In recent years the field of cardiology has undergone a significant revolution thanks to both technological advances and medical innovations. The potential for preventive medicine and early detection has been enhanced by extensive research analyzing the risk factors and elements that bring about heart disease. Major breakthroughs in interventional cardiac technologies such as nonsurgical corrections of structural heart disease and percutaneous aortic valve implantation, as well as development of novel drugs, have improved the prognosis and quality of life of cardiac patients. These impressing advances in cardiac medical care are instrumental in saving lives, yet require life-long follow-up and care.
One of the foremost areas of excellence at Rabin Medical Center is cardiology. Rabin Medical Center’s Department of Cardiology is a leading force in Israel and the Middle East for comprehensive treatment of cardiovascular diseases, providing state of the art medical care to patients from Israel and abroad.
The Cardiology Department has earned widespread recognition for the excellence of its medical care. The highly expert medical team, comprised of 50 top-quality experienced cardiologists and fellows, together with 100 other staff members including nurses, technicians, secretaries, and paramedical professionals, works around the clock to save lives and ensure longer life spans, offering our cardiac patients the best possible high quality care.
Cardiovascular disease (CVD) is the leading cause of death in the western world, in both genders. Although awareness to the importance of prevention, diagnosis and optimal treatment of CVD has risen in general, most women are not fully aware to their CVD risk. Moreover, women are not alert to the burden of risk in their reproductive years (e.g. complicated pregnancy and/or peri-menopausal period) and their impact on future CVD. Unique women issues such as: fertile age, menopause, oral contraceptives, hormonal and metabolic disorders during pregnancy, labor, as well as psychological matters, and healthy life-style are major contributors to primary and secondary prevention of CVD.
On the basis of that knowledge, and the need to promote CVD prevention in women, we opened the women's heart center at the end of December 2013. The clinic collaborates with obstetrics and gynecology physicians, internal medicine departments, family physicians and cardiologist, from in and out the hospital. Since then, more than 300 new patients were referred to the clinic and followed. There are currently more than 500 patients in our care.
The clinic provides team consultation. Each women referred to the clinic is seen by a cardiologist, dietician and a psychologist (5 meetings). All visits are conducted at the clinic, in a mode of "one shop" evaluation. Actually the clinic is busy with team activity most of the week:
*One day per week – cardiology consultation
*One day per week – dietician consultation
*Two days per week – psychology consultation
Women are also referred to physical activity consultation and special programs outside the clinic. At the clinic women get full risk evaluation including all evidence based tests, as well as gender-specific risk assessment such as endothelial function tests. All evidence-based treatments are given according to established guidelines.
Rabin Medical Center seeks new ways to improve and extend patients’ cardiac health by building a new Comprehensive Heart Center to open in 2017. This Comprehensive Heart Center will accommodate Rabin Medical Center’s cardiology related medical services, placing all cardiac facilities under one roof. The Center will be planned by a team of leading American and Israeli architects with a modern design emphasizing staff efficiency and patient comfort and dignity.
In order to provide improved comprehensive care to cardiology patients, and especially to emergency cardiac patients with urgent life-threatening conditions, it has been deemed of vital importance that we build new, enlarged and modern facilities. For this purpose, we propose to establish the new comprehensive Heart Center at Rabin Medical Center.
The Heart Center will accommodate most of Rabin Medical Center's cardiology related medical services placing all cardiac facilities under one roof to create a comprehensive Heart Center for patients suffering from cardiovascular diseases.
The new Heart Center will be planned by a team of leading American and Israeli architects, experienced in hospital planning and development. The design will be based on the most modern and up-to-date hospital-planning concepts worldwide emphasizing staff efficiency and coordination. • Special focus will be placed on patient comfort and dignity. Most of the inpatient rooms will be private and semi-private and the various waiting areas will be designed to accommodate patients and their families in pleasant and harmonious surroundings.
The new facility will be equipped according to the highest standards, to enable immediately life-saving care and quick and accurate diagnosis. It will include the most reliable life-sustaining and telemetry monitoring tools with long-distance telecommunication to the nurses’ station to ensure ultimate care of intensive care patients; a wide range of assessment and evaluation devices such as holter monitors, exercise stress tests, echocardiography modules including transthoracic, transesophageal, 3D and stress echo; electrophysiology laboratory equipment for sophisticated mapping and radiofrequency ablation; advanced cardiac catheterization equipment, and more.
Success of oncology improves survivorship in cancer patients and cancer even in its advanced stages now is manageable as a chronic condition. Cancer survivors number steadily increases in the western world and in the United States at present there about 15 million people who are alive after they defeat their malignant disorder. In Israel there are more than a quarter of million cancer survivors (numbers are extrapolation from the relevant US data in the absence of the dedicated database). Between 20 to 40 percent of those survivors have acquired (partially due to cancer chemotherapy or radiotherapy) or previously diagnosed heart disease that requires appropriate follow-up and management.
With this figures in mind the cardio-oncology clinic was established in the Department of Cardiology in Rabin Medical Center, Petah Tikva in close collaboration with the Davidoff Comprehensive Cancer Center in May, 2013. Since then more than 300 new patients were referred to the clinic and are followed. There are more than 900 patient-visits till the end of January 2015. The clinic provides 24/7 consultation service for the in-patient departments of Oncology and Hematology Divisions in the Davidoff center. The clinic was instituted as 1 day per week consultative service at the beginning and later on, due to high request, was enlarged to 1.75 day per week. The mean age of the patients is 64.5 ± 15.2 years, with males comprising 45.0%.
Figure 1. Cardio-oncology clinic patients distribution by the malignant disease diagnosis (n=300)
The patients are monitored according to the reason of their referral with high-sensitivity cardiac troponin T to define the highest risk population for the development of cardio-toxicity and are referred to the full echocardiographic evaluation including myocardial deformation indices, especially myocardial global longitudinal strain (GLS) – the emerging parameter which is believed to diagnose myocardial dysfunction at the very early preclinical state of heart failure. The strain imaging now is limited because of overwhelming load of our echocardiography laboratory.
Hematology division in the Davidoff Comprehensive Cancer Center has very active myeloma service. We follow those patients with suspicion of cardiac amyloidosis as the part of multidisciplinary team. All of the suspected cardiac amyloidosis patients undergo dedicated echocardiography examination (including GLS), cardiac biomarkers testing (hs-cTnT, and NT-proBNP) for staging, cardiac magnetic resonance imaging (MRI) and endomyocardial biopsy.
Most of the patients in cardio-oncology clinic undergo serial functional status assessment by treadmill exercise test or 6 minute walk test as appropriate.
As the continuum of clinical activities on February 12-13, 2015 Rabin Medical Center Cardio-oncology clinic launched the first in Israel International Meeting on Cardio-Oncology (www.cardioncologycare.com) with excellent attendance of more than 200 cardiologists, cancer specialists and nurses, some of them from abroad. The distinguished international faculty – Prof. Steven Lipshultz (chair of the Wayne State University School of Medicine Department of Pediatrics, USA), Prof. Joachim Yahalom (Attending Radiation Oncologist and Member, Memorial Sloan Kettering Cancer Center, USA), Prof. Giuseppe Curigliano, (Co-Chair of the Division of Medical Oncology at European Institute of Oncology, in Milan, Italy), Dr. Boaz Mendzelevski, (consultant cardiologist and vice-president of cardiology BioClinica, Inc., United Kingdom), Dr. Chiarra Lestuzzi, Cardiologist (CRO National Cancer Institute, Aviano, PN, Italy) together with local faculty presented up-to-date data about the scope and management of cardiotoxicity, diagnosis and management of cardiac tumors, discussed the management of malignant pericardial effusion and cardiac amyloidosis as well the newly discovered links between the heart failure and cancer and overlapping research opportunities in cancer and cardiology. The meeting was endorsed by International CardioOncology Society (ICOS), Israel heart Society, Israel Society of Clinical Oncology and Radiotherapy, Israel Society of Hematology. Multiple pharmaceutical companies sponsored the event. The lectures will be available online at www.cardioncologycare.com in the nearest future.