911: Endangered Heart
words by eve jacobs / photograph by pete byron
(LEFT) mark klapholz, MD, professor, Department of Medicine, UMDNJ-New Jersey Medical School (NJMS), and director, Division of Cardiology, NJMS and
UMDNJ-University Hospital. (RIGHT) tina occhiuto, rn, ms
clinical trials
coordinator, Division of Cardiology’s Heart Failure Program, UMDNJ-New Jersey Medical School
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failing heart is indeed a dire diagnosis that five million Americans are grappling with right now. But a failing heart is not a stopped heart but an organ in distress. It’s a pump that can no longer adequately do its job and is threatening to quit without major assistance. So when symptoms such as breathlessness, chest pain and extreme exhaustion ring alarm bells, the job of heart failure specialists like Marc Klapholz, MD, is to listen closely to that heart and figure out how to prop it up and keep it working — even if (and this is often the case) the heart cannot be returned to optimum function. And because failing hearts do not necessarily wind down for the same reasons, the experts have a major job on their hands devising the right strategies to rescue that particular organ.
One such damaged heart belongs to Carmen Rodriguez of Newark. In her mid- fifties, she felt “old,” so tired all the time that any activity beyond shuffling at a snail’s pace left her breathless and debilitated. She could no longer even climb the stairs in her home slowly or do the simple tasks of life, such as grocery shopping and cleaning. In essence, she was homebound and relegated to sitting on her couch. Not much of a life.
Her dire symptoms brought her to the hospital, where two surgeries partially corrected her condition. But the damage to her heart was so significant that no current therapy could adequately address it. That is the point when she was asked to enroll in a clinical trial that could add a new pharmaceutical therapy, a drug that looks like a winner for her particular condition, to the ones with already proven track records in the cardiology arsenal.
According to nurse practitioner Tina Occhiuto, RN, MSN, clinical trials coordinator in the Division of Cardiology’s Heart Failure Program at UMDNJ-New Jersey Medical School, this patient matched with a 147-week -long international study (RED/HF) that is looking at a drug called darbepoetin alpha, already approved for dialysis patients. “This drug helps with a low hemoglobin level, which affects both dialysis and heart failure patients,” she explains. It addresses the inadequacy of available oxygen throughout the body, a major effect of heart failure. The lower level of oxygen can also cause the heart to work harder, and may, in turn, worsen heart disease. Rodriguez readily consented to try this new treatment, which entails more frequent visits to the medical school for evaluations and discussions about her perceptions concerning her condition. So far, about 19 months after joining the trial, Rodriguez feels she is somewhat improved, although she’s hoping to feel even better.
While the mainstay of Klapholz’s job is fixing “broken hearts” using state-of-the-art medicine, his other primary goal is breaking the boundaries that frequently stop him from reaching the level of success he wants for his patients. He is tireless in the pursuit of new therapies and new avenues for heart repair. Just 14 months ago, his team was singled out for much-deserved praise in Time magazine’s end-of-the-year wrap-up of top worldwide achievements in medicine for a breakthrough in the treatment of heart attack.
In spite of, or maybe because of, his many years of experience, knowledge and skill in his specialty, Klapholz’s thinking out-of-the-box led him to a discovery that has no-doubt already saved many lives and will continue to do so. His question: Which factors impede greater survival post-heart attack? The answer was simple and singular: Time. Most patients have their heart attacks at home and many just cannot get to the hospital fast enough to be saved. If treatment had been provided often just minutes faster, they would still be alive.
The team put their heads together: There had to be a practical solution. They needed to save precious minutes. So, Klapholz thought, why not use time spent in the ambulance in route to the hospital to start the necessary work to open a blocked artery “stat” — before irreversible damage occurs? How could our ever-more-sophisticated-technology be used to shorten time between heart attack and treatment?
The solution: Have an EMT administer an EKG right in the ambulance and send the data wirelessly to the cardiologist’s “smart phone” for interpretation. If the patient needs a cardiac catheterization, he can bypass the emergency room entirely upon arrival and be whisked into treatment. Bluetooth technology and dedicated e-mail servers helped cut “door-to-intervention time” (D2I) dramatically. “This is a paradigm shift,” comments Klapholz, who heads up the 12-person team, all of whom receive the data via smart phones, although only the physician on-call jumps into action. This stroke of brilliance was tested in a clinical trial called STAT-MI and clearly demonstrated its value. What it means to you — if you are having a heart attack — is sophisticated treatment in half the usual time.
Klapholz is the kind of dedicated doctor who works 80 plus hours a week and will still show up at your bedside “after hours” if your heart cries out for help. You don’t need to wade through a long list of his clinical trials (looking at new drugs and new combinations of drugs to prevent and treat cardiac disease, head off recurrent stroke or target heart failure in minority populations), or the longer list of his achievements during his 25 years in practice, to understand an important truth. Entrusting the care of your car to an expert is important, but trusting the survival of your heart to an ultra-specialist often spells the difference between its shut-down or waking up for tomorrow morning’s coffee.
And the reason that you wake up could very well be traced to a precious kernel of knowledge derived from a clinical trial that others volunteered for – fellow heart failure sufferers whom you wouldn’t even know if you were sitting face-to-face passing the time in your doctor’s waiting room.