The Knapp Cardiac Care Center at Long Island Community Hospital marshals the full spectrum of care, from non-invasive treatments to interventional procedures and cardiac rehabilitation, to meet the needs of local patients and their families in both emergent and non-emergent situations.
In 2016, the opening of the Knapp Cardiac Care Center marked the culmination of more than two decades of improvement and expansion within the hospital’s cardiac care program. Shahriar Khalili, MD, FACC, Chief of Cardiology at Long Island Community Hospital, spearheaded those efforts.
Shahriar Khalili, MD, FACC, Chief of Cardiology, and Nuclear Cardiology Supervisor Minya Gao-Chin Suey prepare a patient for a Nuclear Medicine imaging study.
“When we started, we had a very basic program that was providing mostly non-invasive and clinical care,” Dr. Khalili says. “In the past, patients with significant coronary disease or acute myocardial infarction were transferred to another hospital immediately or soon after admission. Now, we’re able to provide a vastly greater number and type of interventions right here — in a beautiful, updated building.”
That is thanks in part to the talented specialists who have been drawn to the institution as it has advanced the level of care it offers.
“We’ve tripled or even quadrupled the number of cardiologists here, which makes a huge difference in care,” Dr. Khalili says.
The Start of a Journey
When Dr. Khalili first joined Long Island Community Hospital — then known as Brookhaven Memorial Hospital Medical Center — as a staff cardiologist in 1994, the cardiac care program was limited in scope and did not offer heart attack treatment or percutaneous coronary intervention (PCI). However, Dr. Khalili envisioned a far more expansive role for the hospital in the community.
“At the very beginning, we were more of a transitional facility for patients with myocardial infarctions in need of elective, semi-elective and emergency treatments, as well as patients in need of PCI,” Dr. Khalili says. “The only way I felt a busy hospital like ours could serve patients effectively was to provide these treatments.”
Cardiologist Raja Varma, MD, talks with a patient in the Knapp Cardiac Care Center prior to a loop recorder insertion.
Recognizing the local need for a higher level of service, the hospital turned Dr. Khalili’s pursuit of comprehensive cardiac care into a reality, creating PCI and acute myocardial infarction (MI) service initiatives within the Knapp Cardiac Care Center. These initiatives have bolstered Long Island Community Hospital’s cardiac care program — especially in regard to emergency services — and have been complemented by additional services over the years, including noninvasive testing, interventional cardiology procedures and electrophysiology (EP) offerings.
“Long Island Community Hospital is a place that serves the community well — not just for emergencies, but also for elective cases,” Dr. Khalili says. “We offer treatments now that, in the past, required local patients to travel farther away from their homes.”
Cardiac Catheterization: Emergency Treatment
The Knapp Cardiac Care Center is home to two cardiac catheterization laboratories, both of which can handle emergent and non-emergent diagnostic procedures and treatments. The labs are a vital component of Long Island Community Hospital’s acute MI program — a program that, in turn, is the centerpiece of the hospital’s cardiac services, according to Dr. Khalili.
The on-site catheterization labs help the Knapp Cardiac Care Center decrease door-to-balloon time for patients in need of coronary angioplasty, as well as for those who need stent placement or PCI. Limiting the time necessary to deliver these types of procedures helps decrease the amount of heart muscle damaged during an acute MI, which results in better outcomes.
“We have improved overall care for this group of patients,” Dr. Khalili says. “We are able to spare them an additional ambulance ride and further coordination in a separate lab. Instead, we do everything immediately on-site at the Knapp Cardiac Care Center. For patients experiencing a heart attack, quick, effective treatment is what matters most.”
Moreover, because heart attacks and other life-threatening cardiac conditions often occur without notice, a team of interventional cardiologists is on call 24/7.
Cardiac Catheterization: Non-Emergent Treatment
In addition to emergency cardiology interventions, the catheterization labs offer a number of diagnostic interventional procedures, including standard coronary angiograms and more advanced procedures, such as intravascular ultrasound.
Intravascular ultrasound uses sound waves to create images of arteries that supply blood to the heart. However, unlike methods that emit sound waves outside the body, intravascular ultrasound is performed using a catheter that is threaded up through an artery in the groin until it reaches the heart.
Compared with external ultrasound, or echocardiography, this method provides more detailed images that can help interventional cardiologists better evaluate plaque buildup within arteries and determine whether a treatment is successful or if the patient requires further intervention.
“Intravascular ultrasound can help us reach a diagnosis when visual interpretation doesn’t explain a patient’s recurring symptoms,” says Raja Varma, MD, cardiologist at Long Island Community Hospital. “For example, we have had patients with coronary artery blockages that didn’t look severe, but after performing intravascular ultrasound, we realized they had significant stenosis and were in need of cardiac stent placement or bypass surgery.”
Another diagnostic tool at the Knapp Cardiac Care Center was introduced in 2018. The CardioMEMS Heart Failure System is used over long periods of time to evaluate patients with heart failure and is approved for patients who have been hospitalized for heart failure within the past year.
Dr. Varma checks on a patient prior to discharge following treatment for a myocardial infarction.
“This special device is placed in the pulmonary artery through a catheterization procedure,” Dr. Varma says. “Once there, it monitors fluid status and pulmonary artery pressure, which can give us an early indication that the patient is going into worsening congestive heart failure. This information can then be used to modify the patient’s treatment, such as by changing their medications, to address symptoms before they occur.”
Patients can set up the CardioMEMS Heart Failure System antenna and system unit in a room of their choice for maximum convenience. Patients wirelessly transmit information daily from the system to specialists at Long Island Community Hospital from the comfort of their own home. If physicians notice something amiss, they can contact the patient for a follow-up appointment to alter treatment.
Physician Assistant Stephanie Luca; cardiologist Waqas Khan, MD; Dr. Khalili; Nurse Practitioner Samantha Scheer; Senior Director of Operations Nona Kupfer; Dr. Varma; and cardiologist Soma Pulipati, MD, in the ASU/PACU of the Knapp Cardiac Care Center
Non-Invasive Diagnostic Procedures
Long Island Community Hospital provides non-invasive diagnostic procedures that complement its interventional cardiology offerings. These procedures include echocardiography, transesophageal echocardiography, and conventional, nuclear and pharmacologic stress testing. Non-invasive options are usually the first-line approach to diagnosing patients.
The detail provided by echocardiograms is enhanced using the contrast agent Definity, which improves the definition of images by making the left ventricular chamber more opaque. This can help physicians better measure the dimension and volume of heart chambers while assessing wall motion and identifying structural abnormalities.
“It can be hard to see the cardiac chambers and heart valves from a transthoracic echocardiogram in patients with a short body stature, as well as those who are morbidly obese or have severe lung disease,” Dr. Varma says. “Definity makes it easier to see what we’re looking for, including the diagnosis of clots in the heart chambers. It also gives us more information about the patient’s condition, which helps us decide on the optimal treatment method.”
Having non-invasive services in the same facility as interventional services also improves patient safety and quality.
“One of the unique benefits of providing these services in one location is that we can perform a total screening process in our non-invasive program to help prevent complications,” Dr. Khalili says. “Using non-invasive screening options, such as stress testing, we can determine if patients have a low or high risk for complications associated with a certain procedure. If they are low-risk, we can refer them to the catheterization lab for treatment, or we can look for alternative treatment options if they are high-risk.”
Used to diagnose and treat heart rhythm abnormalities, electrophysiology (EP) services are another essential component of the cardiac care program at Long Island Community Hospital. Diagnostic options include EP studies, which use catheters to examine the electrical activity of the heart, and tilt table testing, which is used to determine the cause of fainting in certain patients.
Dr. Khalili reviews a patient imaging study in the Cardiology Department reading room.
Another diagnostic option is the insertable loop recorder. This device is implanted just under the skin on a patient’s chest. It provides long-term monitoring of the electrical activity of the heart to determine the cause of symptoms, including the diagnosis of a common abnormality — atrial fibrillation — or finding the cause of recurrent syncope and cryptogenic shock, Dr. Varma explains.
On the treatment side, services for unnatural heart rhythms include cardiac ablation, cardioversion and the implantation of devices such as cardiac defibrillators and permanent pacemakers.
“We can provide single- and dual-chamber defibrillators and pacemakers for patients who need them,” says Dr. Khalili, who anticipates further expansion of the EP program. “We can also perform right-sided ablations locally.”
Closing the Gap
Cardiologist Christopher Garcia, MD, and Dr. Varma collaborate on the interpretation of patient imaging studies.
Concentrating such a wide range of services and specialists in one location allows area residents to receive virtually all the cardiac care they need without traveling significant distances. In many cases, this means patients receive care and follow-up they would not receive otherwise.
“Some of our patients — particularly those who are sicker or older — may face hindrances to care if they have to go to another location farther away. They may not want to travel 20 miles from home for a pacemaker or defibrillator implant,” Dr. Khalili says. “However, if you mention that a specialist they’ve known for a long time is providing those same services a few blocks from their house, they are more likely to get the care they need.”
In addition, to better coordinate care and ensure patient cases are reviewed by multiple specialists, cardiac councils are held monthly. These meetings include physicians, the interventional team nursing staff, physician assistants and other medical staff from throughout the hospital.
“If a case requires the expertise of specialists from the pathology lab, radiology or another department, they are invited to the council,” Dr. Khalili says. “It’s a collaborative approach with all the relevant clinicians involved.”
Moreover, with care provided by a multidisciplinary team representing numerous departments of the hospital, dedicated schedulers at the Knapp Cardiac Care Center help ensure that patients do not get lost in the shuffle.
“Our schedulers look at which specialties are involved in a patient’s care and communicate with both the patient and their physicians’ offices,” Dr. Varma says. “They coordinate both internally and externally and know what’s going on with a patient from start to finish.”
Patients also benefit from a 14-bed pre- and postprocedural area, and patients and families are provided a private consultation room for discussions with physicians. The family waiting area offers contemporary styling in a spacious and soothing atmosphere.
Personalized, wraparound care is a hallmark of the broad spectrum of cardiac services that Long Island Community Hospital provides today.
“There’s a high level of continuity — we see patients when they come in, we see them get better, and we send them home knowing they can get the information and services they need all in one place,” Dr. Khalili says. “We have comprehensive care within one institution.”
Visit licommunityhospital.org/cardiac-care to learn more about the Knapp Cardiac Care Center and how to refer patients.