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Heart patients have new advantages

The science of heart health has changed a lot since Dr. Ameya Kulkarni, Permanente cardiologist, finished medical school some 15 years ago. (He now practices at Kaiser Permanente.) Physicians now have unprecedented access to technology and research about the heart and procedures. This is spurring innovations that are changing how heart care is delivered, from controlling blood pressure to offering minimally invasive alternatives to open heart surgery and streamlining the barrage of pre-operative tests. Such changes are giving patients greater access to their doctors and greater control over their health and time, echoing an earlier era of medical care in which family doctors made house calls that were convenient, comfortable, and personalized for patients. Among the many advancements that have taken shape, Kulkarni said the most exciting is the transcatheter aortic valve replacement, better known as TAVR. 

The TAVR procedure is most commonly used in older patients who are experiencing a narrowing of the aortic valve, explained Kulkarni, the chief of cardiology for the Mid-Atlantic Permanente Medical Group in northern Virginia, where he collaborates with a team of cardiology specialists. In the past, the only treatment was open heart surgery — a high-risk procedure, particularly for older patients. TAVR, however, is minimally invasive, using a combination of a catheter and an artery from the leg to accomplish the same, lifesaving opening. 

Kaiser Permanente, for example, has streamlined the TAVR evaluation process from 12 days to a one-day evaluation, which eliminates the waiting time for patients, according to Kulkarni.

One of Kulkarni’s first Kaiser Permanente TAVR patients was a 90-year-old man who was the primary caregiver for his wife of 60 years, who was suffering from dementia. 

“She anchored to him. She would get lost in the world, but when she saw him, she would refocus,” Kulkarni recalled. “When I met him, he said, ‘I’m OK with dying, but I need to live long enough so that my wife has an anchor.’” 

Kulkarni knew the patient wouldn’t survive open-heart surgery; TAVR was his only option. 

“We performed the TAVR procedure on him, and he did great. And he got his wish of outliving his wife. He was able to anchor her until the end of her life,” Kulkarni recalled. 

Stories like that have not always been possible in the world of cardiac medicine. But recent advances are proving revolutionary when it comes to heart health in patients of all backgrounds, ages and levels of health, Kulkarni said. 

While the TAVR procedure has been one surgical advancement, preventive care has also experienced a sea change, he explained. “We’ve known for decades if you quit smoking, your heart health will improve, but in the last decade, there’s been an explosion of research in understanding the real underpinnings of coronary disease — what causes it and what doesn’t. And they’re both equally important,” Kulkarni said. 

In addition to the advancements on the prevention side, delivery of care is experiencing significant shifts, and it’s upending certain longtime standards in the field of cardiac care. Technological advancements mean that Permanente physicians and other care providers can collect patient data without an office visit, instead relying on telemedicine and remote monitoring, he said. “With heart failure patients, the old adage was, ‘You have to see the patient a lot outside the hospital, or you’ll see him a lot in the hospital,’” Kulkarni explained. “But the truth is, a lot of important preventive care can be done virtually.”

“That, to me, is a really exciting change. Permanente physicians are rethinking every single aspect of care, and rather than doing what’s convenient for us, we’re saying, ‘What can we do to ensure our patients are healthy and at home or work or school and not taking three hours to see the doctor because it’s comfortable for us?’” 

While much has changed when it comes to cardiac care, there are still those aspects of heart health that remain largely the same. That’s especially true when it comes to prevention, Kulkarni said. 

Diet remains the most important element in maintaining low blood pressure and a healthy heart, he said. Rather than tapping into current diet trends, focus on fruits and vegetables, avoid red meat and flip your plate, filling half of it with fruits and vegetables and saving the other half for starches and meats, he said. 

Exercise is another key factor. But contrary to popular belief, Kulkarni said people don’t have to spend hours in the gym to positively impact their heart health. “If you go from being sedentary to just a little bit active — 10 minutes of walking, four times a week — that has the same effect on reducing your risk of a heart attack as quitting smoking,” he said. 

In addition, people need to know their numbers when it comes to heart health — specifically their blood pressure, cholesterol and whether they are significantly overweight, Kulkarni said. Permanente physicians check their patients’ blood pressure at every visit, and are even able to monitor blood pressure remotely, which is how Kaiser Permanente Mid-Atlantic States is leading the nation in blood pressure control, according to benchmark data from the National Committee for Quality Assurance (NCQA). 

They need to manage their stress, and they need to monitor the use of their electronic devices. “When you use devices, you tend to be less active, less social, and being social is associated with a lower risk of coronary disease,” Kulkarni explained. 

Those steps, along with the recent medical and technological advancements, are helping us get back to the level of care we saw back when there were house calls and one doctor overseeing the well-being of entire communities, Kulkarni said. 

“With modern medicine, it’s difficult to create that village doctor, but you can use technology to change the paradigm of care to make it more conversational,” he said. “The process of care, which affects so many of us, is such a cool place to innovate.” 

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Originally posted on The Washington Business Journal.