Seconds count when treating heart attack patients, and UCSF Medical Center is recognized nationwide for its speed in using balloon angioplasty to open narrow or blocked blood vessels that are associated with heart failure. In a recent survey, UCSF interventional cardiologists treated patients with the procedure less than an hour after their arrival in the Emergency Department, considerably faster than the 90-minute benchmark of the National Cardiovascular Data Registry.
Michael Conte, MD
UCSF’s achievement means more lives saved and less risk as patients recover because each second risks the loss of precious heart muscle.
“But it is not just a matter of speed,” says electrophysiologist Jeffrey Olgin, MD, chief of the UCSF Division of Cardiology. “Because we maintain a steady dialogue among clinical experts and researchers, heart and vascular patients at UCSF receive the finest care from the broadest and most up-to-date perspective possible.”
Cardiac electrophysiology – a specialty that diagnoses and treats electrical activity in the heart – is one of several examples of how patients benefit from this approach.
In the 1980s, a UCSF electrophysiology team led by Melvin Scheinman, MD, pioneered use of radiofrequency catheter ablation to treat patients with irregular heartbeats, known as arrhythmias. In this procedure, physicians lace a tiny tube, called a catheter, through a patient’s circulatory system to the area of the heart where the irregular heartbeat is occurring. Then they send electrical energy through the catheter to destroy the tissue causing the disturbance, curing some types of heart rhythm problems without the need for open heart surgery.
Today, catheter ablation has become a standard treatment for many arrhythmias, which affect millions of Americans, can be life-threatening and tend to afflict the nation’s rapidly growing population of older adults. At UCSF, expert teams perform more than 400 catheter ablation procedures annually to successfully treat up to 98 percent of the arrhythmias from the upper chambers of the heart, as well as certain arrhythmias from the lower chambers.
In 2006, UCSF electrophysiologists were first in California to use a magnetic navigation system to more precisely complete an ablation. Since that time, UCSF electrophysiologists have used the procedure on hundreds of patients from around the world. UCSF also was the first hospital in California to use a magnetic navigation system to open complex coronary artery blockages that were otherwise inaccessible by conventional techniques.
“Because the complication rate is so minimal, ablation is now a better alternative to drugs for many patients with certain types of arrhythmias, including the particular type known as atrial fibrillation,” says Olgin.
Atrial fibrillation affects more than 2 million Americans, and can put people at risk for such dangerous conditions as stroke and congestive heart failure.
PAD and Aortic Aneurysms
UCSF also is a leader in treating peripheral artery disease, known as PAD. In this condition, blood vessels in a patient’s arms and legs become at least partially blocked, putting the individual at increased risk for death, heart attack, stroke and limb loss, as well as for a significantly impaired quality of life. The disease affects about a third of adults over the age of 70.
PAD care at UCSF begins with a team of vascular surgeons, cardiologists and nurses who encourage important lifestyle changes (diet, exercise, smoking cessation) and provide medical management of cardiovascular disease risk factors, such as high cholesterol, hypertension and diabetes.
“Choosing the right approach for each individual patient demands experience with and access to the full range of treatment options,” says Michael Conte, MD, chief of the Division of Vascular and Endovascular Surgery and one of the world’s foremost experts in PAD.
When medical management alone is not adequate to treat leg symptoms, UCSF offers a full range of revascularization options. These include balloon angioplasty (a procedure to open narrow or blocked blood vessels), stents (tubular devices placed inside a blood vessel to bypass an obstruction), and surgical bypass using either the patient’s own veins or artificial grafts.
To prevent amputations wherever possible, especially in diabetic patients who are particularly vulnerable, UCSF is developing a limb salvage center as a joint effort among vascular surgeons and diabetic podiatrists. This center, the first of its kind in the San Francisco Bay Area, is slated to open in 2011.
UCSF surgeons also offer the latest options to treat aneurysms, which are bulges or ballooning in a blood vessel caused by a weakening in the vessel wall. Ruptured aneurysms are potentially fatal, particularly in the aorta, the body’s largest artery. Specialists at UCSF repair aortic aneurysms either through open surgery or, when appropriate, through endovascular repair, another area where UCSF surgeons have led innovation.
Endovascular repair involves a surgeon or interventional radiologist using a catheter to place a stent graft in a blood vessel to bypass the aneurysm. This approach does not require a large incision and has a shorter recovery time than open surgery.
Services from Prevention to Heart Transplantation
UCSF offers a full range of cardiology and cardiovascular services, from prevention to heart transplantation.
Teresa De Marco, MD and Jennifer Ho, MD
- Prevention: The UCSF Center for Prevention of Heart and Vascular Disease, led by William Grossman, MD, is a world-renowned, research-driven prevention program, now located in the Smith Cardiovascular Research Building on the Mission Bay campus. A comprehensive team of heart experts works with patients who are at risk for a first or recurring heart problem to develop a thorough, personalized, up-to-date prevention plan that covers medication, diet and lifestyle recommendations.
- Culturally sensitive help for at-risk Asian Americans: “Cardiovascular disease and stroke are the leading causes of death among Asian American adults. This is why the Asian American community needs culturally and linguistically competent evaluation, management and treatment of disease and risk factors,” says cardiologist Gordon Fung, MD, MPH, PhD, director of the UCSF Asian Heart and Vascular Center. When it opened in 2006, the center was the first of its kind in the United States. It serves as a cardiovascular care hub for the Asian community, providing patient outreach, education and screening, as well as access to UCSF heart and vascular specialists.
- Imaging: The Department of Radiology and Biomedical Imaging at UCSF offers comprehensive evaluation of a patient's cardiovascular system by drawing on a full range of imaging capabilities, as well as on a history of leadership in the field. UCSF was instrumental in the development of magnetic resonance imaging (MRI) of the heart, which today is an important part of any diagnostic arsenal. The UCSF Imaging Center at China Basin is one of the few in the world that offers a combination of high-tech approaches that can create a one-stop service for diagnosing coronary artery disease during a single patient visit. Dedicated to quality care in a patient-oriented environment, the center offers patients the opportunity to become familiar with the facility through a virtual tour accessed through its website. The website also posts the center’s statement of commitment to referring physicians, which includes a turnaround time for reports of less than 24 hours after a patient exam is completed.
- Heart failure: “We work with referring physicians to provide treatments that relieve symptoms, slow disease progression, prolong survival and improve quality of life,” says Teresa De Marco, MD, medical director of the UCSF Advanced Heart Failure and Heart Transplant Program. An expert heart failure team of doctors, nurses, pharmacists, dietitians, physical therapists and medical social workers delivers this care. In addition, UCSF offers therapies through clinical trials that are not available at other health care centers. Mechanical assistance devices are a particular treatment for patients with a diseased heart that can no longer adequately pump blood to the body. UCSF interventional cardiologists and surgeons can implant a mechanical device in a patient either for short-term support of the heart while it recovers from trauma or for a longer period to extend life or serve as a bridge to a heart transplant. When a patient returns home with a device in place, UCSF offers around-the-clock clinical and technical support. “Inserted correctly and with proper follow-up, medications and mechanical devices can extend and improve quality of life for a significant number of years,” says De Marco.
- Heart transplantation: If a patient has a progressive, potentially fatal heart disease that substantially impairs quality of life and daily function, transplantation becomes an option. The UCSF Heart Transplant Program has performed more than 250 procedures since it was launched in 1989. The program is designated as a Center of Excellence by Blue Cross and Blue Shield insurance plans of California.