MDNews - Minnesota

Specialty Consults Because cardiologists, internists and other referring physicians send patients to University of Minnesota Physicians Heart from a wide catchment area that includes Minnesota, Iowa, South Dakota, Wisconsin and beyond, the staff delivers a swift, comprehensive first visit. Patients initially attend a heart failure clinic. "New patients come through the clinic and consult with one of the nine heart failure cardiologists on staff," says Monica Colvin-Adams, MD, MS, FAHA, cardiologist, Assistant Professor in the Department of Medicine at the University of Minnesota and Medical Director of Cardiac Transplantation. "From there, if appropriate, we guide them to a transplant or LVAD coordinator." For the convenience of patients, these are often same-day appointments. Exercise tests and other steps of the evalu- ation process begin promptly, moving the patient along the path to relief from his or her heart failure condition. LVADs: Experience Leads to Excellence For some patients, the next step is LVAD implantation. This helps heart function in patients awaiting transplant, called "bridge" patients, as well as those not interested in or eligible for transplant, or "destination" patients. Modern technol- ogy makes LVADs appropriate for a wide range of patients. "One of the biggest changes came eight years ago, when LVADs became much smaller," says Peter Eckman, MD, FACC, cardiologist, Assistant Professor in the Department of Medicine at t he Un iversit y of Min nesot a a nd Medical Director of the CORE Clinic and Mechanical Circulatory Support Program for University of Minnesota Physicians Heart. "As we became more comfortable with the risks and benefits of these devices, we developed protocols to better determine the relative risks versus relative contraindications." University of Minnesota Physicians Heart specialists and researchers have contributed to many of these advances, including key studies that helped establish the efficacy of continuous-flow devices with limited adverse events. With this background, they have increased aware- ness of the nuances of LVAD therapy. As a result, some patients who have been denied LVADs elsewhere have been accepted at University of Minnesota Physicians Heart, Dr. Eckman says. "We have been participating in clinical trials of assist devices for almost 20 years," adds Ranjit John, MD, cardiothoracic surgeon, Associate Professor in the Department of Surgery at the University of Minnesota and Surgical Director of the Mechanical Circulatory Support Program for University of Minnesota Physicians Heart. University of Minnesota Physicians Heart physicians implant about 60 LVADs annually, for a total of more than 700 since 1995. Nationally, they were a major enroller for HeartMate II trials and are currently participating in several studies of next-generation devices. More than 100 patients on chronic LVAD support are actively supported by the program. The organization focuses on device tri- als that may lead to significant, practicable changes in the field of cardiology. "We are less interested in a technology that is incrementally different than in one likely to substantially improve care," Dr. Eckman says. "We try to maintain at least two LVAD models. When new, potentially transformative models come out, we are eager to ensure that our patients have access to the best options for their care." "Our patients and referring physicians love our hands-on care. They appreciate receiving a call from a physician or coordinator. We strive to form ongoing relationships with our patients and their physicians, and that makes our program unique." — Monica Colvin- Adams, MD, MS, FAHA, cardiologist, Assistant Professor in the Department of Medicine at the University of Minnesota and Medical Director of Cardiac Transplantation for University of Minnesota Physicians Heart The various models allow the special- ists to focus on both destination and bridge patients. With today's improved models, many patients can live actively for years with LVADs. "Patients who are not transplant candidates benefit from devices with lower risk of complications than were previously available," Dr. John says. "We support numerous patients who live at home, are socially active and function very well." Approaching 1,000 Heart Transplants When patients qualify for heart trans- plant, they benefit from the experience of the medical team at one of the world's M D N E W S . CO M ■ MD NEWS Minnesota | 1 1

• Cover