At the Heart of It All

Chicago Health Cardiology Roundtable

Our hearts are the engines that propel us, circulating blood to the farthest reaches of our bodies. But just like any engine, time and usage take their toll.

For more than 100 years, heart disease has been the no. 1 cause of death in the U.S. Yet, within that same time period advancements in medical knowledge, diagnostics, and treatment have revolutionized care, enabling people to live longer than ever before despite heart disease.

Q: What can individuals do to prevent heart and vascular problems?

Rami Doukky, MD: The American Heart Association defines “Life’s Essential 8” as a framework of eight behaviors or risk factors for cardiovascular health. These include maintaining a healthy diet; engaging in physical activity; avoiding tobacco use; getting enough healthy sleep; managing body weight; and controlling cholesterol, blood sugar, and blood pressure levels.

Anna Joong, MD: Prevention of heart and vascular problems begins in childhood with a balanced diet rich in fruits and vegetables and regular physical activity. School aged-children and adolescents need 60 minutes of physical activity a day, so limit screen-time and spend more time playing! Discussing preventative health during early childhood check-ups is important for fostering healthy habits from a young age.

Adhir Shroff, MD: For people without any medical conditions, eating a healthy diet, avoiding tobacco products, having regular physical activity, managing stress, and having a good sleep regime are all helpful in preventing or delaying heart and vascular problems. For others, managing conditions such as hypertension and diabetes are crucial to preventing such problems.

Pratik Parikh, MD: The most important thing an individual can do to prevent heart and vascular problems is to be aware of the risk factors. Risk factors such as family history, high blood pressure, diabetes, high cholesterol, obesity, and smoking are the most commonly associated with heart and vascular problems. If you have one or more of these risk factors, then it is important to have a consultation with your primary care physician or cardiologist.

Solomon Sager, MD: For lifestyle, stick to what has always worked: Mediterranean diet, regular exercise, good sleep habits, and no smoking! Think long term — not just about the next 10 years, but the next
30-40 years if you’re younger. I am a big believer in calcium scores to screen for subclinical atherosclerosis.

Q: If I have a family history of heart disease, what are my chances that I will have heart disease? Should I meet with a cardiologist before a problem arises?

Joong: If a child’s immediate family member or multiple extended family members have a history of congenital heart disease, cardiomyopathy, heart attack at a young age, or sudden cardiac death — then talk to your pediatrician about referring your child to a pediatric cardiologist. In some cases, we even start following children before they are born with fetal echocardiography, which is a specialized ultrasound of the fetus’s heart performed by the cardiac team. Early detection allows us to be proactive in monitoring and, if indicated, provide treatments to improve outcomes.

Shroff: Quoting an exact risk is difficult, but people with a family history of heart disease are at increased risk of developing heart disease. It is debatable if this is due to inherited risk factors or environmental factors such as diet and lifestyle. Asking your primary care provider is a good place to start.

Doukky: Although there are genetic predispositions, 80% of heart disease is preventable. Inform your doctor if a close family member has had a cardiovascular condition before age 60. Adults around age 20 should start checking blood pressure, cholesterol, and blood sugar, and follow healthy habits for heart disease prevention, regardless of family history.

Q: How has Covid-19 affected patients with heart disease?

Doukky: Covid can have a significant effect on the heart. Some of these effects can be temporary, but the virus can also cause serious, long-term complications and increase the risk of heart attack or stroke. Covid leads to an increase in blood clotting, which can cause an atypical heart attack due to a blood clot without an underlying cholesterol plaque narrowing in the heart vessel. Covid also causes myocarditis (inflammation in the heart muscle), which mimics a heart attack and causes heart damage.

Joong: The biggest effect of the Covid-19 pandemic on children was a decrease in physical activity and increases in obesity, which can have long term cardiovascular effects. Early on, some children experienced cardiac issues with a rare post-Covid complication known as multisystem inflammatory syndrome in children (MIS-C), but the vast majority recovered without long-term heart problems. Fortunately, the risk and severity of MIS-C has decreased substantially over the years and is now extremely rare. Although long Covid is more prevalent in the adult population, it can also affect children and adolescents. Cardiac symptoms can be present, but cardiac testing is typically completely normal.

Q: What new heart and vascular procedures are you most excited about?

Doukky: Cardiology is a dynamic field with constant innovations. I’m excited about the growth of minimally invasive, catheter-based treatments for valvular, structural, congenital, and vascular heart and vascular diseases. Additionally, novel electronic implantable stimulation devices will enhance heart failure management and provide patients with more treatment options. The advancements being made in cardiology are resulting in improved outcomes and better quality of life for our patients.

Joong: I’m most excited about advances in the care of children who need ventricular assist devices (VADs) to treat heart failure while they await heart transplantation. These are mechanical pumps that help the weak heart pump blood throughout the body when medicines aren’t strong enough. We have VADs that can support babies to adults, and they can even send elementary and high school students to school on VAD support.

Sager: Non-surgical options to treat valvular heart disease increase opportunities to treat patients with severe valve disease and to prevent them from needing open heart surgery. Most recently there’s a procedure for fixing the tricuspid valve — the forgotten heart valve. I’m also very excited about the revolutionary changes AI will bring to cardiac care.

What does a practice need in order to thrive in today’s healthcare environment?

Doukky: The aging population and the increasing healthcare costs render providing quality cardiac care using the current fee-for-service model unsustainable. We need to do more with less. Therefore, we must redesign our healthcare delivery and incentives into a model that emphasizes prevention over intervention, quality over quantity, and value over volume.

Parikh: MCI is a private-practice model which is not that common in the field of cardiology. We distinguish ourselves by providing early access to our patients. For practices like ours to succeed we need the Center for Medicare Services (CMS) and the federal government to stop cutting reimbursements for our services. CMS has decreased reimbursement over the past decade by 30%. We’re hopeful to get public support so that we can continue to serve our patients in the communities that we reside in.

How does a practice improve the overall healthcare system for patient care?

Shroff: As an interventional cardiologist, my practice thrives on coordinated care between myself, primary care providers, and other cardiologists. We are able to provide state-of-the-art procedures to treat heart blockages and work closely with our partners to help patients manage risk factors and promote positive lifestyle changes. Together, we’re able to help patients take steps to prevent new blockages from developing and maintain their quality of life.

Parikh: The best way to improve the overall healthcare system for patient care is to improve access in the outpatient setting so we can offload our emergency rooms and hospitals (which are much costly ways of providing healthcare). Despite significant advances, cardiovascular disease remains the no. 1 cause of mortality and morbidity in the United States. We have made great advances in new medications, testing and procedures that we perform. None of this would matter unless we give access to the patient in a timely fashion before it’s too late.

Sager: The private-practice model will always be the most patient friendly and valuable model. Chicago Cardiology Institute offers all of the same cardiac services as an academic hospital, at quality equal or better, and at a fraction of the cost to the healthcare system.

How do the current private equity models impact patient care within your specialty?

Parikh: Private equity models have a significant impact in patient care within our specialty. No one is under any assumption as to the reason why private equity is being drawn towards the field of cardiology. Recently we have seen multiple cardiology practices all over the country integrating with private equity due to decreasing reimbursement leading to the inability of the private practices to survive. Despite multiple attempts, MCI has so far elected not to go down that route.

Sager: Private equity models with an ethos of physician leadership are helping to save the private practice paradigm. They empower doctors to continue to practice independent medicine, free of the bureaucratic burdens of hospital systems. In this way, they improve quality, decrease cost, and allow doctors to focus on keeping patients first.

What do you think is the biggest challenge facing healthcare services today?

Shroff: There are several challenges facing all of us today. Patients are bombarded with messages in the traditional media and online promoting tests and treatments with questionable results. Also, the rising costs of healthcare and medications, while insurance coverage is being threatened, make me the most concerned.

Joong: The biggest challenge in advancing the care of children with heart conditions is the shortage of high-quality research and investments in innovation. This stems from the challenges of having a small patient population with varied conditions and limited funding for children with heart disease.

Parikh: Lack of access for the patient. We see more than 1,000 new patients combined every month at MCI locations. We’d like to continue to provide this access, but it’s difficult to do so with decreasing reimbursements and increasing cost of the labor market. There are also significant disadvantages for private practice like us with differential payments for the cardiovascular services being delivered in our office versus a hospital outpatient setting. For example, an echocardiogram when done in our office gets reimbursed at less than one-third the cost as compared to hospital setting. Unless this changes, it would be difficult for private practice like us to continue to provide the services which are vital in our local communities. I encourage the public to speak to their elected officials to pass laws so that all cardiac services are valued the same, irrespective of location where it’s performed. This would save a great deal of money for Medicare and will also help our patients, as they would pay less for that particular service.

Sager: The disruption of the doctor-patient relationship at the point of care — by EMRs, by administrators, by commercial insurance, by government agencies, by lawyers. There is no silver-bullet solution, but we can start by empowering physicians to be stakeholders instead of employees.