duke heart report 2012

Duke Heart Report 2012

ChangingpraCtiCeChanginglives

Robert J. Lefkowitz, MD Winner, 2012 Nobel Prize in Chemistry


Christopher M. O’Connor, MDDirector, Duke Heart Center Chief, Division of Cardiology Professor of Medicine

Victor J. Dzau, MDChancellor for Health Affairs, Duke UniversityPresident and CEO, Duke University Health SystemJames B. Duke Professor of MedicineDirector, Molecular and Genomic Vascular Biology

LetteR fRoM LeaDeRsHip

The Duke Heart Center is consistently recognized as one of the premier cardiovascular treatment and research centers nationally and internationally. Our goal is simple—to provide state-of-the-art, evidenced-based patient care while continually advancing the practice of cardiovascular medicine through our robust clinical research programs.

Our commitment to caring for patients with heart disease begins with impactful research—from the seminal work conducted by Robert J. Lefkowitz, MD, for which he was recently awarded the 2012 Nobel Prize in chemistry, to our leadership and participation in virtually every major heart-related investigational network, clinical trial, and registry—including the 40-year-old Duke Databank for Cardiovascular Research, which in the 1990’s led to the creation of the Duke Clinical Research Institute and continues to be a rich source of research data today.

Perhaps most importantly, we continue to translate the discoveries and findings from our research into innovative models of care that draw together multidisciplinary teams of specialists and staff in new ways to, among other things,

ensure that the most appropriate, effective therapies are selected and delivered to all of our patients. (See pages 8-9.)

Our faculty also continue to have a profound impact on setting standards for quality heart care through their work with the American Heart Association, American College of Cardiology, National Heart, Lung, and Blood Institute, and many others. Through our growing network of affiliated heart centers, we are working to help advance the delivery of the highest quality of care throughout the Southeast.

Through these efforts we are changing practice—and changing lives. We’re pleased to share with you our latest initiatives, innovations, and achievements in this year’s Duke Heart Report.


facts anD stats

Ranked among the top 10 programs nationally, Duke Heart center serves more than 65,000 patients every year

Total Patient Visits

Outpatient Visits

Inpatient Discharges

Unique Patients

182,877

175,182

7,402

68,281

Figures are for calendar year 2011. Volumes are for Duke University Hospital, Duke Raleigh Hospital, Durham Regional Hospital, and hospital-based locations.

patient volumesDuke University Health System, CY11

Adult Echo*

Cardiac Catheterizations**

Arrhythmia/EP

Peripheral Vascular***

26,644

14,888

2,800

1,614

proCedure volumesDuke University Health System, CY11

*Includes stress echo and TEE **Diagnostic and interventional ***Noninvasive arterial and carotid, plus diagnostic and interventional peripheral and carotid

Total Faculty and Staff

Board-Certified Cardiologists, Cardiac Surgeons,

and Cardiothoracic Anesthesiologists

Cardiac and Cardiothoracic Surgical Nurses

1200+

110+

800+

the people of Duke Heart center

one of the nation’s top cardiovascular critical care UnitsDuke University Hospital’s 16-bed cardiac care Unit (ccU) is one of the nation’s top acute myocardial infarction care units, serving some 1,700 critically ill patients each year.

Duke Heart Center 888-HRT-DUKE

exceeding Benchmarks Leader in Minimally invasive surgery

#1 Volume in the U.s.

CardiovasCular and thoraCiC surgerY volumesDuke University Medical Center, CY11

44Other

50Heart Transplant

109CABG and Valves

147Lung Transplant

73Adult Congenital

372Isolated CABGs

342Isolated Valves

VolumesTotal Procedures

Mortality RateMin. Invasive

9901.72%2011

heart surgerY volumes and mortalitYDuke University Medical Center general thoraCiC surgerY volumes

1,654

Cardiac catheterization lab procedure volumes for Duke University Health System and affiliate sites, CY11

12,038Diagnostic (coronary and peripheral)

3,073inteRVentionaL (coronary and peripheral)

among the southeast’s Highest-Volume interventional cath Labs

Stress echo and nuclear imaging volumes for Duke University Hospital, Duke Clinic, and Duke Health Centers at Southpoint and North Duke Street. MRI volumes for Duke University Hospital and Duke Clinic.

imaging proCedure volumes, CY11

20,202ecHo

3,673stRess ecHo

2,769tee

485VascULaR

3,155caRDiac MRi

2,059nUcLeaR iMaging tests

1,654Thoracic

1,429

1,302

1,388

1,486

910

935

1,048

1,018

1.90%

3.32%

1.62%

2.58%

2007

2008

2009

2010

one-Year lung transplant patient survival rate

DUke Us

From the Scientific Registry of Transplant Recipients (srtr.org), for adults receiving their first transplant between 1/1/09 and 6/30/11. A p-value of 0.01 indicates that this difference is statistically significant.

89.04% 81.76%

1,018

Volumes for Duke University Hospital, Durham Regional Hospital, and Duke Raleigh Hospital, CY11

748

748

787

888

2011

2007

2008

2009

2010

among the world’s highest volumes

With more than 900 open-heart procedures annually, Duke’s volumes far exceed those suggested by national guidelines—and survival rates consistently exceed society of thoracic surgeons benchmarks.

More than half of the general thoracic surgeries performed at Duke annually use minimally invasive techniques—compared to 20 to 30 percent nationally.

Duke performed 147 lung transplants in 2011 with survival rates that far surpass the national average.

32012 RepoRt

“ When the American Heart Association announced its top advances in cardiovascular quality of care and

outcomes research for 2011, more than half of them involved Duke faculty. That speaks volumes.”

– eric D. peterson, MD, MpH Director, Duke Clinical Research Institute

Duke Heart center is internationally known for translating scientific discoveries

into better treatments for heart disease—and expanding the evidence base for

clinical practice worldwide.

Duke is a founding site of both the

NIH-funded Heart failure clinical

Research network and the clinical

and translational science awards

consortium

One of nine US sites in the NIH-funded

cardiothoracic surgical trials network

Research coordinating unit for the nHLBi

centers for cardiovascular outcomes

Research

Home to the Duke Databank for cardio-

vascular Disease—the world’s largest and

oldest such outcomes registry, with infor-

mation on more than 200,000 patients

Home to Duke clinical Research institute

(DCRI)—the world’s foremost academic

research organization—which has conduct-

ed more than 870 studies in 65 countries

at more than 37,000 sites, enrolling more

than 1.2 million patients

DCRI faculty published 568 papers in peer-

reviewed journals during the 2011-2012

academic year—more than 20 percent of

them in high-impact journals

Duke Heart Center faculty receive more

than $130 million in cardiovascular

research funding each year from govern-

ment and private sources, including more

than $5 million for basic research and more

than $110 million for clinical research

60 cardiology studies and 18 cardiotho-

racic surgery studies are currently under

way at Duke Heart Center—including a

number of “first-in-man” studies.

Home to the editors of The Journal of Clinical

Investigation, the American Heart Journal,

and the Journal of the American College of

Cardiology: Heart Failure, premier venues for

disseminating critical advances in cardiovascu-

lar research

Defining Best pRactices


setting national Quality and appropriateness guidelinesDuke leads the creation of national quality standards through work with entities such as the Centers for Medicare and Medicaid Ser-vices, the Food and Drug Administration, and the National Academy of Sciences’ Institute of Medicine.

Faculty are also leading and serving on committees of the American College of Cardiology (ACC) and the American Heart Association (AHA) to develop appropriate-ness guidelines and performance indicators for cardiovascular imaging, PCI, CABG, ICDs, TAVR, and more—as well as chairing the overarching ACC/AHA Performance Measures Task Force that champions the development of new performance measures to improve cardiovascular care quality.

Home to national RegistriesDuke is the coordinating center and analytic engine for national quality initiatives that collect data from US hospitals to improve treatment and outcomes: Society of Thoracic Surgeons (STS)

National Database AHA’s Get With the Guidelines initiative AHA, American Diabetes Association,

and American Cancer Society’s The Guideline Advantage outpatient registry

ACC’s National Cardiovascular Data Registry percutaneous coronary interven-tion registry and the NCDR-ACTION acute coronary syndromes registry—each the world’s largest clinical registry in its class

ORBIT-AF, the nation’s largest longitudi-nal registry of atrial fibrillation patients

PREVAIL, a large registry of diabetic treatment in clinic populations

STS/ACC TVT Registry, the post-mar-ket-approval registry for transcatheter aortic valve replacement (TAVR)

Robert M. califf, MDMember, American Heart Association, Scientific Publishing CommitteeMember, NIH National Advisory Council on AgingMember, IOM Board on Health Sciences PolicyMember, NHLBI Board of External ExpertsMember, Board of Directors, Society for Clinical and Translational SciencesMember, CTSA External Advisory BoardEditorial Boards: American Heart Journal, Circulation, European Heart Journal, Journal of the Society of Clinical Trials

James Daubert, MDSimon Dack Award for Outstanding Scholarship, Journal of American College of Cardiology, 2011Senior Consulting Editor, Journal of American College of Cardiology, 2012

pamela s. Douglas, MDMember, NHLBI External Advisory CouncilMember, National Space Biomedical Research Institute External Advisory CouncilCo-Chair, FDA Standardized Data Collection for Cardiovascular Imaging Initiative Chair, ACC Publications CommitteeCo-Chair, ACC Cardiovascular Leadership InstituteChair, ACC Quality in Technology Working Group Chair, ASE Extramural Research Committee

Donald glower, MDMember, The Journal of Thoracic and Cardiovascular Surgery Editorial BoardMember, Journal of Cardiac Surgery Editorial BoardMember, South Atlantic Cardiovascular Society Steering Committee Co-Principal Investigator, EVEREST Evalve FDA Phase III Trial

christopher granger, MDChair Emeritus, AHA Mission: Lifeline Member, ACTION Registry: GWTG Research and Publications CommitteeMember, NHLBI Board of External Experts

g. chad Hughes, MDMember, The Society of Thoracic Surgeons Task Force on Thoracic EndograftingMember, The Society of Thoracic Surgeons/ FDA Center for Devices and Radiological Health (CDRH) Network of Experts Percutaneous Heart Valves Bench

Robert Jaquiss, MDChairman, Berlin Heart Study Group and Publications CommitteeMember, Education Committee of the American Association for Thoracic SurgeryMember, Membership Committee for the Congenital Heart Surgeons’ Society

William e. kraus, MDMember, Board of Trustees, American College of Sports MedicineMember, Board of Directors, International Society for Physical Activity and Health

Robert J. Lefkowitz, MD2012 Nobel Prize in Chemistry (shared)

Jennifer Li, MDMember, Institute of Medicine committee to evaluate Pediatric Drugs and Biologics under the Best Pharmaceuticals for Children Act

Joseph p. Mathew, MD, MHscChair, Neurocognitive Committee, Cardiothoracic Surgical Trials NetworkMember, Abstract Review Committee, Society of Cardiovascular AnesthesiologistsMember, Database Task Force, Society of Cardiovascular Anesthesiologists

L. kristin newby, MD, MHsChair, Council on Clinical Cardiology, American Heart AssociationPresident, Society of Cardiovascular Patient CareSenior Associate Editor, Journal of the American Heart AssociationMember, ESC/ACC/AHA/WHF Task Force for the Redefinition of Myocardial Infarction

christopher o’connor, MDEditor-in-Chief, Journal of the American College of Cardiology: Heart FailureTreasurer, Heart Failure Society of AmericaFDA Working Group: Acute Heart Failure Syndromes—Clinical TrialsNIH/NHLBI Working Group: Emergency Department Management of Heart FailureNIH/NHLBI Working Group: Cardiac Transplantation Workshop and Guidelines Committee

Magnus ohman, MDMember, FDA Center for Device Evaluation PanelMember, ACC/AHA Guidelines Oversight CommitteeMember, ESC Task Force for Non-STEMI Guidelines

Manesh patel, MDChair, AHA Diagnostic and Invasive Cath CommitteeChair, Writing Committee, ACCF/SCAI/STS/AA TS/ASNC Appropriateness Criteria for Coronary RevascularizationMember, ACC Task Force, Appropriate Use CriteriaWriting Committee, AHA/ACC CABG Guidelines Committee

eric peterson, MD, MpHChair, ACC/AHA Performance Measures Task ForceBoard President, AHA Mid-Atlantic Affiliate Member, AHA Strategic Executive Planning CommitteeMember, ACC Quality Oversight Committee Member, FDA/CDRH MDEpiNET Technical Working Group Member, Institute of Medicine (IOM) Large, Simple Trials Group Member, ACC/AHA Guidelines on the Management of Unstable Angina/Non-ST- Segment Elevation Myocardial Infarction Member, AHA Guidelines for Secondary Prevention Contributing Editor, JAMA

Howard Rockman, MDEditor in Chief, The Journal of Clinical Investigation, 2012-2017

Joseph Rogers, MDBoard of Directors, International Society for Heart and Lung TransplantationVice Chair, UNOS Thoracic CommitteePrincipal Investigator, HeartWare ENDURANCE Trial

peter k. smith, MDVice Chair, ACC/AHA CABG Guidelines CommitteeMember, Advisory Panel, Joint Commission/AMA National Overuse Summit for PCIMember, Writing Committee, ACCF/SCAI/STS/ AATS/ASNC Appropriateness Criteria for Coronary RevascularizationMember, Relative Value Update Committee, AMAMember, ACCF/AHA/PCPI CAD/HTN Committee; PCPI Quality Measures Committee, AMA

top Doctors Six Duke Heart Center cardiologists and three cardiothoracic surgeons were recognized as Top Doctors by U.S.News & World Report—estimated to be among the top one percent in their specialty nationwide.

cardiologistsThomas M. Bashore, MD; Robert M. Califf, MD; J. Kevin Harrison, MD; Christopher M.O’Connor, MD; Harry R. Phillips III, MD; Joseph G. Rogers, MD

cardiothoracic surgeonsThomas A. D’Amico, MD; David H. Harpole Jr., MD; Peter K. Smith, MD

national Leadership

52012 RepoRt

four decades with Duke—and counting Bobby Hartley’s relationship with Duke started forty years ago, when at the age of seven he was diagnosed with Hodgkin’s lymphoma. Chemotherapy and radiation to his chest cured the lymphoma, but weakened his heart. Last year, Bobby was diagnosed with congestive heart failure. He needed an aortic valve replacement, but was not a candidate for open surgery because of a severely calcified,

“porcelain” ascending aorta. Duke’s leadership in advanc-ing transcatheter aortic valve replacement (TAVR) gave Bobby access to more options. In May 2012, he underwent a TAVR procedure and less than a day later was up and walking around. “My heart failure made me feel like I was drowning,” he said. “After my procedure, I started feeling better almost immediately. It was truly an amazing thing.”

Leading the way with TAVRReseaRcH tHat cHanges pRactice

tavr volumes*

76

11sapien coReVaLVe

Duke Heart Center has helped pioneer the use of transcath-eter aortic valve implants, which offer a lifesaving option for patients who are not able to undergo open surgery. Our experience and outcomes with both the CoreValve and Sapien Valve systems, mean we are able to offer this mini-mally invasive option to a much wider spectrum of patients. Learn more on page 19.

*Data as-of 11/6/12

sticH—The largest-ever trial of surgical therapy in isch-emic heart failure, STICH compared coronary artery by-pass grafting (CABG) surgery plus medical management to drug therapy alone. Researchers found no difference in overall survival but lower rates of cardiovascular events for patients with CABG. N Engl J Med. 2011; 364(17):1607-1616.

aRistotLe—This study of 18,201 patients with atrial fibrillation found apixaban superior to warfarin in pre-venting stroke. A 2012 Duke study published in Lancet showed apixiban’s superiority held true regardless of the risk score used and regardless of the patient risk category.N Engl J Med 2011; 365:981-992

Rocket-af—This DCRI-led international study of more than 14,000 patients found rivaroxaban equally effective as warfarin in preventing stroke in AFib patients—while providing more consistent and predictable anticoagula-tion effects. Rivaroxaban was approved by the FDA for use in atrial fibrillation patients based on the ROCKET- AF results. N Engl J Med 2011; 365:883-891

ascenD-Hf—Duke researchers led the largest-ever trial to evaluate the effectiveness of nesiritide as a treatment for dyspnea in patients with decompensated heart failure, determining that the drug was no better than placebo yet increased rates of hypotension. N Engl J Med. 2011 Aug 25; 365(8):773.

appropriate use of icDs—A Duke-led retrospective study using data from the National Cardiovascular Data Registry (NCDR)’s ICD Registry found that 22.5 percent of patients receiving implantable cardioverter-defibril-lators (ICDs) did not meet evidence-based criteria for implantation. JAMA. 2011; 305(1):43-49.

appropriate use of pci—A Duke review of data from the NCDR CathPCI Registry found that while almost 99 percent of percutaneous coronary interventions (PCI) performed in acute settings followed standard criteria for appropriate use, only half of PCIs performed in non-acute settings were appropriate—suggesting “an important opportunity to examine and improve the selection of patients undergoing PCI in the non-acute setting.”JAMA. 2011; 306(1):53-61.

caBana—Duke is the #1 U.S. enroller—#2 worldwide —in the largest-ever and most significant clinical trial of its kind comparing catheter ablation to anti-arrhythmic drug therapy in atrial fibrillation patients. Coordinated by Duke Clinical Research Institute, the 140-site trial will de-termine which therapy is best in terms of reducing mortality, reducing treatment costs, and preserving quality of life.

pRoMise—This 150-site study is the first to compare how two kinds of diagnostic tests—anatomic testing with CT angiography versus functional testing with stress im-aging or exercise ECG—correlate to outcomes in patients presenting with chest pain. Results are expected to have a major impact on health-care policy and practices.

BRiDge—This NHLBI-funded trial led by DCRI is designed to establish an evidence-based standard of care for patients who must temporarily stop using warfarin because of elective procedures or surgery.

iscHeMia—DCRI serves as the statistical and data coordinating center as well as the economics and quality- of-life coordinating center for this international study to determine whether invasive procedures combined with medical therapy improve outcomes compared to medical therapy alone in the initial treatment of ischemic heart disease. tecos and eXsceL—Multinational trials coordinated by DCRI and the University of Oxford (UK) Diabetes Trial Unit to evaluate the cardiovascular outcomes of adding sitagliptin (TECOS) or exenatide (EXSCEL) to the usual care of patients with type 2 diabetes. TECOS completed enrollment of over 14,000 patients in June 2012, with results expected in 2015; EXSCEL is enrolling 9,500 patients with results expected in 2017.

changing practice through clinical Research internationally renowned for cardiovascular clinical research, Duke Heart center and Duke clinical Research institute conducts pivotal studies that define best clinical practices. a few examples:

72012 RepoRt

they call him “Miracle Man”Andy Smith lives deep in the North Carolina mountains, nearly two hours by winding roads from the nearest cath lab. It was not a good place to be when he suffered a heart attack with left-bundle branch blockage. Smith was ambulanced and airlifted to a hospital at a breathtaking rate, all thanks to the Duke-designed Regional Approach to Cardiovascular Emergencies (RACE) system that re-

vamped protocols for hospitals and EMS teams to speed up heart-attack treatment statewide. Along the way, his heart stopped seven times and went into fibrillation at least 39 more, but the specially trained team kept him alive until he could receive lifesaving percutaneous cor-onary intervention (PCI)—only 72 minutes after he was picked up from his home.

Half the battle in advancing heart care

is working evidence-based procedures

into practice. Duke Heart Center has

designed revolutionary models of care

that do exactly that.

ReDesigning caRe

The RACE-ER project is a collaborative network of PCI centers, EMS providers and other care teams throughout NC working to improve STEMI care. EMS teams are able to interpret ECG readings faster and prepare care teams at destination PCI hospitals, greatly decreasing the time between heart attack and the provision of life-saving care for the patient.

ems use of pre-hospital 12-lead eCg

67%

88%

pRe Race-eR post Race-eR

new evidence-Based Models of careDuke Heart center has pioneered nationally recognized approaches

to delivering heart care more efficiently and effectively, including:

Race: Regional approach to cardiovascular emergenciesIntroduced in 2003 by Duke Heart Center and named a 2007 American Heart Association (AHA) top 10 research advance, RACE has improved myocardial infarction (MI) care in North Carolina by creating a statewide system of rapid coronary artery reperfusion delivery to patients with ST-elevation MI (STEMI). Now involving 119 hospitals and 540 regional EMS agencies in all 100 North Carolina counties, phase two—called Reperfusion of Acute MI in Carolina Emergency Departments - Emergency Response (RACE-ER)—has improved treatment times between first medical contact (by EMS) to balloon or device time throughout the state. North Carolina care teams meet the 90-minute STEMI threshold 75 percent of the time, compared to 68 percent of PCI centers nationally.

An expansion of the RACE program, called Regional Approach to Cardiovascular Emergencies Cardiac Arrest Resuscitation System (RACE CARS), was made possi-ble thanks to funding from the Medtronic Foundation’s HeartRescue Program. RACE CARS aims to improve survival of out-of-hospital sudden cardiac arrests by 50 percent over five years. Currently, 92 percent of North Carolinians who suffer sudden cardiac arrest (SCA) each year die. Strategies to improve survival include: teaching quality bystander CPR and the use of automatic defibril-lators; ensuring rapid defibrillation and transport of patients to the most-appropriate hospital; and increasing the use of evidence-based interventions, such as primary PCI for STEMI and therapeutic hypothermia for coma-tose patients.

Duke is in the process of evaluating expansion of the RACE network and protocols to include aortic dissection and cardiogenic shock.

Resources for advanced Heart failureDuke offers an innovative Heart Failure Disease Man-agement Program that has shown to reduce inpatient

admissions, length of stay, and costs. In Fall 2012, Duke opened a multidisciplinary walk-in HF clinic that can offer infusion and ultrafiltration services for advanced HF patients. This novel offering is available nowhere else locally and is available only a few other places nationally. The level of service and convenience is akin to an urgent care model, but exclusively for HF treatment. (see page 15) The clinic is part of the new Center for Advanced Heart and Lung Disease.

Hypertension Management initiativesEstablished in early 2012, our Resistant Hypertension Program involves a team of cardiologists, nephrologists, a physician assistant and research coordinators to assist in the management of patients with resistant hyperten-sion. Treatment strategies are based upon a patient’s prior treatment history, underlying cause of hypertension, barriers to treatment and target organ damage. The team provides assistance with blood pressure management and opportunities to participate in clinical research trials including the Symplicity HTN-3 study (see page 13).

Duke is participating in an AHA-funded initiative called Secondary Prevention Risk Interventions via Telemedicine and Tailored Patient Education (SPRITE), a home-based telemedicine study that is a randomized trial of tailored and telemedicine-based interventions for risk-factor modification in patients after MI. Participants receive home BP-monitoring equipment that automati-cally uploads their BP to the AHA portal. Patients receive either Web-based education or nurse-delivered education by phone to assist in BP reduction and control.

team approach to clinical care and accessDuke Heart Center employs team-based care on both inpatient and outpatient fronts to enhance the effective-ness and timeliness of treatment. Highlights include:

Redesigned clinic space to improve patient access and to maximize efficient care of complex disease by creating

teams of cardiologists, pulmonologists, and specially trained advanced practice providers and other team members across related sub-specialties who provide collaborative clinic coverage.

Multidisciplinary evaluations by cardiologists and car-diothoracic surgeons to determine objectively the best treatment for each patient, backed by joint research to compare the effectiveness of medical, cardiology inter-ventional, surgical, and hybrid treatments on a popula-tion level. This represents the “Heart Team” approach that is newly called for in the Coronary Revasculariza-tion National Guidelines and Appropriate Use Criteria sponsored by the American Heart Association and the American College of Cardiology.

innovative Lung transplant protocolsIn 2011, Duke’s median wait time for lung transplant was only 12 days, thanks to aggressive organ-recovery strategies. We have seen excellent outcomes in transplant-ing patients who have not historically been candidates for lung transplantation, including those older than 70; pa-tients with cystic fibrosis whose lungs are colonized with resistant pathogens; patients with concomitant coronary artery and/or valvular heart disease; and patients with respiratory failure requiring mechanical ventilation and extracorporeal membrane oxygenation (ECMO).

The Duke Lung Transplant Program, the nation’s largest program of its kind, was established in 1992. Since then, the Duke team has performed more than 1,100 lung transplants—145 in 2011 alone. Our program is proud to achieve both one- and three-year posttransplant survival that is significantly greater than national averages. Duke is one of only three US lung transplant sites with better than expected one-year patient survival.

92012 RepoRt

Locations

improving cardiovascular care Quality across the southeast (and Beyond) With a robust network of locations and affiliated hospitals,

Duke Heart center is improving cardiovascular care quality and

outcomes for patients across the southeastern United states.

Duke University Health System Hospitals

Medical Center Staffed by Duke Heart Center Physicians

Duke Lifepoint (DLP) Hospitals

Duke Heart Center-Affiliated Hospitals

Adult Cardiology and Cardiothoracic Surgery Community-Based Practices

Pediatric Cardiology Community-Based Practices

Life Flight Satellite Locations

Duke Mobile Cardiac Catheterization Sites

DLP Cardiac Partners Mobile Cardiac Catheterization Sites

global Reach outside of our home region, Duke Heart center works to improve heart care globally through strong clinical and research collaborations with partners in countries including:

singapoRe Duke-National University of Sin-gapore Graduate Medical School, National University Health System, SingHealth

cHina Center of Excellence in Cardiovascular Disease, Beijing

inDia Medanta Duke Research Institute

kenya ASANTA Cardopulmonary Center of Excellence

BRaziL Brazilian Clinical Research Institute

MULtinationaL Virtual Coordinating Center for Global Collaborative Cardiovascular Research (DCRI)


Quality care close to HomeThe Duke Heart Network works with heart programs throughout the Southeast to advance the quality and level of cardiovascular care available to residents in their home communities. In addition to operating more than 20 mo-bile cath lab sites and outpatient clinics staffed by Duke physicians, the Network provides intensive clinical and programmatic guidance to seven hospital-based cardiac affiliates:

Alamance Regional Medical Center, Burlington, NC

Beaufort Memorial Hospital, Beaufort, SC

Danville Regional Medical Center, Danville, VA

Indian River Medical Center, Vero Beach, FL

High Point Regional Health System, High Point, NC

Lexington Medical Center, West Columbia, SC

Southeastern Regional Medical Center, Lumberton, NC

Quality improvement a HallmarkEach of Duke’s cardiac affiliates undergoes rigorous quality oversight and process improvement initiatives, with the goal of exceeding the benchmark measures of national cardiac registries such as the National Car-diovascular Data Registry and the Society of Thoracic Surgeons National Database. Some recent highlights:

2011 ACC-NCDR-Get with the Guidelines Program Performance Achievement Recognition: Acute Myocardial Infarction

Gold: Danville Regional Medical Center, Danville, VA

2012 AHA-Get with the Guidelines Program Performance Achievement Recognition: Heart Failure

Gold: Beaufort Memorial Hospital, Beaufort SC

Silver: Danville Regional Medical Center, Danville, VA

2012 AHA Mission: Lifeline Program Performance Achievement Recognition-Receiving Hospital

Gold: High Point Regional Health System, High Point, NC

2011-2012 HealthGrades Cardiac Care Excellence Award Ranked among the top 10 percent in the nation for overall cardiac services

Southeastern Regional Medical Center, Lumberton, NC

affiLiate case stUDies

southeastern Heart center, Lumberton, sc Since Southeastern Regional Medical Center—located in rural Robeson County, NC—became a Duke Medicine affil-iate, mortality rates from heart disease in the region have decreased far faster than in the rest of the state. Between 2005-2011, mortality rates dropped 12 percent for all North Carolina residents, but 20 percent for residents of Robeson County. Source: North Carolina State Center for Health Statistics

Danville Regional Medical center, Danville, Va Mortality rates for heart attack and heart failure have dra-matically declined at Danville Regional Medical Center since the Virginia hospital became a Duke heart affiliate in 2008. Source: Centers for Medicare and Medicaid Services Outcome Measures

CardiovasCular proCedures at duKe heart Center affiliated sites

4,150

4,790

5,550

6,629

8,458

2007

2008

2009

2010

2011

240

230

220

210

200

190

180

Duke heart affiliation initiated April 2006

Dea

th R

ate

(per

100

,000

)

heart disease—mortalitY rates for nC residents

Cms annual 30-daY mortalitY: ami

Cms annual 30-daY mortalitY: hf

20062005 2007

FY05-FY08

FY05-FY08

2008

FY06-FY09

FY06-FY09

2009

FY07-FY10

FY07-FY10

2010

FY08-FY11

FY08-FY11

Robeson

DRMC

North Carolina

National Average

23.3%

16.7%

19.8%

14.6%

18.1%

13.6%

17.4%

12.7%

16.6%

11.1%

16.2%

11.2%

15.9%

11.3%

15.5%

11.6%

Duke Heart networkthrough collaboration with its affiliate sites,

Duke helps community hospitals achieve clinical excellence.

Harry R. phillips iii, MD Chief Medical Officer, Duke Heart Network

112012 RepoRt

pRogRaMs of Distinction Advanced Coronary & Vascular Disease

peter k. smith, MD Chief, Cardiovascular and Thoracic Surgery

g. chad Hughes, MD Director, Thoracic Aortic Surgery

e. Magnus ohman, MD Medical Director, Advanced Coronary Disease

Manesh R. patel, MD Medical Director, Percutaneous Interventions (PCI)

case stUDy

James Whitaker has battled heart disease for more than two

decades. In 1990, at 42, he underwent his first bypass sur-

gery at Duke. In September 2011, his feelings of fatigue and

breathlessness returned.

When Whitaker met with Duke cardiologist E. Magnus Ohman,

MD, he was experiencing chest pain. A cardiac catheterization

revealed extensive coronary damage and the need for a more

aggressive intervention. Ohman, working with Duke heart

surgeon Carmelo Milano, MD, evaluated Whitaker for a hybrid

revascularization, an approach that involves a minimally inva-

sive coronary artery bypass followed by percutaneous stenting

of the remaining diseased arteries.

Whitaker’s procedures went well, and he exceeded even the

nurses’ expectations for recovery in the hospital. “My quality

of life went from 20 to 100 percent,” he said. “I have a lot of

life left to live.”

Duke cardiologists and cardiothoracic surgeons collaborate

to perform about 20 hybrid revascularizations each year, an

approach available only at major academic medical centers.


Data are for Duke University Medical Center. Duke’s annual CABG volumes, which consistently exceed those reco- mmended by the AHA and ACC as indicators of care quality. And Duke Heart Center’s cardiac surgeons have produced consistently exceptional patient outcomes—with survival rates significantly higher than what is expected in a patient population as complex as ours.

primarY isolated CaBg volumes and mortalitY

VolumesMortality Rate

3452.61%2011

thoraCiC aortiC surgerY volumes Duke University Hospital, FY11

96ascenDing aoRta/Root

107aRcH (open anD HyBRiD)

47DescenDing (open anD enDoVascULaR)

43taaa (open anD HyBRiD)

Hybrid operating RoomDuke’s hybrid OR—the first in North Carolina—enables cardiol-ogists and cardiothoracic surgeons to perform percutaneous and open procedures simultaneously. This collaboration reduces the risk of complications and length of stay associated with multiple procedures, allowing patients to experience a quicker recovery. Our hybrid OR is equipped with the most advanced imaging technology, providing Duke physicians with precise information and improving overall patient outcomes.

Hybrid coronary RevascularizationIn 2012, Duke completed enrollment in an NHLBI-funded obser-vational study of hybrid revascularization (see case study on facing page). Results from the study are informing the development of a pivotal comparative effectiveness study of this transformational approach to treating patients with complex coronary artery disease, which combines minimally invasive off-pump arterial grafting of the left anterior descending artery and simultaneous stenting of other coronary lesions.

sticHA 2012 report released by NHLBI named the STICH trial, devel-oped and led by Duke faculty, as one of the most important scientif-ic advances of 2011. The results of this multinational trial showed no difference in overall survival rates for patients with coronary disease and heart failure who received CABG compared to optimal medical therapy, but they did reveal lower rates of cardiovascular events for CABG patients. The trial follow-up was extended to 10 years through new NIH funding. Both the American College of Car-diology and the European Society of Cardiology have modified their guidelines to include the STICH results. NEJM 2011; 364 (17):1607-1616

symplicity Htn-3 Duke is one of the top enrolling centers in the Southeast for the Symplicity HTN-3 trial, exploring novel ways to treat patients with resistant hypertension. The trial is evaluating the effectiveness of renal denervation for patients whose systolic blood pressure is greater than 160 in spite of taking three or more blood pressure medications. Traditionally, these difficult-to-treat patients have endured multiple drug therapy combinations without success, but early results from this one-time procedure show a median decrease in systolic blood pressure of 24 mmHg at six months.

thoracic aortic surgery As a leading research center for thoracic aortic surgery, Duke partic-ipates in virtually all major thoracic endovascular stent graft-related clinical trials as well as research to determine appropriate patient selection for endovascular repair of aortic disease. Our faculty are leading the way in defining the surgical management of Loeys-Dietz syndrome, a rare connective tissue disorder that increases the risk of aortic aneurysm. Duke is one of the few centers in the country that offers “hybrid” repairs for thoracoabdominal and aortic arch aneurysms. This technique is a combination of open debranching and endovascular aneurysm exclusion, which eliminates the need for cardiopulmonary bypass and aortic cross clamp.

advanced coronary artery DiseaseOne of only a handful of its kind, this program serves patients with debilitating chest discomfort for which few novel therapies exist and focuses largely on older people for whom treatments may be limited. We employ sophisticated angina therapies, such as enhanced external counterpulsation, a noninvasive treatment that increases the flow of oxygenized blood to the heart, and spinal-cord stimula-tion, a pain-blocking therapy used in some chronic and severe cases. Some 85 percent of patients improve to the extent that they are able to return to performing most daily activities.

410

405

478

393

1.71%

3.13%

1.46%

2.03%

2007

2008

2009

2010

132012 RepoRt

pRogRaMs of Distinction Advanced Heart Failure

case stUDy

When Lynn Gullick, a 59-year-old attorney and mother,

couldn’t shake a persistent cough, she went to her doctor,

expecting a prescription. Instead, she was diagnosed with

congestive heart failure.

Referred by Cleveland Clinic to Christopher O’Connor, MD,

a Duke heart failure specialist, Gullick began medical therapy.

When imaging showed her condition was worsening, she

was evaluated for a heart transplant by Joseph Rogers, MD.

Not ready for surgery, Gullick wanted other options. A team

of Duke interventional cardiologists, electrophysiologists,

and heart failure specialists worked successfully to manage

her heart failure for more than three years. After three hos-

pitalizations in as many weeks, Gullick agreed to be listed for

transplant. Seven days later, Carmelo Milano, MD, a Duke

heart surgeon, gave Gullick a new heart.

Duke’s multidisciplinary approach meant Gullick was given in-

dividualized treatment options for her failing heart. And Duke’s

experience in cardiac transplant—performing nearly 900 since

1985—means the new heart isn’t likely to fail her.

carmelo a. Milano, MD Surgical Director, Cardiac Transplant

Joseph g. Rogers, MD Medical Director, Cardiac Transplant

christopher o’connor, MD Director, Duke Heart Center

adrian f. Hernandez, MD, MHs Director, Outcomes Research


top program in the countryThe Duke Heart Failure Program treats more than 3,600 patients each year, using a proven disease-management approach that has evolved over the past decade to reflect advancements in care.* * Arch Intern Med. 2001 Oct 8;161(18):2223-8.

#1 program in the country by research, education, and clinical metrics

First comprehensive Heart Failure Disease Management Program

#3 in LVAD and #4 in heart transplant volumes nationally

$40 million in NIH funding in 2011-2012

More than 100 peer-reviewed publications with 15 percent in high-impact journals

2 FDA-approved biomarkers

novel Heart failure same-Day access clinicIn 2012, Duke launched a same-day access clinic for heart failure patients, providing acute management of shortness of breath and edema in early-stage heart failure. The clinic offers intravenous diuretics and ultrafiltration with the goal of reducing unnecessary hospital admissions. This novel urgent care heart failure clinic represents a patient-centered approach to managing this chronic condition by providing support during the critical transition out of the hospital and in times of acute distress.

Mechanical circulatory support: VaDsDuke’s mechanical circulatory support program was among the first US programs approved by the Centers for Medicare and Medicaid Services and is certified by The Joint Commissionfor destination ventricular assist devices (VAD). In addition to having access to all the standard FDA-approved devices for destination therapy, Duke is involved in clinical trials, including REVIVE-IT and ROADMAP. Duke was also the leading enrolling center in the HeartWare DT trial and one of only eight hospitals nationwide offering FDA-mandated HeartMate II surgical training in partnership with VAD manufacturer Thoratec Corp., training surgeons from across the country.

ReneW trial: cell therapyDuke Heart Center cardiologist Thomas Povsic, MD, is the national co-PI for the RENEW trial, the first phase III pivotal study of a cell therapy for cardiovascular indication seeking FDA ap-proval in the United States. The study aims to determine the effectiveness of targeted in-tramyocardial delivery of Auto-CD34+ cells for increasing exercise time and reducing symp-toms in patients with refractory angina and chronic myocardial ischemia. Enrollment began in April 2012.

Data for July 1, 2008, to June 30, 2011. These percentages were calculated from Medicare data on patients dis-charged from Duke University Hospital and do not include people in Medicare Advantage plans or those without Medicare. Source: Hospital Quality Alliance.

heart failure readmission rate

23.9%24.7%

DUke Us

heart transplant and vad volumes Duke University Hospital

602011 83

Heart TransplantVAD

one-Year heart transplant patient survival rate

DUke Us

For adults receiving their first transplant between 1/1/09 and 6/30/11. Visit ustransplant.org for most current data.

92.5% 90.2%

51

41

48

61

2007

2008

2009

2010

42

57

64

74

vad survival rateDuke University Hospital

One Year Two Year

DUKE US

85%

77%78%

68%

Percent survival among primary me-chanical circulatory support implants between 06/23/06 and 6/30/11

Duke’s VaD survival rates exceed the national average. in fact, our longest surviving patient lived more than seven and a half years with pump support.

152012 RepoRt

pRogRaMs of Distinction Electrophysiology

James p. Daubert, MD Chief, Cardiac Electrophysiology

tristram D. Bahnson, MD Director, Duke Center for Atrial Fibrillation

sana M. al-khatib, MD, MHs Clinical Research Director, Cardiac Electrophysiology

case stUDy

John Ponton, 66, underwent a successful lung transplant at

Duke in January, 2012. Within weeks, the former environmen-

tal scientist was feeling short of breath—frightening for any-

one, but particularly for a man with new donor lungs. Ponton

was hospitalized with atrial fibrillation caused by fluid buildup

around his heart and lungs.

Duke Cardiologist Richard Becker, MD, managed to control

the AF with medication and Ponton was discharged. But by

early spring, the AF was no longer controllable. Ponton had

developed atrial tachycardia, suspected to be located where

the donor pulmonary veins were sewn into his heart. Working

carefully with cardiac imaging experts and the transplant team,

James Daubert, MD, chief of cardiac EP, successfully ablated

the area and corrected the rhythm disorder.

Since then, Ponton is doing well and recently celebrated his

37th wedding anniversary with wife, Terry. He attributes his

successful outcome to Duke’s expertise and cross-discipline

coordination. The experience offered by Duke’s EP team is

what makes theirs one of the most successful in the southeast.

augustus o. grant, phD, MB chB Cardiologist, Duke Heart Center


proCedure volumes Duke University Health System, CY11

2,800totaL ep pRoceDURes

709aBLations

1,452icDs

37LeaD eXtRactions

209BiVentRicULaR DeVices

393paceMakeRs

HighlightsDuke Heart Center’s Electrophysiology Program is an international arrhythmia referral center treating nearly 1,700 patients per year. We offer the most comprehensive, expert, and highest-ranked EP program in the Southeast.

14 specially trained cardiac EPs Four state-of-the-art EP labs Team-approach model that includes EPs, cardiothoracic sur-

geons, dedicated NPs, PAs, RNs, technicians, patient educators, and pharmacists

Expertise in complex atrial fibrillation (AF) catheter ablation procedures, as well as assessment and care of patients with prior failed catheter or surgical ablation

Duke has the Southeast’s busiest implantable-device lead-extraction programs and offers laser extractions in a fully hybrid OR with an EP-cardiac surgical multidisciplinary team and ongoing clinical trials in extraction.

We perform ventricular tachycardia ablations for cases ranging from normal hearts to those postinfarction or those with cardiomy-opathy and end-stage heart failure on LVAD or ECMO. Our team has extensive experience in percutaneous epicardial ablation.

adult cardiovascular genetics programDuke is one of the only centers in the Southeast to offer screening for inherited cardiac rhythm disorders, such as the long QT and Brugada syndromes, and to offer expertise in care management.

cardiac Resynchronization centerDuke EP offers new hope for heart failure patients with its cut-ting-edge research and technology. Our team has extensive invasive clinical experience; a national physician-education program; and a multidisciplinary Optimization Clinic for non-responders that includes EP, heart failure (HF), and echocardiography specialists working together to fine-tune patients’ implanted devices.

Duke center for atrial fibrillationDuke offers comprehensive medical-surgical, invasive, and noninva-sive AF-related care.

Duke center for prevention of sudden cardiac events in athletesLaunched in 2011, our center adds EKG testing to the standard physical exam given to all members of Duke University athletic teams. In addition to detecting asymptomatic heart pathologies and preventing premature deaths, we plan to assess the value of using EKG on athletes and will mine the newly created data registry for other trends.

Research

RaiD—Investigator-initiated, NIH-sponsored trial aims to de-termine whether ranolazine administration in ICD patients will decrease the likelihood of a composite arrhythmia endpoint, con-sisting of ventricular tachycardia or ventricular fibrillation requiring anti-tachycardia pacing, ICD shocks, or resulting in death. The team includes members of the Duke University Cooperative Cardiovascu-lar Society consortium, who are in practice throughout the U.S.

caLypso piLot tRiaL—Duke investigator-initiated, multicenter pi-lot study comparing catheter ablation against antiarrhythmic drugs for cardiomyopathy patients with ventricular tachycardia.

caBana—Duke Clinical Research Institute-coordinated mega- trial of catheter ablation versus antiarrhythmic drug therapy in AF patients. Duke is the highest US enrollment site—and second highest in the world—out of 140 sites.

pace-RBBB—Duke investigator-initiated trial evaluating three pacing treatment arms for patients with systolic heart failure and right-bundle branch block.

fiRMat-paf—Intense investigation of the use of a novel system capable of mapping of rotors to ablate atrial fibrillation.

172012 RepoRt

pRogRaMs of Distinction Structural Heart

case stUDy

Heart problems were the last thing that Simon Griffith, a

52-year-old avid cyclist, expected. After biking some 200

miles for charity, he grew concerned when a short ride left

him winded and fatigued. His cardiologist discovered a heart

murmur, and an echocardiogram revealed significant mitral

regurgitation.

Griffith was referred to Duke heart surgeon Donald Glower,

MD, a renowned leader in minithoracotomy valve repair. Mitral

valve repair instead of replacement meant Griffith could avoid

blood thinners or repeat surgeries and the minimally invasive

approach meant he could avoid the lengthy recovery associat-

ed with an open procedure. Glower made a small incision on

the right side of Griffith’s chest and, through a series of other

small access points, used a robot to guide the necessary instru-

mentation to the heart to make the repair.

After five days in the hospital, Griffith returned home. After

six weeks of recovery, he returned to biking. Duke’s exper-

tise in mitral valve repair and replacement leads to not only a

high-quality outcome, but ultimately a higher quality of life.

Donald D. glower, MD Surgeon, Duke Heart Center

thomas M. Bashore, MD Clinical Chief, Cardiology

g. chad Hughes, MD Director, Thoracic Aortic Surgery

J. kevin Harrison, MD Director, Cardiac Catheterization


transcatheter aortic Valve Replacement (taVR)Duke is one of the top recruiting sites in the CoreValve pivotal clinical trial of transcatheter aortic valve implantation (TAVI). Our patient outcomes with CoreValve are among the best, earning Duke one of the first US invitations to participate in SUR-TAVI, an international trial assessing the appropriateness of TAVI for patients with less severe aortic stenosis at intermediate risk for open-heart surgery.

Duke is also one of the first US centers to implant a valve within a valve successfully, reinforcing a failed prosthetic valve with the Sapien implant. Our knowl-edge and experience working with both implant systems available on the market and through clinical trials means we are able to offer more treatment options to a wider spectrum of patients.

With novel applications and expanded indications for TAVR, patient selection is critical to a successful outcome. Duke faculty coauthored the 2012 ACCF/AATS/SCAI/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement and Duke

Clinical Research Institute will house the STS/ACC TVT Registry, a national benchmarking tool to monitor patient safety and out-comes for TAVR. JACC 2012;59(13):1200-1254

percutaneous Mitral Valve RepairAs one of only 40 North American centers with access to MitraClip, Duke has been a trial site for REALISM and EVEREST and will be participating in COAPT, a new clinical trial evaluating the safety and effectiveness of this device for patients with moderate-to-severe mitral regurgitation.

Minithoracotomy Valves Duke Heart Center is a global leader in minithoracotomy valve repair and replacements. With more than 1,400 minithoracotomy mitral procedures without femoral arterial cannulation, approx-imately 300 repeat mitral surgeries, and more than 250 tricuspid surgeries, our faculty has the world’s highest volumes using this sophisticated, small-incision technique. We have performed more than 1,500 minithoracotomy mitral procedures, making us one of the top three volume leaders in the world and are among the nation’s top five volume leaders in minithoracotomy aortic valve replacements, with more than 600 procedures.

Hypertrophic cardiomyopathy Duke offers a range of treatment options for patients diagnosed with hypertrophic obstructive cardiomyopathy, including medical management, catheter-based alcohol septal ablation and surgery. In 2011, we performed 23 septal myectomies. Our faculty are actively researching advancements in therapies for patients with this genetic condition; we are initiating a new study of medical therapy for those with severe symptoms. We offer patients and their families genetic counseling and education in collaboration with the Adult Cardiovascular Genetics Clinic.

adult congenital Heart DiseaseServing more than 1,200 patients annually, the Adult Congeni-tal Heart Disease Program at Duke is a top referral center in the Southeast and one of the world’s few major training programs in adult congenital heart disease. Specially trained physicians include two cardiothoracic surgeons who perform adult congenital proce-dures with volumes that rank in the top 10 nationally. The program offers specialized interventional catheterization for defects that have historically required open surgery, such as atrial septal defects; ven-tricular septal defects (VSD), including implantation of a muscular VSD device; and patent foramen ovale.

isolated mitral valve repair and replaCement volumes

ReplacementRepair

40 742011

All volumes are from Duke University Medical Center, CY11

primarY and isolated mitral valve repair and replaCement

Min. InvasiveConventional

94%6%2011

isolated and primarY valve surgerY volumes

Isolated Primary

342 2762011

The world leader in minimally invasive procedures

and pioneering research for two decades

60

91

70

91

47

44

54

54

2007

2008

2009

2010

261

289

306

332

213

239

250

280

2007

2008

2009

2010

86%

86%

81%

93%

14%

14%

19%

7%

2007

2008

2009

2010

Sapien Valve

CoreValve

192012 RepoRt

HigH-iMpact papeRs

O’Connor CM, Starling RC, Hernandez AF, et al. Effect of nesiritide in patients with acute decompensated heart failure. N Engl J Med. 2011 Jul 7;365(1):32-43.

Tricoci P, Huang Z, Held C, et al. Throm-bin-receptor antagonist vorapaxar in acute coronary syndromes. N Engl J Med. 2012 Jan 5;366(1):20-33.

Alexander JH, Lopes RD, James S, et al. Apixaban with antiplatelet therapy after acute coronary syndrome. N Engl J Med. 2011 Aug 25;365(8):699-708.

Weintraub WS, Grau-Sepulveda MV, Weiss JM, et al. Comparative effectiveness of revascularization strategies. N Engl J Med. 2012 Apr 19;366(16):1467-76.

Makkar RR, Fontana GP, Jilaihawi H, et al. Transcatheter aortic-valve replacement for inoperable severe aortic stenosis. N Engl J Med. 2012 May 3;366(18):1696-704.

Allen LA, Stevenson LW, Grady KL, et al. Decision making in advanced heart failure: a scientific statement from the American Heart Association. Circulation. 2012 Apr 17;125(15):1928-1952.

Hara MR, Kovacs JJ, Whalen EJ, et al. A stress response pathway regulates DNA damage through beta2-adrenoreceptors and beta-arrestin-1. Nature. 2011 Aug 21;477(7364):349-53.

Chan PS, Patel MR, Klein LW, et al. Appropriateness of percutaneous cor-onary intervention. JAMA. 2011 Jul 6;306(1):53-61.

Hillis LD, Smith PK, Anderson JL, et al. 2011 ACCF/AHA guideline for coronary artery bypass graft surgery: executive summary: a report of the American Col-lege of Cardiology Foundation/American Heart Association Task Force on prac-tice guidelines. Circulation. 2011 Dec 6;124(23):2610-42.

Shahian DM, O’Brien SM, Sheng S, et al. Predictors of long-term survival after coro-nary artery bypass grafting surgery: results from the Society of Thoracic Surgeons Adult Cardiac Surgery Database (The ASCERT Study). Circulation. 2012 Mar 27;125(12):1491-1500.

Whitlow PL, Feldman T, Pedersen WR, et al. Acute and 12-month results with cath-eter-based mitral valve leaflet repair: the EVEREST II (Endovascular Valve Edge-to-Edge Repair) high risk study. J Am Coll Cardiol. 2012 Jan 10;59(2):130-9.

Wang TY, Angiolillo DJ, Cushman M, et al. Platelet biology and response to anti-platelet therapy in women: implications for the development and use of antiplatelet pharmacotherapies for cardiovascular disease. J Am Coll Cardiol. 2012 Mar 6;59(10):891-900.

Hernandez AF and Granger CB. Prediction is very hard, especially about the future: comment on ‘factors associated with 30-day readmission rates after percutaneous coronary intervention’. Arch Intern Med. 2012 Jan 23;172(2):117-9.

Williams JB, Peterson ED, Brennan JM, et al. Association between endoscopic vs. open vein-graft harvesting and mortality, wound complications, and cardiovascular events in patients undergoing CABG sur-gery. JAMA. 2012 Aug 1;308(5):475-84.

Patel MR, Dehmer GJ, Hirshfeld JW, Smith PK, Spertus JA. ACCF/SCAI/STS/AATS/AHA/ASNC/HFSA/SCCT 2012 appropriate use criteria for coronary revascularization focused update: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery, American Heart Association, American Society of Nuclear Cardiology, and the Society of Cardiovas-cular Computed Tomography. J Am Coll Cardiol. 2012 Feb 28;59(9):857-81.

Lefkowitz, RJ. A tale of two callings. J Clin Invest. 2011 Oct.3;121(10):4201-3

Califf RM and Kornbluth S. Establishing a framework for improving the quality of clinical and translational research. J Clin Oncol. 2012 May 10;30(14):1725-6.

© D

uke University H

ealth System, 2012 9685

High-impact Basic, translational, and clinical Research papers Duke cardiovascular faculty generated more than 500 papers in peer-reviewed journals during the

2011-12 academic year. publication highlights of our collaborative and Duke-led investigations include:


Resources for clinicians Resources for patients support Duke Heart center

consultations and ReferralsSchedule appointments and access information by calling:

Duke consultation and Referral center 800-MED-DUKE (633-3853) 7:30 a.m. – 6:00 p.m. (EST)

Duke Heart center 888-HRT-DUKE (478-3853) or 919-681-5816 8:00 a.m. – 5:00 p.m. (EST)

Duke University Hospital (After Hours) Dial 919-684-8111 and ask for the on-call cardiologist.

acute care services

acute chest pain clinic Same-day appointments for patients with urgent (not emergent) chest pain. Area physicians can dial 888-HRT-DUKE (478-3853) for details.

acute Myocardial infarction (Mi) Hotline When ECG indicates ST-elevation MI, regional physicians and EMS personnel can contact a Duke cardiologist, activate the cath lab, and arrange transport to the nearest Duke Heart Center or affiliate site for PCI. Dial 919-627-0485 to learn more.

continuing Medical education and professional Development Educational opportunities for clinicians, educators, and researchers include:

office of continuing Medical education Offers live courses; Web- and CD-ROM-based seminars; and remote real-time training. Visit cme.mc.duke.edu and/or cardiology.duke.edu, call 919-401-1200, or e-mail [email protected].

Duke clinical Research institute’s clinical Medicine series Offers an array of courses and conferences. Visit dcri.org/education-training/dcms or e-mail [email protected].

clinical trials

Duke clinical Research institute Interested researchers may visit dcri.org/trial-participation.

clinical trials networks Best practices For clinical research resources, visit ctnbestpractices.org. Co-sponsored by DCRI and NIH.

Duke Heart center Visit dukehealth.org/clinicaltrials for partial lists of current trials.

Duke consultation and Referral center 888-ASK-DUKE (275-3853)

Heart center patient support program Unites recovered Duke Heart Center patients with current patients. Dial 919-681-5031.

special constituent patient program Patient Navigators serve patients with unique needs or who require special assistance. Learn more at 919-684-6919.

international patient center Dial 919-681-3007 for details.

To find out how you can support the Duke Heart Center’s mission to achieve the highest level of excel-lence in patient care, research, and education, please contact:

L. Blue Dean Executive Director, Development

512 S. Mangum Street, Suite 400 Durham, NC 27701

919-385-3159

[email protected]

DUke HeaRt centeR ResoURces

Visit dukemedicine.org/heartreport for a

list of Duke heart care-related Web sites.

Join us in changing practice and changing lives. stay in touch with the

latest advances and educational opportunities from Duke Heart center

through these resources, available year-round:

access the Duke Heart center Report online

Visit dukemedicine.org/heartreport for a PDF of this report. While care was taken to ensure the accuracy of data and information in this publication, any necessary updates or corrections will also be available via this Web page.

ChangingpraCtiCeChanginglives Duke Heart Report 2012

duke heart CenterDUMC 3525 Durham, NC 27710

888-HRT-DUKE800-MED-DUKEdukehealth.org/heart

non-profit org.U.s. postagePA IDDurham, ncpermit no. 60

Ranked seventh among the nation’s best heart programs by U.S.News & World Report for 2012-2013—and in the top ten since 1993.

All three Duke University Health System hospitals have earned Magnet status for nursing excellence from the American Nurses Credentialing Center.

2012 Rising Star award from University HealthSystem Consortium in recognition of significant improvements and exempla-ry performance in patient safety, mortality, and clinical effectiveness. Duke University Hospital is one of only four hospitals nationally to win the award.

Duke University Hospital recognized as a 2012 Top Performer by The Joint Com-mission on key quality measures including heart attacks, heart failure, and surgical care. Just 18 percent of eligible U.S. hospitals received the recognition.

Duke University Medical Center ranked #8 among America’s Best Hospitals by U.S.News & World Report, 2012-2013.

Duke Heart Center faculty member and Howard Hughes Medical Institute inves-tigator Robert J. Lefkowitz, MD, shared the 2012 Nobel Prize in Chemistry for his discovery of G protein-coupled cell receptors, which are the target of some 40 percent of pharmaceuticals.

For the fifth consecutive year, Duke Uni-versity Hospital received the Get With the Guidelines—Heart Failure Gold Plus Quali-ty Achievement Award from the American Heart Association. The awards recognizes exceptional performance on adherence to the guidelines and quality measures.

American Heart Association’s 2012 Mis-sion: Lifeline® Bronze Quality Achievement Award in recognition of Duke University’s Hospital’s commitment and success in implementing a high standard of care for heart attack patients.

All three Duke University Health System Hospitals received Platinum Performance Achievement Awards for their perfor-mance on the ACTION Registry-GWTG indicators for evidence-based treatment of AMI patients.

duke heart report 2012

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