Sanford Heart Hospital Project Summary:
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Transcript of Sanford Heart Hospital Project Summary:
Sanford Heart Hospital
Project Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Comparison of Coronary Calcium Score and Framingham Score in
Determination of Cardiovascular Risk and Disease in Native American vs.
General Population.
Muhammad Khan, MD
Tom P. Stys, MD, FSCAI, FACC
Medical Director, Sanford Heart Hospital
Sanford Cardiovascular Institute
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Background: Scope of Cardiovascular Problem.
• 81 million have 1 or more type of CVD †• CVD # 1 cause of mortality for the last 100 yrs • Cost of CVD and stroke in 2009 $470 billion †• At 50 yrs lifetime risk of
– CVD 50% ‡– breast cancer at 50 yrs 10%
† Lloyd-Jones, D., R. Adams, et al. (2009). "Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee." Circulation 119(3): e21-181.
‡ Lloyd-Jones, D. M., E. P. Leip, et al. (2006). "Prediction of lifetime risk for cardiovascular disease by risk factor burden at 50 years of age.“ Circulation 113(6): 791-798.
http://seer.cancer.gov
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Background: Cardiovascular Disease is Preventable and Treatable; Early Detection is Key.
• CVD mortality declined by 50% from 1980 to 2000 †
• Decline due to:
– Half of the decline due to primary prevention †
• 24% due to cholesterol reduction• 20% due to blood pressure control• 12% due to smoking cessation• 5% due to increase in physical activity
† Ford, E. S., U. A. Ajani, et al. (2007). "Explaining the decrease in U.S. deaths from coronary disease, 1980-2000." N Engl J Med 356(23) 2388-2398.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Background: Need to do more.
• Rate of decline of CVD mortality is slowing down †
• 50% of adults suffer acute MI each year without prior symptoms ‡
• For 25% of people the first sign of underlying CVD is sudden cardiac
death ‡
† Cooper, R., J. Cutler, et al. (2000). "Trends and disparities in coronary heart disease, stroke, and other cardiovascular diseases in the United States: findings of the national conference on cardiovascular disease prevention." Circulation 102(25): 3137-3147.
‡ Myerburg, R. J., K. M. Kessler, et al. (1993). "Sudden cardiac death: epidemiology, transient risk, and intervention assessment." Ann Intern Med 119(12): 1187-1197.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Background: Coronary Calcium Score.
• Strong correlation between coronary artery calcium score and underlying
coronary atherosclerosis †• Coronary artery calcium score predicts CVD outcomes prospectively
‡• Calcium score has incremental value over traditional risk factors ‡• Adding calcium score to traditional risk factors can change
recommended therapy *
† Sangiorgi, G., J. A. Rumberger, et al. (1998). "Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque
burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology." J Am Coll Cardiol 31(1): 126 133.
‡ Detrano, R., A. D. Guerci, et al. (2008). "Coronary calcium as a predictor of coronary events in four racial or ethnic groups." N Engl J Med 358(13):1336-1345.
* Polonsky, T. S., R. L. McClelland, et al. (2010). "Coronary artery calcium score and risk classification for coronary heart disease prediction." JAMA 303(16): 1610-1616.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Background: Coronary Calcium Score.
Coronary artery calcification provides additional risk stratification beyond the Framingham risk estimate, especially in individuals with high calcium scores. A zero score does not exclude the risk of an event.
Greenland, P., L. LaBree, et al. (2004). "Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals." JAMA 291(2): 210-215.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Background: Why Native Americans?
• Higher cardiovascular risk patient population• 8% of all Native Americans reside in SD †
• Incidence of CVD on the rise among Native Americans Ε SD/ND has the highest rate of non fatal MI * • SD/ND has twice as high CVD mortality as general US population *
† www.census.govÎ Howard, B. V., E. T. Lee, et al. (1999). "Rising tide of cardiovascular disease in American Indians. The Strong Heart Study." Circulation 99(18): 2389-2395* Lee, E. T., L. D. Cowan, et al. (1998). "All-cause mortality and cardiovascular disease mortality in three American Indian populations aged 45-
74 years, 1984-1988. The Strong Heart Study." Am J Epidemiol 147(11): 995-1008
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Purpose: Comparison of Coronary Calcium Score and Framingham Score in Determination of Cardiovascular
Risk and Disease in Native American vs General Population.
Compare the value of coronary calcium score in detection of higher cardiovascular risk profile in a higher cardiovascular risk patient population (Native Americans) vs general patient population.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Methods: Study Design.
Retrospective comparative analysis of Sanford Cardiovascular Prevention Program February 2008 – February 2010
This project was reviewed and approved by the Sanford IRB.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Methods: Sanford Cardiovascular Prevention Program.
• Program initiated February 2008• The Heart Screen is available for any person between the ages of 40-70
years old• Personal and Family History by Self Report• Height, Weight, BMI• Non-Fasting Cholesterol, HDL• Blood Pressure and EKG• CT Coronary Calcium Score• Physician Review of all test results• Case Manager follow-up with participant
* Data is recorded in Sanford Prevention Program Database.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Results: Baseline Demographics of Non-Native American vs. Native American patient population.
Non Native- American Native American
Number of patients 16453 1304
Gender Male 7546 (45.9%) 459 (35.2%) p<.0001 ChiSq
Female 8907 (54.1%) 844 (64.8%)
Age Mean (Std Dev) 56.298.55 54.309.17 p<.0001 ANOVA
Height Mean (Std Dev) 67.55(3.98) 66.48(3.84) p<.0001 ANOVA
Weight Mean (Std Dev) 193.33(44.52) 201.75(46.39) p<.0001 ANOVA
BMI Mean (Std Dev) 27.32(5.37) 29.50(6.21) p<.0001 ANOVA
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Results: Medication use.
General Population Native Americans
BP medication 29.3% 36.8% <.0001 ChiSq
Cholesterolmedication
20.5% 12.2% <.0001 ChiSq
ASA 11.1% 11.7% 0.5240 ChiSq
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Results: Risk status of General Population vs Native Americans.
General Population
Native Americans
HDL Cholesterol(Mean ±SD)
48.57(16.92) 42.40(15.67) <.0001 ANOVA
TC/HDL Ratio(Mean ±SD)
4.50(3.82) 4.57(1.64) 0.5118 ANOVA
BP: Systolic(Mean ±SD)
125.98(14.66) 127.22(16.44) 0.0040 ANOVA
BP: Diastolic(Mean ±SD)
78.78(9.19) 78.33(10.71) 0.0933 ANOVA
Diabetic (PH) 7.1% 20.3% <.0001 ChiSq
Smoking 10.3% 40.4% <.0001 ChiSq
Stroke (PH) 0.8% 2.1% <.0001 ChiSq
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Results: Coronary Calcium Score VS Framingham Score.
General population
Native Americans
Framingham Score
(Mean ± SD)
5.73 ± 6.30 5.77 ± 6.29 0.7960 Anova
Calcium Score(Mean ±SD)
122.87 ± 361.47 171.67 ± 465.19 p<.0001 Anova
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Conclusions:
• Native Americans are a higher cardiovascular risk patient population
– Higher prevalence of Smoking– Higher BMI– Less optimal lipid profile and less frequent pharmacotherapy for
dyslipidemia– Higher systolic blood pressure– Higher prevalence of Diabetes and Stroke
• Framingham score failed to identify Native Americans as a higher risk patient population
• Calcium score did differentiate between higher risk patient population (Native Americans) as compared to general population
16
Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Conclusions:
• Coronary Calcium Score is superior to Framingham Score in identification of patients with higher cardiovascular risk profile.
• Early identification of patients with higher cardiovascular risk profile through Cardiovascular Prevention Programs allows earlier initiation of aggressive preventive cardiovascular care measures.
• Coronary Calcium Score should be considered a valuable tool (superior to traditional approaches) in early detection of higher risk cardiovascular patients allowing appropriate early initiation of cardiovascular disease management and preventive care.
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Special Thank You To:
• Adam Stys, MD, FACC, FASA, FSCAI• Marian Petrasko, MD, PhD, FACC, FSCAI, FACP• Karen Tobin Heart and Vascular Vice President• Lynn Thomas RN, BSN
• Nichol Burton, RN, BSN• Richard Clark, MD• Christian Gaissmaier, MD• Deb Griffith RN, BSN• Orvar Jonsson, MD, FACC
• James Olson, MD, FACC• Scott Pham, MD, FACC• Lloyd Solberg, MD, PhD,
FACC, FASA, FSCAI• Maria Stys, MD, FACC• Paul Thompson, PhD
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Sanford Heart HospitalProject Summary:
•Total Estimated Square Feet 205,000
•Physician Offices 23•Cardiac, Thoracic, and Vascular Surgery•Sanford Cardiovascular Institute
•Inpatient Beds Potential for 58•Critical Care Unit•Cardiology
•Operating Rooms Potential for 5
•Cath Labs Potential for 9 including a Hybrid Cath and dedicated EP Cath Lab
•Outpatient Diagnostic Testing Nuclear Medicine, Echo, Stress, Imaging
•Project Completion Early 2012
Thank you