Building a Protected PCI Program: The Community Hospital Approach

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 - Bakersfield Heart Hospital - PCI
“Impella provides a safety net for the heart. You have the advantage of continuing the perfusion from a cardiac perspective and you can perform complex interventions that you otherwise would be very bashful about.” —Brijesh Bhambi, MD, Chief Medical Officer
Source: Bakersfield Heart Hospital

Despite its name, Bakersfield Heart Hospital offers more service lines than just those under its cardiovascular umbrella. It’s an accredited stroke center as well as a go-to site for total joint replacement, neurosurgery, wound management and multispecialty emergency care. At its core, it’s a heart center offering comprehensive community care close to home. This 47-bed, 14-clinic institution excels regionally and leads nationally, having leapt to the forefront in 2008 as an early adopter of Abiomed’s Impella 2.5 miniature temporary heart pump, which is now FDA-approved for use in elective and urgent high-risk PCI procedures.

Hear more from the team at Bakersfield Heart Hospital, watch Episode 3: The Community Hospital Approach from the series, Building a Protected PCI Program. 

The PMA approval, received this past March expanded the device’s indications from its 2008 510(k) clearance, and now permits treatment of elective and urgent high-risk PCI patients who are hemodynamically stable but have severe coronary artery disease and depressed left ventricular ejection fraction. The approval comes in the wake of the PROTECT II study that showed that patients supported during PCI by the Impella 2.5 had certain improved outcomes at 90 days. (Circulation: 2012 Oct 2;126(14):1717-27; Dangas GD, Kini AS, Sharma SK, et al. Am J Cardiol. 2014;113(2):222-228.)

For Bakersfield Heart Hospital, the expanded indications have given the 11 board-certified, subspecialized cardiologists of Bakersfield-based Central Cardiology Medical Clinic a chance to bear out a belief they have held for years: Given the right toolset, cardiologists working in a community setting can meet or exceed the pace of progress expected at academic medical centers.

With a cachement area extending to communities well beyond this California metro area nestled in the large agricultural county of Kern midway between Los Angeles and Fresno, Bakersfield Heart is showing that proficiency in high-risk PCI is the product of real-world experience with notably substantial volumes. And the proof is in the outcomes.  

“If a facility doesn’t do sufficient volume, the quality will never be there,” says Brijesh Bhambi, MD, the interventional cardiologist who serves as the chief medical officer of the heart hospital. “We have performed close to 100 PCIs using Impella, and I actually have a number of patients on the north side of 90 who received the interventions two to five years ago and are still around. That’s amazing.”

It’s also consistent with the findings of the PROTECT II study that showed PCI patients supported by Impella 2.5 had certain improved outcomes at 90 days when compared to those treated with the older intra-aortic balloon pump technology. (Circulation: 2012 Oct 2;126(14):1717-27) “We lean heavily on evidence-based medicine and for PROTECT II there’s considerable evidence that in high-risk interventions, there is a very substantial role for LV assist devices and Impella,” he notes.

Bakersfield Heart’s CEO Michelle Oxford, MBA, likes that the Protected PCI program offers high-tech care within soft-touch surroundings to people in Bakersfield and up to two hours away. “Community care means to our patients that they don’t have to travel to larger facilities out of the area when we have physicians in our community that can meet the standard of care for them,” she says.

Big benefits across the board 

For Bhambi, maintaining the highest standards of clinical care means not only aiming for perfection via practice but also relying on evidence-based medicine to guide clinical decision-making. He points to PROTECT II as a source of high confidence when proceeding with high-risk PCI procedures, that accord with a very substantial role for proven LV assist devices.

“Impella is a useful tool,” he says before likening it to a padded trampoline for an acrobat walking the high wire. “It allows us to perform complex procedures without the stress of a stumble that could lead to a disastrous consequence. Impella has emboldened us in taking on severe heart disease patients who have a damaged heart and who otherwise couldn’t stand the additional insult of ischemia.”

Stated simply: “Impella provides a safety net for the heart,” Bhambi adds, “You have the advantage of continuing the perfusion from a cardiac perspective and you can perform complex interventions that you otherwise would be very bashful about.”

Interventional Cardiologist Sarabjeet Singh, MD, notes that, before the expanded