Department of cardiology

A concise presentation on history, layout, marketing and management of cardiac unit as independent or a part of a multi specialty hospital

1. DEPARTMENT OF CARDIOLOGY SHILPA SINGH     SHIVANGI DAS     SHIVANI SHAKTI RAO     SHIVANI VISHWAKARMA     SHREEPARNA DAS   SHREOSEE MUKHERJEE   1 By GROUP H SHRUTI AGGARWAL     SHWETA BISHT     SHWETA SHASTRI     SONAL JAIN   SONALI TAGGAR  

2. INTRODUCTION Cardiology is the medical subspecialty concerned with the prevention, diagnosis, management, and rehabilitation of patients with diseases of the cardiovascular system. A Cardiologist is a specialist who is an expert in the diagnosis and management of all aspects of cardiovascular disease. CVDs are the number one cause of death globally, taking an estimated 17.9 million lives each year. Of these deaths, 85% are due to heart attack and stroke. In 2016, the estimated prevalence of CVDs in India was estimated to be 54.5 million. One in 4 deaths in India are now because of CVDs with ischemic heart disease and stroke responsible for >80% of this burden.

3. HISTORY      TRADITIONAL INDIAN HISTORY PRE-VEDIC ERA explained heart & circulation RIG & ATHARVA VEDA covered concept of health  Role of YOGA & TRANSCENDENTAL MEDICINE -  cure of heart problems ‘ HATHAYOGA’-  prevention of cardiovascular diseases The 4th Chakra   HEART CHAKRA- controlled the operation of the heart and the circulation of blood.        GLOBAL HISTORY WILLIAM HARVEY - Circulation of Blood in Body in 1628 STEPHEN HALES - Measurement of Blood pressure in 1733 RENE T.H LAENNEC - Invented the Stethoscope in 1816 First  Electrocardiograph  was invented in 1905 First  open-heart surgery  was done in 1952 First whole  heart transplant  in 1967 by Christian Bernard First  artificial heart  was implanted in 1982 3

4. INDIA'S FIRST Dr. Bidhan Chandra Roy led  formation of the Cardiological Society of India (CSI) on 4th April 1948 In 1994, Indian Academy of Echocardiogarphy was founded Dr. KS Shadaksharappa  founded Indian College of Cardiology at Bengaluru  First cardiac catheterisation laboratory for clinical studies in AIIMS,Delhi First cardiothoracic surgery department at Vellore in 1949 First ECG machine in K.E.M. Hospital, Mumbai, late 40's  First Coronary Artery Bypass Graft (CABG) surgery done by Dr. K.M. Cherian in 1975 at Chennai. First heterologous cardiac transplan t with pig's heart was done at K.E.M. Hospital, Mumbai by Dr. PK Sen First heart and lung transplant  in 1999 by  Dr. KM Cherian   First electrophysiology lab established in 5th March 1975 at G.B. Pant Hospital by by Dr. M Khaliluallah   First temporary pacemake r manufactured in India was the Khalilullah-Mendez pacemake r in 1970 First Indian doctor   in Paediatric Cardiology was Dr. S Padmawati.   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4475834/

5. CARDIAC HOSPITAL PLANNING AND DESIGNING

6. COVID-19 CLINICAL GUIDELINES FOR THE CARDIOVASCULAR TEAM COVID-19 Implications For Patients With Underlying Cardiovascular Conditions Quickly identify and isolate cardiovascular patients with COVID19 symptoms  All cardiovascular patients should be  made aware about the risk and  precautions  Patients with CVD to remain current with vaccinations like the pneumococcal vaccine ,vaccination against influenza   Use telephonic or telehealth visits for in-person routine visits for stable CVD patients to avoid possible nosocomial COVID-19 infection Protocols for the diagnosis, triage, isolation, and management of COVID-19 patients with cardiovascular complications should be developed in detail and rehearsed; the cardiovascular team has to be trained properly in  personal protective equipment (PPE) donning, usage, and doffing Case fatality rates for comorbid  patients are materially higher than the average population:  Cancer: 5.6%  Hypertension: 6.0%   Chronic respiratory disease: 6.3%  Diabetes: 7.3% Cardiovascular disease: 10.5% Source- American Collge of Cardiology

7. PATIENT  MANAGEMENT The use of telemedicine in heart failure patients is one of the most advanced approaches in telecardiology regarding feasibility and clinical evidence Telemonitoring with cardiovascular implantable electronic devices (CIED) provides diagnostic information about early markers regarding the onset of pulmonary congestion Remote patient management (RPM) describes a holistic digital concept in the outpatient care of HF patients

8. 8 RPM PROVIDED BY A TMC Within the last 15 years, many RCTs have been conducted to demonstrate the efficacy of RPM to reduce cardiovascular morbidity and mortality It can be concluded that RPM patients recently hospitalized for HF had fewer unplanned hospitalization and days in hospital, a lower all-cause/cardiovascular mortality and improved quality of life compared to patients with usual care only The TMC represents a department of a third level hospital (e.g., a university clinic) with departments to treat the most common comorbidities of HF (e.g., stroke, depression, kidney dysfunction, diabetes) and to carry out consultations. 

9. 9 8 Ways to Improve the Hospital's Heart Program and overall performance  Combine government-recommended quality measures with measures that serve your specific community Choose a payment model that incents physicians to perform better. Organize your teams by specialty Build a structured process for deciding which technologies to invest in. Review every single patient death.  Eliminate unnecessary transitions between providers. Promote good relationships with community providers and other hospitals. Promote collaboration between nurses, physicians and administration. 

10. 10 CORONARY CARE UNIT   An article, Evolved role of the cardiovascular intensive care unit mentioned the main feature of CCU as:   Continuous monitoring of the cardiac rhythm  Cooperation between cardiologists and intensive care specialists  Targeted temperature management Another article,  ' The Changing Role of the Coronary Care Unit Cardiologist '  stated the changing face of CCU & roles of cardiologists for managing the acutely unwell cardiac patients  : Ventilator blood purification device auxiliary circulation devices, such as IABP & PCPS To cope with CVD patients with various complications, such as respiratory failure, renal failure, and sepsis.  to improve long-term neurological outcome   Mandatory additional training & close collaboration between cardiologists and intensivists.

11. PROGRESSIVE CARDIAC CARE UNIT Patients admitted to specialized progressive care units typically have a cardiac (heart-related) diagnosis  Patients who needs PCCU - Post-stent placement  Post-cardiac catheterization Heart attack Congestive heart failure (CHF) Heart rhythm abnormalities Pacemaker  Internal heart defibrillator.  DIFFERENCE BETWEEN PROGRESSIVE & INTENSIVE  CARE UNIT Progressive Care Unit   Intensive Care Unit  Intermediary step between an ICU and a medical/surgery floor  A special facility in a hospital or other healthcare facility to serve the extremely ill Patients are more stable than the patients who require Critical Care  For the patient who requires the highest level of care that stabilizes the condition.  ICU patients are unstable and might be relying on a range of equipment such as artificial ventilators.  PCU personnel must work in close-knit environments with more support staff that those in general care units.   ICUs usually have a large care team that might not provide care at the same time, but each of them provides service that complements the care beach professional to save the life of the patient and enable healing  Surgical Progressive Care Unit Medical Progressive Care Unit

12. New Pacemaker Technologies  MRI- Safe Pacemakers  One of the biggest trends in pacemaker technology in the last few years has been the introduction of U.S. Food and Drug Administration (FDA)-cleared MRI-conditional models.  Pacemakers without MRI-conditional use technology usually prevented patients from being able to get an MRI. Biotronik is the first company in the United States to offer both single- and dual-chamber pacemakers approved for use in an MRI environment. The Leadless Pacemaker   leadless pacing systems that are small enough to be placed inside the heart and avoid the need for a subcutaneous pocket and transvenous leads Current leadless pacemakers are designed to be compatible with magnetic resonance imaging.  Battery life is approximately 5-15 years, comparable to that of a transvenous pacemaker.  The primary advantage of a leadless pacemaker is the elimination of several complications associated with transvenous pacemakers and leads. 

13. MARKETING FOR 150 BEDDED CARDIAC HOSPITAL Strategic Place Infrastructure Facilities Interventional Cardiology Service Profile Choose your Personal Cardiologist Non-Invasive Cardiology Services Pediatric Cardiac Care Heart Failure & Transplant Program

14. PROMOTIONAL ACTIVITIES Cardiac Rehabilitation      Center of the Hospital     Cardiac Health    Check Up Camps           Corporate           Promotion      Golden Hour Moment  &  Emergency Services         Media Promotion       Branding     Internal      Marketing Medical Value ​Accreditation  Tie Ups​ Collaboration       Patient Assistance  Department    Special  Cause     Related Marketing

15. CATHETERIZATION LABORATORIES Cardiac catheterization  is an invasive procedure used to identify cardiac anatomy, measure intracardiac pressure shunt and oxygen saturation and calculate systemic and pulmonary resistance.  This procedure is performed in an area of the hospitals called the 'catheterization laboratory' or 'cath labs' Catheterization lab is an examination room used to visualize the arteries and treat any stenosis or abnormality found India is a country of about 1.3 Billion people, with  35 million people suffering from Cardiovascular disease.   There are just  1300-1400 Cath labs  available in about  140 cities . About 225  Cath Labs  get added to the market every year

16. CATHETERIZATION LABORATORIES (contd...) Equipements of  cath  lab:   C- arm  X-ray source tube  Detector  Catheterization table  X-ray generator  Monitors  Control handle  Pedals  Control room with diagnostic application  Staff requirements:   Chief cardiologist  Assistant angiographer  Laboratory director  Cardiovascular trainee  Nursing personnel- scrub nurse & float circulating nurse  Technical staff- radiation technologist, radiation physicist, lab technologist, dark room technician, computer technician, monitoring technician  Non-technical staff- medical transcriber, Clerks  

17. Components of Cath Lab and area required by each component 17 Use  Suggested min. Size (in sq. Ft.) Procedure room 500-600 Control room 150-200 Equipment room 100-120 Dark room 70 Holding room >120 Patient preparation room 120 Recovery room 120 Stock room 100 Patient dressing room  70 Staff dressing room 70 Toilets (staff & patient) 60 Reception area 70 Blood gas analysis 20 Conference room 120

18. ADMINISTRATIVE ISSUES 2. Lab performance evaluation 1. Utilization levels 3. Quality assurance Laboratory safety and efficiency is measured by : 1. Complication rates (through records) 2. No, of studies that must be  repeated because of inadequate data or image quality 1. Laboratory  For optimum lab performance & cost effectiveness 2. Physician-Operator For adequate performance  and preventing excessive radiation exposure. The quality assurance program in cardiac cath labs has 3 components: Clinical proficiency Equipment maintenance and management Quality improvement program development Administrative issues

19. INNOVATIONS IN CARDIOLOGY WEARABLE TECHNOLOGY FOR PATIENT MONITORING Smart software and AI is being incorporated into the wearable and app algorithms to detect abnormally high heart rates, arrhythmias, and other factors to alert patients to contact their doctors.  VIRTUAL AND AUGMENTED REALITY The latest technology is being used in medical devices to make visualization effortless and precise. EASE OF PLANNING AND PROCEDURE Three-dimensional-printed cardiac prototypes aid surgical decision-making and preoperative planning of complicated cases

20. INNOVATIONS IN CARDIOLOGY (contd...) 3D PRINTING Scientists all around the world are at the brink of a breakthrough in 3D printing of a heart, it will revolutionize the transplant industry. ARTIFICIAL  HEART It is a prosthetic device implanted in the body to replace the cardiac functions. LAB GROWN HEART TISSUE Lab grown heart tissue was transplanted for the first time in 2020. If successful, it could ultimately eliminate some of the transplant procedures.

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