NewYork-Presbyterian Lawrence Hospital’s high-quality, collaborative cardiovascular care is enhancing cardiovascular disease outcomes throughout the region.
In addition to his work at NYP Lawrence, Mark A. Apfelbaum, MD, is an Associate Clinical Professor of Medicine at Columbia University College of Physicians and Surgeons and Director of NYP System Cath Labs at the Center for Interventional Vascular Therapy at NewYork-Presbyterian Hospital/Columbia University Medical Center.
Cardiovascular disease is a leading cause of morbidity and mortality nationwide, and New York State is no exception. In 2014, the disease accounted for nearly 40 percent of all statewide deaths, and one in five New Yorkers ages 65 and older reported having some type of heart disease, according to the New York State Department of Health.
From diagnosis to treatment, rehabilitation and long-term follow-up, NewYork-Presbyterian Lawrence offers all-inclusive cardiovascular care for the most routine to the most complex conditions. Making this possible is a team of experienced and well-respected cardiologists, interventional cardiologists and electrophysiologists from ColumbiaDoctors, the faculty practice of Columbia University Medical Center, and NewYork-Presbyterian Medical Group Westchester. With practices based in Bronxville at NYP Lawrence and throughout Westchester County, they offer patients quality care in collaboration with their colleagues at NewYork-Presbyterian/Columbia University Medical Center.
An Array of Noninvasive Diagnostic Capabilities
Cardiologists at NYP Lawrence have many noninvasive tools in their diagnostic arsenal, including Holter monitors, nuclear stress tests, noninvasive arterial Doppler studies and electrocardiograms (EKGs). The Hospital’s Echocardiography Laboratory is accredited by the Intersocietal Accreditation Commission.
Gary Gabelman, MD, FACC, is board-certified in both cardiology and echocardiography and has been practicing medicine for nearly 30 years. In his Scarsdale-based office, he sees patients and performs select diagnostic testing.
“Our accreditation ensures that our physicians are well-trained and that cases are reviewed regularly,” says Gary Gabelman, MD, FACC, fellowship-trained cardiologist at NewYork-Presbyterian Medical Group Westchester. “It also verifies that we stay up to date through continuing education and use the most recent technology.”
NYP Lawrence is developing the first PET/CT cardiac imaging program that will perform PET myocardial perfusion imaging in Westchester County. Compared with conventional single-photon emission CT myocardial perfusion, PET myocardial perfusion offers several advantages, including greater diagnostic accuracy and lower doses of radiation exposure, according to a 2013 review published in Imaging in Medicine. Dr. Gabelman believes this test will be especially beneficial in diagnosing significant coronary artery disease.
Timely Care in an Emergency
One person has a heart attack every 40 seconds in the United States, according to the Centers for Disease Control and Prevention. The sooner physicians diagnose a heart attack and open the occluded artery, the less permanent damage patients sustain and the better their long-term outcomes, notes Mark Apfelbaum, MD, Director of the NewYork-Presbyterian Lawrence Hospital Cardiac Catheterization Laboratory.
New York-Presbyterian Lawrence Hospital offers patients a multidisciplinary Cardiopulmonary Rehabilitation program. Upon physician referral, anyone who has had a heart attack, bypass surgery, angioplasty/stents, cardiac transplant, or heart valve repair or replacement is eligible for the program located in Scarsdale, next door to NewYork-Presbyterian Medical Group Westchester’s cardiology practice.
The American Heart Association recommends a door-to-balloon time — the time from when a patient arrives at the emergency room to when he or she receives emergent percutaneous coronary intervention — of 90 minutes or less for patients experiencing an ST-segment elevation myocardial infarction. The NYP Lawrence Cath Lab’s average door-to-balloon time is less than 60 minutes, thanks to close collaboration between the Lab and the Emergency Department (ED).
Ambulances equipped with a special pre-notification system send an alert to ED physicians, making them aware that a heart attack patient is en route. The system also enables EMS personnel to transmit results wirelessly from an EKG performed in the field to the NYP Lawrence Emergency Department.
“In these cases, we can confirm the heart attack diagnosis before patients arrive at the hospital,” says Dr. Apfelbaum. “We can then begin preparing for the patient’s arrival, which shaves off time between ED arrival and the opening of the occluded artery.”
If patients presenting with chest pain arrive at the hospital by means other than an ambulance equipped with the special pre-notification system, the Emergency Department’s clinical team rapidly performs an EKG.
“The national standard from the time patients get to the ED to the time they receive the EKG is 10 minutes,” explains Dr. Apfelbaum. “We work hard every day to do better than that. Our time is in the five-minute range.”
If a heart attack patient arrives during the day, when the Cath Lab is open, a physician assistant, nurse or other members of the Cath Lab team go to the ED to help stabilize the patient and transport him or her to the laboratory. If the patient arrives at night or on a weekend, ED personnel alert the physician on call and the techs who assist physicians during procedures. Once the patient is in the Cath Lab, physicians perform an angiogram to identify the occluded artery causing the heart attack. They then access the artery through the femoral artery or the radial artery to complete angioplasty and stenting.
“NewYork-Presbyterian Lawrence Hospital’s cardiovascular services are in step with the most advanced and intricate forms of cardiac care, which are available only at the nation’s leading tertiary centers. It’s very exciting to have this comprehensive cardiology program at the community level.”
— Robert Sommer, MD, Director of Adult Invasive Congenital Heart Disease and Associate Professor of Medicine at NYP/Columbia University Medical Center
“After removing the blockage and restoring blood flow, we place one of the latest-generation drug-coated stents to get the pristine result of a wide-open artery with healthy blood flow,” Dr. Apfelbaum says. “In the span of minutes, patients who look ashen and have low blood pressures and fast heart rates stabilize.”
The opening of the NewYork-Presbyterian Lawrence Cardiac Catheterization Laboratory nearly three years ago has dramatically reduced the time heart attack patients wait to receive this vitally important level of care, as well as the need to transfer patients for angioplasty.
“Our Cath Lab has been a lifesaver for patients who’ve presented at our ED for care,” notes Dr. Apfelbaum.
A Nationally Recognized Team
U.S. News & World Report’s 2017–2018 Best Hospitals edition ranks the cardiovascular care available at NewYork-Presbyterian No. 3 in the country and No. 1 in New York. The NYP Lawrence Cath Lab is an extension of NYP/Columbia University Medical Center’s laboratory. The same team of physicians, nurses, physician assistants and techs cares for patients at both facilities, which means NYP Lawrence offers local access to that same high level of care at its Bronxville campus.
Robert Sommer, MD, has been caring for pediatric and adult patients with congenital heart disease for more than 25 years. He examines a baby in the Hospital’s Level II Neonatal Intensive Care Unit as the unit’s manager looks on.
“We’ve assembled an incredible group of Cath Lab nurses, as well as a group of physician assistants and techs who are among the best-trained I’ve worked with in my career,” adds Dr. Apfelbaum. “I’ve been involved in starting a number of Cath Labs, and I’ve never had a staff of this caliber. We work well together, and it reflects in the quality of care we are able to provide and the high satisfaction scores we’ve received.”
In addition to providing emergent care when necessary, the NYP Lawrence Cath Lab team cares for patients with cardiac arrhythmias and peripheral vascular disease, as well as patients who are experiencing angina or whose stress tests reveal abnormal results. Elective angiogram and stent placement, pacemaker or defibrillator placement, and peripheral arterial angioplasty and stenting are among the interventions physicians may perform to treat these conditions.
In some instances, interventional cardiologists repair aortic aneurysms in the Cath Lab. In cases of aortic aneurysm or other complex conditions, interventional cardiologists work closely with the patient’s cardiologist to determine if the patient would benefit from the tertiary care available at NYP/Columbia.
Cutting-edge Treatment of Structural and Valvular Disease
NYP Lawrence also is acquiring the equipment necessary to perform advanced procedures that address structural and congenital heart problems, such as atrial septal defect (ASD) and patent foramen ovale (PFO).
Dr. Apfelbaum oversees the busy NewYork-Presbyterian Lawrence Hospital Cardiac Catheterization Laboratory in Bronxville.
“The world of the Cardiac Catheterization Laboratory has totally changed within the past decade,” says Robert Sommer, MD, Director of Adult Invasive Congenital Heart Disease and Associate Professor of Medicine at NYP/Columbia. “Traditionally, catheter-based procedures focused on opening blockages in the vessels delivering blood to the heart muscle. Today, we can perform procedures including heart valve repair and replacement that would have seemed like science fiction a few years ago.”
Dr. Sommer annually performs around 200 catheter-based procedures to close ASDs and PFOs at NYP/Columbia. He expects to begin performing transcatheter closure of ASDs and PFOs at NYP Lawrence in the coming weeks.
“The relationship between NewYork-Presbyterian Lawrence Hospital and NYP/Columbia University Medical Center represents the best of both worlds. Patients receive close-to-home care delivered by physicians who know them and can provide community-based follow-up, and, if they need more complex care, we have the luxury of seamlessly transferring them to a tertiary care center.”
— Mark Apfelbaum, MD, Director of the NewYork-Presbyterian Lawrence Hospital Cardiac Catheterization Laboratory
“During these procedures, we thread a catheter to the heart and place an umbrella-like device to seal the hole,” Dr. Sommer says. “The procedure is done using local anesthesia and mild sedation, and patients are able to return home the same day with no pain or discomfort.”
ASDs and PFOs rarely cause symptoms during childhood. As a result, patients may not realize they have a congenital or structural heart problem until they begin to experience shortness of breath, exercise intolerance or other symptoms as adults.
Left untreated, ASDs and PFOs can cause serious complications. Both conditions are associated with stroke because they make it possible for blood clots to exit the heart and travel to the brain. A growing body of research also links PFOs to migraine with aura. The American Headache Society estimates that 40–60 percent of people who have migraine with aura also have a PFO, compared with 20–30 percent of the general population. In these patients, PFO closure may provide significant relief of migraine symptoms.
“This is one of the most promising areas of research in medicine right now,” insists Dr. Sommer. “We’ve had some major breakthroughs in the past few months, and we’ve actually been able to cure migraine headaches by closing these holes in the heart.”
Thanks to the partnership between NYP Lawrence and NYP/Columbia, patients also have access to more complex transcatheter procedures, including transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve repair. Satellite clinics ensure patients can receive all of their preoperative and follow-up care, such as CT scans and echocardiograms, at NYP Lawrence and travel to NYP/Columbia only on the day of their procedure.
From Follow-up to Rehabilitation
The ability of patients to receive comprehensive care following diagnosis or corrective treatment of a cardiovascular condition plays an important role in the outcomes they achieve. Every Thursday, Dr. Sommer, who is fellowship-trained in pediatric cardiology, and other members of the NYP/Columbia team host a clinic for pediatric and adult patients with congenital heart disease at NYP Lawrence that allows physicians to monitor progress and perform any additional diagnostic testing that may be necessary. NewYork-Presbyterian is also finalizing a follow-up program for patients with heart failure that aims to reduce subsequent ED visits and hospitalizations.
Dr. Gabelman is a member of NewYork-Presbyterian Medical Group Westchester, a group that represents primary care and medical specialists who are part of the NewYork-Presbyterian care network, one of the nation’s most comprehensive academic and patient care delivery systems.
“Heart failure is a major cause of hospital readmissions,” explains Dr. Gabelman. “We not only get patients on the appropriate medications, but we are committed to helping them remain compliant with their treatment plans.”
Through the follow-up program, patients will receive information about their medications and the importance of a low-sodium diet. A designated nurse will also follow up with patients to ensure they are remaining compliant with their medications between office visits.
Finally, all patients who have been treated at NYP Lawrence for a heart attack or other cardiac condition receive referral to the hospital’s Cardiopulmonary Rehabilitation program. One of the only programs of its kind in southern Westchester County, the Cardiopulmonary Rehabilitation program allows patients to exercise and regain their strength in a medically supervised and safe environment.
“Cardiopulmonary rehabilitation is indicated for patients who are recovering from a cardiac event or who have heart failure,” Dr. Gabelman says. “In these patients, it is shown to improve their quality of life.”
Collaboration at Every Level of Care
All members of a patient’s treatment team — from the cardiologist making the diagnosis to the interventional cardiologist or electrophysiologist performing advanced procedures to the clinicians overseeing patients’ progress in cardiopulmonary rehabilitation — work together closely to coordinate patient care and foster the best possible outcome. When patients are treated at NYP Lawrence or NYP/Columbia, physicians also prioritize communication with the referring primary care physicians and cardiologists, so these partners in care know exactly the treatments their patients received and can better maintain continuity of care.
Dr. Sommer discusses a case with a nurse on an inpatient unit at NYP Lawrence. An accomplished researcher, Dr. Sommer is actively involved in a number of cutting-edge clinical trials at NewYork-Presbyterian/Columbia University Medical Center, including the HELICOPTER Migraine Headache Trial, assessing new medical therapy for patients with migraine and patent foramen ovale, a commonly undiagnosed heart condition.
“NYP Lawrence has always been a very collaborative environment,” Dr. Gabelman says. “Our affiliation with NYP/Columbia University Medical Center, as well as the advanced procedures available in the Cardiac Catheterization Laboratory, take that collaboration one step further. At NYP Medical Group Westchester, we have an outpatient facility with the ability to do noninvasive testing, including echocardiograms. The Hospital builds on that, with interventional cardiologists and electrophysiologists who perform a wide range of procedures, and then we have the ability to refer patients in need of more complex care to NYP/Columbia.”
“Time is of the essence when treating cardiac conditions. Having a Cardiac Catheterization Laboratory capable of performing emergent procedures for acute myocardial infarction at NewYork-Presbyterian Lawrence Hospital represents a major advance in local cardiac care.”
— Gary Gabelman, MD, FACC, cardiologist at NewYork-Presbyterian Medical Group Westchester
For more information about the comprehensive cardiology services available at NewYork-Presbyterian Lawrence Hospital, visit nyp.org/lawrence.