Baylor advances heart care through technology, research and education.

The result, says Clyde Yancy, MD, medical director of the Baylor Heart and Vascular Institute and member of the medical staff at Baylor Dallas, is heart care that is advanced in scope and direction. Besides providing patient care that is driven by quality initiatives, cardiac doctors on the medical staff at Baylor Dallas also conduct dozens of research trials on heart medicines, devices and procedures. They also teach new cardiac specialists in an established fellowship program.

"It goes beyond basic care," Yancy says. "There's a synergy here that our patients can sense because of advanced information, relevant research, education and quality. I call it a hybrid institution."

Nearly 80 million people — more than a quarter of the country's population — live with cardiovascular disease, which includes heart disease and stroke, according to the U.S. Centers for Disease Control and Prevention. Heart failure is diagnosed in about 550,000 new patients every year, according to the American Heart Association.

For three consecutive years, Baylor University Medical Center at Dallas has been named one of the nation's top 50 hospitals for heart disease treatment and heart surgery by U.S. News and World Report. Baylor Dallas offers services for complex heart and vascular diseases, from open heart surgery and specialized programs for congestive heart failure to artificial hearts and heart transplantation. Baylor Jack and Jane Hamilton Heart and Vascular Hospital, on the campus of Baylor Dallas, was the first heart hospital in the area. It offers a wide scope of interventions for patients with cardiovascular disease — from patient education and early interventions to novel diagnostic and treatment options to cardiac rehabilitation, Yancy says.

Baylor University Medical Center at Dallas has a long history of being the first in North Texas to offer many heart care procedures. Nearly two dozen procedures, including coronary balloon angioplasty, arterial stenting, implantable cardiac defibrillators and open heart surgery, were first done in North Texas by cardiologists or cardiothoracic surgeons on the medical staff at Baylor Dallas, Yancy says.

In the area of heart interventions, Baylor's invasive vascular laboratory does more than 2,000 coronary artery interventions a year. Baylor Dallas also is a primary percutaneous coronary intervention, or PCI, hospital. That means patients who come into the emergency department with an acute heart attack, an artery to the heart completely closed off by a clot, will be immediately sent to one of six catheterization labs for an angiogram and possible stenting of the artery, rather than be treated first with clot-busting medications, says James Choi, MD, an interventional cardiologist on the medical staff at Baylor.


The goal is to follow the national heart care guideline of 90 minutes or less from the ER door to an open artery, he says.

The catheterization labs also provide stents for leg and arm artery blockages, as well as for clogged arteries to the brain that cause strokes.

In addition to caring for patients, cardiologists on the medical staff at Baylor are participating in studies that could circumvent the need for bypass surgery. One clinical trial compares the safety and efficacy of a certain type of drug-eluting stents to the more standard coronary artery bypass surgery in some of the most complex patients.

Despite progress in medications and noninvasive procedures, surgery is still an important option for patients with cardiovascular diseases. Surgeons on the medical staff of Baylor Dallas perform around 1,000 procedures a year, says Baron Hamman, MD, chief of cardiothoracic surgery and a physician on the medical staff at Baylor.

As with other areas of heart care, surgery continues to reflect important strides made in innovation and standards, Hamman says.

Surgeons on the medical staff at Baylor Dallas also are working increasingly on patients in their 80s and even 90s. "Ten percent of our patients are more than 80 years old, and we're seeing results as good as with 60-year-old patients," Hamman says.

The heart disease management program at Baylor Dallas also is helping a growing number of patients, says Shelley Hall, MD, medical director for cardiac transplantation and congestive heart failure programs.

The volume has increased, she says. "We're seeing new patients every week."

Through patient education and oversight of medications and vital signs by Mae Centeno, MS, RN, who runs the program, disease management can have a powerful effect on patients with congestive heart failure, Hall says.

"Educating patients is by far the best course against heart failure," she says. "Good disease management can drastically reduce [heart] events, which means patients are able to decrease their re-admission rate into the hospital, reduce emergency room visits and improve their quality of life."

The program was lifesaving for Thema Anderson, who says she was experiencing severe shortness of breath after the birth of her second child, Joi.

"I was sick for a month after Joi was born," she says. "Finally, I just couldn't stand it and my Mom said, 'Let's go to Baylor.' "

After an echocardiogram, Anderson was diagnosed with postpartum cardiomyopathy. She was placed on several heart medications including carvedilol, a novel medicine for heart failure, for strengthening her heart. Anderson also started weekly visits to the heart disease management program, where Centeno helped her learn about diet and exercise while being monitored.

"When I first came to the hospital, my heart was beating at 13 percent capacity. Now it's at 70 percent capacity and I can do everything I did before, even working out at a gym," she says. "Mae has been so supportive. I know she saved my life."

Echocardiography, which uses sound waves to evaluate the functions and fluid volumes in the heart, is one of three types of cardiac diagnostic imaging done at Baylor, says Jeffrey Schussler, MD, medical director of the critical care unit and a member of the medical staff at Baylor.

The other two methods are coronary ultrasound performed by sending a miniature ultrasound catheter through the artery or noninvasive angiography done with a less invasive method using Baylor's Heart and Vascular 64-slice computed tomography scanner.

"The CT scanner gives accurate images of the heart and the coronary arteries without having to introduce catheters inside the body," Schussler says. This technology is taking the place of some angiograms because it's safer and may be more cost-effective. Schussler and colleagues have written a number of papers and reports detailing the use of this technology in the place of more invasive angiography. Schussler said he believes that this new technology is the next big step in the evolution of cardiac diagnostic procedures.

"Cardiac computed tomography stands poised to revolutionize the way in which cardiac pathology is diagnosed, and change the way in which decisions are made with regards to invasive treatment of cardiac disease," he says.

Another important area of heart care — known as electrophysiology — deals with the electrical processes in the heart. Electrical problems in the heart can arise from common heart conditions, such as heart attack, or can be present since birth, or acquired through aging, says Kevin Wheelan, MD, chief of the medical staff at Baylor Jack and Jane Hamilton Heart and Vascular Hospital. Electrical problems can occur frequently and occasionally with significant consequences.

Treatments for patients with electrical heart issues, Wheelan explains, include pacemakers, implantable defibrillators, ablations and hemodynamic monitors, which monitor fluid inside lungs to check for development of congestive heart failure.

"EP can address a broad range of issues from helping people with very advanced heart conditions that place them at constant risk of death to helping restore a young athlete [with heart arrhythmia] to go back to competitive sports," he says. "We can fix those problems and in most cases with an outpatient procedure."

"More than 50 percent of what we do are ablations for people who are born with electrical problems," Wheelan says. "Others acquire it from heart attack, leaky valve, high blood pressure, or a virus that damages the heart."

An ablation is a nonsurgical procedure where catheters — flexible, narrow wires — are inserted through a blood vessel to the heart, where measurements are made of the faulty electrical sites in the heart. An abnormal electrical flow can often be corrected through the catheter.
By eliminating extra or abnormal circuits, certain heart problems can be corrected, Wheelan says. Before the field of EP, the only options were to use different medicines or complicated surgery to suppress the problem, but now there are more options to restore people to a healthy life.

Baylor's EP program includes six electrophysiologists on its medical staff working in four laboratories. This fall, Baylor will be adding a robotic system called a Stereotaxis Magnetic Navigation System to the labs in order to place the catheters more precisely in the heart.

Baylor Dallas is currently involved in a clinical trial examining patients with atrial fibrillation, a common abnormal heartbeat. Yet another clinical trial at Baylor will look at repairing heart valves without surgery, says Paul Grayburn, MD, medical director of research in the Baylor Heart and Vascular Institute and a clinical cardiologist on the medical staff at Baylor.

Another novel clinical study is seeking to find a better test for hypertrophic cardiomyopathy, or HCM, a leading cause of sudden death in young athletes.

"Right now there is not a good test for this kind of potentially fatal heart muscle disease," Grayburn says. The trial is testing the use of new genetic markers to screen for this disease. The study is currently seeking candidates. Candidates must be at least 18 years old and either be diagnosed with the disease or have family members with the disease.

Twenty clinical trials, including eight that started this year, are under way at Baylor's Clinical Cardiovascular Research Center, says Cara East, MD, medical director of the center and a member of the medical staff at Baylor.

Clinical trials of drugs have had a profound effect on care for patients with cardiovascular diseases. Some drugs are now poised to drop dramatically in price as patents expire and generic forms come on the market, East says.

One clinical study at Baylor is looking at a new medication for blood thinning. Another trial is examining a drug to regulate the heart's fluid levels in patients with congestive heart failure.

"Older medications are chemical, not biologically based," East says. "The new drugs are more specific in task and based on biology that the body normally makes."

With all the leading research going on, physicians on the medical staff at Baylor Dallas produce at least 45 to 50 articles a year based on the research done at the heart and vascular institute, Yancy says.

"It's clinical research to improve clinical care," he says. "These are near-term projects in which drugs, devices and procedures are investigated that may have an immediate impact on the delivery of care. In my judgment, this is very pragmatic research and is very necessary."

The American Journal of Cardiology, one of the leading international journals for clinical heart care, also is housed at Baylor. Its editor-in-chief is Bill Roberts, MD, a cardiologist on the medical staff at Baylor Dallas.

Along with innovation in medicines and procedures, Baylor Dallas and the heart hospital have adopted the quality initiatives for heart care established by the Joint Commission and the Institute for Healthcare Improvement, says Tom Andrews, MD, medical director for health care improvement and a physician on the medical staff at Baylor Dallas.

"We're hitting 100 percent most of the time on the Joint Commission performance measures," Andrews says. "Very few hospitals are doing that." Achieving high marks in adherence to quality measures will ultimately yield better outcomes for patients who seek care at Baylor.

Yancy says: "Overall, Baylor Dallas is a dynamic environment that allows physicians on the medical staff to provide the quality care, investigate novel initiatives in cardiology, train future doctors and cardiologists, and contribute to the medical literature and the entire process of medical education. This really is a unique institution and at least a community if not a national health care resource."  : :