Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And joining me today to highlight the latest advancements in cardiology and cardiac surgery at Northwestern Medicine is Dr. Douglas Johnston, he's the Chief of cardiac Surgery at Northwestern Medicine, Bluhm Cardiovascular Institute, and a professor of Cardiac Surgery at Northwestern University Feinberg School of Medicine; and Dr. Jane Wilcox, she's the Associate Chief of Cardiology and a Heart Failure and Heart Transplantation cardiologist at Northwestern Medicine. And she's an Associate Professor of Medicine at Northwestern University Feinberg School of Medicine.

Doctors, thank you so much for joining us today. Dr. Johnston, I'd like to start with you. What are some recent developments within cardiac surgery? How have they impacted the Bluhm Cardiovascular Institute? What's exciting?

Douglas Johnston, MD: It's a time of great transition in cardiac surgery. I think from the idea that there's a one-size-fits-all operation for all patients, that is what surgeons have been used to doing for a long time, to embracing some of these new technologies that allow us to treat disease less invasively and also to treat patients who were previously thought to be higher risk.

So a couple of examples, one is the rapid growth of transcatheter valve therapies. That's a joint venture in essence between Cardiology and Cardiac Surgery where we are increasingly able to provide at least one intervention without much of an incision. And in parallel really on the surgical side has been the development of less and less invasive approaches that allow us to do a very similar operation. We have embraced the robotics revolution here at Northwestern, starting to do our first mitral valve repairs this year. That is a technology that is also in rapid evolution. Our job really is to try to figure out, not just for today, but for the next 20 years, 30 years, especially in the life of a younger patient, what are the best ways to get them back up and running as soon as possible, and doing all the things they want to do and fortunately, we have a lot of new tools to let us do that.

Melanie Cole, MS: It is certainly a very exciting time in cardiology and cardiac surgery, Dr. Johnston. And as you were discussing minimally invasive and valve surgeries, really the advancements are amazing. And Dr. Wilcox, from your point of view, what do you consider to be some of the most impressive recent innovations within Cardiology itself? And how are these innovations improving patient care, because that's really what's the most exciting part of all of this?

Jane Wilcox, MD: Melanie, absolutely right. And it's the individual patient. So, what are we able to provide at that personal level of that patient and that individual patient outcome? I think that's something that Doug highlighted and it's definitely been a team sport here at Northwestern Medicine.

So, I think from the cardiology lens, really thinking about how artificial intelligence and machine learning can interact with both the electronic health record as well as our image analysis, clinical decision support. We're really using AI and integrating AI into our clinical operations. So, what does that mean?

I think we hear a lot of, "Oh, AI and ML," just in healthcare in general. But our folks really actually using it and integrating it to improve patient outcomes, and that's something that we're doing at Northwestern. So, we have actually a pretty unique platform that allows us to build algorithms, search across our entire health network, our entire health system to look for patients who have advanced heart failure, who may benefit from advanced therapies like left ventricular assist device or heart transplantation. We then reach out to those patients and get them into our clinics sort of ASAP, because time is incredibly important. And we see them, and then we can sort of shunt them into the appropriate pathway to get, you know, the appropriate care, whether that's a transplant, whether that's a new valve procedure, a pacemaker, or potentially even a clinical trial for patients who may qualify. So, I think that's really been the main thing that I think Northwestern is really leading the way.

Melanie Cole, MS: It certainly is, and thank you for telling us about those. So, Dr. Johnston, which Bluhm Cardiovascular Institute accomplishments are you most proud of from the last year? How is this a reflection of Bluhm Cardiovascular Institute's commitment to excellence? It's been around a while, and you're doing some amazing things, as Dr. Wilcox just pointed out, and the technology is advancing all the time. What's gone on in the last year or so that you really feel like you want to highlight?

Douglas Johnston, MD: We've had a tremendous period of growth in the last year. It's a testament to all of the hard work that's gone on over 19 years of Bluhm Cardiovascular Institute, the great support of our philanthropic donors, and the team that Northwestern has built. But we've been able to recruit five cardiac surgeons, which is a lot to add to a team for not only our downtown campus, but the health network. And with that, we've seen a growth in our cardiac surgery volume of over 30%, which is fairly unique. I

think what that represents is a few things. One is a recognition that we are able to provide the kind of care that people will travel for and that procedures that may not be available to them elsewhere are done here. I think we can say with confidence that the entire spectrum of cardiac surgery is done here and done extremely well, and we have experts in all of these areas. We've also been able to open up access, which I know coming out of COVID, has been a challenge for us in a lot of institutions, but we spent a lot of effort. And Jane and I are working together very closely to disseminate some of these practices across BCVI, but to make it easy for patients with a single phone call or a web link to get in touch with an expert nurse who is essentially a concierge to guide them through the care process.

We really have to focus on the patient as the most important factor in all of this transaction with the healthcare system, which often is very frustrating to people. And I think we've made some real inroads into making that be a more friendly process. If you ask me what I'm most proud about, because it directly affects patients, I think it's making the care process easier for them.

Jane Wilcox, MD: One-hundred percent, Doug, I think the patient experience. You said frustration, but also really an overwhelming time, right? I mean, needing heart surgery, needing a heart transplant, needing a clinical trial for your tricuspid valve. All of those things can be overwhelming. And so, we really want to make it easy for patients and then also easier for their referring doctors or really a partner to feedback that information and get the patient the best care.

Melanie Cole, MS: I'd like to expand for just a minute on that, Dr. Johnston and Dr. Wilcox, as we're speaking about patient-centered care and that stress that they are under when they're looking for that excellence in care. Dr. Johnston, what would you like referring providers to know about the ease of getting their patients involved in the programs at Bluhm Cardiovascular Institute? And if patients are listening and they want to meet you, get involved, what's the process for doing that?

Douglas Johnston, MD: I think we've done a lot to make this much easier over the last year. There's a single point of contact on the website or patients can call 312-NM-HEART that will get them directly to one of our coordinators who is able to answer their questions, number one. I think to Jane's point, patients are often overwhelmed and what they want quickly is answers. And often for referring providers, they just need somebody to take it from there. "This is a patient that I'd like to get a second opinion on," or have one of our experts weigh in on. We shouldn't be asking them to do all the work. And what we've done is to put that work on our coordinators who will help get all the data into our medical record system, so the imaging that we need to look at. And increasingly in my practice, that first contact with the patient or provider is not going to be an office visit. It's going to be a telehealth. And even within greater Chicago, we know how hard it is to get around with traffic. So if we can make things efficient for the patients and their referring doctors early on, we can get them a quick answer. And that may be we need some more data or we know exactly what to do, but we can get them those answers quickly. And we try to turn those around within 48 hours of when we get the imaging in house. So, it can be a very rapid conversation and then we can make some plans from there.

Melanie Cole, MS: What a comprehensive approach. Thank you for sharing that. And Dr. Wilcox, tell us some of the priorities for the institute in the next year, specifically for Cardiology. What plans or developments are you most looking forward to this coming year?

Jane Wilcox, MD: So, I think we're really focused, like Doug said, on recruiting the best talent. We've grown so much in the last 19 years. We're about to have our 20th year anniversary next year. And so, we really have top experts, but we really want to be focusing on how we deliver care, how it's more efficient, and then integrating our technologies, not just at the downtown campus, but also across our network. So wherever you come into Northwestern, you have access to, you know, an expert that can look at your data efficiently, see if we need more testing, would you be a candidate for a clinical trial, or potentially a newly approved FDA therapy, such as our transcatheter valve team, which Doug mentioned, lots of exciting stuff going on here. And so, I think that's really going to be our focus over the next year.

Long-term, it's going to be really, as I mentioned, integrating artificial intelligence, augmented intelligence, and machine learning into our sort of day to day practice, as well as really, you know, the intersection of technology and patient care, delivering that with remote monitoring, digital health solutions, really focused on prevention as well. Obviously, I'm in the transplant business and we do a fair number of heart transplants. But really, if we can focus on gene therapy, novel medications, and really preventing progressive heart failure, or progressive valvular disease, that's really the holy grail. And so, our Center for Preventive Cardiology will be a focus in the coming years as well.

Melanie Cole, MS: I'd love to give you each a chance for a final thought here. So Dr. Wilcox, as you speak about those plans you were just telling us about, how will these continue to build on the demonstrated excellence of Bluhm Cardiovascular Institute at Northwestern Medicine? And while you're telling us that, you're mentioning prevention and I, myself, as an exercise physiologist, that's what we focus on. Can you speak a little bit about community awareness and how Bluhm Cardiovascular Institute is reaching out to the community to work on these initiatives? And yes, you're in transplantation, but you're also a cardiologist, and working on prevention is a key message. How is the community being made aware of these things?

Jane Wilcox, MD: That's a great question, . Couple of things that we're doing at Northwestern Medicine, particularly in BCVI that are really important with both community engagement, community awareness. And then also, I'll say training the next generation of folks who are coming up.

So with regard to the community engagement, we have such fantastic faculty who are interested in social determinants of health, as well as access to care, as well as just awareness. And so, we do things like community events of teaching CPR, hands only CPR, in our various neighborhoods. We also volunteer at our community health locations in Chicago. And you may be aware we are about to break ground in Bronzeville, and we have an entire first floor that is going to be dedicated to community engagement. I think, like you said, an ounce of prevention is worth a pound cure. And so, moving forward, this is going to be a huge focus in BCVI.

Melanie Cole, MS: Dr. Johnston, last word to you. Sir, which cardiac surgery innovations or developments do you really think will come into play in 2024? How will they impact patient care at Bluhm Cardiovascular Institute? And what would you like other providers around the country and community physicians to know about referring their patients and the importance of early referral?

Douglas Johnston, MD: Melanie, that's a great question. I think our procedures continue to evolve in an iterative fashion. And as the development of a new device, a new valve, for instance, it's a decade from the idea to get to the bedside. What is evolving even dramatically more rapidly is our ability to identify which patients to intervene on.

And as Jane told us about the AI revolution in healthcare is still very early. Our ability to figure out which patients are out there who need our help and who may benefit from an earlier evaluation or earlier intervention or a different intervention is going to evolve dramatically in the next year or two.

To do that, our philosophy really is to be able to provide care to any patient, whoever they are, wherever they are, and bring the expert care of Northwestern medicine to them. So, our national practice is growing dramatically, and those areas of expertise we have, like heart failure under Dr. Wilcox's direction, and things like radiation heart disease, where people may not be able to get the answers they need locally, we will increasingly be able to provide that care easily and seamlessly in a remote fashion, where we only need to bring a patient to downtown Chicago for certain procedures, but we can help manage them remotely with AI, wearables, et cetera, and partner with their physicians in their area, so they're referring doctors. And we do this very well.

I guess the final message is please use us as a resource. The expertise that's been built up in the Bluhm Cardiovascular Institute over the last 19 years is tremendous. We have a great team. We are growing and we're looking for top talent to join us. And you don't have to live locally to take advantage of it. So, please reach out to us, use us as a resource and we're happy to help you in whatever stage of your health journey you're on.

Jane Wilcox, MD: Absolutely. And we want to see folks early if you have hypertrophic cardiomyopathy, if you have a heart murmur, aortic stenosis, tricuspid regurgitation, all of these diagnoses that patients carry, we'd like to see you earlier in the course of your disease, so that we can do that telehealth visit, review your data, kind of plug you into our system, and then use AI, use the things that we talked about to sort of keep you in our system and then potentially only coming downtown to Chicago when you need that procedure, when you need that clinical trial, et cetera. So, seeing patients early, I think, is also going to be a focus for us moving forward.

Melanie Cole, MS: What an important message of referral. I thank you both so much for joining us and sharing your incredible expertise for other providers today and to refer your patient. Or for more information, please visit our website at breakthroughsforphysicians.nm.org/cardiovascular to get connected with one of our providers.

That concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. Thanks so much for tuning in

today.