"The first and most important component is great people — at the cutting edge but careful, thoughtful, considerate physicians, nurses, technicians and researchers," Dr. Kasper says. "The second component is technology — again at the cutting edge. The third component is research. Bright people should yearn to ask and answer questions — I see this almost as a subset of component one. Finally, there should be great leadership. Somebody (or a group of people) who has a good track record in betting on the right people and the right technology."
Physicians and hospital leaders identified the following six characteristics as most critical for a long-term, successful cardiovascular program:
- Excellent and compassionate patient care.
- Aggressive and sincere research.
- Departmental collaboration.
- Experienced staff and excellent leadership.
- Success rates.
- State-of-the-art equipment and facilities.
Here are 15 cardiovascular programs (in alphabetical order) that embody these characteristics.
1. Barnes-Jewish Hospital/Washington University (St. Louis, Mo.). The Washington University Heart Care Institute at Barnes-Jewish Hospital in St. Louis offers comprehensive heart care. The physicians at the Heart Care Institute are top-ranked, board certified, and specialize in several arenas of heart care. They've spearheaded innovative treatments in interventional cardiology, electrophysiology, cardiac surgery and heart transplant. According to Centers for Medicare & Medicaid Services, Barnes-Jewish Hospital is 1 of 17 out of 4,477 hospitals in the United States with heart attack outcomes better than the national average.
"The most important factor for patients is their outcome, and this is the ultimate gauge in the effectiveness of care," says Richard Bach, MD, director of the cardiac intensive care unit at Barnes-Jewish Hospital and Washington University School of Medicine. "Our numbers are remarkable and I can't begin to say how proud I am of this." www.barnesjewish.org
2. Beaumont Hospital, Royal Oak (Royal Oak, Mich.). The size of an average American hospital, the Beaumont Heart Center (located on the hospital's Royal Oak campus) is one of the most extensive cardiac care facilities in the world. By using smaller incisions for open-heart procedures, Beaumont surgeons have pioneered innovative, minimally invasive techniques, reducing patient risk and recovery time. Beaumont performs many cardiovascular procedures, including cardiac valve surgery and coronary artery bypass. The hospital's vascular surgeons, interventional radiologists and interventional cardiologists have also pioneered several endovascular treatments.
Much of the organization's success is attributable to the staff's continuing strive for excellence and quality, says David Haines, MD, corporate chief of Beaumont's Cardiovascular Medicine division. "Beaumont has long been recognized as one of the nation's premier heart centers," says Dr. Haines. "Over the years its researchers have established many cardiac 'firsts' including the use of angioplasty as a primary heart attack treatment, minimally-invasive implantation of aortic valves and the role of CT heart scans in diagnosing chest pain. Our physicians are dedicated to bringing the highest level, highest quality and 'cutting edge' care to all of our patients. Excellent programs use evidence-based decision making for patient care and have robust quality assurance programs. They direct national and international research protocols in order to move the field forward." www.beaumonthospitals.com
3. Brigham and Women's Hospital (Boston). Brigham and Women's Cardiovascular Center continually makes new cardiovascular discoveries. The center performed the first successful heart valve surgery in the world, researched cholesterol and clot-busting drugs and identified the C-reactive protein. The center offers a range of care in cardiac and vascular surgery, clinical cardiology, interventional cardiology, vascular medicine, electrophysiology, and cardiovascular imaging and the new Carl J. and Ruth Shapiro Cardiovascular Center is fully equipped with the latest cardiovascular technologies. On Dec. 21, 2007, the organization saved the life of a patient experiencing a heart attack in 14 minutes, a record for heart attack treatment.
"One of the ingredients for the excellence for which we strive is a balance between patient care and the quest for innovation and new knowledge through research," says Peter Libby, MD, chief of cardiovascular medicine at Brigham and Women's says. "We have a long tradition of leading clinical trials and in basic investigation discoveries. We have striven over the last decade to bring the same élan to our clinical programs. With the opening in 2008 of the new Shapiro Cardiovascular center, we have a physical embodiment of the ideal for patient care to which we aspire.
"Another asset from which we derive great pride, our fellowship program, continues to thrive and train leaders who populate important posts in cardiovascular medicine in the United States and abroad," Dr. Libby says. "Another feature of our program is close collaboration, not only among cardiovascular medicine specialists, but also with our cardiac and vascular surgeons and colleagues in Radiology. We recently merged non-invasive cardiovascular imaging with radiology, and instead of fighting 'turf' battles, are pouring our energies in program building and clinical cooperation." www.brighamandwomens.org
4. Cedars-Sinai Medical Center (Los Angeles). The Cedar-Sinai Heart Institute at the Cedar-Sinai Medical Center diagnoses, prevents, treats, manages and researches diseases, conditions and disorders of the heart and vascular system. Services range from noninvasive techniques, such as nuclear and echocardiography imaging, cardiac MRI and electron beam computed tomography, to invasive procedures, including angioplasty, stenting, arrhythmia ablation, pacemaker/defibrillator implantation, bypass surgery, valve repair/replacement and heart transplants. Cedars-Sinai Medical Center had the first transmyocardial laser revascularization center in the southwestern United States, was the first medical center to provide pediatric video-assisted thoracotomy surgery in Southern California, the second in the nation to implant the St. Jude valve and the first in California to offer low-density lipoprotein (LDL) aphaeresis treatment.
The Heart Institute is currently conducting several research studies, including investigations on the role of blood thinners in heart failure, early detection of heart disease through noninvasive techniques, the effects of supplemental magnesium on patients with heart disease, the effects of hormone replacement therapy for women with heart disease and a number of new treatments for congestive heart failure. www.cedars-sinai.edu
5. Cleveland Clinic (Cleveland). The Cleveland Clinic Heart and Vascular Institute has a long innovative history, performing the first cardiac catheterization and using new diagnostic imaging approaches to handle heart disease. The department of cardiovascular medicine has physicians in many specialties offering the latest medications and heart disease procedures. The organization has several cardiovascular departments including the following: cardiac electrophysiology and pacing, clinical cardiology, cardiovascular imaging, invasive cardiology, heart failure and transplantation, preventive cardiology and rehabilitation and vascular medicine. The Cleveland Clinic's Heart and Vascular Institute also maintains an aorta center, atrial fibrillation center, the Kaufman Center for Heart Failure and a women's cardiovascular center. For the past 14 years, Cleveland Clinic has been ranked No. 1 in the nation for heart care, according to the 2008 U.S. News & World Report "America's Best Hospitals" survey. Furthermore, the survey recognizes Cleveland Clinic as one of the nation's best hospitals overall, ranking it fourth in the country.
In 2007, patients traveled from every state and 77 different countries to Cleveland Clinic for their cardiovascular care and hospital mortality for all cardiac surgeries was only 3.1 percent despite the high patient acuity. Cleveland Clinic also continues to perform the largest number of valve operations in the United States. In 2007, Cleveland Clinic surgeons performed 2,194 total valve operations, including 1,584 primary operations and 610 reoperations. Cleveland Clinic supports transparent public reporting of healthcare quality data and participates in several initiatives toward that goal. A copy of the Cleveland Clinic's 2007 Heart and Vascular Institute outcomes is available online. www.clevelandclinic.org
6. Duke University Medical Center (Durham, N.C.). Duke University Medical Center treats numerous heart conditions such as aortic disease, congenital heart disease, heart failure, peripheral vascular disease and valvular heart disease, and provides a variety of cardiovascular services including those related to heart rhythm, children's heart care, consultative heart care and women's heart care. With more than 700 expert faculty and staff, Duke Heart Center operates the world's largest cardiovascular MRI program, the country's top congestive heart failure program and the only program in the United States for advanced coronary artery disease.
Duke University Medical center also has the largest heart transplant, adult valvular disease and congenital heart disease programs in the Southeast. Duke has been at the forefront of approaches to balloon angioplasty and heart imaging, and has shown extensive leadership in the introduction and improvement of cardiovascular stents. The Duke Clinical Research Institute is the world's largest academic clinical research entity and the Duke Databank for Cardiovascular Disease is the world's oldest and most comprehensive database of coronary disease outcomes. www.mc.duke.edu
7. Emory University Hospital (Atlanta). In the U.S. News & World Report Emory Heart & Vascular Center was rated the 13th best heart and heart surgery hospital in the nation. The center offers the following services: general cardiology, adult congenital cardiology and surgery, electrophysiology, heart failure therapy and transplantation, cardiac catheterization, interventional, cardiology, cardiothoracic surgery, cardiovascular disease risk reduction and cardiac, rehabilitation, cardiac imaging (PET, MRI, CT), echocardiography, and prevention heart health care. Emory's heart specialists established Georgia's first cardiac catheterization, performed Georgia's first and most significant open-heart procedures and made significant advancements in heart transplantation. Emory is also known for pioneering angioplasty, the less-invasive alternative to cardiac bypass surgery.
"Everyone who is part of Emory can take pride in the Emory Heart & Vascular Center," says Emory Heart & Vascular Center Director Douglas Morris, MD. "Our experience, history and teamwork enable us to provide the best care to our patients. In fact, physicians all over the country routinely refer patients here for the multitude of resources, innovative options and procedures we can offer even the most complex heart and vascular cases." www.emoryhealthcare.org
8. Hospital of the University of Pennsylvania (Philadelphia). At each of the University of Pennsylvania's hospitals, a variety of cardiovascular medicine programs and cardiothoracic surgeries are performed, and Penn Cardiac Care offers several unique and highly specialized services not found at any other facility in the region such as bloodless medicine/surgery, cardiac robotic surgery and valve repair, and non-invasive cardiac imaging. Every year since 2002, cardiovascular research at Penn has received $50 million or more in funding from the National Heart Lung and Blood Institute.
Penn's cardiothoracic surgeons perform more than 1,800 open heart procedures annually in the cardiac surgical facilities at the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center and Pennsylvania Hospital, and nearly 50 percent of the doctors listed in Philadelphia Magazine's 2005 "Top Docs" issue for heart-related specialties were from Penn Cardiac Care — more than any other hospital in the region. In 2007, Penn Medicine led the region in cardiovascular surgery discharges in southeastern Pennsylvania and southern New Jersey. Penn Medicine hospitals had a combined 5.5 times more cardiovascular surgery discharges than the regional average in 2007. www.pennhealth.com
9. Johns Hopkins Hospital (Baltimore). Johns Hopkins Hospital's cardiology program features expert physicians who diagnose and treat common and rare cardiac diseases including coronary artery disease, heart failure, cardiac arrhythmia, valvular heart disease and inherited heart disease. The Johns Hopkins Heart and Vascular Institute (HVI), within the organization's new Cardiovascular & Critical Care Tower, also integrates diagnostic and therapeutic services. Surgeons at the Institute perform many procedures including coronary artery bypass, valve replacement, congenital cardiac surgery, minimally invasive cardiac surgery, off-pump coronary bypass and surgical ablation for atrial fibrillation.
"The HVI epitomizes the best of Johns Hopkins Medicine: bringing together world class clinicians in a truly collaborative team approach to precisely diagnose the patient's problem and to formulate the most appropriate treatment plan, including medical, minimally invasive endovascular, or surgical treatments," says Bruce Perler, MD, chief of the division of vascular surgery at the Johns Hopkins Heart and Vascular Institute. www.hopkinsmedicine.org
10. Massachusetts General Hospital (Boston). The Massachusetts General Hospital (MGH) Heart Center provides multidisciplinary, comprehensive and innovative cardiovascular care. It has several programs and offers a variety of diagnostic services including cardiac arrhythmia service, cardiac resynchronization therapy program, cardiovascular disease prevention center, congenital heart disease program, coronary artery disease program, clinical cardiology, heart failure and cardiac transplant program. The organization also has a variety of diagnostic services ranging from cardiac catheterization to stress testing. Nationally recognized, its research is conducted in three primary medical specialties: cardiac anesthesia, cardiac surgery and cardiology.
Twenty-eight patients received heart transplants at MGH in 2008 — a new record for the program, representing a 70 percent increase over the number completed in 2007. MGH also decreased patients' time-to-transplant after being placed in the organ list. The Heart Center is also dedicated to the discovery of new therapies. The Cardiovascular Research Center at MGH was founded in 1990 to bridge the gap between the science of heart disease and the practice of cardiovascular medicine. www.massgeneral.org
11. Mayo Clinic, Rochester (Rochester, Minn.). The Mayo Clinic offers cardiovascular care at its three locations, treating more than 70,000 patients for heart and vascular diseases annually. In total, Mayo Clinic has more than 170 cardiovascular specialists: 16 physicians in Jacksonville, Fla., 144 in Rochester, Minn., and 16 in Scottsdale/Phoenix, Ariz. Physicians specialize in heart and blood vessel disorders including aneurysms, cardiomyopathies, coronary artery disease, heart attack, lymphatic obstruction, marfan syndrome, myocarditis, peripheral arterial/vascular diseases, pulmonary hypertension, venous thrombosis, women's heart disease and wound/vascular ulcer healing.
More than 20 Mayo surgeons perform thousands of operations each year using state-of-the-art technology, including minimally invasive techniques and "off pump bypass" heart procedures. Mayo also has a pediatric heart and heart surgery practice, which treats 5,000-6,000 children and adolescents for congenital (present at birth) heart problems annually. www.mayoclinic.org
12. New York-Presbyterian University Hospital of Columbia and Cornell (New York). As one of the nation's largest clinical and research institutions, New York- Presbyterian brings together renowned expertise in all areas of cardiovascular medicine from both New York-Presbyterian Hospital/Columbia University Medical Center and New York-Presbyterian Hospital/Weill Cornell Medical Center, to provide the great patient care and services. It has access to advanced diagnostic equipment and offers a range of diagnostic services including intracoronary ultrasound, cardiac catheterization, electrophysiological studies, and cardiac MRI, scans and offers a full range of non-surgical treatment options like carotid artery stenting, coronary artery stenting with state-of-the-art drug eluting stents, ablative treatment of arrhythmias, carotid, renal, and peripheral vascular angioplasty, balloon valvuloplasty for mitral and aortic heart valve disease.
The hospital has recently started implanting new aortic heart valves without open-heart surgery, using innovative technology. The organization's division of cardiology has a fellowship program offering many research opportunities. Finally, the hospital has a resource center for patients and healthcare professionals called the Cardiovascular Health Education Center (CHEC). CHEC provides access to classes, educational materials, counseling, professional development and innovative research. www.nyp.org
13. NYU Medical Center (New York). The NYU Langone Medical Center's Leon H. Charney Division of Cardiology provides comprehensive cardiovascular care at its Tisch Hospital, NYU Hospital for Joint Diseases, Bellevue Hospital Center and the VA Medical Center New York. The Division of Cardiology is home to clinical research programs and receives $5,000,000 annually, with grants from agencies including the National Institutes of Health, American Heart Association, Burroughs-Welcome Fund, Doris Duke Charitable Foundation and others to pursue its investigations.
"Our faculty provides comprehensive and personalized cardiovascular care, pursue cutting-edge biomedical research and educate the next generation of cardiovascular specialists," says Glenn Fishman, MD, a director of the Division of Cardiology. "We have several world-class specialty programs in several important areas of cardiovascular medicine, including our Heart Failure Program, which treats patients with heart failure and various cardiomyopathies; our Heart Rhythm Center, which excels in the treatment of arrhythmias, including atrial fibrillation, supraventricular tachycardias (SVT), ventricular tachycardia (VT), long QT syndrome or other inherited arrhythmias. Faculty in the Heart Failure and Heart Rhythm Programs work closely with members of our new Cardiovascular Genetics Program, which uses modern molecular genetics techniques to identify and treat, inherited forms of heart disease."
Dr. Fishman says the organization prides itself on its vigorous research program.
"Our scientists are exploring key aspects of cardiovascular biology and genetics, including the cellular basis for heart rhythm disorders, mechanisms of atherosclerosis, heart failure and congenital heart disease, stem cells and cardiac regeneration," he says. "The Cardiovascular Clinical Research Center coordinates a broad array of global multi-center research trials, including pivotal studies that have defined the standard of care for patients with heart disease. Our basic and clinical research programs are singularly focused on identifying novel approaches to diagnose and treat cardiovascular disease, with the long term goal of diminishing the burden of heart disease." www.nyumedicalcenter.org
14. Stanford Hospital and Clinics (Palo Alto, Calif.). Each year, more than 5,000 patients receive cardiovascular care from Stanford Hospital and its clinics. The hospital's heart center provides the full range of services for adults including arrhythmia/atrial fibrillation, heart failure, congenital heart disease, coronary artery disease, valvular heart disease, heart transplant/artificial heart support and thoracic aortic aneurysm.
The Stanford Cardiovascular Institute (SCVI) researches and treats numerous cardiovascular diseases. At SCVI, 178 University faculty scientists, scholars, engineers and adult and pediatric clinicians collaborate on the prevention, treatment, and elimination of cardiovascular diseases. Surgeons at Stanford, led by Norman Shumway, MD, were the first to perform a human heart transplant in the United States, and have since done more than 1,000 transplants. www.stanfordhospital.com
15. St. Luke's Episcopal Hospital (Houston). The Texas Heart Institute at St. Luke's is one of the largest cardiovascular centers in the world. St. Luke's offers a full range of specialty heart programs for patients. Its programs and services include a cardiac catheterization laboratory, cardiac rehabilitation program, center for cardiac arrhythmias and electrophysiology, echocardiography laboratory, heart and lung transplant and treatment center, a heart failure program, heart transplant services and the hospital's HeartMate Ventricular Assist Device program.
"The Texas Heart Institute at St. Luke's Episcopal Hospital takes great pride in its past accomplishments and its ranking as one of the nation's top ten cardiovascular centers for 18 consecutive years," says James T. Willerson, MD, president and medical director of the Texas Heart Institute. "We realize, however, that great institutions cannot live forever off spectacular achievements and discoveries. On the contrary, their reputations derive from a record of continuing discovery, sharing of new knowledge and exceptional patient care. For more than 45 years, that has been our goal." www.sleh.com