The addition of the NewYork-Presbyterian Hospital Cardiac Catheterization Unit at NYP/Lawrence Hospital broadens access to emergent and elective cardiology services for patients in the lower Hudson Valley.
With 85.6 million Americans coping with some form of heart disease according to the American Heart Association, cardiovascular disease remains the leading cause of death in the nation. In New York alone, more than 50,000 coronary interventions on cardiac patients occurred in 2011, notes the State Department of Health. To better serve patients in Westchester County and beyond, NewYork-Presbyterian/Lawrence Hospital will expand its cardiac care with a state-of-the-art Cardiac Catheterization Unit. Through collaboration with NewYork-Presbyterian/Columbia University Medical Center, an expert team of cardiac specialists is now performing diagnostic and interventional treatments as part of NewYork-Presbyterian/Lawrence Hospital’s around-the-clock cardiac care, the initial step in the expansion of the hospital’s cardiology services.
“The main purpose of our new Cardiac Catheterization Unit is to perform an expanded array of safe, effective cardiac procedures for diagnosis and treatment of heart disease,” says Mark Apfelbaum, MD, Director of the Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital and Associate Clinical Professor of Medicine at Columbia University College of Physicians and Surgeons. “Patients will no longer have to leave their community to have these procedures performed. One of the essential features is that the catheterization lab provides ready access to the best treatments for patients experiencing a heart attack. We can determine which artery is blocked and open it as quickly as possible, buying valuable time that can save lives.”
Experienced interventional cardiologists associated with NewYork-Presbyterian/Columbia and the Columbia University College of Physicians and Surgeons are lending their expertise and are among the physician staff of the Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital.
“There is a strong affiliation between NewYork-Presbyterian/Lawrence Hospital and NewYork-Presbyterian/Columbia,” Dr. Apfelbaum says. “Patients are benefiting from the same high-quality, nationally renowned cardiologists doing the same procedures, which is vitally important for patients in need of tertiary care. Because of our relationship, patients with complex or end-stage heart disease can be transferred seamlessly and receive the care they need in a timely fashion.”
“The goal is to emulate the services and quality at NewYork-Presbyterian/Columbia and the Division of Cardiology,” adds Anthony Pucillo, MD, FACC, Director of Cardiology at NewYork-Presbyterian/Lawrence Hospital and Assistant Professor in the Division of Cardiology at NewYork-Presbyterian/Columbia. “Under Dr. Apfelbaum’s leadership, supported by an excellent team of physicians, nursing and ancillary staff, the program is thoroughly equipped to render these much-needed services.”
All of the physicians at the new Cardiac Catheterization Unit have a broad range of experience in high-volume case- loads and a history of quality results, notes Dr. Pucillo.
“The team is in place across the board,” he says. “We have the highest-caliber angioplasty specialists, and the program is a real extension of NewYork-Presbyterian/Columbia. The community can be confident in the expertise and services offered by the new Cardiac Catheterization Unit.”
“The NewYork-Presbyterian Hospital Cardiac Catheterization Unit at NYP/Lawrence Hospital is there to provide the highest-quality cardiac care 24 hours a day, seven days a week and 365 days a year to bring a new level of care to this community in conjunction with our partners at NewYork-Presbyterian/Columbia University Medical Center.”
— Mark Apfelbaum, MD, Director of the Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital and Associate Clinical Professor of Medicine at Columbia University College of Physicians and Surgeons
The full-service Cardiac Catheterization Unit’s team, board-certified in cardiology and interventional cardiology, can perform angioplasty, diagnostic cardiac catheterization, electrophysiology, intravascular ultrasound/fractional flow reserve measurement, stenting, and thrombectomy for emergent and elective patient care.
Columbia physicians are staffing the new Catheterization Unit at NYP/Lawrence Hospital. They include: Kumar S. Kalapatapu, MD; Ziad A. Ali, MD; Mark A. Apfelbaum, MD, Medical Director; Christopher N. Irobunda, MD, PhD; Carmine A. Sorbera, MD; and Daniel Y. Wang, MD. Not pictured are Jose Dizon, MD; Philip Green, MD; Craig Hjemdahl-Monsen, MD; Susheel Kodali, MD; Martin B. Leon, MD; Tamim M. Nazif, MD; David Rubin, MD; and Torsten Vahl, MD.
“Although the Cardiac Catheterization Unit is new, the interventional cardiologists who are performing the procedures are not new to the discipline at all,” says Sri Rama Kalapatapu, MD, FACC, Assistant Clinical Professor of Medicine at NewYork-Presbyterian/Columbia and Chief of Cardiology at NewYork-Presbyterian/Lawrence Hospital. “They all have a wealth of experience.”
Emergent Interventional Cardiology
Sri Rama Kalapatapu, MD, FACC, is an Assistant Clinical Professor of Medicine at NewYork-Presbyterian/Columbia University and Chief of Cardiology at NewYork-Presbyterian/Lawrence Hospital.
In cardiac care, the adage “time is muscle” remains true. Recognizing that reality, physicians in the Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital provide rapid, lifesaving interventions to patients in acute myocardial infarction who arrive through the emergency department.
“If patients need angioplasty and stents, those can be performed as acute care for heart attacks,” Dr. Kalapatapu says. “Having an interventional cardiologist available lessens the amount of time from the initiation of a heart attack until the blood vessels are reopened. That will ultimately save more lives and preserve more heart function.”
“By having the lab at the hospital and a cardiac team accessible 24 hours a day, these emergencies can be dealt with within minutes, which is a major advantage,” adds Mitchell Fishbach, MD, FACC, Director of Cardiovascular Unit Services at NewYork-Presbyterian/Lawrence Hospital and Assistant Clinical Professor at Columbia University College of Physicians and Surgeons. “An interventional cardiologist can open the blood vessel with a catheter, use medication to dissolve the clot and restore the blood flow to the heart.”
The treatment procedures for acute cardiac care highlight the emphasis the emergent cardiac care program places on prioritizing patients effectively and expeditiously, according to Dr. Pucillo.
Anthony Pucillo, MD, Director of Cardiology Operations at NYP/Lawrence Hospital
“Of all the things we do on the cardiology side, the treatment of acute heart attack and acute coronary syndromes has the greatest impact in terms of lives saved,” he says. “We have programs for patient identification and triage in place to optimize emergent cardiac care. We can move patients quickly through to perform high-level, sophisticated procedures in the Cardiac Catheterization Unit. For those cases that do require transfer in an emergency for cardiac surgery, transplantation or advanced support for patients in severe heart failure, we can initiate an immediate transfer to NewYork-Presbyterian/Columbia based upon our close working relationship.”
Elective Interventional Cardiology
The Cardiac Catheterization Unit provides patients in the region with a new destination for elective cardiac treatments, as well.
Mark A. Apfelbaum, MD, Medical Director of the new Catheterization Unit at NYP/Lawrence Hospital
“We can perform diagnostic cardiac procedures and elective coronary angioplasty as well as electrophysiology procedures for patients with various types of heart rhythm disturbances that involve implantation of pacemakers or defibrillators,” Dr. Apfelbaum says. “These procedures are comparable to those of other catheterization labs; however, it is our expert staff and affiliation with NewYork-Presbyterian/Columbia that distinguishes the Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital from others.”
“Electrophysiology provides another new treatment measure for arrhythmias we were not treating previously at NewYork-Presbyterian/Lawrence Hospital,” Dr. Kalapatapu adds. “Having this modality available through the Cardiac Catheterization Unit adds to the advanced procedures accessible in our service area.”
A range of other procedures is also available to area patients who may desire elective cardiac care but do not wish to travel, notes Dr. Fishbach.
“Elective procedures are more convenient for patients to receive close to home,” he says. “Diagnostic cardiac catheterization and elective cardiac stents can prevent a heart attack. For angina patients experiencing chest pain or shortness of breath that is not well-controlled by medication, an interventionalist can restore blood flow with stenting or by opening an artery. That can dramatically impact their quality of life. Patients have come in extremely ill, and because we treated them in the lab and opened their vessel, they experienced a complete turnaround in minutes. We improved their heart function and prevented permanent damage to the heart muscle.”
(L–R) Chris Wayner, RCIS; Mark Apfelbaum, MD; Christine Resto, RN; and Fatou “Khady” Fall, MD, at the beside
Creating a positive patient experience during elective procedures is another key aspect of the Cardiac Catheterization Unit program. Community physicians may refer patients for an angiogram, and from that point, the cardiac care team maintains communication to put patients at ease and educate them about the scheduled procedure.
“The first call a patient receives is from our physician assistant to assemble a detailed medical history and a list of current medications, as well as to resolve any concerns before the procedure,” Dr. Apfelbaum says. “A second call from a catheterization nurse can readdress any questions patients might have. Patients also have the opportunity to speak with both the physician assistant and physician prior to the angiogram.”
“This is much more than a cardiac catheterization laboratory. It is one step toward making NewYork-Presbyterian/Lawrence Hospital the preeminent cardiology center in Westchester County. Our goal is to develop a complete cardiovascular package that serves patients who have coronary artery disease, valvular heart disease and heart failure syndromes and provide access to cardiac surgery consultative services right here in the Westchester community.”
— Anthony Pucillo, MD, FACC, Director of Cardiology Operations at NewYork-Presbyterian/Lawrence Hospital and Assistant Professor in the Division of Cardiology at NewYork-Presbyterian/Columbia University Medical Center
A diagnostic catheterization with no angioplasty may take 25–30 minutes as an outpatient procedure. If an artery has a blockage, the cardiologist may use a balloon or stent to open the vessel. In that instance, recovery generally is complete within eight hours and entails an overnight stay.
“Communication with patients is one of the most important components of making them more comfortable,” Dr. Apfelbaum says. “We want to provide them with all of the information so they are less apprehensive and have a more positive patient experience during elective procedures.”
Expanding Cardiac Care
The Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital is the first endeavor toward the hospital’s commitment to become a premier cardiology center in the region.
Christine Resto, RN, Assistant Patient Care Director, with Fang Yuan, RCIS
“In addition to the Cardiac Catheterization Unit, we want to develop an accredited chest pain center in the emergency department, where patients can be seen expeditiously and evaluated as to whether their chest pain is of cardiac origin,” Dr. Pucillo says. “Our plan is to develop a vascular medicine and vascular surgery program in the next three years. The hospital intends to invest in hybrid operating rooms and an endovascular suite. We plan to make NewYork-Presbyterian/Lawrence Hospital a center of excellence that offers a quality of cardiac services not previously available in Westchester County.”
This expansion of cardiac care should also change patient expectations for care in a community hospital setting, according to Dr. Pucillo.
“We are raising the sophistication of the cardiac care we offer to a more tertiary level,” he says. “It begins with the Cardiac Catheterization Unit and extends to other areas of expertise in the treatment of heart failure. It enhances the patient experience by offering superior service. We are putting patient care first to ensure the experience is first-class.”
Changing Cardiac Outcomes
The Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital creates further opportunities for interventional cardiologists to save more lives in New York, where cardiovascular disease remains the leading cause of death statewide.
Jessica Forman, PA-C, and Pilar Dolcimascolo, PA-C, explain to a patient what she can expect during her procedure.
“NewYork-Presbyterian/Lawrence Hospital had approximately 80 acute myocardial infarction patients seek care in 2014,” Dr. Kalapatapu says. “That number is low because the emergency department had to transfer them for tertiary care to other hospitals with capabilities for angioplasty. By having the Cardiac Catheterization Unit in place, we expect that number to more than double or triple, and that is 200 or more patients who can immediately benefit from the addition of the lab and now be treated at NewYork-Presbyterian/Lawrence Hospital.”
Dr. Fishbach has witnessed technology and medical treatments evolve to change cardiac care for the better and create more positive patient outcomes over the course of his 32-year career.
“Catheterization labs are certainly part of the major advancements over the years,” he says. “Having these lifesaving treatment modalities available now at NewYork-Presbyterian/Lawrence Hospital provides the opportunity to work with interventional cardiologists to tailor an individualized plan of care that can ultimately save a patient’s life.”
“There was a time when there were diagnostic catheterization labs only, and what we now term ‘elective’ interventions were performed only as a necessity,” Dr. Pucillo adds. “Today, angioplasty specialists work side-by-side with interventionalists on every case, which is an enormous advantage in terms of successful outcomes and safety for patients.”
Serving the Region
NewYork-Presbyterian/Lawrence Hospital serves patients from throughout Westchester County and the Lower Hudson Valley, and the addition of the Cardiac Catheterization Unit makes elective and emergent cardiac care more readily available to this patient population.
“We draw from a large catchment area, including portions of New York City and the Bronx, so many people will benefit from the Cardiac Catheterization Unit,” Dr. Apfelbaum says. “Cardiac patients may be meeting one of our cardiologists for the first time, but their primary care or other community physicians often have hospital affiliations, making quality cardiac care services attainable to patients who may already be utilizing NewYork-Presbyterian/Lawrence Hospital as their primary source of medical care.”
With their own personal ties to the Lower Hudson Valley, the specialists in the Cardiac Catheterization Unit also recognize the value of bringing cardiovascular services to the region.
“I was born in the area, and I have family here,” Dr. Pucillo says. “This is my opportunity to reach a community I am very familiar with. With the Cardiac Catheterization Unit, we are extending our footprint from Columbia to Bronxville by providing comprehensive cardiac care with the highest level of excellence across the board. We will maintain open lines of communication and interaction with patients’ referring physicians in the community. Making sure we bring the very best cardiac care to the region is our goal.”
Lawrence Medical Associates’ cardiologists will see patients and can determine who is a candidate for a Catheterization Unit procedure. (L–R) Mitchell Fishbach, MD, FACC; Anthony Mercando, MD, FACC; Gary Gabelman, MD, FACC; Gabriela Grasa, MD, FACC; and Douglas Hart, MD, FACC
“The Cardiac Catheterization Unit is the initial step in making a new level of cardiac care accessible to patients.” Dr. Fishbach adds. “As a referring cardiologist, having confidence that a procedure will positively impact one’s patient and knowing the patient enjoys the convenience of being so close to home make a difference. NewYork-Presbyterian/Lawrence Hospital is looking to become a hospital that better serves this community.”
For more information about the Cardiac Catheterization Unit at NewYork-Presbyterian/Lawrence Hospital, please visit nyp.org/lawrence.