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Prakash Chandran (Host):  Heart failure affects approximately 5.7 million people in the United States and is escalating rapidly with about 550,000 newly diagnosed cases annually. St. Joseph's Health Hospital is the heart hospital in the region. In the past few months, they've added services to their already outstanding cardiac care areas that we'll learn about today. Let's talk about it with Dr. Russell Silverman, Medical Director of the St. Joseph's Health Heart Failure Clinic, and the Chief Medical Officer at Rome Memorial Health. This is St. Joseph's Health Med Cast from St. Joseph's Health. I'm Prakash Chandran. So, first of all, Dr. Silverman, it is great to have you here today. Can you tell us a little bit more about the Cardiovascular Institute and the new Heart Failure Clinic?

Russell Silverman, MD (Guest): Yes, thank you for asking me to be on the podcast today. St. Joseph's Health is a premier Cardiovascular Institute in Central New York. We provide all of the necessary diagnostic and interventional procedures, both in the cardiac catheterization laboratory and in the surgical suite for cardiovascular surgery. We also have an outstanding Electrophysiology Program and we have just added to that menu, the St. Joseph's Health Heart Failure Center. As you have already noted, heart failure in the United States is rising at an alarming percentage. And it's very important that heart failure be treated appropriately, with the present available medications and interventions that are necessary for proper medical management.

Not only is heart failure, bad for patients, but it's also bad for our health system because of the immense cost that is associated with it. By treating people properly as outpatients, and providing Heart Failure Centers and Clinics, we can provide patients with the highest quality heart failure management, keep them out of the hospital and keep them home, and hopefully prolong their lives and make their lives better.

So, we have recently opened our Heart Failure Program. We are doing this in conjunction with our partners in Rochester, New York, Strong Memorial Hospital and their Heart Failure team who will be coming to our Heart Failure Clinic on a monthly basis to see our much more complex heart failure patients who may be candidates for more advanced heart failure interventions.

Host: Yeah. And I was just going to ask, what are the differences between what you do at the Heart Failure Clinic versus what a patient might experience on a normal visit?

Dr. Silverman: The management of heart failure patients goes beyond just an office visit with somebody going through their medications and making sure that the list is correct. It really involves a detailed history on these patients. What they eat, when they take their medications. Are they taking them properly? Are the doses proper? Have the medications been maximized for the patient’s clinical state? And so a Heart Failure Clinic is much more than just a glorified office visit. It is an intense evaluation of the patient's needs. Our nurse and mid-level that are involved with the management of this program spend lot of time with patients going through their medications, going through their diet, making sure they have the proper help at home and making sure that their medications are coming to them in a timely manner, that they don't miss doses.

And if they're missing doses, what are the barriers that are preventing them from taking their medications properly? By taking medications properly and having their medications maximized for their clinical state, they will have a much happier life, a healthier life, stay out of the hospital and be much better off than what they would be if they're not doing things properly. We don't want to see patients making frequent trips to the hospital every month or two, because they have too much volume on board and they need a little extra diuretic therapy or something along those lines. We can provide all of those treatments and interventions on an outpatient basis, which is much better for the patient and the family and society in general.

Host: Yeah, I can see that. One of the quotes that I read from you is that time and time again, you see people that come to the emergency room with those heart conditions, they don't see a cardiologist fast enough. So, they end up right back at the hospital because they aren't given that treatment that they're needed. So this incorporation of the Heart Failure Clinic is something that can improve those outcomes for those patients. Isn't that correct?

Dr. Silverman: That is really what we're after is improving outcomes. I'm glad you used that phrase because that is really what it's necessary for. We can intervene in patients who are becoming decompensated before they even have to go to the emergency room. A simple phone call will initiate our home care services in order to get somebody over to the home, if possible, to see the patient, even in this COVID environment, we have to be able to treat patients who have diseases that are not COVID related. And we can't forget about those people. So, we have a Diuretic Program that we can intervene with patients and go to their homes and give them diuretics to help keep them out of the hospital. It's a very intensive program and involves measuring their labs, measuring their weight.

They even have equipment at home, Bluetooth equipment that can transmit their weight and other parameters to a central monitoring station. So, we can hopefully head off issues before they become too apparent and work very hard to keep patients out of the hospital.

Host: Yeah, that certainly sounds fascinating. And we're going to get to that, but before we do, I wanted to ask a little bit about who can get referred to the Heart Failure Clinic? Are there certain candidates that you look for?

Dr. Silverman: It suits really patients who have very complex heart failure. We will see anybody that a primary provider or cardiologist wants us to see. And we will see any patient who has been discharged from the hospital with a diagnosis of congestive heart failure. Really our goal is not to take patients away from primary care providers or other cardiologists. We want to work in concert with those providers. We want to give the patient what I call a safe landing place for their discharge after being in the hospital for treatment of heart failure. And that means that we want them seen within three to five to seven days, no later after the discharge, if they can't get in to see a primary care provider or their cardiologist. We will return those patients of course, to their primary provider and their cardiologists.

But we want to be sure the first seven days of discharge is the most important time for a patient because frequently patients do leave the hospital and don't get their medications in a timely manner. And they may miss two or three days of medications. And what an early visit after discharge provides is us being able to make sure that the patients get their meds in a timely manner.

We do have a program at St Joseph's, so that patients actually can get medications at the time of discharge, but that doesn't always work the way you want it to because of how busy our hospital is with, and every hospital is now in this particular environment. So, we provide a safe landing place for patients so that they can be seen quickly after discharge, have a better outcome from their hospitalization, prevent the readmission and provide them with the care they need.

Host: So, let's talk a little bit about this technology. One of the things that I do know is that St Joseph's has teamed up with Rome Memorial Hospital to use this technology called the Bluetooth stethoscope. Can you speak to that a little bit?

Dr. Silverman: Yes, I can. We actually don't use their program, that is actually something that St Joseph's Health put together with one of our surrounding hospitals that we partner with, Rome Hospital in Rome, New York. And we worked with them, their IT departments and our IT departments combined to form a team that allows me to listen to hearts, listen to lungs from anywhere I am. Not just in the country, but potentially in the world because of the development of a stethoscope by a company called Eko. But other companies also have this technology. So, we can actually examine patients from afar and listen to their lungs, listen to their heart and with other criteria that we can find, which is simple things like their weight some recent blood work, we can effectively treat those patients and prevent their rehospitalization as well.

And I want to bring that technology and capability to our outlying areas north of here that may not have cardiology care the way we would like it to occur. We do have a very close relationship with Dr. Leeway Chen and Dr. Mark Tallman from Rochester Strong Memorial Hospital, in treating complex heart failure. They also have a remote program. I'm not too familiar with how it works. I know how ours works, which is pretty seamless. In fact, I just did one yesterday on a patient in an intensive care unit as an inpatient.

So, we have this capability we have equipment that goes to the patient's homes to monitor their heart rhythm, to monitor their weights, blood pressure things along those lines, which are all markers of how well we're doing with treating their heart failure. And if they are decompensating, that we can prevent that decompensation from progressing.

Host: Wow. That is incredible to hear that this technology exists. Just as we come to a close here, I always like to ask about proactive measures that people can take especially around improving or maintaining their heart health. What advice might you have?

Dr. Silverman: Well, if they are already dealing with a reduced heart function and heart failure, I would say that they need to follow the recommendations of their providers in terms of their diet, which is utmost in helping to protect them from decompensation, particularly during holiday times when diets may vary a bit more than we would like them to.

So if you follow your provider's instructions. But in general, I think from a heart healthy perspective, you always want to reduce your fats, reduce your concentrated sweets, if possible, keep your blood pressure under control. Keep your cholesterol under control, whether that requires medications or diet, that is between you and your provider. Certainly smoking is a major problem in this country. As young people smoke, they become older, as they age and they also face the same risks. So, you know, diabetes, high blood pressure, smoking. We have to address high cholesterol. there isn't much you can do about your family history, but we want your offspring's family history to be better than your family history, which is what I tell my patients.

So if you manage those five risk factors as best you can, you will have a healthier and happier lifestyle going forward.

Host: Very good advice, Dr. Silverman. Anything else before we wrap up today?

Dr. Silverman: I would say that it's not only however, the technology that we bring to the patient's homes, but the technology that gets implanted in patients that helps us manage their heart failure as well. Defibrillators can actually tell us patient's volume status and we use that information as well as everything else to determine how well somebody is doing with management of their heart failure.

Host: Well, thank you so much for educating us today, Dr. Silverman, I truly appreciate it. That's Dr. Russell Silverman, Medical Director of the St. Joseph's Health Heart Failure Clinic and the Chief Medical Officer at Rome Memorial Health. For more information, please visit everybeatmatterssJh.org. If you're a primary care physician or a cardiologist, you can refer patients who need advanced heart failure management by calling (315) 703-5090.

If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been St Joseph's Health Med Cast from St. Joseph's Health. I'm Prakash Chandran. Thanks so much for listening.