Inova Heart and Vascular Institute (IHVI) is now the ninth busiest heart transplant center in the U.S. Even as the program’s volume has more than doubled over the past five years, clinical outcomes remain excellent compared to national benchmarks from the Scientific Registry of Transplant Recipients.
Shashank Desai, MD, MBA, IHVI’s Director for Strategy and Growth and Director of Thoracic Transplant, attributes the exponential growth to three key factors: innovations in managing patients with heart failure and cardiogenic shock so they are better candidates for transplant, partnerships with healthcare organizations and cardiology practices throughout the region that have expanded access to advanced treatment protocols, and the decision by Inova’s leadership to invest resources in communities underserved by transplant services.
Hub-and-spoke model for cardiogenic shock
The expertise of the multidisciplinary cardiogenic shock team based at Inova Fairfax Medical Campus is now available 24/7 to more than 30 hospitals in a regional “hub-and-spoke” model.” Cardiogenic shock is an often fatal condition resulting from a complex heart attack that can quickly deteriorate into multi-organ failure. Nationwide, half of all patients who experience cardiogenic shock die – a rate that has held steady for nearly two decades. At Inova, over 75% of cardiogenic shock patients recover.
“By building this infrastructure and focusing on best practices, we saw survival rates skyrocket because we were able to deploy decision making and intervention in a much timelier fashion for these complex patients,” said Dr. Desai. “Our use of devices like Impella® (a miniaturized mechanical heart pump) and ECMO (Extracorporeal Membrane Oxygenation) grew, and we saw an increase in the number of patients who became eligible for transplantation as a way out of cardiogenic shock.”
A partnership for advanced heart failure expertise
Inova’s comprehensive approach to treatment involves an advanced heart failure and transplant program that uses proven clinical protocols, including medications and devices, as either a bridge to transplant or a therapeutic intervention to avoid transplantation for patients whose condition improves.
“One of the biggest drivers of transplant growth has been the system’s collaborative approach to partnering with surrounding cardiology groups to facilitate timely identification and evaluation of patients in need of advanced therapies,” said surgeon Daniel Tang, MD, Surgical Director of Inova’s Cardiothoracic Transplant Program.
“Nationwide, less than 1% of symptomatic patients are actually seen by a heart failure specialist,” added Dr. Desai. “Inova is trying to change that by bringing our specialists to the cardiologists and their patients.”
Inova has embedded heart failure specialists in cardiology practices and locations throughout Northern Virginia, making their services more accessible.
Meeting community needs
The growth in heart transplants is also a result of Inova’s commitment to identifying unmet community needs and investing resources in those communities. More than 100 cardiologists are now affiliated with Inova, including dozens of highly trained interventional specialists as well as cardiac surgeons. Working collaboratively within IHVI and alongside clinicians throughout the region creates a seamless continuum of care that benefits all patients with heart disease.
This past year, the addition of another transplant surgeon, Katherine Klein, MD, further increased the program’s capacity. Dr Klein also serves as IHVI’s Regional Cardiothoracic Surgery Director. “I have a 360-degree perspective of each patient because I have the opportunity to do the preoperative assessment and the surgery, manage the patient in the cardiovascular surgical ICU, and collaborate with the referring cardiologist after discharge,” Dr. Klein said.