Heart smart: an update on Indiana heart centers and treatments for cardiovascular disease.

• Author: Held, Shari
• Position: HEALTH CARE

HEART DISEASE IS STILL the leading cause of death in the United States, responsible for 700,000, or nearly one-third of all deaths, according to the Centers for Disease Control. Despite those numbers, the outlook for Hoosiers with heart disease has never been better.

"The good news is that there has been a dramatic reduction in both the incidence and the mortality rates associated with the major forms of cardiovascular disease--heart attack and stroke," says Eric Williams, M.D., associate director of the Krannert Institute of Cardiology in Indianapolis, the Indiana University component of the Clarian Cardiovascular Center. "The bad news is that most of us will probably die of a heart attack or stroke because it still remains an important problem."

The recent reduction in numbers can be attributed to a variety of things--sophisticated imaging and diagnostic tools, a better understanding and control of risk factors and improved medications, such as statins, a class of drugs that lower cholesterol.

[ILLUSTRATION OMITTED]

Better surgery. "Now with the use of medications to aggressively treat lipid abnormalities, we are seeing less cholesterol/plaque buildup and less need for open heart surgery and angioplasty" says Rose Mary Wasielewski, regional director of cardiac rehabilitation and heart ambulatory clinics for Community Healthcare System in Northwest Indiana.

Even open-heart surgery has become less invasive. Some cardiac surgeries are now being performed "off-pump," allowing the heart to circulate the blood throughout the body rather than using a heart/lung machine. "Over the years we have learned that there are certain risks with being on a heart/lung machine," says Mary Jackson, director of cardiovascular and critical care services for Floyd Memorial Hospital in New Albany. "You have to use blood thinners so the blood flows better through the heart/lung machine. There's increased risk of stroke.

Floyd Memorial's comprehensive Heart & Vascular Center opened in January 2006. The level of care in its Cardiovascular Care Unit, where patients are taken after open-heart surgery, is designed to change around the patient rather than have the patient move from unit to unit. "Our patients have really liked that and our surgeons appreciate the continuity of care it provides," Jackson says. "We are a smaller hospital and I think our care is a bit more intimate and family-focused." The Center benchmarks itself against the Society for Thoracic Surgeons' national database. Its outcomes to date have been at benchmark, or better.

In a heart attack scenario, where quick action is crucial for a positive outcome, a large percentage of Indiana heart centers have consistently outperformed the national initiative of a 90-minute "door-to-balloon" time. "We are very proud of our numbers--62.9 minutes," says Julie Thomas, director of cardiology for Good Samaritan Hospital in Vincennes. "Our personal goal is not 90 minutes, it's 60 minutes."

Good Samaritan's cardiology program offers 24/7 state-of-the-art cardiovascular services by a team of...