Changing practice Changing lives Duke Heart Report 2012 Changing practice Changing lives obert J. Lefkowitz, MD R Winner, 2012 Nobel Prize in Chemistry g g letter from leadership The Duke Heart Center is consistently recognized as one of the premier cardiovascular treatment and research centers nationally and internationally. Our goal is simple—to provide state-of-the-art, evidenced-based patient care while continually advancing the practice of cardiovascular medicine through our robust clinical research programs. Our commitment to caring for patients with heart disease begins with impactful research—from the seminal work conducted by Robert J. Lefkowitz, MD, for which he was recently awarded the 2012 Nobel Prize in chemistry, to our leadership and participation in virtually every major heart-related investigational network, clinical trial, and registry—including the 40-year-old Duke Databank for Cardiovascular Research, which in the 1990’s led to the creation of the Duke Clinical Research Institute and continues to be a rich source of research data today. Perhaps most importantly, we continue to translate the discoveries and findings from our research into innovative models of care that draw together multidisciplinary teams of specialists and staff in new ways to, among other things, ensure that the most appropriate, effective therapies are selected and delivered to all of our patients. (See pages 8-9.) Our faculty also continue to have a profound impact on setting standards for quality heart care through their work with the American Heart Association, American College of Cardiology, National Heart, Lung, and Blood Institute, and many others. Through our growing network of affiliated heart centers, we are working to help advance the delivery of the highest quality of care throughout the Southeast. Through these efforts we are changing practice—and changing lives. We’re pleased to share with you our latest initiatives, innovations, and achievements in this year’s Duke Heart Report. Christopher M. O’Connor, MD Victor J. Dzau, MD Director, Duke Heart Center Chief, Division of Cardiology Professor of Medicine Chancellor for Health Affairs, Duke University President and CEO, Duke University Health System James B. Duke Professor of Medicine Director, Molecular and Genomic Vascular Biology facts and stats Ranked among the top 10 programs nationally, Duke Heart Center serves more than 65,000 patients every year Patient Volumes Duke University Health System, CY11 Procedure Volumes Duke University Health System, CY11 182,877 Total Patient Visits 175,182 Outpatient Visits Inpatient Discharges 7,402 Unique Patients Figures are for calendar year 2011. Volumes are for Duke University Hospital, Duke Raleigh Hospital, Durham Regional Hospital, and hospital-based locations. 14,888 Cardiac Catheterizations** Arrhythmia/EP 68,281 26,644 Adult Echo* Peripheral Vascular*** 2,800 1,614 *Includes stress echo and TEE **Diagnostic and interventional ***Noninvasive arterial and carotid, plus diagnostic and interventional peripheral and carotid The People of Duke Heart Center 1200+ Total Faculty and Staff Board-Certified Cardiologists, Cardiac Surgeons, and Cardiothoracic Anesthesiologists 110+ Cardiac and Cardiothoracic Surgical Nurses One of the Nation’s Top Cardiovascular Critical Care Units Duke University Hospital’s 16-bed Cardiac Care Unit (CCU) is one of the nation’s top acute myocardial infarction care units, serving some 1,700 critically ill patients each year. Duke Heart Center 888-HRT-DUKE 800+ Exceeding Benchmarks Leader in Minimally Invasive Surgery With more than 900 open-heart procedures annually, Duke’s volumes far exceed those suggested by national guidelines—and survival rates consistently exceed Society of Thoracic Surgeons benchmarks. More than half of the general thoracic surgeries performed at Duke annually use minimally invasive techniques—compared to 20 to 30 percent nationally. Heart Surgery Volumes and Mortality Duke University Medical Center GENERAL THORACIC SURGERY VOLUMES 1.90% 2008 3.32% 2009 1.62% 2010 2.58% 1,018 2011 1.72% 990 910 935 1,048 44 Other 2007 748 2008 748 2009 787 2010 2011 Min. Invasive CARDIOVASCULAR AND THORACIC SURGERY VOLUMES Duke University Medical Center, CY11 73 1,429 Isolated CABGs 3,673 TEE 485 1,388 888 1,486 1,018 1,654 Total Procedures Volumes for Duke University Hospital, Durham Regional Hospital, and Duke Raleigh Hospital, CY11 Duke performed 147 lung transplants in 2011 with survival rates that far surpass the national average. Isolated Valves 109 CABG and Valves ONE-YEAR LUNG TRANSPLANT PATIENT SURVIVAL RATE 89.04% 81.76% duke US 50 Thoracic Echo 2,769 1,302 #1 Volume in the U.S. 372 342 1,654 20,202 Vascular 3,155 Cardiac MRI Volumes Adult Congenital IMAGING PROCEDURE VOLUMES, CY11 Stress Echo 2007 Mortality Rate Among the world’s highest volumes Heart Transplant 147 Lung Transplant From the Scientific Registry of Transplant Recipients (srtr.org), for adults receiving their first transplant between 1/1/09 and 6/30/11. A p-value of 0.01 indicates that this difference is statistically significant. 2,059 Nuclear imaging tests Stress echo and nuclear imaging volumes for Duke University Hospital, Duke Clinic, and Duke Health Centers at Southpoint and North Duke Street. MRI volumes for Duke University Hospital and Duke Clinic. Among the Southeast’s Highest-Volume Interventional Cath Labs 12,038 Diagnostic (coronary and peripheral) 3,073 Interventional (coronary and peripheral) Cardiac catheterization lab procedure volumes for Duke University Health System and affiliate sites, CY11 2012 Report 3 Defining Best Practices “When the American Heart Association announced its top advances in cardiovascular quality of care and outcomes research for 2011, more than half of them involved Duke faculty. That speaks volumes.” – Eric D. Peterson, MD, MPH Director, Duke Clinical Research Institute Duke Heart Center is internationally known for translating scientific discoveries into better treatments for heart disease—and expanding the evidence base for clinical practice worldwide. Duke is a founding site of both the Duke Heart Center 888-HRT-DUKE DCRI faculty published 568 papers in peer- NIH-funded Heart Failure Clinical reviewed journals during the 2011-2012 Research Network and the Clinical academic year—more than 20 percent of and Translational Science Awards them in high-impact journals Consortium Duke Heart Center faculty receive more One of nine US sites in the NIH-funded than $130 million in cardiovascular Cardiothoracic Surgical Trials Network research funding each year from govern- Research coordinating unit for the NHLBI ment and private sources, including more Centers for Cardiovascular Outcomes than $5 million for basic research and more Research than $110 million for clinical research Home to the Duke Databank for Cardio- 60 cardiology studies and 18 cardiotho- vascular Disease—the world’s largest and racic surgery studies are currently under oldest such outcomes registry, with infor- way at Duke Heart Center—including a mation on more than 200,000 patients number of “first-in-man” studies. Home to Duke Clinical Research Institute Home to the editors of The Journal of Clinical (DCRI)—the world’s foremost academic Investigation, the American Heart Journal, research organization—which has conduct- and the Journal of the American College of ed more than 870 studies in 65 countries Cardiology: Heart Failure, premier venues for at more than 37,000 sites, enrolling more disseminating critical advances in cardiovascu- than 1.2 million patients lar research National Leadership Setting National Quality and Appropriateness Guidelines Duke leads the creation of national quality standards through work with entities such as the Centers for Medicare and Medicaid Services, the Food and Drug Administration, and the National Academy of Sciences’ Institute of Medicine. Faculty are also leading and serving on committees of the American College of Cardiology (ACC) and the American Heart Association (AHA) to develop appropriateness guidelines and performance indicators for cardiovascular imaging, PCI, CABG, ICDs, TAVR, and more—as well as chairing the overarching ACC/AHA Performance Measures Task Force that champions the development of new performance measures to improve cardiovascular care quality. Home to National Registries Duke is the coordinating center and analytic engine for national quality initiatives that collect data from US hospitals to improve treatment and outcomes: Society of Thoracic Surgeons (STS) National Database AHA’s Get With the Guidelines initiative AHA, American Diabetes Association, and American Cancer Society’s The Guideline Advantage outpatient registry ACC’s National Cardiovascular Data Registry percutaneous coronary intervention registry and the NCDR-ACTION acute coronary syndromes registry—each the world’s largest clinical registry in its class ORBIT-AF, the nation’s largest longitudinal registry of atrial fibrillation patients PREVAIL, a large registry of diabetic treatment in clinic populations STS/ACC TVT Registry, the post-market-approval registry for transcatheter aortic valve replacement (TAVR) Robert M. Califf, MD Robert Jaquiss, MD Eric Peterson, MD, MPH Member, American Heart Association, Scientific Publishing Committee Member, NIH National Advisory Council on Aging Member, IOM Board on Health Sciences Policy Member, NHLBI Board of External Experts Member, Board of Directors, Society for Clinical and Translational Sciences Member, CTSA External Advisory Board Editorial Boards: American Heart Journal, Circulation, European Heart Journal, Journal of the Society of Clinical Trials Chairman, Berlin Heart Study Group and Publications Committee Member, Education Committee of the American Association for Thoracic Surgery Member, Membership Committee for the Congenital Heart Surgeons’ Society Robert J. Lefkowitz, MD Chair, ACC/AHA Performance Measures Task Force Board President, AHA Mid-Atlantic Affiliate Member, AHA Strategic Executive Planning Committee Member, ACC Quality Oversight Committee Member, FDA/CDRH MDEpiNET Technical Working Group Member, Institute of Medicine (IOM) Large, Simple Trials Group Member, ACC/AHA Guidelines on the Management of Unstable Angina/Non-ST Segment Elevation Myocardial Infarction Member, AHA Guidelines for Secondary Prevention Contributing Editor, JAMA 2012 Nobel Prize in Chemistry (shared) Howard Rockman, MD Jennifer Li, MD Editor in Chief, The Journal of Clinical Investigation, 2012-2017 James Daubert, MD Simon Dack Award for Outstanding Scholarship, Journal of American College of Cardiology, 2011 Senior Consulting Editor, Journal of American College of Cardiology, 2012 Pamela S. Douglas, MD Member, NHLBI External Advisory Council Member, National Space Biomedical Research Institute External Advisory Council Co-Chair, FDA Standardized Data Collection for Cardiovascular Imaging Initiative Chair, ACC Publications Committee Co-Chair, ACC Cardiovascular Leadership Institute Chair, ACC Quality in Technology Working Group Chair, ASE Extramural Research Committee Donald Glower, MD Member, The Journal of Thoracic and Cardiovascular Surgery Editorial Board Member, Journal of Cardiac Surgery Editorial Board Member, South Atlantic Cardiovascular Society Steering Committee Co-Principal Investigator, EVEREST Evalve FDA Phase III Trial Christopher Granger, MD Chair Emeritus, AHA Mission: Lifeline Member, ACTION Registry: GWTG Research and Publications Committee Member, NHLBI Board of External Experts G. Chad Hughes, MD Member, The Society of Thoracic Surgeons Task Force on Thoracic Endografting Member, The Society of Thoracic Surgeons/ FDA Center for Devices and Radiological Health (CDRH) Network of Experts Percutaneous Heart Valves Bench William E. Kraus, MD Member, Board of Trustees, American College of Sports Medicine Member, Board of Directors, International Society for Physical Activity and Health Member, Institute of Medicine committee to evaluate Pediatric Drugs and Biologics under the Best Pharmaceuticals for Children Act Joseph P. Mathew, MD, MHSc Chair, Neurocognitive Committee, Cardiothoracic Surgical Trials Network Member, Abstract Review Committee, Society of Cardiovascular Anesthesiologists Member, Database Task Force, Society of Cardiovascular Anesthesiologists L. Kristin Newby, MD, MHS Chair, Council on Clinical Cardiology, American Heart Association President, Society of Cardiovascular Patient Care Senior Associate Editor, Journal of the American Heart Association Member, ESC/ACC/AHA/WHF Task Force for the Redefinition of Myocardial Infarction Christopher O’Connor, MD Editor-in-Chief, Journal of the American College of Cardiology: Heart Failure Treasurer, Heart Failure Society of America FDA Working Group: Acute Heart Failure Syndromes—Clinical Trials NIH/NHLBI Working Group: Emergency Department Management of Heart Failure NIH/NHLBI Working Group: Cardiac Transplantation Workshop and Guidelines Committee Magnus Ohman, MD Member, FDA Center for Device Evaluation Panel Member, ACC/AHA Guidelines Oversight Committee Member, ESC Task Force for Non-STEMI Guidelines Joseph Rogers, MD Board of Directors, International Society for Heart and Lung Transplantation Vice Chair, UNOS Thoracic Committee Principal Investigator, HeartWare ENDURANCE Trial Peter K. Smith, MD Vice Chair, ACC/AHA CABG Guidelines Committee Member, Advisory Panel, Joint Commission/AMA National Overuse Summit for PCI Member, Writing Committee, ACCF/SCAI/STS/ AATS/ASNC Appropriateness Criteria for Coronary Revascularization Member, Relative Value Update Committee, AMA Member, ACCF/AHA/PCPI CAD/HTN Committee; PCPI Quality Measures Committee, AMA Top Doctors Six Duke Heart Center cardiologists and three cardiothoracic surgeons were recognized as Top Doctors by U.S.News & World Report—estimated to be among the top one percent in their specialty nationwide. Cardiologists Thomas M. Bashore, MD; Robert M. Califf, MD; J. Kevin Harrison, MD; Christopher M. O’Connor, MD; Harry R. Phillips III, MD; Joseph G. Rogers, MD Cardiothoracic surgeons Thomas A. D’Amico, MD; David H. Harpole Jr., MD; Peter K. Smith, MD Manesh Patel, MD Chair, AHA Diagnostic and Invasive Cath Committee Chair, Writing Committee, ACCF/SCAI/STS/AA TS/ASNC Appropriateness Criteria for Coronary Revascularization Member, ACC Task Force, Appropriate Use Criteria Writing Committee, AHA/ACC CABG Guidelines Committee 2012 Report 5 Leading the way with TAVR Research That Changes Practice tavR volumes* 76 11 sapien corevalve Four decades with Duke—and counting Bobby Hartley’s relationship with Duke started forty years ago, when at the age of seven he was diagnosed with Hodgkin’s lymphoma. Chemotherapy and radiation to his chest cured the lymphoma, but weakened his heart. Last year, Bobby was diagnosed with congestive heart failure. He needed an aortic valve replacement, but was not a candidate for open surgery because of a severely calcified, “porcelain” ascending aorta. Duke’s leadership in advancing transcatheter aortic valve replacement (TAVR) gave Bobby access to more options. In May 2012, he underwent a TAVR procedure and less than a day later was up and walking around. “My heart failure made me feel like I was drowning,” he said. “After my procedure, I started feeling better almost immediately. It was truly an amazing thing.” Duke Heart Center has helped pioneer the use of transcatheter aortic valve implants, which offer a lifesaving option for patients who are not able to undergo open surgery. Our experience and outcomes with both the CoreValve and Sapien Valve systems, mean we are able to offer this minimally invasive option to a much wider spectrum of patients. Learn more on page 19. *Data as-of 11/6/12 Changing Practice Through Clinical Research Internationally renowned for cardiovascular clinical research, Duke Heart Center and Duke Clinical Research Institute conducts pivotal studies that define best clinical practices. A few examples: STICH—The largest-ever trial of surgical therapy in ischemic heart failure, STICH compared coronary artery bypass grafting (CABG) surgery plus medical management to drug therapy alone. Researchers found no difference in overall survival but lower rates of cardiovascular events for patients with CABG. N Engl J Med. 2011; 364(17):1607-1616. ARISTOTLE—This study of 18,201 patients with atrial fibrillation found apixaban superior to warfarin in preventing stroke. A 2012 Duke study published in Lancet showed apixiban’s superiority held true regardless of the risk score used and regardless of the patient risk category. N Engl J Med 2011; 365:981-992 ROCKET-AF—This DCRI-led international study of more than 14,000 patients found rivaroxaban equally effective as warfarin in preventing stroke in AFib patients—while providing more consistent and predictable anticoagulation effects. Rivaroxaban was approved by the FDA for use in atrial fibrillation patients based on the ROCKETAF results. N Engl J Med 2011; 365:883-891 ASCEND-HF—Duke researchers led the largest-ever trial to evaluate the effectiveness of nesiritide as a treatment for dyspnea in patients with decompensated heart failure, determining that the drug was no better than placebo yet increased rates of hypotension. N Engl J Med. 2011 Aug 25; 365(8):773. Appropriate use of ICDs—A Duke-led retrospective study using data from the National Cardiovascular Data Registry (NCDR)’s ICD Registry found that 22.5 percent of patients receiving implantable cardioverter-defibrillators (ICDs) did not meet evidence-based criteria for implantation. JAMA. 2011; 305(1):43-49. Appropriate use of PCI—A Duke review of data from the NCDR CathPCI Registry found that while almost 99 percent of percutaneous coronary interventions (PCI) performed in acute settings followed standard criteria for appropriate use, only half of PCIs performed in non-acute settings were appropriate—suggesting “an important opportunity to examine and improve the selection of patients undergoing PCI in the non-acute setting.” JAMA. 2011; 306(1):53-61. CABANA—Duke is the #1 U.S. enroller—#2 worldwide —in the largest-ever and most significant clinical trial of its kind comparing catheter ablation to anti-arrhythmic drug therapy in atrial fibrillation patients. Coordinated by Duke Clinical Research Institute, the 140-site trial will determine which therapy is best in terms of reducing mortality, reducing treatment costs, and preserving quality of life. BRIDGE—This NHLBI-funded trial led by DCRI is designed to establish an evidence-based standard of care for patients who must temporarily stop using warfarin because of elective procedures or surgery. ISCHEMIA—DCRI serves as the statistical and data coordinating center as well as the economics and qualityof-life coordinating center for this international study to determine whether invasive procedures combined with medical therapy improve outcomes compared to medical therapy alone in the initial treatment of ischemic heart disease. TECOS and EXSCEL—Multinational trials coordinated by DCRI and the University of Oxford (UK) Diabetes Trial Unit to evaluate the cardiovascular outcomes of adding sitagliptin (TECOS) or exenatide (EXSCEL) to the usual care of patients with type 2 diabetes. TECOS completed enrollment of over 14,000 patients in June 2012, with results expected in 2015; EXSCEL is enrolling 9,500 patients with results expected in 2017. PROMISE—This 150-site study is the first to compare how two kinds of diagnostic tests—anatomic testing with CT angiography versus functional testing with stress imaging or exercise ECG—correlate to outcomes in patients presenting with chest pain. Results are expected to have a major impact on health-care policy and practices. 2012 Report 7 Redesigning Care Half the battle in advancing heart care is working evidence-based procedures into practice. Duke Heart Center has designed revolutionary models of care that do exactly that. EMS use of pre-hospital 12-lead ECG 88% 67% Pre RACE-ER Post RACE-ER They call him “Miracle Man” Andy Smith lives deep in the North Carolina mountains, nearly two hours by winding roads from the nearest cath lab. It was not a good place to be when he suffered a heart attack with left-bundle branch blockage. Smith was ambulanced and airlifted to a hospital at a breathtaking rate, all thanks to the Duke-designed Regional Approach to Cardiovascular Emergencies (RACE) system that re- vamped protocols for hospitals and EMS teams to speed up heart-attack treatment statewide. Along the way, his heart stopped seven times and went into fibrillation at least 39 more, but the specially trained team kept him alive until he could receive lifesaving percutaneous coronary intervention (PCI)—only 72 minutes after he was picked up from his home. The RACE-ER project is a collaborative network of PCI centers, EMS providers and other care teams throughout NC working to improve STEMI care. EMS teams are able to interpret ECG readings faster and prepare care teams at destination PCI hospitals, greatly decreasing the time between heart attack and the provision of life-saving care for the patient. New Evidence-Based Models of Care Duke Heart Center has pioneered nationally recognized approaches to delivering heart care more efficiently and effectively, including: RACE: Regional Approach to Cardiovascular Emergencies Introduced in 2003 by Duke Heart Center and named a 2007 American Heart Association (AHA) top 10 research advance, RACE has improved myocardial infarction (MI) care in North Carolina by creating a statewide system of rapid coronary artery reperfusion delivery to patients with ST-elevation MI (STEMI). Now involving 119 hospitals and 540 regional EMS agencies in all 100 North Carolina counties, phase two—called Reperfusion of Acute MI in Carolina Emergency Departments - Emergency Response (RACE-ER)—has improved treatment times between first medical contact (by EMS) to balloon or device time throughout the state. North Carolina care teams meet the 90-minute STEMI threshold 75 percent of the time, compared to 68 percent of PCI centers nationally. An expansion of the RACE program, called Regional Approach to Cardiovascular Emergencies Cardiac Arrest Resuscitation System (RACE CARS), was made possible thanks to funding from the Medtronic Foundation’s HeartRescue Program. RACE CARS aims to improve survival of out-of-hospital sudden cardiac arrests by 50 percent over five years. Currently, 92 percent of North Carolinians who suffer sudden cardiac arrest (SCA) each year die. Strategies to improve survival include: teaching quality bystander CPR and the use of automatic defibrillators; ensuring rapid defibrillation and transport of patients to the most-appropriate hospital; and increasing the use of evidence-based interventions, such as primary PCI for STEMI and therapeutic hypothermia for comatose patients. Duke is in the process of evaluating expansion of the RACE network and protocols to include aortic dissection and cardiogenic shock. Resources for Advanced Heart Failure Duke offers an innovative Heart Failure Disease Management Program that has shown to reduce inpatient admissions, length of stay, and costs. In Fall 2012, Duke opened a multidisciplinary walk-in HF clinic that can offer infusion and ultrafiltration services for advanced HF patients. This novel offering is available nowhere else locally and is available only a few other places nationally. The level of service and convenience is akin to an urgent care model, but exclusively for HF treatment. (see page 15) The clinic is part of the new Center for Advanced Heart and Lung Disease. Hypertension Management Initiatives Established in early 2012, our Resistant Hypertension Program involves a team of cardiologists, nephrologists, a physician assistant and research coordinators to assist in the management of patients with resistant hypertension. Treatment strategies are based upon a patient’s prior treatment history, underlying cause of hypertension, barriers to treatment and target organ damage. The team provides assistance with blood pressure management and opportunities to participate in clinical research trials including the Symplicity HTN-3 study (see page 13). Duke is participating in an AHA-funded initiative called Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE), a home-based telemedicine study that is a randomized trial of tailored and telemedicine-based interventions for risk-factor modification in patients after MI. Participants receive home BP-monitoring equipment that automatically uploads their BP to the AHA portal. Patients receive either Web-based education or nurse-delivered education by phone to assist in BP reduction and control. Team Approach to Clinical Care and Access Duke Heart Center employs team-based care on both inpatient and outpatient fronts to enhance the effectiveness and timeliness of treatment. Highlights include: teams of cardiologists, pulmonologists, and specially trained advanced practice providers and other team members across related sub-specialties who provide collaborative clinic coverage. Multidisciplinary evaluations by cardiologists and car- diothoracic surgeons to determine objectively the best treatment for each patient, backed by joint research to compare the effectiveness of medical, cardiology interventional, surgical, and hybrid treatments on a population level. This represents the “Heart Team” approach that is newly called for in the Coronary Revascularization National Guidelines and Appropriate Use Criteria sponsored by the American Heart Association and the American College of Cardiology. Innovative Lung Transplant Protocols In 2011, Duke’s median wait time for lung transplant was only 12 days, thanks to aggressive organ-recovery strategies. We have seen excellent outcomes in transplanting patients who have not historically been candidates for lung transplantation, including those older than 70; patients with cystic fibrosis whose lungs are colonized with resistant pathogens; patients with concomitant coronary artery and/or valvular heart disease; and patients with respiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation (ECMO). The Duke Lung Transplant Program, the nation’s largest program of its kind, was established in 1992. Since then, the Duke team has performed more than 1,100 lung transplants—145 in 2011 alone. Our program is proud to achieve both one- and three-year posttransplant survival that is significantly greater than national averages. Duke is one of only three US lung transplant sites with better than expected one-year patient survival. Redesigned clinic space to improve patient access and to maximize efficient care of complex disease by creating 2012 Report 9 locations Improving Cardiovascular Care Quality Across the Southeast (and Beyond) With a robust network of locations and affiliated hospitals, Duke Heart Center is improving cardiovascular care quality and outcomes for patients across the Southeastern United States. Duke University Health System Hospitals Medical Center Staffed by Duke Heart Center Physicians Duke Lifepoint (DLP) Hospitals Duke Heart Center-Affiliated Hospitals Adult Cardiology and Cardiothoracic Surgery Community-Based Practices Pediatric Cardiology Community-Based Practices Life Flight Satellite Locations Duke Mobile Cardiac Catheterization Sites DLP Cardiac Partners Mobile Cardiac Catheterization Sites Global Reach Outside of our home region, Duke Heart Center works to improve heart care globally through strong clinical and research collaborations with partners in countries including: Singapore Duke-National University of Singapore Graduate Medical School, National University Health System, SingHealth Kenya ASANTA Cardopulmonary Center of Excellence China Center of Excellence in Cardiovascular Disease, Beijing Multinational Virtual Coordinating Center for Global Collaborative Cardiovascular Research (DCRI) India Medanta Duke Research Institute Duke Heart Center 888-HRT-DUKE Brazil Brazilian Clinical Research Institute AFFILIATE CASE STUDIES Duke Heart Network Southeastern Heart Center, Lumberton, SC Quality Care Close to Home Quality Improvement a Hallmark The Duke Heart Network works with heart programs throughout the Southeast to advance the quality and level of cardiovascular care available to residents in their home communities. In addition to operating more than 20 mobile cath lab sites and outpatient clinics staffed by Duke physicians, the Network provides intensive clinical and programmatic guidance to seven hospital-based cardiac affiliates: Alamance Regional Medical Center, Burlington, NC Each of Duke’s cardiac affiliates undergoes rigorous quality oversight and process improvement initiatives, with the goal of exceeding the benchmark measures of national cardiac registries such as the National Cardiovascular Data Registry and the Society of Thoracic Surgeons National Database. Some recent highlights: Beaufort Memorial Hospital, Beaufort, SC Danville Regional Medical Center, Danville, VA Indian River Medical Center, Vero Beach, FL 011 ACC-NCDR-Get with the Guidelines 2 Program Performance Achievement Recognition: Acute Myocardial Infarction Gold: Danville Regional Medical Center, Danville, VA High Point Regional Health System, High Point, NC 012 AHA-Get with the Guidelines Program 2 Performance Achievement Recognition: Heart Failure Lexington Medical Center, West Columbia, SC Gold: Beaufort Memorial Hospital, Beaufort SC Southeastern Regional Medical Center, Lumberton, NC Silver: Danville Regional Medical Center, Danville, VA 012 AHA Mission: Lifeline Program Performance 2 Achievement Recognition-Receiving Hospital Gold: High Point Regional Health System, High Point, NC 011-2012 HealthGrades Cardiac Care Excellence Award 2 Ranked among the top 10 percent in the nation for overall cardiac services arry R. Phillips III, MD H Chief Medical Officer, Duke Heart Network Since Southeastern Regional Medical Center—located in rural Robeson County, NC—became a Duke Medicine affiliate, mortality rates from heart disease in the region have decreased far faster than in the rest of the state. Between 2005-2011, mortality rates dropped 12 percent for all North Carolina residents, but 20 percent for residents of Robeson County. Source: North Carolina State Center for Health Statistics Heart Disease—Mortality Rates for NC Residents Death Rate (per 100,000) Through collaboration with its affiliate sites, Duke helps community hospitals achieve clinical excellence. 240 Duke heart affiliation initiated April 2006 230 220 210 200 190 180 2005 2006 Robeson 2007 2008 2009 2010 North Carolina Danville Regional Medical Center, Danville, VA Mortality rates for heart attack and heart failure have dramatically declined at Danville Regional Medical Center since the Virginia hospital became a Duke heart affiliate in 2008. Source: Centers for Medicare and Medicaid Services Outcome Measures CMS Annual 30-Day Mortality: AMI 23.3% 16.6% 19.8% 16.2% 18.1% 15.9% 17.4% 15.5% Southeastern Regional Medical Center, Lumberton, NC FY05-FY08 CARDIOVASCULAR PROCEDURES AT DUKE HEART CENTER AFFILIATED SITES 2007 2008 2009 2010 2011 FY06-FY09 FY07-FY10 FY08-FY11 CMS Annual 30-Day Mortality: HF 16.7% 11.1% 4,150 14.6% 11.2% 13.6% 11.3% 12.7% 11.6% 4,790 5,550 FY05-FY08 6,629 DRMC FY06-FY09 FY07-FY10 FY08-FY11 National Average 8,458 2012 Report 11 Advanced Coronary & Vascular Disease Programs of distinction Case Study James Whitaker has battled heart disease for more than two sive coronary artery bypass followed by percutaneous stenting decades. In 1990, at 42, he underwent his first bypass sur- of the remaining diseased arteries. gery at Duke. In September 2011, his feelings of fatigue and breathlessness returned. nurses’ expectations for recovery in the hospital. “My quality When Whitaker met with Duke cardiologist E. Magnus Ohman, of life went from 20 to 100 percent,” he said. “I have a lot of MD, he was experiencing chest pain. A cardiac catheterization life left to live.” revealed extensive coronary damage and the need for a more aggressive intervention. Ohman, working with Duke heart surgeon Carmelo Milano, MD, evaluated Whitaker for a hybrid revascularization, an approach that involves a minimally inva- eter K. Smith, MD P Chief, Cardiovascular and Thoracic Surgery Duke Heart Center Whitaker’s procedures went well, and he exceeded even the 888-HRT-DUKE . Chad Hughes, MD G Director, Thoracic Aortic Surgery Duke cardiologists and cardiothoracic surgeons collaborate to perform about 20 hybrid revascularizations each year, an approach available only at major academic medical centers. anesh R. Patel, MD M Medical Director, Percutaneous Interventions (PCI) . Magnus Ohman, MD E Medical Director, Advanced Coronary Disease Hybrid Operating Room Symplicity HTN-3 Duke’s hybrid OR—the first in North Carolina—enables cardiologists and cardiothoracic surgeons to perform percutaneous and open procedures simultaneously. This collaboration reduces the risk of complications and length of stay associated with multiple procedures, allowing patients to experience a quicker recovery. Our hybrid OR is equipped with the most advanced imaging technology, providing Duke physicians with precise information and improving overall patient outcomes. Duke is one of the top enrolling centers in the Southeast for the Symplicity HTN-3 trial, exploring novel ways to treat patients with resistant hypertension. The trial is evaluating the effectiveness of renal denervation for patients whose systolic blood pressure is greater than 160 in spite of taking three or more blood pressure medications. Traditionally, these difficult-to-treat patients have endured multiple drug therapy combinations without success, but early results from this one-time procedure show a median decrease in systolic blood pressure of 24 mmHg at six months. Hybrid Coronary Revascularization In 2012, Duke completed enrollment in an NHLBI-funded observational study of hybrid revascularization (see case study on facing page). Results from the study are informing the development of a pivotal comparative effectiveness study of this transformational approach to treating patients with complex coronary artery disease, which combines minimally invasive off-pump arterial grafting of the left anterior descending artery and simultaneous stenting of other coronary lesions. STICH A 2012 report released by NHLBI named the STICH trial, developed and led by Duke faculty, as one of the most important scientific advances of 2011. The results of this multinational trial showed no difference in overall survival rates for patients with coronary disease and heart failure who received CABG compared to optimal medical therapy, but they did reveal lower rates of cardiovascular events for CABG patients. The trial follow-up was extended to 10 years through new NIH funding. Both the American College of Cardiology and the European Society of Cardiology have modified their guidelines to include the STICH results. NEJM 2011; 364 (17):1607-1616 PRIMARY ISOLATED CABG VOLUMES AND MORTALITY 2007 1.71% 410 2008 3.13% 405 2009 1.46% 2010 2.03% 2011 2.61% 478 393 345 Mortality Rate Thoracic Aortic Surgery As a leading research center for thoracic aortic surgery, Duke participates in virtually all major thoracic endovascular stent graft-related clinical trials as well as research to determine appropriate patient selection for endovascular repair of aortic disease. Our faculty are leading the way in defining the surgical management of Loeys-Dietz syndrome, a rare connective tissue disorder that increases the risk of aortic aneurysm. Duke is one of the few centers in the country that offers “hybrid” repairs for thoracoabdominal and aortic arch aneurysms. This technique is a combination of open debranching and endovascular aneurysm exclusion, which eliminates the need for cardiopulmonary bypass and aortic cross clamp. Advanced Coronary Artery Disease One of only a handful of its kind, this program serves patients with debilitating chest discomfort for which few novel therapies exist and focuses largely on older people for whom treatments may be limited. We employ sophisticated angina therapies, such as enhanced external counterpulsation, a noninvasive treatment that increases the flow of oxygenized blood to the heart, and spinal-cord stimulation, a pain-blocking therapy used in some chronic and severe cases. Some 85 percent of patients improve to the extent that they are able to return to performing most daily activities. Volumes Data are for Duke University Medical Center. Duke’s annual CABG volumes, which consistently exceed those recommended by the AHA and ACC as indicators of care quality. And Duke Heart Center’s cardiac surgeons have produced consistently exceptional patient outcomes—with survival rates significantly higher than what is expected in a patient population as complex as ours. THORACIC AORTIC SURGERY VOLUMES Duke University Hospital, FY11 96 Ascending Aorta/Root 107 Arch (Open and Hybrid) 47 Descending (Open and endovascular) 43 TAAA (Open and hybrid) 2012 Report 13 Advanced Heart Failure Programs of distinction Case Study When Lynn Gullick, a 59-year-old attorney and mother, and heart failure specialists worked successfully to manage couldn’t shake a persistent cough, she went to her doctor, her heart failure for more than three years. After three hos- expecting a prescription. Instead, she was diagnosed with pitalizations in as many weeks, Gullick agreed to be listed for congestive heart failure. transplant. Seven days later, Carmelo Milano, MD, a Duke Referred by Cleveland Clinic to Christopher O’Connor, MD, heart surgeon, gave Gullick a new heart. a Duke heart failure specialist, Gullick began medical therapy. Duke’s multidisciplinary approach meant Gullick was given in- When imaging showed her condition was worsening, she dividualized treatment options for her failing heart. And Duke’s was evaluated for a heart transplant by Joseph Rogers, MD. experience in cardiac transplant—performing nearly 900 since Not ready for surgery, Gullick wanted other options. A team 1985—means the new heart isn’t likely to fail her. of Duke interventional cardiologists, electrophysiologists, hristopher O’Connor, MD C Director, Duke Heart Center Duke Heart Center 888-HRT-DUKE armelo A. Milano, MD C Surgical Director, Cardiac Transplant drian F. Hernandez, MD, MHS A Director, Outcomes Research J oseph G. Rogers, MD Medical Director, Cardiac Transplant Top Program in the Country Mechanical Circulatory Support: VADs The Duke Heart Failure Program treats more than 3,600 patients each year, using a proven disease-management approach that has evolved over the past decade to reflect advancements in care.* Duke’s mechanical circulatory support program was among the first US programs approved by the Centers for Medicare and Medicaid Services and is certified by The Joint Commission for destination ventricular assist devices (VAD). In addition to having access to all the standard FDA-approved devices for destination therapy, Duke is involved in clinical trials, including REVIVE-IT and ROADMAP. Duke was also the leading enrolling center in the HeartWare DT trial and one of only eight hospitals nationwide offering FDA-mandated HeartMate II surgical training in partnership with VAD manufacturer Thoratec Corp., training surgeons from across the country. *Arch Intern Med. 2001 Oct 8;161(18):2223-8. #1 program in the country by research, education, and clinical metrics First comprehensive Heart Failure Disease Management Program #3 in LVAD and #4 in heart transplant volumes nationally $40 million in NIH funding in 2011-2012 More than 100 peer-reviewed publications with 15 percent in high-impact journals 2 FDA-approved biomarkers Novel Heart Failure Same-Day Access Clinic In 2012, Duke launched a same-day access clinic for heart failure patients, providing acute management of shortness of breath and edema in early-stage heart failure. The clinic offers intravenous diuretics and ultrafiltration with the goal of reducing unnecessary hospital admissions. This novel urgent care heart failure clinic represents a patient-centered approach to managing this chronic condition by providing support during the critical transition out of the hospital and in times of acute distress. HEART FAILURE READMISSION RATE HEART TRANSPLANT and VAD VOLUMES Duke University Hospital 23.9% 2007 42 2008 2009 2010 2011 VAD 51 57 41 64 48 74 duke 61 83 60 Heart Transplant ONE-YEAR HEART TRANSPLANT PATIENT SURVIVAL RATE US Data for July 1, 2008, to June 30, 2011. These percentages were calculated from Medicare data on patients discharged from Duke University Hospital and do not include people in Medicare Advantage plans or those without Medicare. Source: Hospital Quality Alliance. VAD SURVIVAL RATE Duke University Hospital RENEW Trial: Cell Therapy Duke Heart Center cardiologist Thomas Povsic, MD, is the national co-PI for the RENEW trial, the first phase III pivotal study of a cell therapy for cardiovascular indication seeking FDA approval in the United States. The study aims to determine the effectiveness of targeted intramyocardial delivery of Auto-CD34+ cells for increasing exercise time and reducing symptoms in patients with refractory angina and chronic myocardial ischemia. Enrollment began in April 2012. 24.7% 92.5% 90.2% duke US Duke’s VAD survival rates exceed the national average. In fact, our longest surviving patient lived more than seven and a half years with pump support. 85% 78% For adults receiving their first transplant between 1/1/09 and 6/30/11. Visit ustransplant.org for most current data. One Year DUKE 77% 68% Two Year US Percent survival among primary mechanical circulatory support implants between 06/23/06 and 6/30/11 2012 Report 15 Electrophysiology Programs of distinction Case Study John Ponton, 66, underwent a successful lung transplant at the donor pulmonary veins were sewn into his heart. Working Duke in January, 2012. Within weeks, the former environmen- carefully with cardiac imaging experts and the transplant team, tal scientist was feeling short of breath—frightening for any- James Daubert, MD, chief of cardiac EP, successfully ablated one, but particularly for a man with new donor lungs. Ponton the area and corrected the rhythm disorder. was hospitalized with atrial fibrillation caused by fluid buildup around his heart and lungs. Since then, Ponton is doing well and recently celebrated his 37th wedding anniversary with wife, Terry. He attributes his Duke Cardiologist Richard Becker, MD, managed to control successful outcome to Duke’s expertise and cross-discipline the AF with medication and Ponton was discharged. But by coordination. The experience offered by Duke’s EP team is early spring, the AF was no longer controllable. Ponton had what makes theirs one of the most successful in the southeast. developed atrial tachycardia, suspected to be located where J ames P. Daubert, MD Chief, Cardiac Electrophysiology Duke Heart Center 888-HRT-DUKE ugustus O. Grant, PhD, MB ChB A Cardiologist, Duke Heart Center ristram D. Bahnson, MD T Director, Duke Center for Atrial Fibrillation S ana M. Al-Khatib, MD, MHS Clinical Research Director, Cardiac Electrophysiology Highlights Duke Center for Atrial Fibrillation PROCEDURE VOLUMES Duke Heart Center’s Electrophysiology Program is an international arrhythmia referral center treating nearly 1,700 patients per year. We offer the most comprehensive, expert, and highest-ranked EP program in the Southeast. Duke offers comprehensive medical-surgical, invasive, and noninvasive AF-related care. Duke University Health System, CY11 14 specially trained cardiac EPs Four state-of-the-art EP labs Team-approach model that includes EPs, cardiothoracic sur- geons, dedicated NPs, PAs, RNs, technicians, patient educators, and pharmacists Expertise in complex atrial fibrillation (AF) catheter ablation procedures, as well as assessment and care of patients with prior failed catheter or surgical ablation Duke has the Southeast’s busiest implantable-device lead-extraction programs and offers laser extractions in a fully hybrid OR with an EP-cardiac surgical multidisciplinary team and ongoing clinical trials in extraction. We perform ventricular tachycardia ablations for cases ranging from normal hearts to those postinfarction or those with cardiomyopathy and end-stage heart failure on LVAD or ECMO. Our team has extensive experience in percutaneous epicardial ablation. Adult Cardiovascular Genetics Program Duke is one of the only centers in the Southeast to offer screening for inherited cardiac rhythm disorders, such as the long QT and Brugada syndromes, and to offer expertise in care management. Cardiac Resynchronization Center Duke EP offers new hope for heart failure patients with its cutting-edge research and technology. Our team has extensive invasive clinical experience; a national physician-education program; and a multidisciplinary Optimization Clinic for non-responders that includes EP, heart failure (HF), and echocardiography specialists working together to fine-tune patients’ implanted devices. Duke Center for Prevention of Sudden Cardiac Events in Athletes Launched in 2011, our center adds EKG testing to the standard physical exam given to all members of Duke University athletic teams. In addition to detecting asymptomatic heart pathologies and preventing premature deaths, we plan to assess the value of using EKG on athletes and will mine the newly created data registry for other trends. Research RAID—Investigator-initiated, NIH-sponsored trial aims to determine whether ranolazine administration in ICD patients will decrease the likelihood of a composite arrhythmia endpoint, consisting of ventricular tachycardia or ventricular fibrillation requiring anti-tachycardia pacing, ICD shocks, or resulting in death. The team includes members of the Duke University Cooperative Cardiovascular Society consortium, who are in practice throughout the U.S. 2,800 Total EP Procedures 709 Ablations 1,452 ICDs 37 Lead Extractions 209 Biventricular Devices 393 Pacemakers CALYPSO PILOT TRIAL—Duke investigator-initiated, multicenter pilot study comparing catheter ablation against antiarrhythmic drugs for cardiomyopathy patients with ventricular tachycardia. CABANA—Duke Clinical Research Institute-coordinated megatrial of catheter ablation versus antiarrhythmic drug therapy in AF patients. Duke is the highest US enrollment site—and second highest in the world—out of 140 sites. PACE-RBBB—Duke investigator-initiated trial evaluating three pacing treatment arms for patients with systolic heart failure and right-bundle branch block. FIRMAT-PAF—Intense investigation of the use of a novel system capable of mapping of rotors to ablate atrial fibrillation. 2012 Report 17 Structural Heart Programs of distinction Case Study Heart problems were the last thing that Simon Griffith, a approach meant he could avoid the lengthy recovery associat- 52-year-old avid cyclist, expected. After biking some 200 ed with an open procedure. Glower made a small incision on miles for charity, he grew concerned when a short ride left the right side of Griffith’s chest and, through a series of other him winded and fatigued. His cardiologist discovered a heart small access points, used a robot to guide the necessary instru- murmur, and an echocardiogram revealed significant mitral mentation to the heart to make the repair. regurgitation. After five days in the hospital, Griffith returned home. After Griffith was referred to Duke heart surgeon Donald Glower, six weeks of recovery, he returned to biking. Duke’s exper- MD, a renowned leader in minithoracotomy valve repair. Mitral tise in mitral valve repair and replacement leads to not only a valve repair instead of replacement meant Griffith could avoid high-quality outcome, but ultimately a higher quality of life. blood thinners or repeat surgeries and the minimally invasive onald D. Glower, MD D Surgeon, Duke Heart Center Duke Heart Center 888-HRT-DUKE homas M. Bashore, MD T Clinical Chief, Cardiology J . Kevin Harrison, MD Director, Cardiac Catheterization . Chad Hughes, MD G Director, Thoracic Aortic Surgery The world leader in minimally invasive procedures and pioneering research for two decades ISOLATED MITRAL VALVE REPAIR AND REPLACEMENT VOLUMES 2007 47 60 2008 Transcatheter Aortic Valve Replacement (TAVR) Minithoracotomy Valves Duke is one of the top recruiting sites in the CoreValve pivotal clinical trial of transcatheter aortic valve implantation (TAVI). Our patient outcomes with CoreValve are among the best, earning Duke one of the first US invitations to participate in SUR-TAVI, an international trial assessing the appropriateness of TAVI for patients with less severe aortic stenosis at intermediate risk for open-heart surgery. Duke is also one of the first US centers to implant a valve within a valve successfully, reinforcing a failed prosthetic valve with the Sapien implant. Our knowledge and experience working with both implant systems available on the market and through clinical Sapien Valve trials means we are able to offer more treatment options to a wider spectrum of patients. With novel applications and expanded indications for TAVR, patient selection is critical to a successful outcome. Duke faculty coauthored the 2012 ACCF/ AATS/SCAI/STS Expert Consensus Document on CoreValve Transcatheter Aortic Valve Replacement and Duke Clinical Research Institute will house the STS/ACC TVT Registry, a national benchmarking tool to monitor patient safety and outcomes for TAVR. JACC 2012;59(13):1200-1254 Duke Heart Center is a global leader in minithoracotomy valve repair and replacements. With more than 1,400 minithoracotomy mitral procedures without femoral arterial cannulation, approximately 300 repeat mitral surgeries, and more than 250 tricuspid surgeries, our faculty has the world’s highest volumes using this sophisticated, small-incision technique. We have performed more than 1,500 minithoracotomy mitral procedures, making us one of the top three volume leaders in the world and are among the nation’s top five volume leaders in minithoracotomy aortic valve replacements, with more than 600 procedures. Hypertrophic Cardiomyopathy Duke offers a range of treatment options for patients diagnosed with hypertrophic obstructive cardiomyopathy, including medical management, catheter-based alcohol septal ablation and surgery. In 2011, we performed 23 septal myectomies. Our faculty are actively researching advancements in therapies for patients with this genetic condition; we are initiating a new study of medical therapy for those with severe symptoms. We offer patients and their families genetic counseling and education in collaboration with the Adult Cardiovascular Genetics Clinic. Adult Congenital Heart Disease Percutaneous Mitral Valve Repair As one of only 40 North American centers with access to MitraClip, Duke has been a trial site for REALISM and EVEREST and will be participating in COAPT, a new clinical trial evaluating the safety and effectiveness of this device for patients with moderate-to-severe mitral regurgitation. Serving more than 1,200 patients annually, the Adult Congenital Heart Disease Program at Duke is a top referral center in the Southeast and one of the world’s few major training programs in adult congenital heart disease. Specially trained physicians include two cardiothoracic surgeons who perform adult congenital procedures with volumes that rank in the top 10 nationally. The program offers specialized interventional catheterization for defects that have historically required open surgery, such as atrial septal defects; ventricular septal defects (VSD), including implantation of a muscular VSD device; and patent foramen ovale. 2009 54 70 2010 2011 44 91 54 91 40 74 Repair Replacement ISOLATED AND PRIMARY VALVE SURGERY VOLUMES 2007 213 261 2008 239 289 2009 250 306 2010 332 280 2011 342 276 Isolated Primary PRIMARY AND ISOLATED MITRAL VALVE REPAIR AND REPLACEMENT 2007 14% 86% 2008 14% 86% 2009 19% 81% 2010 7% 93% 2011 6% 94% Conventional Min. Invasive All volumes are from Duke University Medical Center, CY11 2012 Report 19 high-impact papers High-Impact Basic, Translational, and Clinical Research Papers Duke cardiovascular faculty generated more than 500 papers in peer-reviewed journals during the 2011-12 academic year. Publication highlights of our collaborative and Duke-led investigations include: O’Connor CM, Starling RC, Hernandez AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011 Jul 7;365(1):32-43. Tricoci P, Huang Z, Held C, et al. Thrombin-receptor antagonist vorapaxar in acute coronary syndromes. N Engl J Med. 2012 Jan 5;366(1):20-33. Alexander JH, Lopes RD, James S, et al. Apixaban with antiplatelet therapy after acute coronary syndrome. N Engl J Med. 2011 Aug 25;365(8):699-708. Weintraub WS, Grau-Sepulveda MV, Weiss JM, et al. Comparative effectiveness of revascularization strategies. N Engl J Med. 2012 Apr 19;366(16):1467-76. Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012 May 3;366(18):1696-704. Duke Heart Center 888-HRT-DUKE Chan PS, Patel MR, Klein LW, et al. Appropriateness of percutaneous coronary intervention. JAMA. 2011 Jul 6;306(1):53-61. Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2011 Dec 6;124(23):2610-42. Shahian DM, O’Brien SM, Sheng S, et al. Predictors of long-term survival after coronary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (The ASCERT Study). Circulation. 2012 Mar 27;125(12):1491-1500. Whitlow PL, Feldman T, Pedersen WR, et al. Acute and 12-month results with catheter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edgeto-Edge Repair) high risk study. J Am Coll Cardiol. 2012 Jan 10;59(2):130-9. Wang TY, Angiolillo DJ, Cushman M, et al. Platelet biology and response to antiplatelet therapy in women: implications for the development and use of antiplatelet pharmacotherapies for cardiovascular disease. J Am Coll Cardiol. 2012 Mar 6;59(10):891-900. Hernandez AF and Granger CB. Prediction is very hard, especially about the future: comment on ‘factors associated with 30day readmission rates after percutaneous coronary intervention’. Arch Intern Med. 2012 Jan 23;172(2):117-9. Williams JB, Peterson ED, Brennan JM, et al. Association between endoscopic vs. open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG surgery. JAMA. 2012 Aug 1;308(5):475-84. Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/ AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovascular Computed Tomography. J Am Coll Cardiol. 2012 Feb 28;59(9):857-81. Lefkowitz, RJ. A tale of two callings. J Clin Invest. 2011 Oct.3;121(10):4201-3 Califf RM and Kornbluth S. Establishing a framework for improving the quality of clinical and translational research. J Clin Oncol. 2012 May 10;30(14):1725-6. © Duke University Health System, 2012 9685 Allen LA, Stevenson LW, Grady KL, et al. Decision making in advanced heart failure: a scientific statement from the American Heart Association. Circulation. 2012 Apr 17;125(15):1928-1952. Hara MR, Kovacs JJ, Whalen EJ, et al. A stress response pathway regulates DNA damage through beta2-adrenoreceptors and beta-arrestin-1. Nature. 2011 Aug 21;477(7364):349-53. Duke Heart Center Resources Join us in changing practice and changing lives. Stay in touch with the latest advances and educational opportunities from Duke Heart Center through these resources, available year-round: Resources for Clinicians Consultations and Referrals Schedule appointments and access information by calling: Duke Consultation and Referral Center 800-MED-DUKE (633-3853) 7:30 a.m. – 6:00 p.m. (EST) Duke Heart Center 888-HRT-DUKE (478-3853) or 919-681-5816 8:00 a.m. – 5:00 p.m. (EST) Duke University Hospital (After Hours) Dial 919-684-8111 and ask for the on-call cardiologist. Acute Care Services Continuing Medical Education and Professional Development Educational opportunities for clinicians, educators, and researchers include: Office of Continuing Medical Education Offers live courses; Web- and CD-ROMbased seminars; and remote real-time training. Visit cme.mc.duke.edu and/or cardiology.duke.edu, call 919-401-1200, or e-mail email@example.com. Duke Clinical Research Institute’s Clinical Medicine Series Offers an array of courses and conferences. Visit dcri.org/education-training/dcms or e-mail firstname.lastname@example.org. Resources for Patients Support Duke Heart Center Duke Consultation and Referral Center To find out how you can support the Duke Heart Center’s mission to achieve the highest level of excellence in patient care, research, and education, please contact: 888-ASK-DUKE (275-3853) Heart Center Patient Support Program Unites recovered Duke Heart Center patients with current patients. Dial 919-681-5031. Special Constituent Patient Program Patient Navigators serve patients with unique needs or who require special assistance. Learn more at 919-684-6919. International Patient Center L. Blue Dean Executive Director, Development 512 S. Mangum Street, Suite 400 Durham, NC 27701 919-385-3159 email@example.com Dial 919-681-3007 for details. Acute Chest Pain Clinic Same-day appointments for patients with urgent (not emergent) chest pain. Area physicians can dial 888-HRT-DUKE (478-3853) for details. Acute Myocardial Infarction (MI) Hotline When ECG indicates ST-elevation MI, regional physicians and EMS personnel can contact a Duke cardiologist, activate the cath lab, and arrange transport to the nearest Duke Heart Center or affiliate site for PCI. Dial 919-627-0485 to learn more. Clinical Trials Duke Clinical Research Institute Interested researchers may visit dcri.org/trial-participation. Clinical Trials Networks Best Practices For clinical research resources, visit ctnbestpractices.org. Co-sponsored by DCRI and NIH. Duke Heart Center Visit dukehealth.org/clinicaltrials for partial lists of current trials. Visit dukemedicine.org/heartreport for a list of Duke heart care-related Web sites. Chan ging Visit dukemedicine.org/heartreport for a PDF of this report. pra C ChantiCe While care was taken to ensure the accuracy of data and lives ging information in this publication, any necessary updates Access the Duke Heart Center Report Online or corrections will also be available via this Web page. Duke Heart Repo rt 20 12 Non-profit Org. U.S. Postage PA I D Durham, NC Permit No. 60 Duke Heart Center DUMC 3525 Durham, NC 27710 888-HRT-DUKE 800-MED-DUKE dukehealth.org/heart Ranked seventh among the nation’s best heart programs by U.S.News & World Report for 2012-2013—and in the top ten since 1993. All three Duke University Health System hospitals have earned Magnet status for nursing excellence from the American Nurses Credentialing Center. 2012 Rising Star award from University HealthSystem Consortium in recognition of significant improvements and exemplary performance in patient safety, mortality, and clinical effectiveness. Duke University Hospital is one of only four hospitals nationally to win the award. uke University Hospital recognized as a D 2012 Top Performer by The Joint Commission on key quality measures including heart attacks, heart failure, and surgical care. Just 18 percent of eligible U.S. hospitals received the recognition. Duke University Medical Center ranked #8 among America’s Best Hospitals by U.S.News & World Report, 2012-2013. Duke Heart Center faculty member and Howard Hughes Medical Institute investigator Robert J. Lefkowitz, MD, shared the 2012 Nobel Prize in Chemistry for his discovery of G protein-coupled cell receptors, which are the target of some 40 percent of pharmaceuticals. For the fifth consecutive year, Duke University Hospital received the Get With the Guidelines—Heart Failure Gold Plus Quality Achievement Award from the American Heart Association. The awards recognizes exceptional performance on adherence to the guidelines and quality measures. American Heart Association’s 2012 Mission: Lifeline® Bronze Quality Achievement Award in recognition of Duke University’s Hospital’s commitment and success in implementing a high standard of care for heart attack patients. All three Duke University Health System Hospitals received Platinum Performance Achievement Awards for their performance on the ACTION Registry-GWTG indicators for evidence-based treatment of AMI patients.
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