Feb 7, 2019
When you have a team of experts dedicated to caring for your heart condition, you’ll always see providers you know and trust. Dr. Vinod Thourani explains how collaboration among a variety of experts improves our patients’ outcomes and experiences.
Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.
Host: Thank you for joining us today. We’re talking with Dr. Vinod Thourani, chairman of cardiac surgery at MedStar Heart and Vascular Institute and MedStar Washington Hospital Center. Welcome, Dr. Thourani.
Dr. Vinod Thourani: Thank you so much.
Host: Today we’re talking about who makes up a patient’s heart team. When it comes to managing a heart condition, the ‘who’ is just as important as the ‘what.’ Heart team members have specific roles, and the way they collaborate together and with patients can make the difference between successful outcomes and simply managing symptoms. Dr. Thourani, what do you mean when you say “heart team”?
Dr. Thourani: I think that’s a great question and I think that really needs to be defined more because I’m not sure people understand. And a lot of the patients, when I talk to them in the clinic, I have to explain to them exactly what a heart team is. So, this is really evolved. Where the original heart team, meaning a group of doctors on a common theme, was really in heart failure. So, if somebody was coming to get a heart transplantation, they would be evaluated by a multitude of people. They’d be seen by a regular cardiologist, they’d be seen by nurse practitioners or physician’s assistants, and they’d be seen by the surgeon. And that was a very small group of patients. And over the last decade, where it really exploded—the aspect of the heart team—was in valve disease. A study called a Partner Study—and the reason the study was called Partner Study is it was the definition of a heart team. Because we’re going to see surgeons and cardiologists partner together for the treatment of valve disease. And that idea has really been an organic growth over the last decade.
So, the heart team now has really modified since when I knew about this about 12 years ago. And currently the heart team constitutes a specifically—and it can be for coronary disease or valve disease; it can be for any disease process but at the least it includes now a non-invasive cardiologist, a general cardiologist, an invasive cardiologist who puts in stents or helps treat a heart attack with some type of angioplasty procedure. It includes an echocardiographer who’s also a cardiologist—so these are the specific physician who does the sonogram, and sometimes that’s called a transthoracic echocardiogram or TTE. And so you really have those three cardiologists that help the initial part of the heart team. Of course, there’s the cardiac surgeon, especially for those patients who can’t be treated with catheters. And I will tell you now that is grown into something that we call advanced practice clinicians, and those are nurse practitioners and physician’s assistants, so APCs are now an integral component of the heart team. There are other people who are called in to the heart team—sometimes a neurologist is called in if someone has stroke issues or has dementia issues. A nephrologist can be called in for obviously patients who have kidney problems. But really, we have five or six key people that make the heart team, especially at the MedStar Heart and Vascular Institute. Those really five people are key to the process of evaluating a patient.
Host: Is having APCs involved with the heart team more regularly common or is it something unique to MedStar Heart and Vascular Institute?
Dr. Thourani: So, I think that early on, including APCs within the heart team was a unique aspect. So, we really use APCs, which could be a physician’s assistant or a nurse practitioner, almost as an extension of the physician. Their knowledge is unbelievable and they’re able to really bring the patient into it—this family, is what we end up creating. And as I see valve patients, I tell them that you’re now part of the heart team family and that we’ll be managing your valve problems or your coronary problems for the rest of your life. So, the APCs are critical to the preoperative, the intraoperative and the postoperative management of our patients, so they’re really a critical component of the heart team.
Host: Do you work with the palliative care program as well?
Dr. Thourani: We do, and what we’re able to do, uh, for the heart team—if we believe that someone has a life expectancy of less than a year, then we really bring in palliative physician specialists, but also oncologists, ‘cause a lot of those people who have less than a 1-year expectancy of life have some type of malignant cancer that we’re worried about. So, the heart team can really have a multitude of people that we call on, too, and then there’s our core heart team that we use. We’re very fortunate at the MedStar Heart and Vascular Institute that we’re integrated within MedStar Washington Hospital Center that has world class care in all aspects, so we’re really fortunate to be able to call on our colleagues within minutes and we’re able to get someone to see these patients.
Host: What is your patients’ reaction when you mention that they’re now a part of the heart team family?
Dr. Thourani: They love it because sometimes in our care in the United States has become fragmented. So, you see one doctor one time and then you may not—the next time you come to the hospital or the next time you come to the office, you may not see that person again. And so I think that they get lost in the shuffle. And our goal is for the patients to feel very comfortable that they’re coming to a team of physicians who are with them for a long period of time. And I really believe the APCs are a good extension of that because if I’m in, let’s say, in surgery and I can’t see them, they already know our APCs, so they feel very comfortable talking to them and really using them as our extensions.
Host: Why did you choose to come to MedStar Heart and Vascular Institute?
Dr. Thourani: You know, I was in Atlanta for 37 years, and so for me to leave, it really had to be somewhere where I thought it was going to be the next level for me as far as taking care of my patients. And, I looked around the country and, to me, MedStar Heart and Vascular Institute was the place that felt the best to me as far as synergy of not only the medical devices that we treat people, but the actual people, and I think the human interactions in the team that’s here really attracted me to coming here. I’m overwhelmed by the quality of physicians and the interest in taking care of patients. It really is a patient-centric focused pathway and so I couldn’t be happier.
Host: You’ve talked a lot about that collaboration between all of the different physicians. How does that then translate to the patient outcomes and patient care?
Dr. Thourani: So, patient outcomes therefore, I think, benefit because when a patient comes in, we don’t necessarily pigeonhole them into one or two procedures. We have a bevy of procedures we can provide for them, if they need that, of course. Sometimes they don’t and they get medical therapy. But, if they do need a procedure, then we’re able to provide them that traditional pathway or we can give them the pathways that are innovative and new technologies. And so, with our relationship with the FDA and the NIH, we get sometimes therapies here that no one else in the country has, or only two or three sites in the country have, so we’re fortunate with that. That has, therefore, left us with looking at our outcomes, and we find that we are, for instance in cardiac surgery, we are three stars, the highest designation given to a cardiac surgery program, in all 3 categories that exist. And therefore, that puts us within the top 1 to 2 percent of hospitals performing cardiac surgery in the United States. So, we feel that this heart team approach also benefits, not only the patients, but it also benefits our outcomes to give us a program that is unique amongst the entire country.
Host: How does the research portion of being an academic medical center benefit you as a surgeon and your team as well as benefit the patients?
Dr. Thourani: So, that’s a great question. And I’ve been a big proponent of research, and that’s a big part of what I like to do. And my research has been specifically more in the clinical end of taking care of patients with new technologies. And it’s just not mine, but it’s our entire heart team that does that. And what we’ve been able to do is offer patients, when there was no hope, or were able to offer therapies that are less invasive and easier on the patient for recovery. So, it has completely changed with the research aspect, the new technologies we’re able to get here and available to patients. It has completely transformed how we manage patients and I think it’s the future of why patients have great outcomes here. And it’s one of the reasons I also came here. I knew the team here were very interested in providing the best technological support we can.
Host: If there is an individual in the community who has a serious heart condition, what would be the most important thing to impress upon them as to why they should come to MedStar Heart and Vascular Institute for their care?
Dr. Thourani: The most important reason is that you have a dedicated heart hospital here at MedStar Washington Hospital Center, so the MHVI is a functioning, over 200 beds, that are exclusive for the care of cardiac patients. We have nurses that are exclusive to that. We have ICUs that are exclusive to that. Our operating rooms are completely situated with that. And so, we have a MHVI, the MedStar Heart and Vascular Institute, is a really a hospital within a hospital, an institute within a hospital, that allows us to concentrate on the patients with coronary or valvular or heart failure conditions. So, we really have it really finetuned to managing these patients. And this is very unique and it’s not very common to have this type of energy and vision towards this entire pathway.
Host: Thank you so much for joining us today, Dr. Thourani.
Dr. Thourani: It was my pleasure. Thank you so much.
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