Finding the Pulse in cardiac patient care

Sarajane Evans might need a bypass. And probably a new heart valve.

The 69-year-old woman from Tacoma got the news Wednesday from cardiologist Daniel Guerra while she was still on the operating table at Tacoma General Hospital.

Evans had been experiencing shortness of breath lately. Guerra performed a cardiac catheterization on her heart to check coronary arteries and evaluate Evans’ aortic valves.

“It’s a pretty routine diagnostic procedure,” Guerra said.

Over 600 people per year walk or are wheeled into MultiCare Health System’s emergency departments with chest pain indicative of a cardiac event.

In the past, whether admitted or sent home, those patients’ future health care needs could have been relegated to MultiCare’s various heart-related physicians or to a private practice such as the Cardiac Study Center.

But since May 1 patients such as Evans have been directed to Pulse Heart Institute, MultiCare’s and CSC’s new combined center for cardiac and vascular patients.

Pulse unites cardiac, thoracic and vascular services into one entity to manage needs from prevention through supportive care.

“We’re better off together than we are separate,” said Jason Parks, Pulse’s president.

The entity includes a number of facilities and units including cath lab, imaging, cardiac rehabilitation, coronary care and cardiovascular intensive care. Pulse’s 600 employees include 44 providers.

It was in the cath lab where Evans got her procedure Wednesday.

“Are you ready for your close-up?” Guerra asked Evans as he walked into the lab. Evans remained conscious during the procedure.

An X-ray video system recorded the procedure as Guerra and those assisting him put lead aprons on to shield themselves from the radiation.

The catheters looked like thin snakes as Guerra inserted them from Evans’ groin and later her wrist. On the monitors they pulsed along with her heartbeat.

As contrast was injected into Evans’ arteries they suddenly showed dark against the heart muscle.

“We’re done,” Guerra told Evans a few minutes later.

“Already? The whole thing?” Evans asked.

“Yes, you get to go home today,” Guerra said. “Piece of cake, right? No big deal.”

HOW WE RANK

The stakes are high in cardiac health: Heart disease is the leading cause of death for men in Pierce County, according to countyhealthrankings.org. For women, only cancer surpasses it.

And Pierce County has several unwanted first places.

“We’re first in the state for fast-food consumption, type II diabetes and obesity,” Parks said. Health behaviors as tracked by countyhealthrankings.org (smoking, physical inactivity, excessive drinking, etc.) puts Pierce at 33 of Washington’s 39 counties.

Add in a lack of cardiovascular physicians.

“We aren’t even close to being where we should be as a community,” Parks said, referring to cardiovascular care support in the entire South Sound.

He hopes Pulse will be a recruiting magnet for more physicians. They have already added three vascular surgeons and two cardiologists, he said.

“Having a platform like this is really compelling for those docs,” Parks said.

One of those doctors is Needham Ward, Pulse’s chief medical officer and a longtime cardiologist at CSC.

Previous to Pulse it might have taken six to eight weeks before a new heart patient could see a physician outside of an emergency department, Ward said.

Now, Pulse has created a “quick clinic” that can see nonadmitted patients within 72 hours of leaving the emergency department.

“We are allowing them a strategy where they can be seen quickly on an outpatient basis,” Ward said.

The institute launched May 1 with sites in Tacoma, Auburn and Puyallup.

Since then, “we’ve been able to see over 500 patients who would probably still be on our waiting list otherwise,” Ward said.

Pulse is built around five centers that focus on congestive heart failure, coronary artery disease, peripheral vascular disease, valvular heart disease and heart rhythm service.

A new call center has helped decrease waiting times, Parks said, and patients are spending less time in between appointments.

Heart valve replacement surgery is a good example, Ward said. What previously took 86 days on average to evaluate a patient has now been reduced to 38, Parks said.

RESEARCH AND PREVENTION

Cardiology is barely recognizable today compared with when Ward first became a doctor in 1972.

“If a patient had a heart attack, we put them in bed for three or four weeks and gave them morphine and lidocaine and hoped that they lived,” Ward said.

There were no angioplasty, stents, defibrillators, or valve transplants.

“Just a few years ago you had to have your chest opened to get a heart valve,” Ward said. “Now, it’s (commonly inserted) through the leg. We did three of those today.”

Coming soon will be a device implanted in the heart that prevents clots. Also ahead are bioabsorbable stents, and advances in valves, Ward said.

Pulse isn’t just treating heart problems, it’s also conducting research.

Since May 1, 12 studies have been initiated and another 21 have been scheduled, Ward said.

In addition to furthering knowledge those studies allow some patients access to cutting-edge drugs and devices, Ward said.

Prevention is a key aspect of Pulse’s mission.

“It’s difficult for multiple organizations to really have an influence on the community,” Parks said. “You have divergent messages, divergent incentives, divergent goals, divergent work happening.”

The prevention arm of Pulse includes community health, cardiac rehab and women’s cardiac health.

Pulse hopes to change the patient-doctor relationship into one that includes a prevention partnership, Parks said. He also hopes to extend that to the community and include other medical systems.

Both Parks and Ward said that Pulse is an institution where physicians call the shots. That leadership structure couldn’t happen without the support of hospital administration.

“This takes a real partnership between the physicians and the health system,” Ward said.

This story was originally published September 10, 2016 at 11:27 AM with the headline "Finding the Pulse in cardiac patient care."