Englewood Health started September with five new additions to its cardiac care team, a week after announcing it was among the first hospitals to implant a brand-new device for heart valve repair.
Safe to say, the major investments in cardiac care just keep on coming. Other institutions aren’t skipping a beat, either.
Dr. Joseph De Gregorio, executive director of cardiovascular services at Englewood Health, said cardiology departments such as his are putting resources toward adding more subspecialties, often layering more expertise on top of what they do.
One of Englewood’s centerpieces, and an area it’s continuing to grow in, is heart failure. That’s a condition that 6.7 million of the country’s residents over 20 years old now have, a number that’s expected to rise to 8.5 million by 2030, according to a survey posted last year on PubMed Central.
Health systems view the increasing prevalence of certain heart conditions, amid the well-reported boom in the country’s older population that’s expected in coming years, as more than enough reason to keep investments flowing to their cardiac care divisions.
There’s also an indirect investment that health systems are making in bolstering heart programs through their acquisitions of other, smaller care teams.
Dr. Phillip A. Koren, director of the Cooper Heart Institute, said Cooper University Health Care has had significant growth in types of services it provides. Cooper’s completed acquisition of Cape Regional Health System this year will contribute to that.
“That basically gives us a huge referral base for cardiac care and talent in the system,” he said. “What that’s done is not only increase the amount of patients coming to Cooper, but expand newer modalities just by the sheer growth of the program.”
Cooper also, more than five years ago, integrated cardiac services with Inspira Health. Koren serves as an interventional cardiologist for the joint venture, Cooper and Inspira Cardiac Care.
Heart failure treatment is also an area of growth for it, Koren said. This fall, the local cardiac care program is incorporating a type of artificial heart pump called left ventricular assist devices, or LVAD, into its care for patients with end-stage heart failure.
“Of course, the capital expenditure of some of this tech can be overwhelming,” Koren said. “One of my goals after taking over the program was to run it intrinsically so financial investment made sense.”
As an upside, Koren said having an institution that’s expanding and making investments in the latest technologies makes recruitment of new talent an easier proposition.
“Having access to patients and a larger network in a core facility allows us to go out and hire doctors with the right skill-sets,” he said. “Our investments and partnerships give us the size and ability to attract and recruit doctors that can perform the latest procedures.”
For cardiac center centers, making investments and earning credibility as early adopters is a path to establishing solid relationships with medical device companies, De Gregorio added.
“When they know your outcomes are positive, and when you’ve been doing this so long, you get those devices quickly,” he said. “That’s important for something like valvular technologies, as it’s a slower process with a more meticulous release of devices, often in small batches. It’s more complicated, so they’re making sure everyone who they’re releasing it to is capable of using it. They want to put it in the hands of those with experience.”
Dr. Irfan Admani, chief of cardiology at Bergen New Bridge Medical Center, observes that health care organizations are just as often directing investments toward upgrading diagnostic capabilities today.
Bergen New Bridge Medical Center, which is busy building a new campus as a home for cardiology and other specialties, is investing in two new ultrasound machines to perform scans for a wide range of heart conditions, including aortic aneurysms.
Coronary imaging with computed tomography, or CT, is what Admani views as the future of diagnostic cardiology. Paired the latest software, this testing will provide a less invasive and more accurate approach for clinicians, he said.
As for the patients of cardiac care centers, they’re appreciating doctors utilizing costly advances in care — to the extent that they’re aware of it.
“While there are some savvy patients who are familiar with these diagnostic tools and the latest recommended treatment options, for a general patient population, it’s still early for that,” Admani said. “But, as long as it’s efficient and effective, that’s valuable to them.”
Smaller hospitals’ opportunity
If you’re doing a pulse-check on the health of cardiology departments at community hospitals today, Dr. Tariqshah Syed, chief of cardiology at Holy Name, is pleased to say you’d find it’s holding steady.
Cardiology departments at smaller hospitals haven’t always kept pace with those at larger hospitals. They didn’t have much say in the matter: State regulations mandated that some procedures, including elective angioplasty, could only be performed at high-volume hospitals with open-heart surgery options in place.
“The idea was that, if a patient had complications and needed urgent open-heart surgery, if you don’t have it on-site, now that patient needs to be transferred to a hospital that has it,” Syed said. “And, when you have to activate a service team at a different hospital, that could be detrimental to a patient’s outcome.”
But as cardiac care improved over the years, and, as complications from angioplasty appeared at a lower rate, Syed said the limitations on smaller hospitals — and the suppression of cardiac care expertise that dynamic created in certain geographies — didn’t make sense.
“We were actually part of a trial for a number of years, conducted by John Hopkins, that demonstrated there was no difference in terms of harm to patients (undergoing nonemergency angioplasty and stent implantation) at smaller hospitals versus larger ones that had full cardiac-surgery capabilities,” he said.
In 2021, Gov. Phil Murphy signed a law that allowed more community hospitals to provide full-service diagnostic cardiac catheterization and angioplasty services. Syed said that opened up the possibilities for a hospital such as Holy Name.
“Now, from a patient care perspective, you don’t have to go to a bigger hospital that’s maybe farther, but, rather, one within your community,” he said. “It also avoids certain insurance issues for some patients. I think, ultimately, it’s a big improvement for them.”
There’s still some differences Syed hopes the state Legislature could address in the future, such as a minimum number of procedures cardiologists need to perform leading up to working at smaller institutions.
But, there’s no risk of the growth of cardiac care at these smaller hospitals flat-lining anytime soon.
“I’ve seen things progress much in my time here,” Syed said. “It’s really significant. And we’re still progressing.”
