Baptist Heart Hospital

Baptist Heart Hospital2006 Cardiology Report

Baptist Heart Hospital

Noninvasive Procedures

Cardiac Invasive Procedures

Patient Outcomes

Peripheral Vascular Procedures

Electrophysiology Procedures

Cardiac Rehabilitation

Congestive Heart Failure Clinic

Cardiovascular Referral Coordinator

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Table of Contents

About Baptist Health

Driven by our commitment to providecomprehensive health care that our community can depend on for life,Baptist Health includes:

Prevention services delivered throughBaptist Primary Care and communityhealth programs.

Advanced treatment from outpatientprocedures to inpatient care at our hospitals throughout Northeast Florida –plus specialized services through BaptistHeart Hospital, Baptist Cancer Institute,Pavilion Women’s Services and WolfsonChildren’s Hospital.

Healing services and amenities that support physical, emotional and spiritualwell-being, including the therapeutic useof gardens, art, play, music and pets.

Letters from Heart Hospital Leadership

In 2005, Baptist Health opened the new Baptist Heart Hospital. With the establishmentof this state-of-the-art facility, significant attention in the community has beendrawn toward the cardiac program at Baptist and the high quality of service providedby Baptist Health cardiologists and cardiovascular and thoracic surgeons.

For many years, cardiologists at Baptist have seen high success rates for invasiveinterventional procedures that are far above national averages. In the hands ofBaptist physicians, complication rates have been exceedingly low. Together, thesetrends demonstrate that patients can expect excellence from the cardiologists atBaptist Heart Hospital.

We are proud of our comfortable, patient-friendly facility. Our professional staff, as well as the nursing and support personnel, have a consistent attitude of caringand compassion.

I hope this report helps the medical and patient community of North Florida torecognize the continued strength and high quality of the Baptist cardiac program.

Paul H. Dillahunt, II, MDChief, Section of Cardiology

Medical Director, Cardiac RehabilitationBaptist Medical Center Downtown

Since its founding by cardiologist Larry Birch, MD, in 1968, the goal of cardiacservices at Baptist Medical Center Downtown has always been to offer our patientsthe best there is. Some of our innovations have included the first coronaryangiogram in a community hospital in Northeast Florida (1968), the first coronaryballoon angioplasty in Jacksonville (1981) and the first totally digital coronaryimaging laboratory in the region (1994). Volume of all services has grown tenfoldas new noninvasive imaging has been added. Management of rhythm disturbanceswith ablation, pacemakers and defibrillators is burgeoning.

Our newest innovation - Baptist Heart Hospital - is a culmination of 38 years ofefforts to give our caregivers the tools commensurate with their enormous skillsand our patients an environment they deserve.

We will continue to pursue and achieve these worthy goals of care and innovationin our fabulous new home, Baptist Heart Hospital.

Joel P. Schrank, MD, FACCMedical Director, Cardiac Laboratories

Baptist Medical Center Downtown

Baptist Heart Hospital 2006 Cardiology Report 1

Baptist Heart Hospital

2 Baptist Heart Hospital 2006 Cardiology Report

In October 2005, Baptist Health openedNortheast Florida and Southeast Georgia’sfirst and only hospital just for heartpatients, the 175,000-square-foot BaptistHeart Hospital. The four-floor hospitalfeatures:

• Three cardiac catheterization laboratories (including one lab forperipheral vascular procedures)

• Two electrophysiology procedurerooms

• A Congestive Heart Failure Clinic

• Three video-equipped, “smart” operating suites

• 88 private patient rooms

• Two intensive care units (48 beds)

• The Cardiac Rehabilitation programat Wolfson Wellness Center

• On-site pharmacists, respiratory therapists and family liaisons

All diagnostic, treatment and surgicalsuites are located within the HardenCardiovascular Center. Critically illheart patients are placed in a coronarycare unit, comprised of eight intensivecare units, eight interventional beds,and eight progressive telemetry beds.

Baptist Heart Hospital offers a full rangeof surgical services, including three dedicated open-heart suites, eight recovery bays and 16 cardiovascularintensive care unit beds, with around-the-clock critical care.

The centralized design of the HeartHospital allows close contact betweenthe noninvasive cardiologists, invasivecardiologists, the electrophysiologist andcardiac surgeons, on a daily basis.

The location of the Heart Hospital adjacent to the remodeled EmergencyCenter at Baptist Medical CenterDowntown ensures that heart patientsreceive the quickest care possible whenseconds count. A futuristic, circular andadjacent helipad for the Life Flight airambulance service enables criticalpatients to be whisked to the EmergencyCenter or surgery.

All of these services offered in one convenient location give patients theadvanced cardiac technology theyrequire in a family-centered environmentthat caters to their personal needs.

The latest noninvasive procedures fordiagnosing and treating some forms ofcardiovascular disease are performed inthe Harden Cardiovascular Center.

The tilt table test is designed to evaluatehow the body regulates blood pressure orvaso-vagal syncope in response to somevery simple stresses.

Synchronized cardioversion can contribute to the restoration and main-tenance of optimal health by attemptingto convert atrial arrhythmias to normal sinus.

The transesophageal echocardiogram(TEE) is a specialized type of cardiacultrasound that allows imaging of the

heart by the use of a transducer mountedon a gastroscope and positioned in theesophagus behind the heart.

Stress tests are used to determine theamount of stress that a heart can managebefore developing either an abnormalrhythm or evidence of ischemia.Pharmacological stress tests are used inpeople who are unable to exercise. Anuclear stress test helps to determinewhich parts of the heart are healthy andfunctioning normally and which are not.A stress echocardiogram can accuratelyvisualize the motion of the heart’s wallsand pumping action when the heart isstressed. It also may reveal a lack ofblood flow that isn't always apparent onother heart tests.

Noninvasive Procedures


Three cardiac catheterization laboratoriesare used for diagnostic catheterizations,as well as interventional procedures thatopen blocked arteries without surgery.The latest imaging equipment, includingintracoronary ultrasound for evaluationof a cross-section of the interior of thecoronary artery, ensures that cardiologistscan determine the level of blockage.

In addition to conventional percutaneoustransluminal coronary angioplasty (PTCA,also known as balloon angioplasty),Baptist Heart Hospital cardiologists canperform radial artery catheterizationthrough the wrist, which offers an alternate route for some angiography procedures. Coronary artery stentingutilizes conventional metal stents to keepcleared arteries open; new drug-elutingstents can often prevent restenosis following the procedure. High-speedrotational atherectomy, along with cuttingballoons, remove plaque in cloggedarteries, allowing revascularization whereplaque is calcified. The Angiojet®thrombectomy system is a catheter-based technique for removing blood clotsblocking the coronary artery.

Following cardiac interventional procedures, cardiologists use arterialpuncture closure devices to increasepatient comfort and safety, reducingblood loss while leading to earlier post-procedure mobility. Also for patient safety, Baptist Heart Hospital cardiologistsuse distal protection devices to preventembolization that can occur when plaqueand other debris are loosened during acoronary interventional procedure.

Cardiac InvasiveProcedures


Diagnostic Catheterizations

Percutaneous Coronary Interventions (PCIs)


2005 FY Distribution of Invasive Cardiac Procedures

Total Invasive Cardiac Procedures Total Invasive Cardiac Patients


Baptist Heart Hospital offers a full rangeof percutaneous coronary interventions.Baptist Heart’s complication and mortality rates for PCIs are lower by far than national averages provided byrespected organizations such as theNational Heart, Lung and BloodInstitute— a division of the NationalInstitutes of Health and the Departmentof Health and Human Services —andthe Society for CardiovascularAngiography and Interventions.

In 2003, of 934 PCIs, three patientswent for emergency coronary arterybypass graft surgery (CABG); there wasone patient mortality within 24 hours of the PCI procedure. In 2004, of 904PCIs, four patients went for emergencyCABG; that year, there was no patientmortality following a PCI. In 2005, of 957 PCIs, three patients went toemergency CABG; there was one mortality following a PCI.

Patient Outcomes

Mortality Rate

PCI to Emergency CABG Rate

Source: The expected national average rates are derived from an average of percentages provided by the National Heart, Lung and Blood Institute and theSociety for Cardiovascular Angiography and Interventions.


One of the cardiac catheterization labs isused primarily for peripheral vascularprocedures. This allows Baptist HeartHospital to perform a full range of non-surgical vascular procedures, includingdiagnostic angiography. Newer therapiesare enabling patients with conditions likeperipheral arterial disease (PAD) avoidamputation and reduce or eliminate severeleg pain. Since the peripheral programbegan in August 2004, the number ofprocedures has increased dramatically.

Cardiologists with special training performadvanced therapies in the dedicated labthat include FoxHollow Silverhawk™directional atherectomy for the saferemoval of harmful plaque from blockedarteries in the legs. They also performstenting of the renal, iliac, superficialfemoral, and popliteal arteries, as wellas stenting on smaller distal vesselsbelow the knee. Those who suffer fromcoronary artery disease and PAD are ableto have both conditions treated in onelocation since the catheterization lab isfully equipped for cardiac and peripheralprocedures.

In addition, CryoPlasty Therapy is usedto treat peripheral arteries using nitrousoxide gas to open the balloon and coolthe plaque. Studies have shown that this treatment has a lower recurrence of blockage.

Peripheral VascularProcedures

Total Peripheral Patients

Total Peripheral Procedures

Two high-tech electrophysiology (EP) procedure rooms are utilized for treatingpatients with cardiac rhythm disorders.Treatments include pacemaker implanta-tion, automatic internal cardiac defibrillators (AICDs) and ablative therapy for treatment of atrial fibrillation.

The electrophysiologists at Baptist Heart Hospital implant conventionalpacemakers, along with biventricularpacemakers, which restore rhythmthrough cardiac resynchronization andimproving heart function in patients.

AICDs are used to treat life-threateningventricular arrhythmia. They automaticallyshock inside the heart and terminatearrhythmia within a few seconds of itshappening. An outpatient procedureperformed under local anesthesia, AICDsallow patients to return to normal activitiesin a few days. The dramatic increase inAICD implantation procedures at BaptistHeart Hospital is due to the completionof research studies showing that use ofthe devices in a larger group of patients isbeneficial, in combination with rate-controlling medications; previously,patients were considered for the deviceonly if they had severe disease.

ElectrophysiologyProcedures

EP Studies

Ablations


Also on the increase at the HeartHospital are ablation procedures fortreating atrial fibrillation. Using three-dimensional electromagnetic mapping, theelectrophysiologist maps the arrhythmiaand uses echocardiography to define thepositions of a percutaneous catheter. Withablation, the area of the heart from whicharrhythmia is generating is cauterizedutilizing the catheter, which restores normal heart rhythm. Ablative therapyis not new, but using this procedure foratrial fibrillation is.

The use of AICDs and ablation therapiesoften corrects atrial fibrillation, ratherthan just controlling its symptoms, andcan be utilized prophylactically before apatient’s condition progresses.

To treat patients most effectively, the EPprocedure rooms have some of the latestdiagnostic and therapeutic equipment,including biplane fluoroscopy andintracardiac echocardiography.

Pacemakers

AICDs

3-D Mapping



Cardiac Rehabilitation is a physician-referred outpatient program. It is a comprehensive multi-disciplinary intervention program designed to helpimprove or stabilize the patient’s cardiaccondition and cardiac symptoms, whileenhancing his or her overall quality of life.Through a program of EKG-monitoredexercise and a series of educational class-es, patients are able to achieve anincrease in functional outcomes, as wellas modify cardiac risk factors to help prevent further disease progression.Cardiac Rehabilitation works closely withreferring physicians to ensure a safe andbeneficial, individualized plan of care.

The Cardiac Rehabilitation Clinic ishoused at Baptist Heart Hospital. TheBaptist Medical Center Beaches CardiacRehabilitation Clinic recently movedinto a larger space located in theWilson/Epstein Rehabilitation and

Diagnostic Center and has the latesttechnology in monitoring systems.

Cardiac Rehabilitation is comprised of registered nurses, exercise specialists,dietitians, psychologists/chaplains, medical directors and other staff.

The Centers for Medicare and Medicaidrecently announced coverage for cardiacrehabilitation services followingPTCA/stenting, valve repair/replacementand heart or heart/lung transplants. Thesenewly covered diagnoses have been addedto those already covered, including stableangina, CABG and myocardial infarction(within 12 months).

Last year, the Baptist Beaches CardiacRehabilitation Program had 5,142 visits,while during the same time period, theBaptist Downtown Cardiac RehabilitationProgram had 3,623 visits.

Cardiac Rehabilitation


Physicians who refer patients to BaptistHeart Hospital for cardiovascular serviceshave access to our referral coordinator,who is available 24 hours a day, sevendays a week.

The referral coordinator works as a liaisonwith any physician who has admittingprivileges to Baptist Medical CenterDowntown and can facilitate admittingpatients to Baptist Heart Hospital

for diagnostic and therapeutic cardiac procedures, including emergency admissions, as well as transfers fromoffices or hospitals to Baptist HeartHospital. In addition, the referral coordinator can provide families ofpatients with information on communityresources, such as lodging.

Cardiovascular Referral Coordinator

The Congestive Heart Failure Clinic atBaptist Heart Hospital is available forpatients for whom oral therapy and dietmonitoring has not been successful.Staffed by registered nurses who aretrained in intravenous therapy andACLS-certified, the clinic provides educational reinforcement, regular monitoring of kidney function, conditionassessment, and IV medications to helprelieve the symptoms of heart failure.The medications may strengthen theheart muscle contraction, improve energy

levels and hopefully, will ultimately prevent multiple hospitalizations.

Regular communication is maintainedbetween the nursing staff and the referringcardiologist, primary care physician, andconsulting specialty physicians.

Since 2003, when visits were tracked,the program has seen its volume nearlydouble in 2005, and to date in 2006, theaverage number of visits has increased to108 a month.

Congestive Heart Failure Clinic

Baptist Heart Hospital’s circle of care provides state-of-the-art diagnosis, treatmentand rehabilitation services to patientsthroughout the region, from Alma, Georgia,to St. Augustine, from Lake City to theJacksonville Beaches.

Cardiac Rehabilitation 904.202.4200

Cardiovascular Referral Coordinator 904.202.9469 (office)904.889.1823 (pager) 904.686.5045 (cell)

Congestive Heart Failure Clinic 904.202.9177 904.818.8762 (pager)

Contact Information

e-baptisthealth.com/heart

Baptist Medical Center Downtown800 Prudential Drive

Jacksonville, Florida 32207

904.202.CARE (2273)e-baptisthealth.com

Baptist Heart Hospital

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