The Christ Hospital has created disease-specific programs for patient care, several of which include heart failure, women’s heart health and complex coronary intervention. In doing so, they have developed miniature Centers of Excellence, each of which is led by a nationally networked physician champion who is supported by clinical coordinators and advanced practice providers, all of whom are disease specific. For example, every day at The Christ Hospital, when seeing patients suffering from heart failure, a credentialed, board-certified heart failure specialist is accompanied by at least two nurse practitioners, a pharmacist and a dietician, all of whom are trained and dedicated to caring for heart failure patients.
“They intimately know the guidelines for these patients. They follow protocols for care. They ensure that the treatment is guideline compliant,” says Dean Kereiakes, M.D., medical director of The Christ Hospital Heart and Vascular Center. “No stone is left unturned as each patient gets the highest quality of leading-edge, comprehensive care.”
Doctors at The Christ Hospital also look at their procedural results and track their outcomes. Plus, they have created an extensive clinical database in heart failure and other areas. They share — with four other major institutions — access to more than 20,000 heart attack victims whose data they analyze to help guide decisions. What truly sets The Christ Hospital apart, however, is that each of the Centers of Excellence is matrixed with the Lindner Center for Research & Education to provide access to leading-edge technology, new drugs and devices.
“We utilize investigational devices, on average, about three years ahead of when they are commercially available to other institutions,” says Kereiakes. “We are then able to integrate those devices into our practice years ahead of when they are commercially available to others in our region.”
Last summer, Kereiakes and his team cared for a 28-year-old patient with Down syndrome named Jeremiah Dodd who had heart issues since birth. He was dying of heart failure, so Kereiakes utilized a breakthrough technology known as a J-Valve to replace Jeremiah’s aortic valve and correct the aortic regurgitation.
“We were able to give that young man a treatment he couldn’t have gotten anywhere else,” says Kereiakes. “We had the ability to change a life based on access to leading-edge technology.”
One of The Christ Hospital’s most exciting recent developments is the addition of Odayme Quesada, M.D., MHS, an established clinical researcher and board-certified cardiologist with a specialty focus on women’s cardiovascular disease (CVD), who joined the Lindner staff over the summer. The recipient of a prestigious million-dollar grant from the National Institutes of Health (NIH), Quesada is the director of the new Women’s Heart Center.
“When she got here, she hit the ground running,” says Kereiakes. “Work at the Women’s Center has taken off like a rocket. She’s only been here a short while and she’s already booked months in advance, so we’re recruiting another physician champion to help her.”
The mission of the Women’s Heart Center is based on four fundamental pillars: Excellent Cardiac Medical Care, Clinical Research, Education, and Community Outreach. Taking a comprehensive approach to women’s cardiovascular health is critical, given women with heart disease have worse outcomes than men. We know that heart disease is different in women. For instance, many women have myocardial ischemia with no obstructive coronary disease (known as INOCA) but have been falsely reassured because they have a normal stress test or angiogram that shows no significant blockage in the heart arteries. Many of these women actually have coronary microvascular disease — disease of the small vessels in the heart — that requires specialized testing. Why women have this problem is the question Quesada aims to answer through her NIH grant.
“Essentially, they are often dismissed despite having concerning cardiac symptoms,” says Quesada, noting that women have specific risk factors that are unique to their gender. For example, many women don’t realize that having preeclampsia during pregnancy has been shown to increase their risk of developing cardiovascular disease later in life.
“These women should get their blood pressure checked on a regular basis,” says Quesada. “They think they are young and healthy and the next thing they know, they have lived with high blood pressure for months or even years. We want to see and educate them to prevent heart disease from developing in these women at higher risk.”
At the Women’s Heart Center, the following programs are offered:
1) cardiovascular clinic for women’s heart disease; 2) pregnancy and postpartum heart health, including treatment of hypertensive disorders of pregnancy; 3) preventive heart health for women at high risk of cardiovascular disease; and 4) cardio-oncology to support women facing cancer and cancer treatments that can affect their heart health.
“We hear stories all the time of patients telling us how happy they are that someone is finally validating their symptoms and is going to work hard to figure out if there is an underlying cardiac condition that may have been missed,” says Quesada. “They know that the problem is not simply in their head and that there must be something wrong. We are here to investigate further.”
Much of the population is shocked to learn that the No. 1 killer of women is not breast cancer but heart disease. Spreading that knowledge is key to prevention.
The Christ Hospital Women's Heart Center is dedicated to raising the bar for understanding women's heart disease and discovering novel treatments through leading edge research in collaboration with the Lindner Center for Research.
“We are losing traction when it comes to outreach and educating our community,” says Quesada. “Women have worse outcomes than men because heart disease is often not recognized fast enough and/or they are undertreated compared to men.”
At The Christ Hospital, however, the dedicated team of health care workers cares greatly. That’s why they do things a little differently. According to Kereiakes, doctors are often hired at other institutions merely to fill a gap when there is too much work to be done.
“They are afraid of losing patients, so they add a body,” he says. “We don’t do that. Instead, we ask, ‘What does our community need?’”
For instance, with no real expert in complex coronary intervention who had specialized expertise in opening up chronic coronary total occlusions (CTO), The Christ Hospital hired Robert Riley, M.D. He brought a wealth of knowledge and experience in opening up chronically blocked arteries which are often the deciding factor in the decision to recommend coronary bypass surgery versus a stent. Riley was given similar program support (nurse coordinator/navigator, etc.) and in under three years, The Christ Hospital has developed the fastest growing CTO program in the country.
“Doctors at The Cleveland Clinic have referred patients to Riley,” says Kereiakes, noting that the hospital did the same with the Women’s Heart Center because they felt it was a neglected area in the Greater Cincinnati region. “At Christ, we pick top people and build programs around them. It’s a recipe that really works.”
Though the pandemic has served to exhaust us all, no one at The Christ Hospital faltered.
“Here at The Christ Hospital and the Lindner Research Center, we identified our research personnel as essential workers. While other programs shut down clinical research, we shifted our focus,” says Kereiakes. “We did what cardiovascular research could be done during the pandemic, but we also really ramped up a portfolio of COVID-19 clinical research. Again, we moved to meet the needs of our community.”
And that’s only part of the story.
“With Dr. J. Michael Smith joining Drs. Geoffrey Answini, Julian Guitron and Jeffrey Griffin, plus a new cardiothoracic surgeon from the Cleveland Clinic, Dr. Saad Hasan, these guys are really doing great things,” says Kereiakes.
For example, Guitron has developed a pulmonary nodule clinic and is an expert at robotic and minimally invasive surgery for taking out lung cancers. Smith and Answini are presenting at the Society of Thoracic Surgeons on the first human experience with the Foldax Tria-valve for treatment of aortic valve disease.
“We have the largest experience in the U.S. with a revolutionary polymer valve that has the durability of metal but does not require long-term oral anticoagulation,” says Dr. Kereiakes. “We’ve already treated multiple people in Cincinnati with this leading-edge valve, which means they have gotten access to this technology years ahead of others. The Foldax Tria-valve has the potential to revolutionize heart valve treatment.
“Also, we made a decision to invest in the professional and personal development of our critical care nursing staff (CVICU, catheterization laboratories and CV-operating room) to reduce turnover rates and enhance retention of quality staff,” says Kereiakes. To do this, The Christ Hospital raised philanthropic gifts from the Farmer and Holzberger families to underwrite nurse education, credentialing and certification in a clinical advancement ladder that also includes a salary bonus.
“We incentivize and invest in our nursing personnel and their professional development and, in doing so, we have reduced turnover rates dramatically to well below the national average,” says Kereiakes. “These nurses have pride in their work. They are getting smarter and better at what they do, and we underwrite that. It makes for an exciting atmosphere.”
For more information, visit TheChristHospital.com/heart. To schedule a consultation with the Women’s Heart Center, call 513.585.2140. To schedule a second opinion with one of the hospital’s cardiothoracic surgeons, call 513.206.1170.