Physicians at Brookhaven Memorial Hospital Medical Center have developed a strong cardiology program over a period of decades. Reflecting that heritage, the recent opening of the 60,000-square-foot Knapp Cardiac Care Center markedly expands the number of procedures they can offer and the number of patients they can serve locally, while reaffirming Brookhaven’s commitment to patient-centric care.
The population of Suffolk County is booming, and with the Knapp Cardiac Care Center, Brookhaven is meeting the challenge of growing patient volumes. Long a home to excellent diagnostic and medical cardiology, Brookhaven has been advancing its abilities in interventional cardiology, adding acute capabilities and electrophysiology along the way. With an impressive door-to-balloon time and a close partnership with the highly regarded Heart and Vascular Institute at Winthrop-University Hospital, Brookhaven can provide immediate, high-level treatment for advanced cardiac conditions, from chest pain and syncopy to arrhythmias and heart attacks, while a host of programs such as cardiac rehabilitation and support groups continue to make it an integral part of the local healthcare community.
James N. Semertzides, MD, has witnessed the process unfold and has played a key role as a respected community cardiologist. After choosing a noninvasive specialty that would allow him to pursue his passion for working closely with patients, he eventually formed a practice affiliated solely with Brookhaven.
“That’s where we wanted to send our patients,” he says. “That was our decision, and to this day we recognize it was the right thing to do. Our office is a stone’s throw from the hospital, enhancing care coordination for patients. In addition, the hospital has added interventional cardiology capabilities, and now we are adding fellowship-trained interventionalists from Winthrop-University Hospital to take advantage of those capabilities.”
Among these physicians is Waqas Khan, MD, cardiologist at Brookhaven. He performed his residency at Downstate Medical Center in Brooklyn, after working in cardiology in Pakistan. He later completed a general cardiology fellowship followed by a year of training in interventional cardiology. Dr. Khan went on to direct the cardiac catheterization lab but was limited to diagnostic services, as Brookhaven was still obtaining certification from the state of New York.
“Patients were traveling significant distances to have certain procedures,” he points out. “They wanted their families to be able to visit them more often. We performed our first intervention at Brookhaven in December 2013.”
Richard Schwartz, DO, Knapp Cardiac Care Center Director of Cardiac Catheterization Lab, and James N. Semertzides, MD, Knapp Cardiac Care Center Chief of Stress Testing and Cardiac Rehabilitation, review patient’s cardiac catheterization results.
“When Brookhaven Memorial Hospital and Winthrop-University Hospital affiliated, they had a lot of potential for growth,” says Richard Schwartz, DO, FACC, Director of the Cardiac Cath Lab at Brookhaven and Medical Director of Transcatheter Valve Replacement at Winthrop-University Hospital. “I was drawn to the program because they were very eager to get their interventional program started. Winthrop-University Hospital came in as a partner, with my role being to provide quality assurance and help obtain state certification.”
Now, Dr. Schwartz says, patients need not travel away from their local hospital for care during a heart attack or to undergo an interventional procedure. The generous donors and administration of Brookhaven made it possible to institute a comprehensive, high-quality program. At the same time, Winthrop-University Hospital receives any patient transported for more specialized care.
At Brookhaven, in addition to round-the-clock cardiology staffing, the Cardiac Care program has added electrophysiology capability, more catheterization labs, numerous physicians and cardiac rehabilitation. Door-to-balloon time for patients with myocardial infarction stands at 60 minutes, below the national average. And from only 18 cases a year initially, physicians with the Cardiac Care program now see about 1,350 cases annually, Dr. Schwartz says, illustrating that the program is addressing a strong local need for these services.
A key component of the program, interventional cardiology includes both elective and emergency services.
“We treat any patient who presents with acute myocardial infarction, and our mortality is comparable to or lower than that of any hospital in New York state,” Dr. Schwartz says. “For patients in cardiogenic shock, we can place a percutaneous ventricular assist device until they can be transported to a hospital that can offer a long-term solution. We can perform any procedure that does not require surgical backup, and those that do are rare.”
Brandon Schepps and Maria Eisner, nuclear medical technologists, imaging a patient with a nuclear camera
Cardiac catheterization is a two-step process, Dr. Khan explains. First, a patient experiencing chest pain receives an angiogram to reveal any blockage. From there, the physician may decide a significant blockage warrants heart bypass surgery. However, often the problem can be corrected by the placement of stents.
“Time is muscle,” Dr. Khan says. “When arteries are 100 percent closed, the muscles relying on those arteries to supply them with blood begin to die. Early intervention can save patients either by preventing them from dying immediately of a heart attack or from suffering heart failure in the long run, which leads to issues such as the need for multiple medications and possibly a defibrillator, frequent hospital and office visits, and a high risk of mortality if the patient reaches stage 4 heart failure. By acting quickly, we reduce the personal and financial burden on the patient as well as healthcare costs.”
For outpatient chest pain with normal stress test results and an angiogram that does not reveal an emergency condition, the specialists perform an elective procedure, he adds. In addition to stent placement, elective procedures include pacemaker and defibrillator implantation. Electrophysiologists working in the lab may perform ablations to correct arrhythmias. Several of the interventionalists specialize in radial angiography, entering through the radial rather than the femoral artery — a procedure that is popular with patients, Dr. Schwartz says.
Patient-centered Diagnosis: Noninvasive Cardiology
The process of accurate diagnosis starts with conversation, Dr. Semertzides says. In fact, the fulfillment he gains from interacting with patients to successfully resolve their heart conditions is why he chose noninterventional cardiology as his focus.
“I wanted to diagnose and guide patients to the proper interventionalist or surgeon,” he says. “As the years went by, I found working with patients was enormously satisfying. Clinical work is so rewarding. I get involved with patients from the start, perhaps even when they are having a heart attack. I take pleasure in being involved throughout the process of care and rehabilitation, helping get them back on their feet.”
The diagnostic process is patient-driven, Dr. Semertzides adds.
“I place a high priority on listening to what my patients have to say,” Dr. Semertzides says. “During the office visit, when I ask, ‘How are you doing since we last saw each other?’ and they tell me there’s an issue, I focus follow-up questions on that response. Patients typically describe chest discomfort vaguely. Atypical pain may arise in female patients or those with diabetes, so we’re on the lookout for that. Patients may describe fatigue, shortness of breath or lightheadedness as well. All these generate a problem list that I review mentally, thinking, ‘This symptom could represent this disease. Perhaps a stress test or another type of test will uncover that.’ The physical examination helps me narrow it further. If I hear a louder or different murmur than I did six months prior, I may order an EKG.”
“When you have worked as a physician for a number of years, you can follow people — nurses, for example — from the time they start until they become seasoned in their profession. You see how they improve in what they do and how they do it. It is a pleasure to witness. They become experienced as you become experienced. Your community and your patients all benefit as a result.”
— James N. Semertzides, MD
Waqas Khan, MD, and Dr. Schwartz, Knapp Cardiac Care Center interventional cardiac physicians
If a complaint or test result is grossly abnormal, Dr. Semertzides says, he sends the patient directly to the hospital — a process that is streamlined by the location of his practice.
“Proximity is a real advantage for patients,” he says. “It was not by mere chance that we chose a practice site close to the hospital. We didn’t want patients to drive themselves from here to there, and even if we summoned an ambulance, we didn’t want the drive to be long or delayed.”
The logic of exam-based diagnosis is one half of the cardiologist’s problem-solving approach. The other consists of detailed, technology-assisted testing, made possible by advanced tools available at Brookhaven.
“In addition to noninvasive EKGs and stress tests, as well as diagnostic angiograms, we perform echocardiograms and transesophageal echocardiography using ultrasound,” Dr. Khan notes. “Our volume for angiograms has grown quickly; before I joined, we performed 60 or 70 per year, whereas in 2017 alone we had performed 500 cases as of mid-March. The community had a great need for local diagnostic support, and we are the only hospital within 15 miles providing all these services.”
Integrated Care: The Knapp Cardiac Care Center
Coordination of care between the inpatient and outpatient setting, as well as among various specialties, is crucial to a safe and streamlined patient experience. The new Knapp Cardiac Care Center, housing the cardiac catheterization lab, noninvasive cardiology, electrophysiology, the cardiac rehabilitation program and the cardiac outreach program, is emblematic of this full integration of services. Physicians can coordinate easily, and patients can receive multiple services in one familiar location, making the process much more convenient.
“The Knapp Center has changed the whole persona of the hospital,” Dr. Schwartz says. “It allows us to expand our capabilities and to accommodate the advancements that have taken place in the hospital. The physical plant itself has brought in new patients. The buzz in the community is, ‘It’s a whole new hospital.’”
Dr. Schwartz, Richard T. Margulis, President & CEO Brookhaven Memorial Hospital Medical Center, and Dr. Semertzides, in the Knapp Cardiac Care Center
The center is fully staffed with nursing professionals and equipped with leading-edge technology.
“I can’t say enough good things about our nurses,” Dr. Schwartz says. “They are excellent in every area. We interviewed and took on the people we knew were the best.”
Integration extends beyond the walls of the Knapp Cardiac Care Center. In fact, for these cardiologists, it’s a way of life.
“We have constant intra-hospital and trans-hospital communication; we share each other’s cell phone numbers,” Dr. Semertzides says. “We see patients the same day we are requested for a consultation. For instance, today I had three consults before 8 a.m. and have more coming in. I typically visit five or 10 patients every day from other services, whether family practice, internal medicine or surgery. The most interesting for me are the emergency room cases. When they call for a cardiologist, we respond immediately. At other times, patients may be experiencing a hidden cardiac issue, such as an arrhythmia, after they’ve been admitted, and we get involved that way.
“A lot of these patients may already belong to our group, but it’s a society — a community — and we collaborate to produce the best outcomes for them,” he continues. “When they come to the emergency department, we get a call whether they’re ours or not. Often, we know them from elsewhere in the community simply due to our years of practice. We can offer additional information to guide diagnosis and therapy for that particular admission. I call it cross-pollination of services. If a colleague picks up a phone and asks me to review a case, I say, ‘I’ll be right there!’”
Care is also well-integrated between Brookhaven and Winthrop-University Hospital, further optimizing treatment. The relationship between the two organizations is highly collaborative, and patients benefit from the synergistic sharing of expertise between the two institutions.
John Guerra, RPA clinical coordinator, Dr. Semertzides and Dr. Schwartz discuss a patient’s course of treatment.
For the past seven years, these options have been available to patients at Brookhaven, providing support to the hospital’s burgeoning cardiac program. Although Dr. Khan notes that patient transfers are needed only rarely, they are a swift journey via standby ambulance.
A Heartfelt Love of Community
Bringing advanced interventional cardiology to Brookhaven has been an act of love for Dr. Semertzides, Dr. Schwartz, Dr. Khan and their colleagues.
As evidence of the community-centric nature of the program, cardiac rehabilitation and multiple support groups have taken root at the Knapp Cardiac Care Center. Offering education, fellowship and carefully monitored exercise, cardiac rehabilitation keeps patients invested in their recovery process, which fosters better outcomes. Support groups led by social workers or nurses further the medical and educational goals of Brookhaven as well.
“At the Knapp Cardiac Care Center, we provide lifesaving care in a timely fashion, close to patients’ homes. For example, patients can receive care in one of four state-of-the-art catheterization labs without leaving the community. We are proud of that. In addition, it is convenient for family members to visit. I love for a patient’s mother or father or brother to be able to comfort the patient. Seeing a familiar face is so important.”
— Waqas Khan, MD, cardiologist at Brookhaven Memorial Hospital Medical Center
The Knapp Cardiac Care Center clinical team
A heartfelt approach to patients is readily apparent when the physicians discuss their work, as well as the devotion of staff and leadership.
“The dedication of the people who work here is uncompromising,” Dr. Semertzides says. “That includes the administration. You can see it in how they approach issues and in the decisions they make. Our healthcare and other employees are also extraordinarily dedicated. I know many of the people who work here, from nurses to physician assistants to personal assistants and janitors. Some are my patients as well as my co-workers, and they do a stellar job. I see that up close every day, and it is one of the reasons I love the hospital.”
To learn more, visit brookhavenhospital.org/Knapp.