for a “It’s worth it to try to make it through as visit to my office.” many quarters as you’ve got,” he added. “It’s unbelievable how good I feel today.” ANNUAL REPORT 2015
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Research and Continuing Education Lexington Medical Heart Center is at the forefront of cardiovascular research, offering new diagnostic, medical and surgical treatments with the goal of preventing all types of heart disease and illnesses. Participation in regional, national and international studies enhances physicians’ familiarity with promising advancements in interventional procedures, cardiac surgery, vascular surgery and clinical cardiology. The result is improved outcomes for patients.
LEXINGTON CARDIOLOGY CLINICAL TRIALS The clinical trials at Lexington Cardiology are part of Lexington Medical Heart Center’s comprehensive diagnostic, treatment and management services for patients with heart disease. These trials include studies to measure patient compliance, evaluate new methods for interventional procedures and assess the effectiveness of the latest technology. ◆◆ Affordability and Real-world Antiplatelet Treatment Effectiveness After Myocardial
Infarction Study (ARTEMIS) ARTEMIS is a clinical trial that evaluates whether reducing a patient’s copayment significantly influences their selection of antiplatelet therapy and their long-term adherence to the therapy. The study also examines patient outcomes and the overall cost of care after acute myocardial infarction. Researchers hypothesize that reducing the out-of-pocket copayment will lead to greater patient adherence and possible reduction in major adverse cardiac events. Lexington Cardiology is actively enrolling participants, with 52 enrolled to date. ◆◆ Transcaval Access for Transcatheter Aortic Valve Replacement in Patients with No Good
Options for Aortic Access Study Transcaval access for transcatheter aortic valve replacement (TAVR) is an investigational research study sponsored by the National Heart, Lung and Blood Institute at the National Institutes of Health. Lexington Cardiology is one of 20 hospitals participating in the study. Transcaval aortic valve replacement is a way to replace the aortic valve in patients who are considered a high surgical risk or those not eligible for the standard TAVR approach. Robert A. Leonardi, MD, FACC, FSCAI, has performed eight procedures to date. ◆◆ Siello Clinical Study
The Siello clinical study is an investigational study involving the Siello S pacemaker lead, which is a transvenous, bipolar, endocardial lead designed for permanent atrial or ventricular stimulation and sensing. Lexington Cardiology currently has eight active participants in the follow-up data collection phase of this study. ◆◆ ST Monitoring to Detect ACS Events in ICD Patients Study (Analyze ST)
The Analyze ST research study is an investigational study involving patients with implantable cardioverter defibrillators (ICDs). The Analyze ST investigational component of ICD has the capability to record heart rhythm tracing when the heart is not getting enough oxygen due to a blockage in a coronary artery. In this event, the patient receives a vibratory alert through his or her ICD. Lexington Cardiology has five active participants in the follow-up data collection phase of this study.
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◆◆ Site Clinical Trial of the SonRtip Lead and
Automatic AV-VV Optimization Algorithm in the PARADYM RF SonR CRT-D (RESPOND CRT) RESPOND CRT is an investigational study involving patients requiring ICD with cardiac resynchronization therapy (CRT). CRT devices are effective in the treatment of heart failure. The ICD and lead components provide measurements that can be used to optimize therapy without the use of echocardiography. Lexington Cardiology currently has one active participant in the follow-up data collection phase of this trial. ◆◆ Longitudinal Surveillance Study of
the 4-SITE Lead/Header System (LSS of 4-SITE) LSS of 4-SITE pacemaker lead study is a post-market registry study. The primary purpose is to evaluate, document and report on the appropriate clinical performance, long-term reliability and functional integrity of the 4-SITE Lead/ Header System. Lexington Cardiology has three active enrollees in this study.
◆◆ Longitudinal Surveillance Registry
of the ACUITY Spiral Lead (LSR of ACUITY Spiral) LSR of ACUITY Spiral pacemaker lead study is a post-market registry study designed to evaluate and report on the lead’s long-term reliability and clinical performance. Lexington Cardiology currently has four active participants enrolled in this study. ◆◆ St. Jude Medical Product Longevity and
Performance (SCORE) The Score study is an ongoing post-market registry study of patients with implanted St. Jude Medical (SJM) Cardiac Rhythm Management (CRM) devices. CRM devices include pacemakers, ICDs, cardiac resynchronization therapy pacemakers (CRT-P) and cardiac resynchronization therapy defibrillators (CRT-D). The objective of the registry is to evaluate acute and long-term performance of SJM marketreleased CRM products by analyzing product survival probabilities, including electrical and mechanical performance. Lexington Cardiology has 90 patients enrolled in the follow-up data collection phase of this trial. ANNUAL REPORT 2015
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VASCULAR ODYSSEY SYMPOSIUM Each year, Lexington Medical Center’s Vascular Odyssey Symposium focuses on how the hospital’s health care team influences vascular patient outcomes through assessment and management of care. Physicians and clinicians address obstacles that affect the team’s performance in assessing and managing care, and present current recommended approaches during the one-day conference for health care professionals.
CARDIOLOGY SYMPOSIUM Presented in collaboration with Duke Health, Lexington Medical Heart Center’s annual Cardiology Symposium is designed to provide health care professionals with evidencebased diagnostic and management skills to improve health care outcomes and quality of life for patients with cardiovascular risk factors. Physicians, physician assistants, nurse practitioners, nurses, echosonographers and other health care professionals attend this regional conference.
Patient Support Patients and family members may feel frustrated, upset or overwhelmed after learning that they or a loved one has heart disease. Lexington Medical Heart Center is there to help them cope with their diagnosis and improve their health with two cardiac-related support groups.
HEART TO HEART SUPPORT GROUP This free support group enables cardiovascular patients, families and caregivers to learn more about heart disease and vascular disease from guest speakers, and be encouraged by other patients who have recovered from treatment and are living heart-healthy lifestyles. Heart to Heart meets the first Thursday of February, March, April, October, November and December at Lexington Medical Center’s main campus in West Columbia.
AWAKE SUPPORT GROUP The Alert Well and Keeping Energetic (AWAKE) support group offers information and help for those whose lives are affected by sleep apnea. Participants get advice on different treatment options, such as continuous positive airway pressure (CPAP), oral appliances and surgical interventions, and learn ways to best deal with sleep apnea. AWAKE also gives patients and their families an opportunity to share their struggles with sleep apnea. Dedicated health professionals facilitate each meeting and serve as guest speakers.
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Community Outreach In South Carolina, one out of every three deaths is related to heart disease. As part of its commitment to improving the health of its community, Lexington Medical Heart Center promotes early detection and diagnosis of disease and illness with low- or no-cost health screenings and educational events.
HEART & SOLE WOMEN’S FIVE MILER As South Carolina’s premier women-only road race, the Lexington Medical Center Heart & Sole Women’s Five Miler features a five-mile run, and three- and five-mile walks. For the past 15 years, the event has encouraged healthy lifestyles through physical activity for women of all athletic abilities and called attention to the issue of heart disease as the number one killer of women. Elite athletes, as well as first-timers, enjoy this special event that presents participants with red roses at the finish line, medals for all finishers and chocolate-covered strawberries. A post-race health expo provides important hearthealthy information to women and their families each year.
HEART FAIR Lexington Medical Center’s Heart Fair provides the Midlands community with important hearthealth education in an interactive way. From cooking demonstrations to health screenings and fitness classes, community members learn how to improve their cardiovascular health at the annual event. Lexington Medical Center physicians and clinicians are available to discuss heart-related topics, and participants can discover the latest cardiovascular technologies used in diagnostic, interventional and surgical procedures.
SPEAKERS BUREAU Lexington Medical Center is dedicated to educating its community about the risk factors for heart disease and stroke. School, civic, church or other organizational groups interested in educating members or employees about how to live a healthier lifestyle can request a guest speaker from the hospital’s free Speakers Bureau. Physicians, nurses and other health care professionals discuss a wide range of topics, including health and wellness, and advanced medical technology.
CT HEART SCREENINGS Not all heart disease patients have chest pain or trouble breathing. In fact, they may have heart disease and not know it. Because heart screenings are the best way to determine a person’s risk and detect symptoms of disease early, Lexington Medical Center offers discounted computer tomography (CT) heart screenings each February at its main campus in West Columbia. Calcium scoring scans check for plaque buildup in the arteries that supply blood to the heart. A physician must order this non-invasive test, which may help determine if a patient has an intermediate risk for heart disease. ANNUAL REPORT 2015
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LEXINGTON CARDIOLOGY
William W. Brabham, MD, FHRS
William D. Brearley Jr., MD, FACC
Brandon C. Drafts, MD, FACC
Amy Rawl Epps, MD, FACC
Mitchell W. Jacocks, MD
S. Stanley Juk Jr., MD, FACC
Joseph J. Lawton III, MD, FACC, FSCAI
Robert A. Leonardi, MD, FACC, FSCAI
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Physicians Lexington Medical Heart Center’s multidisciplinary team of boardcertified physicians and surgeons offer the most advanced medicine and state-of-the-art technologies to provide comprehensive cardiovascular care in the Midlands. Robert M. Malanuk, MD, FACC
LEXINGTON CARDIOVASCULAR SURGERY
Michael C. Roberts, MD, FACC
Richard E. Umbach, MD, FACC
Deyanira “Dee” Prastein, MD
Stephen E. Van Horn Jr., MD, FACC
R. Taylor Williams, MD, FACC
Jeffrey A. Travis, MD
LEXINGTON RADIOLOGY ASSOCIATES
William P. Brehmer, MD
David N. Knight, MD
SOUTHERN SURGICAL GROUP
Christopher T. McCarty, MD
Jonathan K. West, MD, FAWM
LEXINGTON SLEEP SOLUTIONS
Raymond S. Fryrear II, MD
Jeffrey S. Libbey, MD, FACS
Clarence E. Coker III, MD
Francis M. Dayrit, MD, FCCP
Nicholas A. Limperos, MD
William M. Moore Jr., MD, FACS
Sarkis S. Derderian, DO, FCCP, D, ABSM
Paul M. Kirschenfeld, MD, FACP, FCCP
Ronald G. Myatich, MD, FACS
Terry O. Norton, MD, FACS
M. Christopher Marshall, MD, FCCP
Mohamed S. Soliman, MD, FCCP
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Demographics & Statistics Lexington Medical Center benchmarks itself against nationally recognized registries to ensure its processes and standards lead to the best patient care. Each registry collects a variety of data elements about the care of specific patient populations, and analyzes and compares these standards to hospitals of similar size and services. Lexington Medical Center implements process improvement projects whenever registry data reveals opportunities to improve patient care.
Heart Catheterizations Gender
58%
42%
Race
83%
Men
Caucasian
15%
Women
African-American
1%
63
Average Age
39
Hispanic
LMC 2014 data
Heart Cath Procedure Volume
3,000
2,555
2,500 2,000
2,753
2,945
1,980
1,500 1,000 500 0
2012
2013
2014
2015
Heart Attack Door-to-First Device Time (Lower is better.)
When a patient has a heart attack, the American College of Cardiology and the American Heart Association support a “Door-to-First Device� time of 90 minutes or less. Door-to-first-device time is the number of minutes between the time a patient arrives at the hospital until the blocked artery is opened. Hospitals participating in the National Cardiovascular Data Registry (NCDR) report an average time of 59 minutes, with Lexington Medical Center reporting a time of 53 minutes.
53 min
LMC
59 min
National Source: NCDR Q4 2012, Q4 2013, Q4 2014 CathPCI Report & Internal Case Counts for 2015
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Heart Attacks
40
Gender
Race
66% 34%
82%
Men
Women
Average Age
63
Caucasian
15% African-American
1%
Hispanic
LMC 2014 data
Overall AMI (Heart Attack) Performance STEMI and Non-STEMI Patients (Higher percentage is better.)
Overall AMI Performance
99.5%
99.1%
STEMI Care Performance
100%
99.8%
Non-STEMI Care Performance
99.1%
99%
LMC National 90th Percentile National organizations such as the American College of Cardiology and the American Heart Association recognize that heart attack patients have better outcomes if they receive certain medications and education during their hospital stays. Lexington Medical Center consistently exceeds the top 10 percent of hospitals, as evidenced by the heart attack care composite scores from the National Cardiac Data Registries. (STEMI and Non-STEMI are two specific types of heart attacks.)
Source: NCDR Q4 2014 ACTION Report
STEMI and Non-STEMI Care Performance (Higher percentage is better.)
Aspirin at Arrival
100%
100%
Aspirin at Discharge
100%
100%
Beta Blocker at Discharge
100%
100%
ACE-I or ARB for LVSD at Discharge L
100%
100%
Statin at Discharge
100%
100%
Adult Smoking Cessation Advice
100%
100%
LMC
National 90th Percentile
41
At Lexington Medical Center, 100 percent of our patients receive appropriate medications upon their arrival at the hospital and at the time of discharge. In addition, the hospital provides smoking cessation education to all heart attack patients while they’re in the hospital to help them decrease their risk for further heart attacks and heart damage. ACE-I ARB LVSD
Angiotensin-Converting Enzyme Inhibitors Angiotensin II Receptor Blockers Left Ventricular Systolic Dysfunction
Source: NCDR Q4 2014 ACTION Report
Discharge Location After Heart Attack (Discharge to home is better.)
100% 80%
94.2% 85.4%
60%
2.2% 3%
40%
.9% 4.2%
.5%
5%
20% 0
Home
LMC
Nursing Home
Extended Care/ Transitional Care
Other Hospital
National After a heart attack, 94 percent of Lexington Medical Center patients are able to go home instead of to a nursing home or rehabilitation facility. Nationwide, about 85 percent of patients at similar hospitals go home after a heart attack. Source: NCDR Q4 2014 ACTION Report
ANNUAL REPORT 2015
LEXINGTON MEDICAL HEART CENTER
Implantable Cardioverter Defibrillators (ICD) Gender
Race
66% 34%
42
Women
84%
Men
Caucasian
13% African-American
1%
Average Age
69
Asian
1%
Pacific Islander LMC 2014 data
Implantable Cardioverter Defibrillators Volume Cases
140
150 120
83
90 60 30 0
26 2012
2013
2014
Source: NCDR Q4 2012, Q4 2013, Q4 2014 CathPCI Report & Internal Case Counts for 2015
Medications at Discharge — ICD Patients (Higher percentage is better.)
ACE/ARB for LVSD Prescribed at Discharge
100%
Beta Blocker Prescribed at Discharge for Prior MI Patients
100%
100%
Beta Blocker Prescribed at Discharge for Patients with LVSD
100%
100%
Antibiotics prior to Procedure
100%
100%
Incidence of Hematoma
Zero
Zero
LMC
National 90th Percentile
100%
43
ICD patients must receive the appropriate medications at discharge to improve their overall outcome. In addition, they must receive appropriate antibiotics prior to having an ICD procedure. Hospitals work diligently to minimize complications, such as hematomas, that may lengthen a patient’s length of stay.
ACE-I ARB LVSD
Angiotensin-Converting Enzyme Inhibitors Angiotensin II Receptor Blockers Left Ventricular Systolic Dysfunction
Source: NCDR 4Q 2014 ACTION Report
ANNUAL REPORT 2015
LEXINGTON MEDICAL HEART CENTER
Coronary Artery Bypass Surgery Gender
Race
75% 25%
88%
Men
Caucasian
9%
Women
African-American
44 Average Age
65
Cases
Asian
LMC 2014 data
Coronary Artery Bypass Graft (CABG) Surgery Volume
250 200 150 100
1%
167
197
213
109
50 0
2012
(March–Dec)
2013
2014
2015
Source: STS/DCRI Report published April 2015
Blood Products Used During Cardiac Surgery Percentage of Surgery Cases
(Lower percentage is better.)
43.5%
50 40
30.5%
30
17.4%
20
22.8%
10
45
0
LMC
2012
2013
2014
National
National Benchmark
Blood transfusions are common during cardiac surgery, especially when cardiopulmonary bypass is needed. Decreasing the need for blood products during surgery improves a patient’s overall outcome. Lexington Medical Center has consistently maintained lower-than-average use of blood products during cardiac surgery. Source: STS/DCRI Report published April 2015
Discharge Location After Cardiac Surgery (Discharge to home is better.)
100
89.2%
80
79.2%
60
10.8%
40
16.2%
0%
2.9%
20 0
Home
LMC
Transitional Care Unit/Rehab
Nursing Home
US Registry After coronary artery bypass surgery, 89 percent of Lexington Medical Center patients are able to go home instead of to a transitional care unit, rehabilitation facility or nursing home. Nationwide, about 79 percent of patients at similar hospitals go home after this type of surgery. Source: STS/DCRI Report published April 2015
ANNUAL REPORT 2015
LEXINGTON MEDICAL HEART CENTER
Transcatheter Aortic Valve Replacement (TAVR) Gender
31%
Race
94%
Men
Caucasian
69%
46
Women
6% African-American
82
Average Age
LMC 4th Qtr. 2014 data
TAVR Patient Volume
Procedure Volume
80
66
70 60 50 40
34
30 20 10 0
2014
2015
Number of Procedures
May–December 2015
(Program started in May of 2014)
Source: STS/ACC NCDR Report published August 2015
Discharge Location After TAVR Procedure (Discharge to home is better.)
100 80
75% 67.7%
60
47 18.8%
40
25.6%
6.6%
5.3%
20 0
Home
Transitional Care Unit/Rehab
Nursing Home
LMC US Registry After a TAVR procedure is completed, 75 percent of Lexington Medical Center patients are able to go home instead of to a rehabilitation facility or nursing home. Nationwide, less than 70 percent of patients at similar hospitals go home after this type of surgery.
Source: STS/ACC NCDR Report Published August 2015
ANNUAL REPORT 2015
LEXINGTON MEDICAL HEART CENTER
Stroke Gender
Race
53% 47%
48
83%
Men
Caucasian i
16%
Women W
African-American
Average Age
69
LMC Data Source: 2015 Leapfrog Report
Average Length of Hospital Stay for Stroke Patients (Lower is better.)
10 9
Number of Days
8 7 6
5.6
5.7
5.4
5.8
2013
2014
2015
National Average
5 4 3 2 1 0
LMC National LMC Data Source: 2011–April 2013, All Stroke Discharges Meditech, starting May 2013 EPIC report; Benchmark Source: CY 2014 Outcome Science; 2Q 2013 forward excluded outliers
Stroke Care Performance VTE Prophylaxis by End of Hospital Day 2
100%
97%
98%
99%
Anticoagulation Therapy at Discharge for Atrial Fibrillation
100%
97%
Thrombolytic Therapy within 3 hrs. (Sampling of tPA cases)
100%
Thrombolytic Therapy within 3 hrs. (All of tPA cases)*
88%
(3Q 2014–2Q 2015 Outcome Science)
100%
98%
96%
97%
100%
94%
98%
99%
Discharge on Antithrombotic Therapy
Antithrombotic Therapy by End of Hospital Day 2
Discharge on Statin Medication Stroke Education
Assessment for Rehabilitation
LMC
83%
(CMS)
88%
National Average
The American Stroke Association advocates early recognition and rapid medical treatment of patients experiencing stroke symptoms to help minimize long-term effects and prevent death. As a certified primary stroke center, Lexington Medical Center is committed to the rapid treatment of stroke patients. The hospital consistently meets quality standards set by the Centers for Medicare & Medicaid Services (CMS) and performs higher than the national average in most stroke measures.
*AHA Get With The Guidelines measure
Source: Hospital Compare 3Q 2014–2Q 2015
ANNUAL REPORT 2015
49
CARDIOVASCULAR SERVICES AT LEXINGTON MEDICAL CENTER
LEXINGTON MEDICAL HEART CENTER
A Timeline 2000
August: Lexington Medical Center’s board of directors approves the submission of a certificate of need (CON) application for a diagnostic heart catheterization lab.
2001
January: LMC receives CON approval from S.C. Department of Health and Environmental Control (DHEC) for a diagnostic cath lab.
2002
LMC opens its first diagnostic heart catheterization lab.
2004
50
2006 2008 2009
April: LMC files CON application to provide comprehensive cardiac services, including open heart surgery and elective therapeutic cardiac catheterizations. October: DHEC denies CON application. February: LMC appeals DHEC’s decision to the S.C. Administrative Law Court. April/May: S.C. House and Senate pass a bill that would allow LMC to perform open heart surgery. Bill is vetoed by Governor Mark Sanford. September: S.C. Administrative Law Court denies LMC’s CON application for comprehensive cardiac services. January: S.C. Supreme Court agrees to hear LMC’s appeal for open heart surgery. November: LMC files CON application for addition of second cardiac cath lab and provision of emergency percutaneous coronary intervention (PCI) services. February: LMC partners with Providence Hospitals in an agreement to allow LMC to add an open heart surgery suite. November: DHEC approves addition of second cardiac cath lab and emergency PCI services. December: LMC files joint CON application with Providence Hospitals for an open heart surgery program at LMC.
2010
January: LMC opens second cardiac cath lab.
2011
June: LMC partners with Duke Health to develop comprehensive cardiac program at LMC.
2012
March 28: LMC performs its first three-vessel coronary artery bypass graft (CABG).
June: DHEC gives approval for the hospital to offer comprehensive cardiac services.
April 1: LMC performs its first elective percutaneous coronary interventional procedure.
2013
March: LMC launches its electrophysiology program.
2014
May: LMC launches its structural heart program, performing its first transcatheter aortic valve replacement (TAVR) procedure.
2015
September: LMC performs its first transcaval aortic valve replacement, the first one in South Carolina and the 141st such procedure in the world. April: LMC offers new EKOS EkoSonic® Endovascular System treatment for pulmonary embolism.
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