Cardiac Care That’s More Efficient

In the northwest suburbs of Chicago, cardiac care seems to always be improving. Learn how treatment for heart disease is better now than even a year ago.

No matter your age, race, gender or ethnicity it’s important to prioritize your heart health. The more you can take care of yourself now to prevent heart disease later, the better. Learn from cardiac experts how to maintain a healthy heart and how treatments are improving for those who need intervention.

Preventing Heart Disease

It takes time for heart disease to develop, says Dr. Daniel Sauri, director of cardiac imaging at AMITA Health Medical Group Cardiovascular Associates in Elk Grove Village. The diet and exercise decisions we make, good or bad, have an accumulative effect on our health.

“We actually have several studies that demonstrate that the process of plaque buildup can start as young as our teenage years,” Sauri says. “Because of the obesity epidemic, the diabetes epidemic, we’re starting to see heart disease at a younger age. As a father myself, it’s extremely important to teach kids from a young age about what’s healthy and what’s not. It all begins with how we educate our kids about diet, nutrition and lifestyle.”

Once plaque is in the walls of your arteries, it’s difficult to reverse. And the more plaque that builds up over time, the more risk you face of having a heart attack or stroke.

About 610,000 people die of heart disease in the United States every year, making it the leading cause of death for both men and women. If you know heart disease runs in your family, it’s not a bad decision to begin regular appointments with a cardiologist starting as young as age 40.

“If you have a cardiovascular disease, such as high blood pressure, diabetes or high cholesterol, if you’re a smoker, or if you have a strong family history – meaning your mom, dad or first-degree relative had a heart attack or stroke before age 60 – those are people who should see a cardiologist earlier rather than later,” Sauri says.

“We want to get you on a good regimen and plan. And you really start to see how we can alter that heart disease process, probably not over a short period of time, but over that long haul, in order to prevent those consequences later on, like heart attack, stroke, kidney disease and other things that are very debilitating.”

Prevention is key when combating heart disease, and lifestyle choices are the crux of prevention.

It begins with dietary choices and exercise regimes that prevent the development of risk factors of heart disease. For example, a plant-based diet or low-carb diet can help prevent people from developing atherosclerosis and plaque buildup over time, Sauri explains. Exercising 30 minutes a day, four to five times a week, for a total of about 150 minutes a week is what he suggests for building up cardiovascular fitness.

People who have a genetic predisposition to heart disease, or people who manifest risk factors early on in life, may also want to undertake preventative imaging tests.

One such test is called coronary calcium scoring, which involves getting a CT scan of your heart. The test quantifies the amount of calcified plaque you have in your heart arteries, which correlates with your 10-year risk of having a heart attack or a stroke.

“That’s a good test because we’re learning in medicine that not one size fits all,” Sauri says. “We can’t just say, well, your blood pressure should be 120, and your cholesterol should be 100, and that will work for everybody. It’s really important that cardiovascular imaging looks at you as an individual, and what your risk really is.”

A calcium score of zero is ideal, since it indicates a low long-term risk. But someone with alarming amounts of plaque and a high coronary calcium score should be more aggressive in making lifestyle choices that prevent heart disease. In addition to diet and exercise decisions, this may involve taking medications for cholesterol or high blood pressure.

“If we’re aggressive and treating all the risk factors, we know that we can lower the risk of a heart attack or a stroke by about 80%,” Sauri says. “That’s why identification is so important early on because once we’ve identified plaque and atherosclerosis, we have the opportunity to stop it, to reverse it, and to prevent it from causing a heart attack or stroke.”

Improvements in Cardiac Surgeries

With many advanced heart diseases, treatment with medications alone can be frequently ineffective. So, patients need a reliable team of medical professionals to operate safely and efficiently.

Last spring, Northwest Community Hospital (NCH), in Arlington Heights, opened a new hybrid cardiac catheterization lab to provide better care for cardiac patients. The new space combines a typical cardiac catheterization lab, which is equipped with X-ray technology and multi-modality imaging, with capability to conduct open-heart surgical intervention.

“It’s like bringing a solid operating room and a solid cardiac catheterization lab and putting them in one,” explains Dr. Maen Nusair, an interventional cardiologist and the director of the structural heart program at NCH. “Most importantly, it allows us doctors to perform procedures that we weren’t able to perform in the usual setting.”

Many procedures done in the hybrid operating room don’t require large incisions that open up the chest. But surgeons are able to do so in a split second, if needed.

However, some procedures do require large incisions immediately, followed by X-ray driven techniques that make the procedure less invasive.
For example, one of the prime procedures done in the hybrid lab is called TAVR, or transcatheter aortic valve replacement, which replaces this critical valve on the left side of the heart.

The aortic valve may need replacement for two reasons. One, the valve became narrowed, or two, the valve became leaky. Currently, TAVR is primarily directed toward replacing narrowed valves.

Historically, aortic valve replacement has been done through open heart surgery.

“Now, we recognize that there have been a lot of patients who were not able to receive valve replacements because they were just poor candidates for surgery – they would not tolerate open-heart surgery, the complication rates would have been very high,” Nusair explains. “Surgeons worldwide would turn these people away, and it would have remarkable negative impact on these patients’ livelihood and survival.

“Now, instead of open-heart surgery, we do very small incisions in the groin that, a week later, the patient wouldn’t even realize there was anything that happened,” Nusair continues. “We then combine X-ray visualization of the catheter equipment with ultrasound imaging of the heart simultaneously, so that we’re able to do the valve replacement without opening up the body.”

Patients recover from TAVR much faster than if they had undergone open heart surgery, and their risk of complications is much lower. Nusair considers it a win for NCH that the hospital is able to provide this type of treatment.

In addition to a TAVR program, NCH has also started a left atrial appendage closure program for patients who have atrial fibrillation.

“Atrial fibrillation is a very common heart rhythm problem, and one of the issues with this diagnosis is that it increases a patient’s risk of stroke because clots can form in the heart in an area called the left atrial appendage,” Nusair explains. “These clots can sometimes migrate, go to the brain, and cause really bad strokes.”

So, in order to prevent stroke, patients are typically put on blood thinner medications. However, this can sometimes result in patients bleeding from their stomach, colon or other areas where they shouldn’t. Typically, in these instances, patients would be instructed to stop taking their blood thinner medications so the bleeding would stop.

But, the double-edge sword is now their risk of stroke increases dramatically.

“Patients find themselves between a rock and a hard place. You either bleed, or you have a stroke. Both sound like really bad options,” Nusair says. “But thankfully, humanity continues to evolve, as does medicine.”

Now, NCH is able to offer patients a new therapy that seals the left atrial appendage completely, which is where clots form. This way, patients no longer need to be on blood thinner medications, and they’re protected from stroke.

“There are other procedures to correct atrial fibrillation, but with this therapy, one of the worst complications of the rhythm is prevented,” Nusair explains.

Overall, the hybrid lab is conducive to helping people who have complex or advanced heart diseases. This could be anyone, of any age, and Nusair has treated patients as young as 50 who would’ve been high risk for open-heart surgery.

However, there are some things people can control when it comes to heart health. Diabetes, hypertension, high cholesterol and kidney problems can sometimes promote aortic valve disease. So, managing these risk factors with a primary care doctor is a proactive way to avoid needing heart surgery eventually.

Nusair also recommends that people who already have been diagnosed with a heart disease maintain close follow-up appointments with a cardiologist, especially when diagnosed with structural conditions such as aortic stenosis.

“The bottom line is live healthy, eat healthy and take the advice of your primary care doctor,” Nusair says. “But if you need advanced care, I’m proud to say we’re able to provide it.”

Better Cardiac Care

In September 2018, Centegra Health System became part of Northwestern Medicine. In many ways, this was good news for residents of McHenry and Kane counties, especially those who need quality cardiovascular care.

Northwestern’s Bluhm Cardiovascular Institute (BCVI), in Chicago, is consistently ranked in U.S. News & World Report as a top 10 national program for cardiology and heart surgery, says Dr. Asim Zaidi, medical director of cardiology at Northwestern Medicine McHenry Hospital and Northwestern Medicine Huntley Hospital.

“And, recently, the CMS – that’s the Centers of Medicare and Medicaid Services – announced that Northwestern Memorial Hospital, in downtown Chicago, is one of the only hospitals in the United States to have professional, exceptional and high-quality outcomes at the lowest possible cost in two of the country’s biggest public health threats, which are heart failure and heart attacks,” Zaidi adds. “Northwestern’s main aim is quality care. When you deliver quality outcomes, you get a higher volume of patients, which alleviates cost.”

BCVI currently delivers care to eight of the 10 hospitals in the Northwestern health system. Now that Centegra and Northwestern are aligned, this includes the hospitals in McHenry and Huntley.

So, if a patient walks into the McHenry or Huntley office buildings for a cardiology appointment, or if they arrive by ambulance to one of the emergency rooms, they’ll get the same quality care that’s available at any Northwestern site.

“That’s the main goal,” Zaidi says. “Even before we became part of Northwestern, both McHenry and Huntley were doing well in terms of delivering high-quality and complex care locally. But now, we can extend that further.”

This includes improvements to the technical ability and quality of procedures at both the McHenry and Huntley hospitals. Another big plus for patients is being able to see sub-specialists for appointments more easily.

“And, now that we have access to the other Northwestern hospitals, if we have a patient and we know there’s a limit of what we can do in a community hospital, then we have an avenue to much more easily transfer that patient, mainly to downtown [Chicago],” Zaidi says.

But, he doesn’t want to transfer patients downtown too often.

“And Northwestern doesn’t want that, either,” Zaidi adds.

So, this means more doctors will be coming into suburban areas like McHenry County.

“Starting in January, there’s going to be a lot of changes with our cardiovascular surgery program,” Zaidi explains. “Doctors from the city will be coming out more regularly to see patients both in the hospitals and in the clinics. So, patients don’t have to go to a different building, or a different hospital, than what they’re used to.

“For patients in McHenry and Kane counties, this means they have access to all the physicians, nurses and other medical assistants who have been trained the Northwestern way, which is a very high standard. And it’s going to be efficient, and it’s going to be low cost.”

Zaidi anticipates patients will see improvements over the next five years in the quality and speed of their treatment.

“We’ve had the ball rolling since September 2018, but now it’s really revving up,” Zaidi says.