Detroit Medical Center Achieves Faster PCI Times, Implementing CVI Cardio Team Concept

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 - Ted Schrieber
Theodore L. Schreiber, MD, interventional cardiologist, specialist-in-chief of Cardiovascular Medicine, at Detroit Medical Center, helped found the center’s new Cardiovascular Institute in 2011.

The Detroit Medical Center's (DMC) new Cardiovascular Institute (CVI) has produced faster angioplasty times, or ER-to-balloon times, with lower mortality and morbidity rates and shorter hospital stays as a result. By combining CVI's Cardio Team One process of stationing cardiology specialists onsite 24/7 with acute care technology—including a percutaneous left ventricular assist device (pLVADs)—the CVI approach is saving more PCI patients than ever before, while also improving quality of life and helping to keep down the cost of heart care.

Delivering top cardiac care in record time

At the eight-hospital DMC, on which varied cardiac patient populations often depend for emergency care, the recently launched CVI has been setting records for average angioplasty ER-to-balloon time—after establishing a unique process for rapid delivery of PCI.

As documented in a groundbreaking study, presented at the Transcatheter Cardiovascular Therapeutics Conference (TCT) in 2008, CVI's Cardio Team One (CTO) system for speeding up cardiac interventions by stationing heart doctors, nurses and technologists onsite 24/7 has helped cut the average angioplasty procedure time to about 45 minutes—while the national average is greater than 90 minutes for U.S. hospitals.

More than four years in the planning, the launch of the CVI about 18 months ago also marked the implementation of "a new philosophy of cardiac care," according to CVI Founder and President Theodore L. Schreiber, MD, a veteran interventional cardiologist who began designing and assembling the CTO system of cardiac care soon after signing on as the DMC's specialist-in-chief of cardiovascular medicine in 2004.

"When it comes to caring for acutely ill cardiac patients, it's pretty obvious that time is muscle," says Schreiber. "What we set out to do at CVI was to build a PCI facility that's keenly sensitive to the benefits that can flow from treating cardiac patients rapidly, while also providing them with the latest in LV assist and other cutting-edge cardiac technology."

"Our CTO system is based on a simple, but highly effective approach. We've stationed the doctors and the other cardiac staff at the hospital around the clock—which means they're ready to go into action the moment a heart patient enters the ER."

Schreiber, who estimates that he's performed more than 20,000 heart procedures over the course of his 33-year career, adds: "For the first time, we're asking the doctors to wait, rather than the patients. After about three years of compiling data and publishing our results, it's clear that this approach is paying significant health dividends."

Schreiber, who directs a staff of about 50 cardiologists (of whom about 35 are interventional cardiologists) at CVI, presented research data at TCT 2008, showing that reducing the angioplasty ER-to-balloon time to about 45 minutes would save the lives of up to seven patients out of every 100 who could previously have died.

Since then, he says, the data compiled on CVI acute-care patients have confirmed that the CTO approach is saving lives at about that rate—and that many more cardiac patients are now enjoying enhanced quality of life, after rapid treatment at CVI protected their hearts from damage that would have occurred during longer response times.

Partly as a result of these improved cardiac outcomes, CVI's U.S. News & World Report ranking in "Cardiology & Heart Surgery" improved from No. 44 to No. 36 in last year's annual survey.
 

Latest & greatest of cardiac technology

While Schreiber and his CVI colleagues are convinced that rapid response in the catheterization lab is a crucial component of effective cardiac care, they also underline the importance of making sure that cardiac procedures [and planning] are "physician-run…with strong advice from cardiology staff, day in and day out."

"That's the model we work from at CVI and while to some extent it differs from the standard model across the country of administrator-run specialty hospitals," Schreiber says. "We firmly believe that the most successful hospitals in this country tend to be those that are physician-run and with physicians as CEOs."

'Real-world’ Outcomes for High-risk, Elective PCI at Detroit Medical Center (60 patients)
Types of Procedures Mean
Left main PCI 55%
Left anterior descending PCI 67%
Left circumflex PC: 55%
Right coronary artery PCI 20%
Bypass graft PCI 8%
Multivessel PCI 83%
Outcomes Mean
Mean inflation time 33 seconds
Duration of pLVAD* support 38 minutes