Melnaie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And today, I am delighted to introduce us all to Dr. Palak Shah. He's an Associate Professor of Cardiology at Northwestern Medicine Bluhm Cardiovascular Institute, and the new chief of the Section of Heart Failure and the Medical Director of the Heart Transplant Program.

Dr. Shah, thank you so much for joining us today. I'd love for you to give us an overview of your clinical training and professional background in cardiology, and what ultimately drew you to specialize in heart failure care.

Dr. Palak Shah: That's great. Yeah. Thanks, Melanie, for having me this afternoon. Melanie, I got interested in heart failure during my cardiovascular training fellowship. And what I was struck by was the number of patients who had really advanced heart failure that had been what we consider recalcitrant to medical and device therapy, who really were struggling with advanced symptoms, end-organ failure. And very few of them at that time were eligible for heart transplantation.

I had the fortune of being in training at a time where a new technology called left ventricular assist devices were really becoming more broadly applicable to this patient population with advanced heart failure. And I got really excited by that, because all of a sudden these patients who had very limited therapeutic options now all of a sudden had the option to receive this device, which is called an LVAD. As a result, a lot of these patients received an LVAD as a bridge to eventually get a heart transplant. And for those patients who were ineligible for a transplant, they remained on an LVAD for a long period of time. And this really did revolutionize the field where we had a new kind of therapeutic strategy for this patient population.

And so, very quickly during that cardiology fellowship, I said, "You know what? It's time to pursue dedicated training in advanced heart failure and transplantation." And I went to the University of Michigan to receive that training and also some formalized research training, as part of that experience, which completed almost 14 years ago at this point. And I've been in practice since that time.

Melanie Cole, MS: Well, thank you for telling us that. And Dr. Shah, what drew you to Northwestern Medicine and Bluhm Cardiovascular Institute?

Dr. Palak Shah: I'm excited to be joining the team at Northwestern Medicine as well as the Bluhm Cardiovascular Institute. Northwestern Medicine is in a unique position within the United States because you have this really mature healthcare system that covers really all of the Chicagoland area. But that it is paired with a university and medical school, Northwestern University and the Feinberg School of Medicine that is a powerhouse education and research institute, really doing innovative research, cutting-edge work with respect to development of novel therapeutics, lots of NIH funding to really advance the science of medicine. And so, you have this university that's juxtaposed against this healthcare system. And in parallel, the synergies are really quite attractive. And the system as a whole has the ability to develop and deliver cutting-edge medical care.

Melanie Cole, MS: Well, then, how would you describe your approach to heart failure care, particularly when treating complex patients across outpatient, inpatient, and advanced therapy settings?

Dr. Palak Shah: Melanie, I think it's important to realize that, you know, heart failure is one of the most common cardiovascular diseases that we have in the world. It is the leading cause of cardiovascular mortality. And about one in four of us have the risk of developing heart failure over the course of our lifetime. So, it's a highly prevalent condition, and it's a highly morbid condition once it has been diagnosed.

With respect to how we think a little bit about therapy and managing our patient population, I think it's important to realize that we really do try to take a personalized approach to how we treat each patient. We have really an armamentarium of therapies that are available. This includes things like guideline-directed medical therapy, which are really oral medications that are quite good at reducing the morbidity and mortality of patients who have heart failure, and importantly also have the ability to improve the ejection fracture and hopefully cause remission or recovery from their heart failure.

For patients who continue to have persistent symptoms, there's hemodynamic monitors that we have that can be used in the outpatient setting as well as other implantable technologies that can restore a normal cardiac rhythm, prevent sudden cardiac arrest, resynchronize the left ventricle.

Finally, I think for those patients who have really advanced symptomatology, who despite all of our efforts really are unable to have a satisfactory quality of life and their longevity of life may be limited, that's when we think about what we call advanced therapies. And that's when we would evaluate a patient for something like a left ventricular assist device or potentially a heart transplantation.

Melanie Cole, MS: Wow. So as the new chief of the section of heart failure, what are some of your immediate and long-term goals for the program at the Bluhm Cardiovascular Institute?

Dr. Palak Shah: So, this is really important, right? I think, as I have mentioned to you, there's a large patient population that would benefit from really state-of-the-art heart failure care. But unfortunately, access to that care and getting that care is somewhat challenged based on where patients live and who they may potentially be referred to.

This is where we really want to ensure that our patients are getting met where they live and getting the care that they deserve in their own neighborhoods. Northwestern Medicine, as you know, has over 10 hospitals across the Chicagoland area. But importantly we actually have dedicated heart failure services at about five hospitals that really span kind of the north, northwest, western and southern regions around Chicago. So for patients who live there, there's no need necessarily to travel downtown to Northwestern Memorial Hospital. We can plug them in with a heart failure specialist closer to where they live, where they can get this top-notch heart failure care.

Melanie Cole, MS: Yeah. That's one of the most awesome things really about Northwestern, is that extension of excellent care. Now, how do you envision furthering the integration of heart failure care seamlessly across Northwestern Medicine's health system when we think about how broad that is, what operational and clinical opportunities are most exciting to you, Dr. Shah?

Dr. Palak Shah: So, the position at Northwestern was most attractive, because of the health system aspect of it and the fact that they had already set up both heart failure services as well as cardiac surgery services, which are important for some of our sickest patients, really throughout Northwestern medicine with those services being available at Lake Forest Hospital, at Central DuPage Hospital and at Palos Hospital, aside from just the Northwestern Memorial Hospital.

As we think about the next few years of heart failure care, our goal really is to provide that heart failure care for those patients in those specific regions. When those patients need more advanced procedures, let's say they need a valvular intervention, they need a defibrillator, they need a bypass in the setting of a low ejection fraction, they can get all of those services in that region.

Now, let's say the patient has progressive disease where, despite all of our efforts with kind standard medical therapy and device therapy, they need to be considered for an LVAD or transplant. Well, how do we make sure that that patient can get that evaluation there in their own neighborhood with the community and the providers that they're used to come downtown to get the surgery? Because that surgery is so specialized that it probably could only occur down at Northwestern Memorial Hospital, but then eventually go right back into their own communities to get the longevity of care that they need, and that longitudinal care that they need specifically, which, you know, for an LVAD patient, is typically a median survival of about seven years. And for a heart transplant patient, that's about a median survival of 13 years. And so, how do we make sure that they get that top-notch care again in their own backyard as opposed to feeling like they have to travel downtown to get that care for that time period after surgery.

Melanie Cole, MS: Yeah, that's very exciting. Now, what are some of your key priorities for growing and advancing the heart failure program? Where do you see the greatest opportunities, Dr. Shah, for innovation and collaboration?

Dr. Palak Shah: I think it's important for us to think about how we eliminate all disparities in care and enhance access to care. So, that's probably one of my top initial priorities, where we really want to make sure that patients are able to get heart failure care as quickly as possible. Ideally, seeing a heart failure specialist within a week of requesting an appointment. We want to then make sure that those patients are prescribed not only the guideline-directed medical therapy and device therapy, but really are offered the ability to participate in novel research. This is often where patients get access to novel therapeutics and/or devices that may enhance their quality of life and reduce the morbidity associated with heart failure. Ultimately, whether it's medical therapy or device therapy, really our goal is for our patients to live longer, healthier, lives away from regular healthcare as much as possible.

Melanie Cole, MS: Dr. Shah, you know, we're talking about your approach to heart failure and what you're going to do at Northwestern Medicine, Bluhm Cardiovascular Institute. But I'd like you to tell patients and your colleagues how you would describe your approach to care in general. What's your philosophy of care and what do you want them to know about how you approach disease, wellness, and care for the whole person as you start this new position?

Dr. Palak Shah: One of the things that I'm reminded by after being in practice for this long is the reason we go into this field and in medicine in general. And the reason we went into this field is because of the people. That's not just the people we work with, but that's the patients we take care of.

And I think one of the things that I pride myself on is really meeting the patient where they are, accompanying them on this journey or heart failure and figuring out how to make each patient successful based on their own individual goals for their own life. It's really accompanying the patients. It's a personalized approach where not everything is protocolized and checklist-driven. But really trying to figure out what that patient really values and making sure that we're chasing that, and that's the number one priority when we treat them.

Melanie Cole, MS: And I think that's where medicine is really going, to that personalized medicine. Now, comes my favorite question. Dr. Shah, as you join the Northwestern Medicine team, what do you do for fun? Tell us a little bit about your family and your life outside of work. What are some things that patients or your colleagues may not know about you?

Dr. Palak Shah: So, I am quite fortunate to have a lovely family, with three vibrant teenagers who keep me and my wife active and running and traveling around the world. As a family, we enjoy a lot of the snow sports, including snowboarding and skiing.

We did some pretty intense trucking back in the past year, including climbing Machu Picchu. And I personally climbed Kilimanjaro, which was a once-in-a-lifetime event. And then, other kind of, you know, more regular fitness activities, things like cycling. And with my middle son, I like to play tennis,

Melanie Cole, MS: Wow. That is amazing. Thank you so much for sharing that with us. And Dr. Shah, as we wrap up, is there anything else you'd like referring physicians to know about you as you join the team at Northwestern Medicine?

Dr. Palak Shah: I'll leave you guys with a couple things, right? There's about 1 million patients who are hospitalized for heart failure per year in the United States, and about a third of those patients will die within a year. So, I think for that patient population and for any patient population that you would like an additional opinion about their heart failure management, just feel free to call. We will do our best to get that patient in as quickly as possible to get seen by a heart failure specialist. And ultimately, if that patient does require specific therapies that we provide and/or advanced therapies, we're happy to, evaluate them and, work with you collaboratively to provide those therapies. And ultimately, if they're not ready for anything more advanced, then we're happy to partner with you on their long-term chronic disease management as well.

Melanie Cole, MS: Thank you so much for joining us today. It was a pleasure to meet you. Welcome and congratulations on your new position. 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.