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Article Category: PeopleCare

ZacCare

Published on August 16, 2020

Last updated 04:35 PM August 21, 2020

Zac standing outside the front of his home

Zac standing in front of his parents' home.

Looking at Zac DiGiorgio today, you wouldn't know he almost lost his life — twice.

Like any typical guy in his early 20’s, Zac was always on the move. He liked to keep himself busy and lead an active lifestyle.

So naturally, when his parents needed their shutters replaced, Zac was the first to volunteer. With a drill in hand, he climbed up the ladder to replace the old hardware and change out the shutters.

Moments later, everything changed in the blink of an eye.

A terrifying crash sounded from outside the home. Zac’s father, Chris DiGiorgio, rushed out the front door to see a parent’s worst nightmare: his 23-year-old son face down in the driveway, having a seizure.

After shouting to his wife to call 911, Chris was at his son’s side. He cradled Zac on the concrete driveway, trying to steady his body from the convulsions.

“I really didn't know what was happening,” Chris recalled. “I knew he was having a seizure, but I didn't know if he had any other injuries or anything else going on.”

But one thing was clear: Zac had plummeted to the ground from the top of the ladder, smacking the right side of his head hard on the concrete.

The severity of the fall triggered a seizure, often characterized by body spasms or unconsciousness. However, these episodes can also have cognitive and emotional effects, such as fear or anxiety.

In Zac’s case, he became extremely agitated. After waking from the initial seizure, he argued with his dad and fought against his hold. Even when the first responders arrived, he refused to get on the stretcher and instead walked himself to the ambulance.

With lights flashing and sirens blaring, the ambulance raced towards Wellstar Kennestone Hospital. On the way, Zac complained of pain in his shoulder from a broken collar bone. But after experiencing another seizure on the short eight-minute drive, it was clear much more was going on inside his body.

After being admitted, it would be weeks before Zac awoke again in the hospital — with no memory of the accident.

Performing brain operations on people like Zac is very humbling. Each patient is part of someone’s family, whether they’re a father or mother, son or daughter. At Wellstar, we never lose sight of what really matters.

- Dr. William Benedict

Wellstar Neurosurgeon

Listen to Zac's Story

Brainpower at work

Upon arrival at Wellstar Kennestone Hospital, the DiGiorgios were escorted to a private room, waiting for word on their son’s condition. A short time later, the couple got news, but it wasn’t what they were expecting at all: although Zac had survived the fall, he had suffered a traumatic brain injury (TBI) as a result.

The DiGiorgios were blown away. “Since Zac had gotten into the ambulance himself, we thought he would just be treated for a concussion and released in no time,” Chris explained, recalling how he almost vomited when he heard about the extent of his son’s injuries.

Despite their unrest, the DiGiorgios jumped into action. Zac’s mother, Betsy DiGiorgio, started rallying a support team around her son. She made several calls to out-of-state friends and family with medical backgrounds, and they assured her that Zac was in good hands at Kennestone.

“They all said, ‘He’s in a great place. Don’t move him,’” Betsy remembers.

But despite their initial hopes, getting Zac back to better health wasn’t going to be easy due to the severity of his head injury.

Behind the scenes in the emergency room, the Wellstar team performed a CT scan, which revealed life-threatening bleeding in Zac’s brain. It quickly became clear that he was suffering from a severe TBI. With a network of experts seamlessly working together, Zac was swiftly transferred to the Wellstar Kennestone Neuro ICU for specialized brain care.

Once Zac was transferred to the Neuro ICU, Dr. Christopher Horn — a Wellstar neurologist who specializes in neurocritical care — inspected Zac’s injuries.

“When I first evaluated Zac, his imaging, labs and brain testing were not uncommon for a young trauma patient,” Dr. Horn explained. “However, he had sustained a severe lung injury likely during his seizure and it was throwing us a curveball.”

“Due to the injury, Zac was having trouble oxygenating his body. Unfortunately, that only made his intracranial pressures worse and could cause more harm to the traumatic brain injury,” Dr. Horn said, remembering the grave situation.

To control the pressures in his brain and aid in his lung function, Zac was placed in a medically-induced coma. According to Dr. Horn, the team then closely monitored Zac’s body and brain while treating him with broad-spectrum antibiotics.

“Even with treatment, his intracranial pressure would briefly respond, but still showed a worrying trend,” the neurologist recalled. “To relieve the pressure, we needed to make some space for his brain to swell.”

That’s when Wellstar Neurosurgeon Dr. William Benedict joined the team. He remembered the struggle to control Zac’s building brain pressure.

“When Zac came into the Neuro ICU, he had seizures almost immediately. We monitored his brain pressure and it kept going up,” Dr. Benedict recalled. “Ultimately, it became unresponsive to medication.”

At that point, Dr. Horn, Dr. Benedict and the Neuro ICU team knew Zac would require surgery to save his life. Together, they decided to perform an emergency craniectomy, a surgical removal of part of the skull to expose the brain and allow it to swell.

With Zac’s condition worsening, Dr. Benedict raced to the DiGiorgios to get their permission to perform the surgery. With their son in a comatose state, his parents had to call the shots when it came to his care.

“At that point, I had my game face on,” Betsy said about staying strong throughout the process and signing the surgical consent form. “I thought, ‘Let’s go. We've got to do it.’”

Zac was rushed into emergency surgery to save his life.

With great precision, Dr. Benedict removed part of Zac’s skull to help relieve pressure in his brain. This procedure allowed his brain to swell as needed.

The piece of skull, called a skull flap, was taken off and implanted in his abdomen between the muscle and fat. By storing it in his own body, the skull flap remains viable for reattachment in the future.

The surgery was a success. Through it all, the gravity of the situation was not lost on Dr. Benedict. He and the entire Neuro ICU team take their responsibility for patients seriously.

“Performing brain operations on people like Zac is very humbling,” Dr. Benedict said. “Each patient is part of someone’s family, whether they’re a father or mother, son or daughter. At Wellstar, we never lose sight of what really matters.”

With the help of Wellstar’s Neuro ICU team, Zac narrowly avoided death. But his path to wellness would be a long road, with many ups and downs along the way.


Continued care

Even after the craniectomy, Zac’s long road to recovery was just beginning.

Throughout the aftermath of the accident, Chris and Betsy were at the hospital day in and day out, yet throughout the process, Wellstar made the DiGiorgios feel at home.

“We really felt like we were part of the team,” Betsy said about the Wellstar physicians and nurses in charge of her son’s care.

“One of us was there 24-hours a day and they always welcomed us,” Chris added. “We could be there for him all the time.”

The Neuro ICU team kept close watch on Zac all day and all night. Leading the charge, Dr. Horn became a fixture in Zac’s room. He often would evaluate Zac, studying the beeps, whirs and readings coming from the six or seven machines keeping him alive.

After surveying the room and assessing Zac’s condition, Dr. Horn would come up with the day’s game plan, briefing with the DiGiorgios and the nurses on their next course of action.

“It was incredible to watch Dr. Horn’s mind work,” Chris remembered. “You could see the gears turning.”

“I do whatever I can to help my patients,” Dr. Horn said, sharing his philosophy on patient care. “My patients typically have a tragic or life-altering illness, and I know their life and wishes are now in my hands. The person lying in the hospital bed is counting on me to help them survive.”

Dr. Benedict also visited Zac daily to check progress, monitoring his brain closely.

“There’s a whole other world behind those closed doors,” Betsy added about the Neuro ICU and their team. “We got to experience it on a daily basis. It’s amazing what they do every day.”

Since their son was still in an induced coma, the DiGiorgios were making all the care decisions for him. Quickly, the parents learned to rely on the Wellstar care team for advice along the way.

“It’s scary at first because you don’t know what’s going on with your son,” Chris said. “But once I met with Zac’s doctors and nurses, I trusted them to do what they needed to do and if they recommended a treatment, we did it.”

“We knew we were in good hands at Wellstar,” Chris continued. “We asked a lot of questions about our son’s condition, but we never questioned what they were doing. I felt like Kennestone was the place my son could receive the best care for his injuries.”

A little over a week after his craniectomy, Zac’s brain was slowly getting better. But his respiratory system began to deteriorate. His lungs were failing because of heavy medication and relying on a ventilator to breathe.


50/50

“All the pressure from Zac’s brain had been released after the surgery, but his lungs were failing,” Betsy said, recounting the scary situation. “He was on the ventilator 100% of the time which made his lungs like plastic.”

Zac had developed Acute Respiratory Distress Syndrome (ARDS), a life-threatening condition that causes dangerously low oxygen levels in the bloodstream. Because of ARDS, the tiny sacs in his lungs — called alveoli — filled with fluid, making it more difficult for his lungs to remove carbon dioxide from his bloodstream.

That’s when Wellstar Pulmonologist Dr. Asif Saberi approached the parents about an intense treatment called extracorporeal membrane oxygenation (ECMO).

“ECMO is a way to provide air to the body when the lungs fail completely,” Dr. Saberi explained.

If the lungs are in peril, ECMO can help remove carbon dioxide from the bloodstream using a machine. Once a patient is on ECMO, blood is diverted out of the body using tubes and cleaned of carbon dioxide. It is then re-oxygenated and recirculated through the system again.

Since Zac had just had brain surgery, he was considered a high-risk patient for the treatment, but his odds weren’t looking good either way.

“Dr. Saberi told us our son had about a 50/50 shot of surviving ECMO,” Chris recounted the terrifying moment. “But if we didn’t do anything, I felt like he would die. When it’s your son, you just move forward with whatever might save him.”

“We didn’t have much time. We had to take a shot to save his life,” Betsy added.

But before moving forward, Dr. Saberi met with Dr. Horn and Dr. Benedict — the care team from the Neuro ICU — to make sure it was the right treatment for him.

“At Wellstar, ECMO is a multidisciplinary decision,” Wellstar Neurosurgeon Dr. Benedict said about his involvement in the decision. “We all came together and decided ECMO was the best option, despite the risks.”

During the procedure, a special catheter, called a cannula, was inserted in Zac’s major blood vessels to divert the blood out of his body. The cannula had dual channels: one to move blood out of the body and one to bring the reoxygenated blood back into the system.

“It really hit me after I saw the blood moving in and out of his body through the tubes,” Chris remembered seeing his son after he was placed on ECMO. “The machine was doing the work of his lungs for him.”

“At Wellstar, the medical staff is constantly growing together,” Dr. Benedict said. “With state-of-the-art programs like ECMO coming in, we all learn from each other and push each other to provide next-level care.”

Zac was placed on ECMO for over two weeks to allow his body to rest. His stiff, inflamed lungs began to recover slowly.

Finally, his family could breathe a sigh of relief.


Moving forward

After what seemed like an eternity, Zac opened his eyes.

“I felt anxious at first,” Zac remembered waking up in a hospital bed, hooked up to machines with tubes coming out of his body. “Because of all the tubes, I felt tied down and it was overwhelming. I didn’t know where I was or what had happened.”

He immediately wanted to ask his parents rapid-fire questions about the situation, but he couldn’t even say a word because of a tracheotomy.

“I couldn’t speak. I couldn’t even remember anything from the accident,” he explained. “I honestly thought I had gotten in a car crash or something.”

Pieces started coming back to Zac. It happened in flashes: the beep of a ventilator or the distant memories of visitors.

“The whole time I was in a coma, it almost felt like I was dreaming,” he recalled. “Being in the hospital, hooked up to machines and being wheeled from room to room… I thought it was a dream, but it was real life.”

From physicians to family to friends, Zac had a constant stream of visitors checking in on him after he woke up. It was a lot to take in at once. While learning about the accident, Zac had to keep all of the doctors and their specialties straight, too.

“As time passed and I got to know the doctors and nurses, I felt more comfortable,” he said. “Getting to know everyone by name and learning the hospital routines helped me feel at ease.”

The entire care team — including Dr. Horn, Dr. Benedict and Dr. Saberi — made regular visits to his room. Even after regaining consciousness and working on his rehabilitation, Zac had a lot of work to do to get back to his life.

“One of the first things that crossed my mind was my weight,” Zac said. “I dropped almost 80 pounds when I was in the hospital. One of my biggest goals was just to go back to normalcy and do everything I could do before the accident.”

That’s been one of the toughest lessons he and his family have learned throughout his recovery: it’s not always a fairy tale ending. Recovery looks different for everyone.

“In the movies, people who are given a second lease on life always go off and save the world,” Chris explained. “Zac just wanted to go back to his normal life and routine. In real life, the best part of recovering is getting your life back.”

Three months after the accident, Zac hit a big milestone in his recovery when he went into surgery to have his partially-removed skull reattached by Dr. Benedict.

“It was like a jigsaw puzzle. It went back on perfectly,” Dr. Benedict recalled how the cranioplasty procedure went smoothly without a hitch.

Zac also began rehabilitation to rebuild his strength after the accident. At first, his body was so weak that he couldn’t even walk. But he quickly met the challenges before him with strength and determination.

From taking his first few steps to running a half-marathon just months later, Zac has been making steady progress towards his goals since his hospital release. After a year and a half, he is getting behind the wheel of his car after being seizure-free for several months.

All in all, his journey to recovery has been remarkable.

“When I meet people, they don’t know that I’ve ever been hurt. They don’t know I had a life-threatening brain injury unless I tell them,” Zac said.

“Actually, there is one person who can tell what happened,” he added with a smile, “My barber — he can see the scar whenever I get a fresh haircut.”

Zac’s family is overjoyed by his recovery. They can now cheer him on as he keeps moving forward in everyday life.

“It was divine intervention. We ended up in the right place at Wellstar and it couldn’t have turned out any better,” Chris beamed.

Zac has a lot to look forward to today and in the future. From the first responders to nurses to physicians, he credits his entire care team at Wellstar Kennestone Hospital for saving his life.

“Wellstar is the reason I’m still here today.”

Tags

Kennestone Hospital William John Benedict Jr Christopher M Horn
Asif Ali Saberi Neuro Care
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Illustration of physicians holding stethoscope and magnifying glass.

Highlights

Finding better ways to fight heart disease and accelerate cardiac care progress

This article was originally published on Atlanta Business Chronicle on February 9, 2023.

Cardiovascular disease is the leading cause of death in the United States, claiming more lives than all forms of cancer combined. Heart disease and stroke are among the forms of cardiovascular disease. In 2019, nearly 900,000 people died of cardiovascular disease in the United States, according to the American Heart Association. In Georgia, about 1 in 3 deaths are caused by cardiovascular disease, according to the Georgia Department of Public Health. Most of these deaths are premature and preventable. Atlanta Business Chronicle recently talked with a panel of experts from Wellstar Health System and the American Heart Association about ways to accelerate heart care progress through diversity and inclusion and finding better ways to fight heart disease through unconventional methods, early detection and education and through the workplace.

Panelists & moderator

Moderator: David Rubinger, Market President & Publisher, Atlanta Business Chronicle

Depicts panelist of contributors to the article

Rubinger: What is the best way to define heart disease? And what does it mean for our culture?

Dr. Vivek Nautiyal: Let me start by saying that heart disease or cardiovascular disease is a very broad term which include a wide variety of conditions affecting our heart and blood vessels. The most common type is coronary artery disease, which is usually caused by cholesterol plaque clogging the arteries, supplying blood to our heart. This is the number one cause of death in the U.S. and across the world.

Some other types of heart disease include heart failure, which affects the heart muscle pump, heart valve disease and heart rhythm disorders affecting electrical activity of the heart. Vascular disease includes aortic aneurysm, and disease affecting neck arteries going to the brain or arteries going to the legs. All of these would broadly come under heart disease.

These conditions affect the ability of the heart to function properly and can lead to serious health problems such as heart attacks or stroke.

Rubinger: How much of that would we consider to be genetics and how much would we consider to be lifestyle, leading to the disease itself?

Nautiyal: Genetics is important, but I would say the vast majority are lifestyle-related. And that is why it's killing so many people. Heart disease is often the result of lifestyle factors like poor diet, lack of exercise, mental stress.

About four in 10 U.S. adults currently are obese. Three in 10 have high cholesterol, four in 10 have hypertension. One in 10 have diabetes. So, this is an epidemic. Adolescent and childhood obesity is on the rise and we in Georgia are sitting in the diabetes belt of the U.S.

Lack of awareness of these common risk factors often leads to delay in seeking preventive or medical care. You can have hypertension, high cholesterol, and diabetes for years or decades without knowing, which is why they're called silent killers. Unless you check for them, you may be blissfully unaware of your risk, until one day it leads to a major event.

Rubinger: It's very common to hear about examples where sometimes it can be genetic and other times it can be a lifestyle cause. Dr. Sacks, in your career, how have you viewed this whole conundrum of how to best approach heart disease?

Dr. Harvey Sacks: Getting back to your previous question, one form of heart disease we did not mention is congenital heart disease — malformations of the heart and blood vessels which occur at birth. As regards to lifestyle, when I started practicing cardiology, I saw patients in Paulding County. At that time, it was a rural community, but it is not so rural anymore but rather an extension of Atlanta. Many members of that community had a lifestyle consisting of poor dietary habits, lack of exercise, cigarette smoking and use of smokeless tobacco.

We began an educational process to teach people about healthy living. We socialized this into the community by giving talks to schools, churches and Rotary Club meetings.

The community bought into these new concepts, and we have made great progress. We have made significant changes as a result of this education in heart attack rates and cardiac mortality in that community.

Rubinger: Do we have any data to support that?

Sacks: We do. Since we have been seeing patients in Paulding County, data show a decrease in cardiac mortality. People understand the risk factors that contribute to the development of heart disease. And this trend is not unique to Paulding County. Similar efforts have been successful throughout the country. The American Heart Association (AHA) has helped us educate millions of people, and as a result, people are adopting healthier choices.

Unconventional weapons: Collaboration, technology & more

Rubinger: From a medical standpoint, what have you learned from research that has helped deliver better outcomes?

Nautiyal: As Dr. Sacks was mentioning, we have made huge advancements in improving cardiovasular mortality and morbidity, especially in the Medicare population. There's clear evidence of that in the last two decades. One area where we are lagging behind is in the young population. Unlike the older population, in the younger population the event rates are either flat or going up.

One of the reasons for this is that traditional risk factor calculators tend to underestimate cardiovascular risk in young people. By young people, I mean below 50. So, if you are below 50 and you have family members who had premature events or if you have very high cholesterol, or if you are a woman with certain complications during pregnancy, then be aware that traditional risk factors will underestimate your cardiac risk. Also, younger people tend to have this sense of invincibility. You don't have any symptoms. You think, “I’m doing OK,” not realizing that silently, processes are going on in your body which one day will lead to a catastrophic event.

As part of an NIH-funded 4-year study, led by the Mayo Clinic, we at Wellstar are implementing a shared decision-making electronic tool called CV Prevent Choice in our primary care offices. This enables the patient and physician to have a discussion about their personal risk for heart attack over next 10 years. It shows in an easy-to-understand graphic the impact of lifestyle measures, like healthy diet and exercise and — if needed — medications, in reducing their cardiac risk. We collaborated with the Mayo team to include factors on this risk calculator, like family history, women-specific risk factors and coronary calcium score, which alerts the clinician and patient that actual risk may be higher than indicated.

Another area where we in the U.S. lag behind is utilization and adherence to easily available life-saving therapies. A recent study showed that in over 600,000 commercially insured patients with established cardiovascular disease in the U.S., the utilization of appropriate, life-saving medications, such as statins, was low, despite overwhelming evidence of the benefit and established clinical guidelines. Only one in five patients received appropriate high-strength statins, despite these being relatively inexpensive generic medicines. Younger patients and female patients were less likely to receive these therapies. Furthermore, patient adherence, as measured by prescription refill rates, was low.

To better understand some of the factors behind this and also improve our quality of care, we at the Wellstar Center for Cardiovascular care are honored to have been chosen by the American Heart Association, to be one of six health care organizations across the country to participate in an integrated cardiovascular cholesterol management initiative, a learning collaborative grant. As part of this initiative, we will track patients admitted with heart attacks and follow them as they transition home. We will pilot programs to get patients to their treatment goals within a short time after discharge and improve patient outcomes.

Rubinger: Mr. Mooney, why aren’t people taking their statins? Is this part of the problem? Are people making bad decisions based on lack of education about what the risk factors are?

Mooney: There are a lot of factors that play into why patients are not adhering to taking statins or medications. Some of those barriers is health literacy, access to health care, and the affordability of medications. The expansion of Medicaid could address some of these factors. We at the American Heart Association are supporting the states that are advocating for Medicaid expansion.

Rubinger: What have been the major technological changes that have really made your jobs more effective or easier?

Sacks: There are different kinds of technology. One type is the evolution of the treatment of coronary heart disease. We are not only able to diagnose blockages in coronary arteries, but in a large proportion of the patients we can treat them with stents, reserving surgery for more extensive and complex heart disease. We are treating patients with valve abnormalities without having to open their chests, thus providing a much less invasive procedure.

A spot on the lung, or pulmonary nodule, is sometimes found incidentally on a CT which was ordered for another reason. We have an AI (artificial intelligence) program to follow and surveil these nodules for the possible development of lung cancer. And in addition, some of these patients have been found to have enlargement of their aorta (known as an aortic aneurysm). AI can identify these patients from a narrative report. They can then be referred to medical and surgical specialists for treatment. This helps prevent an otherwise fatal event from rupture of the aneurysm.

The other part is virtual visits. We believe that virtual visits are the future. There are so many people who for many, many reasons cannot come in to see the doctor, whether it's a transportation issue, whether it's having childcare, finances, whatever it may be. We want to bring those technologies to the person when they can't come to us. We believe that we can really influence people's lives greatly by being able to do that technologically by virtual visits.

Rubinger: And virtual medicine was something really born out of the pandemic. Is the concept of virtual medicine here to stay, Dr. Nautiyal?

Nautiyal: I believe so. The idea was there before, but the pandemic forced us into implementing it a very short time span. Now I think it's going to stay, but in a hybrid model. In-person conversation and physical exams still have meaning in spite of all the technology. An example of a hybrid model would be if someone was hospitalized recently for heart failure and now needs frequent visits for adjusting medications, they don't have to come in every time. We can do virtual visits to adjust the medications and get them to their goal.

Sacks: Psychological ill health can be as important as physical disease. Wellstar has introduced a Cardiovascular Behavioral Health program which can in part be virtual. It integrates behavioral health with physical wellbeing. We can help patients identify emotional problems which can contribute to physical maladies. Obesity is a prime example.

Obesity is often stigmatized, but it is actually a disease. And when you recognize it as a disease, you can treat it as such, similar to how we can treat other conditions. We can do a lot of this support virtually. We also have medications to curb obesity and even surgery for complex cases. If we eliminate the stigma associated with certain conditions, we can better treat them. We need to recognize emotional triggers which can lead to physical medical issues.

Prioritizing early detection

Rubinger: You mentioned earlier younger people who may think they’re invincible. These are the people who need to learn about early detection, earlier on in their lives. What is the recommendation you all give to the younger population to start monitoring their own heart health to know whether they need help? What are the steps younger people need to take to make sure they are addressing these issues?

Nautiyal: I would like to highlight two key groups who are at a very high personal risk of heart attacks or strokes. One is familial hypercholesterolemia. This is a genetic condition where you have high cholesterol levels since early childhood. The way to identify this is to know your cholesterol numbers and know your family history. Familial hypercholesterolemia, FH for short, is not as uncommon as we thought. One in 250 people have FH, and only about 20% of people with FH have been identified or recognized. This leaves a vast reservoir of undiagnosed and undertreated people. If you are a man with untreated FH, there is a 50% chance of having a heart attack by age 50, that is basically a coin flip. Women with untreated FH have a one in three chance of having a heart attack by age 60.

The second group is people with family history of premature heart attacks or strokes.

If you are in one of these two groups, I would strongly urge you to seek preventive cardiology consultation.

Regardless of whether or not you belong to one of these two groups, I cannot emphasize enough the importance of following a heart healthy dietary pattern, exercising regularly, not smoking, getting adequate sleep and knowing your numbers — blood pressure, cholesterol and sugar levels.

On a positive note: know that your DNA is not your destiny. If you treat FH adequately early on in life, you can have a healthy and long life without any cardiac problems. Similarly, and this has been well studied, even among people who have a cluster of genetic mutations predisposing them to heart attacks (high polygenic score), following a heart-healthy lifestyle can reduce their risk by 50%. Again, your DNA is not your destiny.

At Wellstar, we also offer a robust 'Know Your Heart' screening program for the general public to schedule an appointment. The advanced version of this includes a CT coronary calcium score. For specialized care, we have a Preventive Cardiology office, where we offer evidence-based, patient and family-centered care with a multidisciplinary team including a cardiologist, dietician, clinical pharmacist and geneticist. Our cardio-genetics program has the highest volume of patients in Georgia.

Mooney: Through programs like Kids Heart Challenge at the American Heart Association, which partners with schools to help prepare children for success by empowering them to embrace a healthy lifestyle — eat well, move more and stay tobacco free. The Kids Heart Challenge prepares elementary students for future success both physically and emotionally. Through cardio-pumping physical activities, kids learn the importance of being heart-healthy. Participating schools and/or teachers receive discounted certificates for PE equipment, direct contributions to their school and new curriculum resources for whole-child centered learning. Healthy students are better learners; teachers and schools have a major influence on students’ health, and the Kids Heart Challenge is designed to support and improve those efforts.

One other AHA program, Target BP (blood pressure), using the M.A.P. (measure accurately; act rapidly; partner with patients, communities) Framework is connecting the community to clinics. This program here at the American Heart Association is designed to work with clinicians with improving how blood pressure is measured, developing treatment algorithms to improve uncontrolled blood pressure. This program’s framework was used to train barbers and stylists in an initiative called “Do You Know Your Numbers?”

We worked in barber shops and salons, faith-based and community-based organizations to install blood-pressure monitors and train them on how to use them. In the barbershop we talk about sports, families, children, so within that conversation it was simple to bring up “do you know your numbers?” And once they asked that question, and their clients are interested in knowing their numbers, they are able to screen those clients for high blood pressure. The people who need medical care are connected with health centers or clinics.

It has worked and it has grown and it's nationwide. We sent this national hypertension project throughout so many different communities, whether rural or urban. We find that bringing in that community component helps get patients to seeing their clinicians.

Education to reduce the numbers

Rubinger: Education about cardiovascular disease risk factors clearly plays a big part in helping people avoid making bad decisions. What programs or initiatives have had the biggest impact?

Sacks: If there is a group of people that we have significantly impacted, it is women. Mr. Mooney can speak to this too. You know, if you ask a woman what is she most likely to die from, she will probably tell you breast cancer or uterine cancer. But the truth is she is most likely to die from heart disease. The AHA has highlighted this with their Wear Red Day events and other programs. Women have come to understand their cardiac risk, and that their symptoms of heart disease may differ from those of men.

Mooney: I would agree with you on that. The information, as it relates to women dying of heart disease, is really the approach of addressing social determinants of health.

And quality improvements are really about self-management. For example, with the blood pressure project, it is a way of educating the patients, empowering the patients to take control of their blood pressure through what the doctors have shared with them. Talking to and educating these patients, as in the example Dr. Sacks gave in Paulding County, helps them know what are those factors that impact their health, such as healthy eating, access to care, also access to medication.

We're discovering in this hypertension research project that these populations would not have had access to blood pressure monitors outside of the doctor's office to get true blood pressure readings. That's self-measurement. Now these devices, when they check their blood pressure, it automatically links up into their EMR systems. It's all about time: the patient comes from that (screening) to a follow-up appointment. Doctors have a real clear big picture of what the patient’s true blood pressure readings are, and that's where it goes into better treatment plans as it relates to physical activity, diet, and so forth.

Sacks: That recent study involving stationing pharmacists in predominantly African-American owned barber shops demonstrated the power of education. They screened patrons’ blood pressure. A large number of men, with no prior medical history, were found to have significant hypertension (high blood pressure). These individuals were then placed on medication. It was an amazing study because they were able to identify, educate and treat these patients thus reducing their risk of heart attack and stroke.

Rubinger: The key here is my numbers. My primary care physician needs be looking at those numbers closely, even though I am a younger person, because they're the bridge to getting referred to take care of these conditions. Is the primary care system addressing the hard health issues in cardiac care?

Nautiyal: When we started the Preventive Cardiology Program about two years ago, we took a holistic or multi-pronged approach for this very reason. When thinking of cardiovascular risk in the population, you can imagine a pyramid. At the base of the pyramid are people with traditional risk factors like obesity, high blood pressure, high cholesterol. As you move up this pyramid, you will have more serious risk factors — for example, diabetes — and at the tip of the pyramid would be people with familial hypercholesterolemia or family history for premature heart disease, who are fewer in comparison to the base, but have highest personal risk.

We'll make the most impact by focusing on the base, because that's where the most patients are and that can be addressed adequately at the primary care level or through community-led initiatives.

And we at the Wellstar Preventive Cardiology Program are engaging with our primary care colleagues to accomplish this through the initiatives I mentioned earlier, helping them in their own preventive strategies and identifying those at the tip of the pyramid, with higher personal risk who will benefit from specialized preventive cardiology care.

Mooney: That's what the American Heart Association is all about: bringing awareness on heart disease to rural and urban communities and vulnerable populations. We are developing science based tools and resources for clinicians and providers to keep them informed with the current research and what's going on out there, as well as providing educational tools in all languages for their patient population.

We discovered that patients heard the numbers but didn't know what they meant and didn't know how they impacted their bodies. We design educational materials for these patients to really understand the consequences of high blood pressure for any literacy level. For example, in some workshops with patients and the community, we may use infographics of a home water hose connected to a street fire hydrant as an example of blood vessels to the heart and/or a boxer beating the kidney to give a visual of what high blood pressure does to the body organs. Blood pressure has impacts on your entire body. Giving the visual, just keeping it simple and straight to the point.

Rubinger: It's all about trust, right? They have to trust the medical system. There are certain communities that in the past have not trusted the medical establishment.

Mooney: Absolutely. That's why we are such a big proponent of diversity in the workplace and bringing young scholars, HBCU scholars, historical black institutions and biomedical students into this arena, connecting them with cardiologists and scientists throughout their undergrad, up into medical school and up into their careers. That's key. And that's important because getting out there in the community is key to building that trust. People trust people who are very familiar with their environment.

Expanding heart care to diverse groups

Rubinger: That need to build trust between the medical profession and certain communities leads me to another issue: the disparity in different groups when it comes to obtaining medical care. How can our cardiac experts help close the gap in this area?

Mooney: The AHA has put a lot of money and research and grants focused on science-based solutions to address health inequalities through, for example, our Health Equity Research Network on Prevention of Hypertension.

I'm research-focused on cardio and oncology working in underserved communities and bringing forward awareness of the connection of heart disease and cancer, as well as putting our money back into the community to support community-based organizations that are addressing social determinants of health that could assist with improving overall cardiovascular health as it relates to addressing food insecurity, vaping advocacy work that we do in school systems throughout the country and also where we are invested into people. We're working with our historically black colleges and universities, identifying those underrepresented in the medical field and enlightening them to also become representatives in the medical field to help improve overall health and communities throughout the nation. We've been committed to that, and we're very much committed to that.

As it relates to the training for our providers and clinicians through quality improvement programs such as “Get Down With Your Blood Pressure” and our cholesterol control program as well, we are providing the research and the educational tools for providers and for patients to assist health systems. We'll start on improving blood pressure with other health systems throughout the United States and particularly in the metro Atlanta area.

Sacks: If we needed a reminder about health equity, certainly the pandemic provided us with that experience. The mortality from Covid was much higher in the African-American and Latino communities. There is a saying that a parent is only as happy as their least happy child. Similarly, the medical community should only be satisfied if everyone has access to health care.

We must do a lot more than we are doing to ensure a better distribution of our resources. That is our obligation as health care providers. We need to deliver health care to those who are unable to come to us, but who nonetheless are in need of our services. We need to go to them.

Winning in the workplace

Rubinger: How important is the employer towards helping deliver on some of these messages to their employees?

Sacks: From the business standpoint, employers need to offer more health and wellness opportunities for their employees. And why is that? Because if they do, their workers will spend more time at work and less time at home, sick. They will spend less time in the emergency room because of adopting a healthier lifestyle and medical conditions will be identified sooner. The more businesses can promote these kinds of internal programs, the more an employee realizes 'my employer really cares about me; they really want me to be healthy.' It's a win-win for everyone, so those programs need to be much more widespread and offered to more people.

Mooney: The American Heart Association has workplace programs where we work with employers throughout the nation and throughout Georgia. Also we work with organizations just in in terms of broadening or expanding the pool of applicants, or those in leadership, to be able to be a representation of the community in which they serve.

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A personalized, 3D HeartFlow study of an individual’s coronary arteries shows blood flow in a color-coded model.

PeopleCare

TomCare

When COVID forced everyone to spend more time at home, Tom Murphy decided he wouldn’t sit around idle. At 62, he upped his regular activity to work out with his son, daughter and daughter’s fiancé — college athletes who kept him in top shape.

Tom’s go-to workout was a long walk in a hilly East Cobb neighborhood. He and the kids also played a lot of pickleball.

About a year in, Tom noticed a physical change.

“I was playing fewer games of pickleball at a time and making it only halfway through my walks,” he said.

Tom turned to his cardiologist, who, with the help of specialized imaging offered at Wellstar Kennestone Regional Medical Center, created a personalized action plan.

Getting answers with the help of HeartFlow

During Tom’s annual appointment with his Wellstar Dr. George Kramer, he shared his concerns about his symptoms.

“I do sports with my kids, and I’m short of breath,” Tom said.

The physician requested a cardiac CT (CCTA), the new standard for detecting heart disease, according to the American Heart Association. It can be more accurate than treadmill stress tests and is less invasive than cardiac catheterization.

“Results of the initial CT showed two blockages,” Dr. Kramer said. “One blockage was 67%, one was 75%, and we decided to follow up with further analysis using the HeartFlow test.”

Because Wellstar was the first HeartFlow Platinum site in Georgia, the cardiology staff were able to create a personalized, 3D model of Tom’s coronary arteries to check on blood flow. HeartFlow is a fractional reserve assessment that looks at how each blockage impacts the heart. Previously, this in-depth view of the heart could only happen with a more invasive procedure.

According to Dr. Kramer, the test itself has been “a godsend” since it makes it possible for patients to avoid invasive tests while still getting important — and potentially lifesaving — information about their hearts.

HeartFlow revealed the blood flow to Tom’s heart was significantly compromised.

Tom and his 91-year-old mother stand together for heart health.

Tom and his 91-year-old mother stand together for heart health.

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Ashley was able to recover from cardiac arrest and walk down the aisle.

PeopleCare

AshleyCare

In March of 2021, Ashley Martin suffered cardiac arrest, which kills about 90% of people when it happens outside of a hospital. Thankfully, she was already at Wellstar Kennestone Regional Medical Center receiving the compassionate care she’d been seeking to address a long list of symptoms.

Everything began at a hectic time in Ashley’s life. She was 30 and had just gotten engaged. Wedding planning had started with the help of her fiancé and their two young boys. The hope had been to have the wedding toward the end of 2021. But the unexpected happened.

“I was always healthy,” she said. “I grew up playing sports. I was a runner. I used to get headaches, but that was the extent of my medical history.”

Finding the right care when there is more than one symptom

Symptoms of what would ultimately be diagnosed as Guillain-Barré syndrome began in February of 2021. This rare neurological disorder causes the body’s immune system to attack the nerves. 

Ashley started experiencing tingling in the tips of her hands and feet, which moved up her legs and arms as days passed. When intermittent numbness became a symptom, Ashley went to a hospital near her Peachtree City home. A clean CT and MRI meant she went home with plans to see a rheumatologist.

As she waited for her first appointment, she started feeling numbness in her feet.

“At one point, I took a step down the stairs and went tumbling down to the concrete floor,” Ashley said. 

On another trip to the hospital near her home, Ashley was diagnosed with Guillain-Barré syndrome, but treatment was unsuccessful. The numbness continued, spreading to her face. She began using a walker and, soon after, a wheelchair.

“The paralysis had moved to my abdomen,” Ashley said. “I went to sleep one night and woke up abruptly gasping for air.”

Compassionate medical care at a pivotal point

 Later that night, an ambulance brought Ashley to Wellstar Kennestone, where she would finally get the specialized neuro care she desperately needed. She was admitted to the Neurocritical Care unit, staffed by physicians, nurses and a medical team with specialized training in neurological conditions.

Upon arrival, she underwent respiratory failure due to paralysis spreading to her diaphragm. She was stabilized, but shortly after that, she experienced sudden cardiac arrest — the abrupt loss of heart function that stops blood flow to the body.

After a critical care nurse administered CPR, Ashley’s heart started beating again. Life support medications were given to keep her heart pumping.

“The neuro ICU nurses and doctors saved my life,” she said.

Later, her attending neurologist explained that the stress of her nervous system and immune system fighting, paired with respiratory failure, caused such high stress that she had a cardiac arrest.

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