Download cardiovascular outcomes

ST. JOSEPH’S HEART CENTER
CARDIOVASCULAR
OUTCOMES
CONTENTS
FROM THE PRESIDENT ......................................................................... 2
CLINICAL EXCELLENCE ......................................................................... 3
ABOUT THE DATA ................................................................................. 3
LEADERSHIP ....................................................................................... 4
OPEN HEART SURGERY ........................................................................ 6
PERCUTANEOUS CORONARY INTERVENTION .........................................10
ACUTE MYOCARDIAL INFARCTION ........................................................12
CONGESTIVE HEART FAILURE ..............................................................14
SUPPORT SERVICES .............................................................................15
HEART RHYTHM MANAGEMENT ...........................................................16
STROKE ..............................................................................................18
PERIPHERAL ARTERY DISEASE .............................................................19
CARDIAC RESEARCH ...........................................................................20
PHYSICIAN LEADERSHIP ......................................................................22
MEET OUR TEAM ................................................................................24
CONTACTS AND RESOURCES ...............................................................25
Cardiovascular Outcomes • compilation of data 2007 – 2012
FROM THE PRESIDENT
I am pleased to present this summary of St. Joseph’s Medical Center’s
cardiovascular outcomes. With a volume of over 4,000 cardiac procedures
annually, which includes over 325 cardiac surgeries a year, St. Joseph’s
ISAMONGTHETOPlFTEENVOLUMECARDIACSURGERYPROGRAMSINTHESTATE
of California.
It is an exciting time at St. Joseph’s, as we’re turning our increasing volume
into new achievements, services, and most importantly, more lives saved in our
COMMUNITY7ELEDTHECOUNTYASTHElRSTDESIGNATED34%-)2ECEIVING#ENTER
for the treatment of heart attacks and surpass national standards for opening a blocked artery, with a
record door to balloon time of 28 minutes.
Most recently, St. Joseph’s earned Joint Commission accreditation as a Primary Stroke Center by providing
advanced care for emergency and follow-up care for stroke victims. With other national and regional
AWARDSANDRECOGNITIONSFORCLINICALEXCELLENCEQUALITYANDINNOVATIONTHESEACCOMPLISHMENTSREmECTOUR
history of excellence in performing all types of cardiovascular care.
We believe that using industry established gold standards in cardiovascular data reporting is the only way
to truly evaluate outcomes. As such, we proudly display benchmark comparisons and risk adjustment
throughout the report. These standards guide our leadership decisions from every vantage point and have
helped us continuously raise the bar to improve our cardiovascular program. We encourage all facilities
performing cardiac procedures to similarly participate voluntarily in national registries and public reporting
of their outcomes.
As a clinician, I observe the technical expertise of highly skilled professionals who come together at
St. Joseph’s to consistently raise the standard of care for our community. I am honored to work with
the talented doctors and hospital staff who join together each day to provide exceptional results for the
patients and physicians who choose St. Joseph’s.
Donald J. Wiley, B.S.N., M.P.H.
President, St. Joseph’s Medical Center
2
CLINICAL EXCELLENCE
CLINICAL EXCELLENCE
St. Joseph’s Medical Center has a legacy of commitment and dedication to providing the best possible
care for our patients. Our exceptional quality outcomes have earned us the Blue Distinction Center for
Cardiac Care, from Blue Cross/Blue Shield, the Aetna Cardiac Center of Excellence, and top star rating for
OVERALLCARDIACSURGERYFROMTHE3OCIETYOF4HORACIC3URGEONS7EHAVEALSORECEIVEDlVESTARRATINGSFROM
a national health care ratings organization for cardiac surgery and percutaneous coronary intervention,
which ranked us among the top 5% in the nation, and the best in northern California, for cardiac surgery.
We believe that excellence is achieved by the collaborative teamwork of St. Joseph’s physicians, nurses,
technicians, support staff, and volunteers, in conjunction with the use of advanced technology. We are
pleased to receive recognition for our clinical accomplishments, but most importantly, we are dedicated to
continuously improve our care to deliver the cardiac excellence that our patients deserve.
ABOUT THE DATA
This report provides a results overview of the major cardiovascular services offered at St. Joseph’s Medical
Center (SJMC) in Stockton, California, between 2007 and 2012. This time frame is recent enough to
REmECTCURRENTTECHNOLOGIESANDCOMPREHENSIVEENOUGHTOREmECTOURPROGRAMOUTCOMES
Data for open heart surgery (OHS), percutaneous coronary intervention (PCI), and automatic internal
CARDIACDElBRILLATORS!)#$ISREPORTEDACCORDINGTOGUIDELINESANDDElNITIONSESTABLISHEDBYTHE3OCIETY
of Thoracic Surgeons (STS) National Database, and the American College of Cardiology (ACC) National
Cardiovascular Data Registry. St. Joseph’s has voluntarily participated in these registries for nearly 20
years, consistently meeting the rigorous data quality inclusion criteria. This places us among leading
institutions for benchmarking and improving quality outcomes.
!DISTINCTADVANTAGEOFPARTICIPATIONINTHENATIONALREGISTRIESISTHEUSESCIENTIlCRISKADJUSTMENT
methodology to account for severity of illness and patient risk factors present prior to the procedures. This
hLEVELSTHEPLAYINGlELDvBETWEENUSANDOTHERPARTICIPATINGINSTITUTIONSANDADJUSTSTHECALCULATEDRESULTS
for factors that may affect patient outcome. Registry participation provides the ability to closely monitor
the outcomes of patients undergoing procedures at our facility and to fairly compare those outcomes to
the overall experience reported by others across the nation. As you’ll see in the subsequent report, we
compare remarkably well.
3
LEADERSHIP
St. Joseph’s is a leader in cardiovascular medicine, demonstrating a record of excellence and innovation in
THEDIAGNOSISANDTREATMENTOFCARDIOVASCULARDISEASES7EHAVEALONGHISTORYOFMEDICALh&IRSTSvINTHE
COMMUNITYWITHCONTINUALADVANCESBEINGMADESINCEWEPERFORMEDTHElRSTOPENHEARTSURGERYIN
San Joaquin county in 1974.
Experience produces the superior outcomes our patients deserve. In the reporting period of
2007-2012, the number of cardiovascular procedures was nearly 22,000.
4
LEADERSHIP
St. Joseph’s Regional Heart Center was opened in 1996 to centralize all cardiac services, furthering our
commitment to comprehensive care. An integrated cardiovascular program, including our highly trained
PHYSICIANSANDCLINICALSTAFFMAKESITPOSSIBLEFORPATIENTSTOlNDTHEWIDEVARIETYOFSERVICESTHEYMAY
need all under one roof in our over 30,000 sq. ft. Heart Center. Services include:
•
Cardiac surgery, including newer and less invasive surgical approaches.
•
Balloon angioplasty, coronary stenting, and other advanced treatments for coronary
artery occlusions.
•
Cardiac catheterization, to diagnose coronary artery and valve disease.
•
Endovascular procedures, including carotid stenting, aortic stent grafting, and peripheral
artery stenting.
•
Complex surgery for the treatment of peripheral vascular disease.
•
Cardiac research, studying an array of medicines and devices.
•
Non-invasive cardiac diagnostic services, including electrocardiogram, echocardiography,
and doppler testing.
•
Electrophysiology studies and interventions, aimed at discovering and correcting heart
RHYTHMDISTURBANCES4HISINCLUDESPLACEMENTOFPACEMAKERSANDINTERNALDElBRILLATORSFOR
more serious heart rhythm ailments.
•
Cardiac Rehabilitation and Home Health Care services.
5
OPEN HEART SURGERY
We perform all types of open heart surgery, from Coronary Artery Bypass (CAB) to complex valve and
combination procedures, offering patients the same surgical treatment options as other quality cardiac
institutions across the country.
6
OPEN HEART SURGERY
OPEN HEART SURGERY MORTALITY
Risk Adjusted Mortality
Taking risk factors and case complexity into account, our mortality rate compares favorably to
the national average for all open heart surgery cases. This includes CAB, Valve, and
CAB/Valve procedures. We are very proud of our results for these high risk procedures.
7
OPEN HEART SURGERY
CORONARY ARTERY BYPASS (CAB)
Risk Adjusted Mortality and Adverse Outcomes
Taking risk factors and case complexity into account, our patients have had fewer post operative adverse
outcomes and a higher survival rate when compared to the national population.
8
OPEN HEART SURGERY
Post Op Length of Stay
We believe that returning patients to their families and home environments as soon as is safely possible
helps physical and emotional recovery after surgery. The proportion of patients able to leave the hospital in
less than six days following surgery, or those who must stay longer than 14 days, compares very favorably to
other hospitals nationally.
Dr. James Morrissey, Cardiothoracic
surgeon, pioneered the open heart
surgery program at St. Joseph’s.
9
PERCUTANEOUS CORONARY INTERVENTION
4HElRST0#)AT3T*OSEPHSWASPERFORMEDIN3INCETHATTIMEMORETHAN
have been performed, with 1,798 in the period of 2007–2012. Technology has advanced in the
AREAOFINTERVENTIONALCARDIOLOGYMOREQUICKLYTHANINVIRTUALLYEVERYOTHERlELDOFMEDICINE
St. Joseph’s has kept pace with innovation, and has produced superior outcomes along the way.
Dr. Gurinder Grewal (left)
performs a percutaneous
coronary intervention (PCI)
to treat coronary artery
disease in our cardiac
catheterization lab.
Adjunctive
Medications
Patients undergoing
PCI for coronary
artery disease at
St. Joseph’s are
more likely to
receive evidenced
based adjunctive
medications than
patients treated at
other institutions.
10
PERCUTANEOUS CORONARY INTERVENTION
Adverse Events
Over the last six years, St. Joseph’s PCI patients have experienced fewer adverse events during or after
their procedure compared to the national population.
Risk Adjusted
Mortality
Encompassing all
presenting case
types, the risk
adjusted PCI
mortality rate for
St. Joseph’s is
equivalent to or
lower than the
national average.
11
ACUTE MYOCARDIAL INFARCTION
At St. Joseph’s, a specially trained team of staff and physicians
is available around the clock to rapidly diagnose a heart attack,
and activate an alert for ST Elevated Acute Myocardial Infarction
(STEMI Alert). Patients are immediately transported to the cath
lab for life saving coronary intervention.
With the implementation of 12-lead ECG transmission
technology in ambulances in our community, paramedics
responding to a possible heart attack call can transmit ECG
RESULTSDIRECTLYFROMTHElELDTO3T*OSEPHS%MERGENCY
DEPARTMENT7HENA34%-)ISIDENTIlEDOURRESPONSETEAMIS
mobilized before the patient arrives utilizing single call
technology. Both strategies save critical minutes and improve
outcomes.
Time Saves Muscle
ST Elevation on 12-Lead ECG
shows Acute Heart Attack.
Angiogram shows blocked
coronary artery causing Heart
Attack, successfully opened
with D2B treatment.
We are proud to report that the results of these advancements and other improvements to streamline
care have been amazing. In 2012, our excellence in the care of Acute Myocardial Infarction patients
earned us designation as a STEMI Receiving Center by the San Joaquin County Emergency Medical
Services Agency.
12
ACUTE MYOCARDIAL INFARCTION
St. Joseph’s has an
exceptionally high rate of
providing all evidenced based
care measures to our AMI
patients. Times to reperfusion,
adjunctive medications, and
assessment of left ventricular
heart function are included
in this comprehensive
measurement.
St. Joseph’s has consistently
surpassed the 90-minute
national standard for getting
a heart attack patient into
cardiac catheterization to
clear heart blockage with an
average D2B time of only
57.5 minutes and a record
time of 28 minutes!
Over the last six years we
have continued to improve the
proportion of patients having D2B
times under 90 minutes. In the
most recent two years we have
achieved 100%!
6W-RVHSK¶V$FXWH0\RFDUGLDO,QIDUFWLRQ$0,GDWDLVUHSRUWHGDFFRUGLQJWR7KH&HQWHUIRU0HGLFDUHDQG0HGLFDLG&06&RUH0HDVXUHGH¿QLWLRQV
and The Joint Commission (TJC) performance measurement system.
13
CONGESTIVE HEART FAILURE
St. Joseph’s performs exceedingly well in providing all evidenced based care measures to over 500
Congestive Heart Failure patients annually. This includes:
• Assessment of left ventricular function.
• Prescription of ACE/ARB medication for patients with severely diminished heart function.
• Smoking cessation instruction for patients with a smoking history in the most recent 12 months.
• Provision of discharge instructions to include signs and symptoms of heart failure to report to a
physician, medications, weight monitoring, diet, activity, and follow up physician care.
Preventing Congestive Heart Failure Hospital Readmission
Congestive Heart Failure (CHF) patients are at risk for hospital readmissions within 30 days of discharge.
St. Joseph’s Medical Center’s interdisciplinary team has implemented national best practices to reduce
CHF readmissions including:
• %NHANCEDPATIENTANDFAMILYTEACHINGDURINGTHEPATIENTSHOSPITALSTAYTHROUGHh4EACH"ACKv
methodology. Particular attention is paid to information patients when to contact their physicians, how
to monitor for changes in their condition, and how to provide self care at home, such as with obtaining
daily weights.
• )DENTIlCATIONOFPATIENTSATHIGHRISKFORHOSPITALREADMISSIONWITHREFERRALTO(OME(EALTH#AREFOR
ongoing outpatient disease management.
• Scheduled follow-up appointments arranged for the patient with their primary care physician at the
time of discharge.
• Specialized teaching around medications, to promote understanding about medications
prescribed and possible side effects.
By implementing these initiatives, we believe our CHF patients will experience smooth hospital-to-home
transitional care, increased patient satisfaction, improved patient outcomes, and fewer hospital readmissions.
14
St. Joseph’s congestive heart failure (CHF) data is reported according to the Center for Medicare and Medicaid Services (CMS) Core Measure
'H¿QLWLRQVDQG7KH-RLQW&RPPLVVLRQ7-&SHUIRUPDQFHPHDVXUHPHQWV\VWHP
SUPPORT SERVICES
CARDIAC REHABILITATION
Cardiac Rehabilitation is indicated for all patients experiencing cardiovascular issues such as coronary
artery bypass (CAB) surgery, acute myocardial infarction (AMI), stent implants, valve repair/replacement,
stable angina, and congestive heart failure (CHF). The
BENElTSOFCARDIACREHABILITATIONINCLUDE
• Increased exercise tolerance.
• Improved skeletal muscle strength.
• Managed symptoms of CHF and stable angina.
• Improved psychological well being.
Therapies include behavioral interventions such as dietary
counseling, lipid management, weight management, and
blood pressure control.
Cardiac rehabilitation has been a part of the St. Joseph’s
award-winning heart program since 1980. Patient exercise
visits per month are over 1,000, and up to 20 new patients
enter the program monthly. Patients may be prescribed
cardiac rehab during the most acute phase of their cardiovascular recovery, although some choose to
continue in the program as part of their regular health regimen, with many patients attending over 20
years.
Commensurate with our other comprehensive cardiovascular services, the Cardiac Rehab staff has obtained
ADVANCEDCERTIlCATIONTOPROVIDECAREFORPATIENTSBEINGTREATEDWITHA,EFT6ENTRICULAR!SSIST$EVICE,6!$
ST. JOSEPH’S CARDIAC NAVIGATOR
St. Joseph’s has complimented its award winning cardiovascular services with a
Cardiac Navigator program designed to support and guide patients dealing with
cardiovascular issues.
St. Joseph’s Cardiac Navigators are available to answer questions about:
• Heart disease prevention and potential risk factors.
• Help patients understanding medical terms and treatment options.
• Interventional and surgical procedures, recovery and rehabilitation.
To contact the Cardiac Navigator, call (209) 467-6540 or
email [email protected].
Joann Marks, Director of
Cardiovascular Services,
coordinates the Cardiac
Navigator Program
15
HEART RHYTHM MANAGEMENT
ATRIAL FIBRILLATION
Atrial Fibrillation is the most common type of heart rhythm disturbance, occurring in 3-5%
OFPEOPLEOVERTHEAGEOF!TRIALlBRILLATIONISMANAGEDWITHHEARTRATEANDRHYTHMCONTROL
medications, as well as with anticoagulants. Treatment goals are symptom alleviation, restoration
of a normal heart rhythm, and prevention of clots (emboli), which can lead to stroke.
ELECTROPHYSIOLOGY and CARDIAC ABLATION
&ORPATIENTSWHOSEATRIALlBRILLATIONISREFRACTORYTOlRSTLINEMEDICALTHERAPIESORFORPATIENTS
with more complex heart rhythm disturbances, St. Joseph’s offers advanced electrophysiology
studies (EPS) and Cardiac Ablation treatment.
During EPS, catheters are inserted through blood vessels in the groin, and electrical stimulations
are applied to map conduction pathways. Once the site of the aberrant impulse is located,
ablation therapy may be performed.
Ablation therapy involves application of a radiofrequency or thermal energy source to destroy a
SMALLAMOUNTOFTISSUEDISRUPTINGTHEDISTURBANCEOFABNORMALELECTRICALmOW$EPENDINGONTHE
variant of the disease, treatment may be done through:
• Catheter based procedures performed in the cardiac catheterization lab by electrophysiologists.
• Surgical based procedures performed in the operating room by cardiothoracic surgeons.
In this setting, lines of conduction block (scar tissue) are created in a more direct approach.
Additionally, the left atrial appendage, a tissue that is a common source of blood clots in
PATIENTSWITHATRIALlBRILLATIONISEITHERSURGICALLYISOLATEDORREMOVEDTOHELPREDUCETHE
risk of stroke.
Electrophysiology is a specialized branch of cardiology and
requires additional training and experience. At St. Joseph’s we
AREFORTUNATETOHAVETWOBOARDCERTIlEDELECTROPHYSIOLOGISTSON
staff, George Charos, M.D. (left) and Walter Chien, M.D. (above).
16
HEART RHYTHM MANAGEMENT
AUTOMATIC IMPLANTABLE CARDIAC DEFIBRILLATOR (AICD)
!UTOMATIC)MPLANTABLE#ARDIAC$ElBRILLATORS!)#$SAREUSEDTOTREATBOTHPRIMARYANDSECONDARY
sudden cardiac death. Placement of AICD’s is one of the many rhythm management treatments that St.
Joseph’s provides.
We are pleased to
report that our patients
receiving an AICD
experienced fewer
complications and no
deaths during their
hospitalization when
compared to patients
at other hospitals
nationwide.
17
STROKE
At St. Joseph’s over 400 patients a year are treated for stroke or TIA with over 300 of these being of the
ischemic type.
#ERTIlED3TROKE#ARE
In 2012, St. Joseph’s proudly passed the rigorous criteria established by The Joint Commission and was
designated a Primary Stroke Center.
!h3TROKE!LERTvISCALLEDFORPATIENTSEXHIBITINGSIGNSOFPOSSIBLESTROKE4HISPUTSTHEWHEELSINMOTION
to rapidly assemble a team, consult a neurologist, and perform a Computerized Tomography (CT) scan,
necessary to diagnose the type of stroke. If an ischemic stroke is present, patients may receive a
MEDICATIONKNOWNASATHROMBOLYTICTODISSOLVETHECLOTANDRESTOREBLOODmOWTOTHEBRAIN4HEGOALISTO
have the CT scan performed and the medication received in less than three hours after arrival.
Additional treatments for stroke at St. Joseph’s comply with The Joint Commission stroke program and
include:
• Assessment for and treatment of heart rhythms that may contribute to stroke.
• Administration of medications designed to reduce the chance of recurrent stroke (statins and
platelet inhibiting medications).
• Therapies aimed at preventing additional blood clots from developing in the extremities (deep vein
thrombosis).
• Evaluation of the need for additional rehabilitation therapy.
• Patient and family education.
18
PERIPHERAL VASCULAR DISEASE
At. St. Joseph’s, our patients are fortunate to be able to receive the full spectrum of diagnoses and treatments
for Peripheral Vascular Disease, most commonly Peripheral Arterial Disease (P.A.D.). Our comprehensive
facilities allow state of the art care to be provided in the cardiac catheterization lab, the surgery department
and the diagnostic imaging and interventional radiologies departments. Specialized services include:
Diagnosis of Peripheral Vascular Disease
• Dopler ultrasound testing.
• Ankle brachial index testing.
• Computerized tomography (CT Scan) including CT angiography.
• !NGIOGRAMVENOGRAMANDlSTULOGRAMPROCEDURES
• Magnetic resonance angiography (MRA).
Treatment of Peripheral Vascular Disease
• Endovascular procedures, including
carotid stenting, peripheral artery
stenting, and aortic stent grafting.
• Endarterectomies, embolization and
pseudoaneurysm repair.
• Bypass grafting and other complex
vascular surgery and aneurysm repairs.
Cardiac Cath Lab
WĞƌŝƉŚĞƌĂůsĂƐĐƵůĂƌŝĂŐŶŽƐƟĐĂŶĚ/ŶƚĞƌǀĞŶƟŽŶĂůWƌŽĐĞĚƵƌĞƐ
Surgery
Peripheral Vascular Procedures
19
CARDIAC RESEARCH
The Cardiac Research Department at St. Joseph’s Medical Center was established in 1996 and has
progressed to participation in nearly 100 medication and device trials. Studies have investigated an array
of cardiovascular conditions and procedures including coronary artery disease, acute coronary syndrome
and myocardial infarction, congestive heart failure, carotid artery disease, coronary artery bypass graft
procedures, and advanced treatment and management of rhythm disorders.
CAROTID STENT STUDIES
A highlight of the research program has been our participation in carotid stent studies including acceptance
for participation in the SAPPHIRE, EXACT, and CHOICE Studies. A particularly noteworthy achievement was
our selection for participation in the CREST Study. St. Joseph’s was one of only four sites in California, and
the only site in Northern California to be selected for participation in this prestigious study.
The CHOICE Study, (Carotid Stenting for High Surgical Risk Patients; Evaluating Outcomes through
the Collection of Clinical Evidence), led by Venkata Emani, M.D., enrolled high-risk symptomatic and
asymptomatic patients with carotid stenosis. This study completed enrollment in 2012.
Before Stent
After Stent
Narrowed
Carotid
Artery
Opened
Carotid
Artery
While these studies are now closed, St. Joseph’s has been able to continue to provide this approved therapy.
We have performed over 250 carotid stent procedures and have a stroke rate of only 1.1% and a TIA
(transient ischemic attack) rate of 2.0%. Highly skilled interventionalists with extensive training in carotid
stent procedures and careful case selection have contributed to these successful outcomes that are superior
to the national average.
20
CARDIAC RESEARCH
CARDIAC STUDIES
COMPARE (Electrocardiographic Evaluation of Ischemia Comparing Invasive to Pharmacological Treatment.
This study is funded by the National Institute of Health and is in collaboration with the University of Nevada,
Reno. The principle investigator, Michele Pelter, RN, PhD, is a professor at the University and St. Joseph’s
Medical Center is a second site under the direction of her co-investigator Teri Kozik, PhD, RN. This is a
prospective longitudinal study to assess and compare the frequency and consequences of transient myocardial
ISCHEMIALACKOFCORONARYARTERYBLOODmOWINPATIENTSWHOCOMETOTHEHOSPITALWITHACUTECORONARYSYNDROME
and are treated initially with a coronary stent and those who are managed initially with medications.
The DAPT Study (Dual Anti Platelet Therapy), led by Richard Waters, M.D.TOASSESSBENElTSOFVS
30 months of dual antiplatelet therapy (aspirin and clopidogrel or prasugrel) to protect patients from
Major Adverse Coronary Events (death, heart attack, stroke, and increased bleeding) following the
placement of a coronary stent. The outcome of this four-year study will help bring clarity to the global
medical community regarding how long patients should be treated with dual antiplatelet therapy after
receiving coronary artery stents. This study is now in the follow up phase.
EMIT (Does iPad [manufactured by Apple] usE in patients with iMplantable cardiac rhythm devices cause
electromagnetic interference, is a study to investigate the safety of iPad use in patients with cardiac rhythm
DEVICESSUCHASINTERNALDElBRILLATORS3INCEMAGNETSAREIMBEDDEDINTHEFRAMEANDCOVERSOFI0ADSITWAS
THEORIZEDBYTHERESEARCHTEAMAT3T*OSEPHSTHATTHISCOULDBEASIGNIlCANTPROBLEMASSOCIATEDWITHTHE
function of these implanted devices. This study is led by Dr. Walter Chien, M.D.
QUAD-PAS1UADRIPOLAR0ACING0OST!PPROVAL3TUDYISAlVEYEARSTUDYLEDBYWalter Chien, M.D. to
collect information on the safety and long term performance of the Promote® Q/Promote® Quadra/Unify
1UADRA•CARDIACRESYNCHRONIZATIONTHERAPYDElBRILLATORDEVICETOPACETHELEFTVENTRICLEINPATIENTS
indicated for cardiac resynchronization therapy. The Promote® Q/Promote® Quadra/Unify Quadra™ CRT-D
devices and Quartet™ left ventricular heart lead are approved by the FDA. This lead has the option to be
programmed by physician to pace the heart in 10 vectors compared to the standard ability to program in
only three vectors. This study is sponsored by St. Jude Medical.
SILVER AMI (Comprehensive Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction)
is a study led by George Charos, M.D. to better understand what is driving outcomes for patients 75 years
or older who have been hospitalized with Acute Myocardial Infarction. This study is funded by the National
Institute of Health and is being directed by Yale University.
WARFARIN (Warfarin Adverse Event Reduction for Adults Receiving Genetic Testing at Therapy Initiation)
led by Teri Kozik, PhD, RN, is a study partially funded by Medicare to determine if using warfarin-related
pharmacogenetic information in calculating warfarin doses will change the incidence of warfarin-related
clinical events, including major hemorrhage and thromboembolic events, at 30 days when compared to
warfarin doses calculated without pharmacogentic data. The target population is 65 or older.
21
PHYSICIAN LEADERSHIP
John Bouteller, M.D.
Medical Director, Cardiac Rehabilitation and Non-Invasive Cardiology
Dr. Bouteller received his medical degree from the University of Oklahoma. He
completed his internship and residency at the Veterans Administration in Long
Beach, California, and his fellowship in cardiology at the University of California
$AVIS-EDICAL#ENTER$R"OUTELLERISBOARDCERTIlEDININTERNALMEDICINEAND
cardiology. He has been a member of St. Joseph’s medical staff since 1979.
Dr. Bouteller is a member of the Cardiac Care Committee, and serves as the
Chair for the Echocardiology Conference Committee.
George S. Charos, M.D.
Medical Director, Medical Cardiology, and Chair, Cardiovascular Department
Dr. Charos completed his undergraduate work at the University of Massachusetts
in Amherst, Massachusetts, and received his M.D. from the University of
Massachusetts in Worcester, Massachusetts. He completed his internship and
residency at Mercy Hospital and Medical Center in San Diego, California, where
he served as chief resident. He completed fellowships in both cardiovascular
medicine and clinical cardiac electrophysiology at the University of Massachusetts
-EDICAL#ENTERIN7ORCESTER-ASSACHUSETTS$R#HAROSISBOARDCERTIlEDIN
electrophysiology and pacing, cardiovascular disease, and internal medicine.
He joined the medical staff at St. Joseph’s Medical Center in 1985.
Walter W. Chien, M.D.
Medical Director, Cardiac Electrophysiology
Dr. Chien completed his undergraduate studies and M.D. degree at Washington
University in St. Louis, Missouri. His internship, residency, and fellowship in
cardiovascular disease were completed at Stanford University Hospital, in Palo
Alto, California. He also completed a fellowship in cardiac electrophysiology at
the University of California, San Francisco Medical Center in San Francisco,
#ALIFORNIA$R#HIENISBOARDCERTIlEDINELECTROPHYSIOLOGYCARDIOVASCULAR
disease, and internal medicine. He joined St. Joseph’s medical staff in 2005.
Venkata R. Emani, M.D.
Chair, Medicine Department
Dr. Emani completed his undergraduate work at A.V.N. College in Visakhapatnam,
India, and received his M.D. at Andhra Medical College in Visakhapatnam, India.
He completed his internship and residency at University of Illinois Medical Center
in Chicago, Illinois. Dr. Emani completed fellowships in cardiovascular disease at
Medical College of Virginia in Richmond, Virginia, and in interventional cardiology
from the University of Alabama Medical Center in Birmingham, Alabama.
$R%MANIHASBOARDCERTIlCATIONSININTERVENTIONALCARDIOLOGYCARDIOVASCULAR
disease, internal medicine, and nuclear cardiology. Dr. Emani joined St. Joseph’s
medical staff in 2002.
22
PHYSICIAN LEADERSHIP
Gurinder S. Grewal, M.D.
Medical Director, Cardiac Cath Lab and Cardiac Research
Dr. Grewal completed his undergraduate studies at Lyallpur Khalsa College
in Jullunder, PB, India, and received his M.B., B.S. at Government Medical
College in Patiala, PB, India. He completed his internship and residency at
Worcester City Hospital in Worcester, Massachusetts, where he served as chief
medical resident. Dr. Grewal completed a fellowship in cardiovascular disease
AT3T%LIZABETHS(OSPITALIN"RIGHTON-ASSACHUSETTSANDISBOARDCERTIlEDIN
interventional cardiology, cardiovascular disease, and internal medicine.
Dr. Grewal joined the medical staff at St. Joseph’s in 1982.
Amod Tendulkar, M.D.
Medical Director, Surgical Intensive Care
Dr. Tendulkar received his medical degree from Saint Louis University, School of
Medicine, Missouri. He completed his general surgery internship, residency, and
cardiac surgery fellowship at the University of California, San Francisco, where
he also served as Administrative Chief Resident. Dr. Tendulkar also served as
Associate and Chief Resident of Cardiothoracic Surgery at the University of
-ARYLAND"ALTIMORE3CHOOLOF-EDICINE$R4ENDULKARISBOARDCERTIlEDIN
general surgery and thoracic surgery. He joined the St. Joseph’s medical staff
in 2010.
James Morrissey, M.D., FACS
Medical Director, Cardiothoracic Surgery, and Vice Chair, Cardiovascular Department
Dr. Morrissey completed his undergraduate work at New York State College of
Forestry in Syracuse, New York, and received his M.D. from State University of New
York in Syracuse, New York. Dr. Morrissey completed his internship, residency, and
fellowship in thoracic surgery at Barnes Hospital in St. Louis, Missouri. He is board
CERTIlEDINTHORACICSURGERYANDINGENERALSURGERY$R-ORRISSEYJOINEDTHEMEDICAL
staff in 1972 and developed the cardiac surgery program for St. Joseph’s. He
PERFORMEDTHElRSTCARDIACSURGICALPROCEDUREINTHE3AN*OAQUINREGIONAT
St. Joseph’s in 1974. Dr. Morrissey continues to be at the forefront of bringing new
technology and state of the art cardiovascular surgical care to our community.
Richard Waters II, M.D., FACC
Chair, Cardiac Quality Improvement Committee
Richard E. Waters II is a native of Stockton and a cardiologist at Stockton
Cardiology Medical Group. He is a graduate of Stanford University and Vanderbilt
University School of Medicine. He completed his internship and residency in
internal medicine at Johns Hopkins Hospital and his general and interventional
CARDIOLOGYFELLOWSHIPAT$UKE5NIVERSITY-EDICAL#ENTER(EISBOARDCERTIlEDIN
Interventional Cardiology, Internal Medicine, and Cardiovascular Disease.
Dr. Waters joined the medical staff at St. Joseph’s in 2005.
23
MEET OUR TEAM
CARDIOLOGY
Suchdeep (Raj)
Bains, M.D.
Fram Buhari, M.D.
Cyrus Buhari, D.O.
Alvin C. Cacho, M.D.
George S. Charos, M.D.
Walter W. Chien,
M.D.
Abbas A. Chothia, M.D.
Ramesh N.
Dharawat, M.D.
Venkata R. Emani, M.D.
Gurinder S. Grewal, M.D.
M. Thabet Karabala, M.D.
Basava (Purnaiah)
Kunamneni, M.D.
Steven D. La Viola, M.D.
David C. Lim, M.D.
Ramin Manshadi, M.D.
John O. Olowoyeye, M.D.
Daren S. Primack, M.D.
Rajiv H. Punjya,
M.D.
Sujeeth R. Punnam, M.D.
Surrender Raina, M.D.
Tejpal Randhawa, M.D.
Ajay Ramanakumar, M.D.
Amardeep K. Singh, M.D.
Lee M. Stenzler,
M.D.
Sanjeev G.
Vaishmpayan, M.D.
Richard E. Waters, M.D.
24
MEET OUR TEAM
CARDIOTHORACIC SURGERY
Cardiothoracic
Surgery Assisting
Cardiothoracic Surgery
Physician Assistant
Kathryn Olson, PA-C
Cardithoracic Nurse
Practititoner
Lorna Nisperos, NP
Isam Felahy, M.D.
James D. Morrissey, M.D.
Amod P. Tendulkar, M.D.
Timothy J. Sloan, M.D.
INTERVENTIONAL RADIOLOGY
Frank S. Callcott, M.D., Chair, Radiology Department
Ezell Askew, M.D.
CONTACTS AND RESOURCES
Contacts
Heart Center
(209) 467-6489
Cardiac Rehabilitation
(209) 467-6360
Cardiac Research Department
(209) 461-5257
Cardiovascular Outcomes
(209) 461-5375
Cath Lab
(209) 467-6574
Echocardiography
(209) 467-6489
Electrocardiography (ECG)
(209) 467-6337
Medical Staff Services
(209) 467-6558
Open Heart Surgery
Informational Sessions
(Patients & Families)
(209) 467-6360
Physician Referral Line
(209) 939-4545
Radiology Department
(209) 467-6363
St. Joseph’s Cardiac Navigator
(209) 467-6540
Data registry and reporting information:
Interventional Cardiology Automatic
)NTERNAL#ARDIAC$ElBRILLATOR
www.accncdr.com
Open Heart Surgery
www.sts.org
This edition of St. Joseph’s Heart Center Cardiovascular Outcomes was produced by:
Karen McNickle, RN, BSN, Manager, Cardiovascular Data and Quality Outcomes
Joann Marks, RN, MSN, Cardiovascular Service Line Director
Natalie Pettis, Director, Marketing Communications
Mark Fields, Graphic Designer, Marketing Communications
25
ABOUT ST. JOSEPH’S MEDICAL CENTER
3T*OSEPHS-EDICAL#ENTERISANOTFORPROlTFULLYACCREDITEDREGIONALHOSPITALWITHBEDSA
physician staff of over 400, and more than 2,000 employees. St. Joseph’s specializes in cardiovascular
care, comprehensive cancer services, and women and children’s services including neonatal intensive
care (NICU). St. Joseph’s Medical Center is the largest hospital, as well as the largest private employer
in Stockton and San Joaquin County. In addition to being nationally recognized as a quality leader,
3T*OSEPHSISCONSISTENTLYCHOSENASTHEhMOSTPREFERREDHOSPITALvBYLOCALCONSUMERS&OUNDEDIN
1899 by Father William O’Connor and administered by the Dominican Sisters of San Rafael, St. Joseph’s
continues to lead the region in medical innovation as well as ongoing clinical research, developing
tomorrow’s advancements, today. St. Joseph’s Medical Center is committed to delivering compassionate,
high-quality, affordable healthcare services with special attention to the poor and underserved. In
3T*OSEPHSPROVIDEDOVERMILLIONINCHARITYCARECOMMUNITYBENElTSANDUNREIMBURSED
patient care. St. Joseph’s Medical Center is a member of Dignity Health, a system of hospitals and
medical centers in California, Arizona and Nevada. For more information, please visit our website at
StJosephsCares.org.
1800 North California Street
Stockton, CA 95204
(209) 943-2000
StJosephsCares.org
13-590