In cardiology departments in hospitals all over the country, teams of specialists employ today's best practices with a keen eye out for new diagnostic and treatment strategies because they know today's best practices were developed not so long ago — and tomorrow's technology is coming just around the corner.
Linda Gillam, MD, chair of cardiovascular medicine and medical director of cardiovascular services at Atlantic Health System, headquartered in Morristown, N.J., spoke with Becker's about her team's dual focus — on what's next in the cardiology care pipeline but also how she believes Atlantic Health's team-oriented approach to heart health ensures multiple great minds are working together when every minute counts.
Question: What's the most significant cardiology-related initiative that's come along recently?
Dr. Linda Gillam: Recognizing and committing to eliminating health inequity is a top priority for the house of cardiology. This is a complex problem — we know there are disparities in care based on race, ethnicity, gender, age and language spoken. We recognize the importance of social determinants of health, which account for over half of one's health.
Solutions are complex, too, but under the leadership of our professional societies, including the American College of Cardiology with which I am personally involved, we have multi-pronged approaches, including advocacy, education and research. It is a top personal priority for me.
Q: How does the Atlantic Health System stand out when it comes to cardiac care?
LG: It starts with our team. We have world-recognized physician leaders particularly in the areas of structural heart disease, complex coronary disease, sports cardiology, hypertrophic cardiomyopathy and imaging. Our award-winning nurses and advanced practitioners help define the patient experience. Our extensive clinical research program gives our patients access to new approaches to care. Our heart hospital on the Morristown Medical Center campus, with over 200 private cardiac beds and state of the art technology, completes the picture.
Q: Do you have a multidisciplinary approach to cardiac patient care?
LG: Definitely — and there are no weak links. Our physicians are national and international leaders in both diagnosis and treatment, and our organizational structure with cardiology and cardiac surgery under the same departmental umbrella facilitates communication. Our allied health professionals are also thought leaders and our nurses are simply the best, as recognized through Magnet and multiple Beacon awards. Our care always focuses on the patient, engaging home and social services where needed and, of course, we collaborate closely with providers in other disciplines.
Q: Can you explain and give an example of how "great minds" have solved major problems?
LG: One of the most challenging problems in cardiology is knowing when to intervene in patients with aortic stenosis, a common valve problem that can lead to heart failure and death. Traditionally, we have waited until symptoms appear or until there is evidence that the left ventricle is failing. Under the national trial leadership of Philippe Genereux, MD, Morristown Medical Center is the highest-enrolling site in a study testing the hypothesis that earlier intervention results in better outcomes (EARLY TAVR).
Dr. Genereux is also leading PROGRESS, a randomized prospective trial evaluating the role of early intervention for patients with moderate aortic stenosis but evidence of cardiac damage and/or symptoms.
Finally, the concept that classifying aortic stenosis based on cardiac damage is prognostically and potentially therapeutically important has been another key contribution of Dr. Genereux.
The results of these investigations have the potential to change guidelines for [treating] valvular heart disease.
Q: What do you see in the cardiology healthcare pipeline that you think will be market-changing?
LG: There are exciting developments in many areas of heart disease. At a 30,000-foot level, advancing personalized medicine with genotyping and more granular phenotyping will be increasingly important.
Artificial intelligence, starting with facilitating diagnosis, is already having a major impact. This includes streamlining and increasing access to existing approaches as well as developing new ones.
Other potential game changers include more sophisticated wearable devices, new approaches to risk management for atherosclerotic disease, devices for structural heart disease and approaches to disease management that more directly simultaneously target cardiac, renal and metabolic disorders.